Preceptorship as a newlyqualified in community

As a previous poster stated, it's difficult to give advice as different organisations and areas vary widely in how they precept and support new starters.

When I started I was given 4 weeks supernumerary. During that time I doubled up with another nurse on my team so that we could carry out visits together, get signed off on some basic competencies and get to know the caseload. That 4 weeks went very quickly! I Had already completed a 12 week management placement with them and I had worked bank shifts as a hca there. It was still a massive learning curve!

Looking back i feel I was very much thrown in at the deep end. We were expected to carry out complex end of life visits pretty much as soon as we started. Having said that, I worked with a very good team who were knowledgable, approachable and supportive.

Our area does things differently now. We used to do "see one, do one" and then you were signed off for various skills. Now new starters do a lot more classroom based courses and have to be watched several times carrying out skills to be signed as competent. New starters are also a lot more supported and don't carry out really complex visits on their own for a long time (up to a year).

You should get training in various extended skills, eg syringe drivers, end of life care, male and suprapubic catheters, vac dressings, venupuncture, IVs, drains, compression. How and in what time frame this happens will depend on your organisation.

The most important advice I can give you is ask lots of questions and make friends. Community nurses tend to have close knit teams. Make friends with your team, make sure you've got a phone full of useful phone numbers and be a team player. The team you work with will be crucial to your success.

Never ever guess, if you don't know how to do something or more likely, you don't know what to do in a particular situation, phone someone, anyone! Now the tricky bit is that everyone is busy and might not always be able to answer the phone when you need them most. This is why it's important to have lots of phone numbers. Introduce yourselves to all the senior nurses and nurses from other teams. Know your resources and specialist nurses. Know how to get hold of them. Have back up telephone numbers. You are going to come accross a lot of new situations and you will not know what to do. This is normal. People will worry if you are not phoning them with a million questions.

Try and find somebody who is prepared to take you under their wing, someone who is prepared to just debrief with you, someone who won't mind if you phone them after work when you realise you forgot to do something or your second guessing something you've done. Hopefully you'll have a couple of "guardian angels"on your team, people who are prepared to drop everything and come and meet you at a patients house when you realise you are out of your depth. I had people like this on my team and I will be eternally grateful to them.

I hope I've not made it sound too scary but community is a massive responsibility. Some of these patients you see.....you may be the only health care professional who sees them for months on end. Take notice of everything, how they walk, how they look, their skin, what's in the fridge, what meds they're on, how they're breathing, any changes, assess assess assess. Some of these patients are very complex, they are often very ill! You will be phoning ambulances from time to time!

Having said all that I would hope that you would be given a gentle introduction. You will probably start off just seeing stable diabetics and doing not too complicated wound care. Hopefully you will not see very complex patients on your own. Then over time you will gradually be trained on additional skills and gradually add to your competencies. The first year will go very quickly and you will look back and be amazed at how much you have learnt.

Don't let anyone push you to do anything you don't feel ready or safe to do.

Just remember, in community nursing, your phone is your life line.....If you don't know....Phone a Friend!

Good luck, it's scary sometimes but it's a very rewarding job. I love it.

Working in the community is not a good place for a newly qualified nurse. You will be essentially working alone, and will need troubleshooting skills and communication skills that you just don't have. Work a year or two in a general ward before going out there. Otherwise your team will be carrying you, having to help out with every little problem you find, especially if you tend to worry and panic rather than approach a situation with the ability to prioritise and use clinical judgement.