preceptor's question(s)

Hey y'all!

I've been a nurse for 4+ years. In this time I've formally precepted two new grads. Informally I teach people all the time, but the new grads are the people I get excited about. Okay so I had very little time to spend with the first one, and I was only a year out of school, and I had my full load as well so it was difficult, plus I had no feedback so no clue how I did.

This time is going better. My orientee is two months into orientation, and has made a lot of progress. She can organize her shift, has a decent brain sheet that she prefers (I made it, but hey we gotta start somewhere, she will make her own eventually), and successfully do a shift with 3 patients. Now this is LTAC setting, so most of them are pretty acute. She has been nice enough to come in on a couple of very short-staffed nights and was not on orientation those nights. One of them she had a 3 patient load and handled it well, asking some questions and mostly just doing her thing, on time and correctly. The second shortstaffed night, they put her in there with four patients: one vent getting blood and on a heparin drip, one trach collar, one easy on TPN pt, and a confused nursing home style patient who likes to rip dressings off and play in his wounds. That night was really hard for her, a days nurse stayed till 11 pm to help her with the blood, and she was kinda shellshocked by the whole experience. (god I remember the first of the really hard nights!)

Anyhow so back to normal staffing, weee! I give my orientee a 4 patient load and instruct her to delegate tasks to me, but manage the load. I'm going to tell y'all how it went and then I want to know, how to do things or say things that have a slightly different outcome.

She gets VS and assessments are completed at the same time, by 2030-ish on all four. VERY good. Meds- 3/4 are done by 2130, again very good. So I pull meds on the 4th one, the complicated one, and meet her in the room, she gives some, I hang some IV antibiotics, we do the complex skin care together and roll the patient, clean him up, etc.

Then it's charting time, PRN med time, and dinner time. After dinner and through the wee hours the delegation goes well, but in the AM's here we draw our own labs if they have PICC or central lines. So 3/4 of the load has labs to do. I did one lab draw, she did two and remembered to turn fluids/tpn off 30 minutes prior with a flush. This is a big deal because it takes until noon to get the correct results back if you have a contaminated sample at 0500. We all don't like being the nurse who did that.

Labs and such, along with all 4 having 0600 meds, of which I did one pt's meds, puts us behind. I start grabbing a pen and adding I/O's on any flowsheets within reach if I know I have the right info. Our relief shows up early, I pretend to read a book during report so I can keep from interrupting her while she gives report. Report is good, we get outta there on time. Woot baby!

Ok. Now for background I am a move it, shake it, don't wait type of nurse who most of the time, would rather do something at roughly the speed of sound, than tell someone else to do it. While you talk about suctioning that snot I have jumped under you and got the loogie out. Seriously.

When I was new, my nightshift preceptor let me delegate only non-nursing or helping tasks to her, so that I could get the nursing things done and learn how to delegate. Like, she would get bedtime snacks, and help me turn and clean folks, and help me weigh them. (my first nursing job we weighed every pt. almost every morning.) Then in the AM she might run down the hall and do everyone's accuchecks while we got 0600 meds done and taped our report. Here I am trying to help my orientee do her meds and draw her labs, both of which are pretty essential nursing functions at this place.

Question: do I make it worse for the orientee by helping with meds? Am I making her look and feel less competent by helping in that area?

Also, how in the bejesus do I go about getting off that transition point to just being a resource for getting people's ice water, food, turns and cleanups done? Along with answering questions, of course. I realize that it is invaluable to follow the orientee around like you are their twin for the first couple weeks or so, to help with identifying strengths and weaknesses, and give good advice, and show how to organize the shift. That part I've got down. The transition from almost got a full load to ok they can handle their full load, that part is where I feel stuck; it feels like I am not transitioning the orientee properly.

I do NOT remember how my preceptor managed this with me. It may be that I took off like a rocket and just tried to do it all until I could, but really I'm not sure.

I'm sorry this is so long, and this orientee will be done with orientation soon, but I could use the advice for next time.