Precepting

Nurseboy1 · Aug 7, 2005

Hey Tweety,

I get the attitude of you have it easy when I precept, but my NM doesn't allow a nurse thats precepting to exceed a certain number of patients. Generally to keep people from giving me grief, I usually elect to precept nursing students rather than new grads. Since the student cannot act independently I have the full load which discourages people from dumping on me.

rehab nurse · Aug 7, 2005

ugh, tweety, i know what you're talking about all too well.

i have been orientating a lot of new nurses over the past two months. one of the problems is they are trained on three different units and all three shifts. add to that they are only given up to two weeks orientation (we are in a LTC), and it makes for a difficult training period.

what tops it all off was the other day when i was brought into my ADON's office and told what a poor, incompetent, stupid LPN i was for allowing a nurse on day six of her orientation to pass meds (supervised by me of course). she had been passing meds for the last two days of her orientation. i still don't know what her reasoning is for not wanting her to pass meds. i was never given any instruction from the ADON (other than passing in the hallway being told i have another new nurse to orientate) about what to help train the new nurse on. but this ADON (in the two months she been here) is notorious for bashing LPN's and telling us what a brilliant nurse she is for having a BSN (the "ultimate" in professional nursing as she said). she is looking to have all BSN staff. she said in a nurses meeting a few weeks ago "i'll be happy when you LPN's decide to quit so i can hire all BSN's here, that's when this place will truly be run by GOOD nurses." she doesn't even respect the ADN RN's who are there, they are still "below her" as she put it. i can't tell you how outraged i was to be called in the office about something so stupid. the nurse didn't make any mistakes or anything! so what's the deal? i was quick to point out that SHE is the one who placed the orientee with ME. it's not like i asked to do it! sheesh! luckily, i am almost finished with my RN program and will be able to get out of this place. i told her point blank, if she doesn't like the way i train, then she and her mighty BSN self can come and do it herself. and i did go to my administrator about her behavior. i will no longer go in the ADON's office without a witness with me.

but as you were pointing out, i also get the comments from co-workers about nit-picky things (she didn't write the refrigerator temp on the flowsheet, she didn't transcribe this MVI order onto the MAR, and not so nice comments about nurses appearances, etc.) we did do two admissions, did rounds with two docs, finshed at least 15 orders, and did all meds and treatments. i get the "well you have an extra nurse with you, so you can do such and such". and of course, getting told to do "such and such" by someone who is sitting down at the desk reading a magazine, while i am out on the floor with my orientee WORKING. :devil: that's ridiculous. and i have also been dealt the "we're not giving you a CNA cause you have an extra nurse" card as well. i can't believe how soon people forget how overwhelming it is to start a new job and have to learn all the little things in a new place. things that are second nature to me, are brand new to them, and they need to be given some slack! it's not like they've been there for three months and aren't picking up on things. they're brand NEW employees!

i so know what you are talking about tweety!

p.s. i love your new avatar!

ValerieB · Aug 7, 2005

ugh, tweety, i know what you're talking about all too well.
i have been orientating a lot of new nurses over the past two months. one of the problems is they are trained on three different units and all three shifts. add to that they are only given up to two weeks orientation (we are in a LTC), and it makes for a difficult training period.
what tops it all off was the other day when i was brought into my ADON's office and told what a poor, incompetent, stupid LPN i was for allowing a nurse on day six of her orientation to pass meds (supervised by me of course). she had been passing meds for the last two days of her orientation. i still don't know what her reasoning is for not wanting her to pass meds. i was never given any instruction from the ADON (other than passing in the hallway being told i have another new nurse to orientate) about what to help train the new nurse on. but this ADON (in the two months she been here) is notorious for bashing LPN's and telling us what a brilliant nurse she is for having a BSN (the "ultimate" in professional nursing as she said). she is looking to have all BSN staff. she said in a nurses meeting a few weeks ago "i'll be happy when you LPN's decide to quit so i can hire all BSN's here, that's when this place will truly be run by GOOD nurses." she doesn't even respect the ADN RN's who are there, they are still "below her" as she put it. i can't tell you how outraged i was to be called in the office about something so stupid. the nurse didn't make any mistakes or anything! so what's the deal? i was quick to point out that SHE is the one who placed the orientee with ME. it's not like i asked to do it! sheesh! luckily, i am almost finished with my RN program and will be able to get out of this place. i told her point blank, if she doesn't like the way i train, then she and her mighty BSN self can come and do it herself. and i did go to my administrator about her behavior. i will no longer go in the ADON's office without a witness with me.
but as you were pointing out, i also get the comments from co-workers about nit-picky things (she didn't write the refrigerator temp on the flowsheet, she didn't transcribe this MVI order onto the MAR, and not so nice comments about nurses appearances, etc.) we did do two admissions, did rounds with two docs, finshed at least 15 orders, and did all meds and treatments. i get the "well you have an extra nurse with you, so you can do such and such". and of course, getting told to do "such and such" by someone who is sitting down at the desk reading a magazine, while i am out on the floor with my orientee WORKING. that's ridiculous. and i have also been dealt the "we're not giving you a CNA cause you have an extra nurse" card as well. i can't believe how soon people forget how overwhelming it is to start a new job and have to learn all the little things in a new place. things that are second nature to me, are brand new to them, and they need to be given some slack! it's not like they've been there for three months and aren't picking up on things. they're brand NEW employees!
i so know what you are talking about tweety!
p.s. i love your new avatar!

Hey hon,

I have my BSN and all that means is that I chose to get my 4 year degree at the same time I went to nursing school. Here are a few of my "required classes" to get my BSN: "statistics"," American Studies" ( I had to take an elective), "algebra" ( another elective), and a "cinema" class( another required elective). I can also tell you that I've worked with some fantastic LPN's over the years that I didn't know they were LPN's for a long time. It's on their badge but I'm not constantly looking at badges for their title and it's not like they are walking around with a sign on their heads saying "I'm an LPN". Many years ago they did a "reduction in force" at my hospital and the LPN's were gone. How stupid it seems today. They are back and I'm glad to have them. Sometimes the only way I know a nurse is an LPN is when she comes up to me and asks me to give pain medicine IV push for her. People need to get a grip. Your ADON needs to worry about good nurses taking care of the patients not whether or not they have a BSN behind their name.

DusktilDawn · Aug 7, 2005

Stick to your guns Tweety. I've been on both sides of the fence as an orientee and preceptor.

As a new orientee, I had a preceptor who literally sat at the desk. After 5 months I was asked to orientate a new employee with previous experience as an RN, we managed to muddle through. :angryfire

It seems like some of the people you work with have forgotten what it is like to be a new employee or a new grad. There is a reason why your orientee is not counted as staff, they are not ready to function fully as staff. Unfortunately there will always be some who will count them as if they are staff. :madface:

It's frustrating when the situation is taken advantage of, "Oh but there's two of you therefore you don't need a CNA".

Whether your an experienced nurse or a new grad, the orientation process is designed to help a new employee acclimate to their working environment. There are always going to be some that will not understand this.

Don't you find the worst complainers about what was missed, what was wrong, etc., are the worst offenders?

julieK · Aug 7, 2005

This is my absolute worst pet peeve! As long as you are precepting, IMO you have more work, not less. You have to care for the patients and teach at the same time. Plus, as long as the orientee is still in training, his job is to learn, not pick up the slack of the unit. He'll have more than enough time to do that later. We ran into this problem on my unit when I was in orientation. The aides got angry b/c we would put an equal number of patients on assignment. Fortunately our NM was behind enough to say, "You are aides, not RNs and do not dictate the assignment." There are still problems, though.

-Julie in NYC

llg, PhD, RN · Aug 7, 2005

Don't you find the worst complainers about what was missed, what was wrong, etc., are the worst offenders?

Oh, yes... definitely!

I've spent much of my career as a CNS/staff develepment educator running orientation programs. So, I have also seen a lot of what you are encountering -- but from a different angle.

I think there is a good "middle ground" that can be found. However, it takes some effort and compromise from the entire unit to find it. It is unrealistic and unfair to consider a preceptor and orientee to count as "2 nurses" when thinking about workload. The whole idea of orientation is that the orientee needs to be taught and is not ready yet to work independently. On the other hand, it's silly and unrealistic to think that someone who will be off orientation in just a few days and carrying their own assignment should be considered in the same way that an orientee in their first week would be "not counted."

I encountered one hospital that dealt with this issue by having a formal system of designating how the orientee "counted in the staffing numbers" throughout the orientation period. The orientee counted as "0" for the first half of orientation.... then as 1/4 of a nurse when they reached the midpoint of orientation ... then as 1/2 of a nurse during the last quarter of orientation.

That system didn't seem quite right to me, but I liked the concept on which it was based. I therefore starting discussing it with the unit in which I was working at the time and together, we came up with a system that worked well for us. The orientee was never officially "counted in the staffing numbers" ... but it was acknowledged that, during the last portion of orientation, it would be OK to ocassionally ask the preceptor/orientee pair to take a SLIGHT extra load -- but only with under certain conditions and only with the consent of the preceptor. Those "certain conditions" and "consent of the preceptor" were essential part of the system. They turned the experience into a positive learning experience for the orientee and prevented it from becoming a "dump job" that interferred with the learning experience. People soon saw the educational value in having the orientee have a little more "supervised" independence late in orientation as a way of preparing them for being on their own in 2 or 3 weeks.

In time, we devleped a formal period of "transition" at the end of orientation during which the orientee was given their own assignment -- but was assigned an official buddy to act as a resource when needed. The assignments of the nurse in transition and of the buddy were made with the need for one to be available for the other in mind.

Perhaps, if you can find the right time and place, you could initiate similar discussions on your unit, Tweety. As someone with a lot of Charge Nurse experience, you may be in a good position to initiate some positive change. People would know that you understood the Charge Nurse's perspective as well as the preceptor's perspective.

Good luck,

llg

UM Review RN, ASN, RN · Aug 7, 2005

Charge nurse to me "how many patients do you have". Me: I have seven, it's written on the board on the assignment that you made. Charge: No, I'm asking how many do you and have how many does he have. Me: We're together, and I have a full assignment and so does he, we have a full assignment together. Charge: You're getting an admission because there's two of you.
The last time I precepted I had a women the last four weeks of her orientation, it was the same thing. "We're short a nurse, so you get seven patients and your orientee gets seven patients. You can handle it."

They actually wondered why two of my preceptees left the facility immediately after orientation with up to 12 patients for the two of us, plus I had to do all the chart checks and admission assessments, as well as IVP meds, by myself.

We're supposed to think about wasting money at our facility. Well, we wasted thousands there. Thousands. In training that will only be used somewhere else because the assignments were just too heavy for a new grad.

CritterLover, BSN, RN · Aug 7, 2005

precepting is hard work, especially a new grad. and your co-workers need to remember that the orientee is working under your license. which means, if they give you both seven patients, that you are actually resoponsible for 14 patients. (i'm hoping that 14 med-surg patients is not acceptable in your facility).

your co-workers need to remember, too, that it takes longer to show someone how to do something and to watch them do it that it takes to do it yourself. so even if you and your orientee only have seven patients, it is going to take the two of you longer to get things done than it would take one experienced nurse alone.

plus, you have to review all of his charts, all of his charting, and basically know what there is to know about his patients, plus then then extra seven they are giving you.

where do your nurse manager and nurse educator stand on the issue?

sjt9721, BSN, RN · Aug 7, 2005

precepting is hard work, especially a new grad. and your co-workers need to remember that the orientee is working under your license. which means, if they give you both seven patients, that you are actually resoponsible for 14 patients. (i'm hoping that 14 med-surg patients is not acceptable in your facility).
your co-workers need to remember, too, that it takes longer to show someone how to do something and to watch them do it that it takes to do it yourself. so even if you and your orientee only have seven patients, it is going to take the two of you longer to get things done than it would take one experienced nurse alone.
plus, you have to review all of his charts, all of his charting, and basically know what there is to know about his patients, plus then then extra seven they are giving you.
where do your nurse manager and nurse educator stand on the issue?

orientees don't necessarily work "under" your license as a preceptor. you are not delegating as you would to nursing assistants, patient care techs, etc. an rn or lvn orientee would be working on their own license. they are responsible in the case of their own errors, although they may have a claim against the facility (not you personally) for not providing adequate orientation. i believe that gns would fall into the same category but i'm not certain. anyone?

SarasotaRN2b · Aug 7, 2005

Watching the preceptors, I can see the amount of work that is required. If their orientees are able to handle patients more on their own, that speaks well of their preceptors. But until the orientation is done or until the preceptor feels that the orientee is ready to work on their own, it isn't right to either the preceptor, the orientee or the patient for preceptors taking on additional patients.

oldiebutgoodie, RN · Aug 7, 2005

I'm a new RN and am being precepted by several wonderful nurses. I do believe that preceptors have MORE work, because I am SLOW, ask a million questions, and am trying to learn things the right way first, which again makes things slower.

The challenge to preceptors, I would imagine, is know when to let go. I think they are all doing a great job, and I hope I can be as good as they are someday.

Oldiebutgoodie