Precepting, questions and a vent!!!!

[annmariern]

A few questions. Are you asked first and are you given the option to decline? Is it ever taken into account in your patient load, particularly if its a new grad, a nurse will no recent clinical experience or a foreign nurse, not just "show them the ropes here" and they are good to go? Do you get a differential and if so how much? Do you have trouble with the perception with other nurses, CNA's, CNC's that you suddenly multiplied yourself and therefore you can actually take on more work, not less. And are your complaints if thats the case acted on? I aske because as an experienced RN in a non teaching, for profit, stressful enough I did decline LPN students and new nurses after stressing myself to the point of being sick, trying to fulfil every role and failing, myself mainly, on all fronts. Now the hospital had taken an "have a pulse, your hired" approach to the recruiting shortage. Go figure, we have a 32% RN turnover and a lot of new hires quit before 3 months is out. A mystery isn't it. I was asked to orient an "experienced" nurse as everyone else was tied up with new grads and a foreign nurse bulk hire. Turns out last floor experience was in 1987. Needless to say, is proving to be a huge challenge. It seems that only I or her can get a pt to bath or have vitals taken more than once every 12 hrs (med/sug, post ops, ER, etc) They "refuse" for the CNA's, not one but 3 different ones. After having to track down my very helpful preceptee and point out she isn't there to learn how to give baths and ice water, but given the computer documentation, emar's, and basic post op equipment, an enormous amount of changes in 20 years, I find myself so sorry for ever agreeing in the first place. I was told it was a couple of weeks. She was told this is a refresher course as the foreign nurses needed extensive orientation. Hmm not quite the same information. So just venting a bit and wondering how I am supposed to take 5-6 pts, do total care, meet there needs, meet there charting needs, and be a clinical instructor while having a meal break, or working 12 1/2 hrs instead of 14-15 and is it just me or is this crap just not worth the stress anymore. Either way I see it, I am gulity because the newbie isn't getting what they need and feel bad, my patients don't get my complete attention and therefore things might get missed, the CNA's get mad because I end up have to actually ask them to do what should be being done anyway, the CNCs are mad because , turns out I really can't divide myself into two and no I can't do whats asked of me and stay sane!!! And again myself, guilty on all fronts:madface: :uhoh21: Oh and that huge mystery as to why nurses leave in droves keeping me awake at nights:rolleyes:

[CritterLover, BSN, RN]

well.

first, i would have to say that in the begining, a preceptor/orientee pair does not equal two nurses. in fact, it doesn't even equal one nurse. why? because it is quicker to do something yourself than to show someone else how to do it. or to monitor someone new doing it. as she get farther along, you will progress to being "one" nurse. and at the end, you may be even equal to 1 1/2 nurses. but, as long as that person is in orientation, you will not be two nurses. otherwise, why are they still in orientation?

second, when the patients "refuse" to have the cnas do their vs and/or baths, are you confirming this with the patients and asking them why? as the preceptor, it is up to you (and maybe the educator) to decide what your orientee needs to work on. it is not the cnas decision that she should be doing her own vs/baths. if these are skills that your orientee has mastered, then there is no need to waste her precious orientation time doing these tasks, if there are other things she needs to be working on. (and i'm not saying that these arn't important tasks; i'm saying once a task is mastered, move on. even if that task was mastered 10 yrs ago). if she needs to work on time-management, then maybe it is appropriate that she is doing her own vs/baths.

third, do you have an educator? if so, please have him/her talk to the charge nurses about what is appropriate expectations for your orientee during her orientation. he/she needs to make it clear that your orientee's learning/education is what needs to be focused on, and set limits as to what is expected of you.

[ckben]

I can't speak for anyone else, but for me:

I was asked by the preceptee if I would orient her. The way it works on our floor, you have a normal patient load and the orientee begins by following you around and observing. The next day, they take 1 of your patients, gradually building her patient load over the next several days to weeks (while yours, therefore, gradually decreases). Eventually, once she's taken a full load, the preceptor and she will have separate patients, but the preceptor is still available for questions/help. There was no differential, but if you completed the preceptorship class (not necessary to be a preceptor), then you would get bonuses for how long that person stayed in that position and how good their evaluation was.

There is, unfortunately, sometimes the illusion that because you share patients you have more time than other nurses. While that is sometimes the case, depending on the orientee, other times (even with the best preceptors and orientees) you will be shorter on time. Especially if you have demanding patients, because you still have to be with your ort and walk him/her through procedures and such. I've had a charge nurse decide that it was okay to take a nurse tech off our patient load since there were two of us, despite the fact that we were running around frantic due to one particular patient's horrendous condition while some other nurses were sitting around chatting. If it happens, you just have to be sure that you talk to that person and let them know that even if there are two of you, you might need extra help from time to time. If that doesn't work, I'd go higher up the chain to the nurse manager and inform them that you aren't getting the support you need. Also, it might not be a bad idea to ask them to intervene for you and have the CNs decrease your patient load until your ort is able to function more independently. And it might not be a bad idea to really emphasize the fact that your ort seems to need more intensive instruction and more time than the standard orientation period. One of the nurses on our floor (from another country) decided that the normal orientation period wasn't enough, so she asked for (and was granted) extra time.

In my experience, having an ort can be an absolute blessing (unless you get one of those whom you have absolutely no idea how they ever passed nursing school much less their boards). On a floor where patients are severely chronically ill and severely chronically noncompliant, sometimes I felt like the only satisfaction I got from my job was helping teach a new nurse how to be more comfortable with nursing and how to believe in herself as a nurse. For me, if I was feeling so hopeless and stressed out as you, I'd go to my NM and have a heart-to-heart, telling them exactly what you said here. If you emphasize that you feel the attention you must give to your ort and the lack of support you receive is cheating your patients out of the care they deserve, despite you trying to the best of your ability to do everything, then any reasonable NM would step in and make the situation easier for you.

Good luck, and I hope it works out for you. And not all precepting experiences are terrible!

[annmariern]

THis morning my orientee just didn't show. Apparently, yesterday she went to the nurse manager and said something along the lines of she wasn't getting what she needed, etc, etc. Oh course no-one talked to me. My immediate manager had pointed out that refresher courses and orientation aren't the same. But you know what, I still feel bad. Today I left my 7-7pm shift at 10pm. So glad I didn't have the added stress, but still. IT was unfair to her, unfair to me and the pts.

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