Published Jun 3, 2004
I just have a couple of questions for all of you preceptors out there. I started my nursing externship at a very busy teaching hospital and am in my third week of the externship. The other day I worked a 12 hour shift and for the first time I took on the entire team. This is what I did:
0800: I went around and did all the assessments. When my patients needed meds I had to go and tell my preceptor what they needed and then she came in with me because I am not allowed to give meds alone. When I was done with my assessments I went back and charted on all 6 patients and went and got my preceptor to sign off. The whole time I carried around the cell phone, answed and fullfilled all patients requests, paged the Docs when needed, called telemetry to see what my patients were running (had 3 patients on Metropolol), and just basically everything. Like I said I just got my preceptor when meds were due, but I had to tell her what the patients needed and at what time and the side effects of the meds. Then I had a quick 15 minute lunch and was back to do the 1600 assessments. I reassessed and charted once more, got my preceptor to sign off, and then I had to call in report on all six patients.
Please don't get me wrong, because I love every minute of it. This is nursing, not like in school, but my question is do all of you precept in the same way? I have heard of GN's and new RN's to a facility that don't even take on a whole team for quite awile and I still have a year of school left. I must know what I am doing, otherwise my preceptor wouldn't be signing my charts. The director of the unit came to me and just raved about how great I was and offered me to stay on as an extern through my last year of school. This is a great reward for me, because most externships are for summer only. This is all new to me and I guess what I am asking is, is this the norm? Do you feel that I am taking on too much, or am I being used? I really don't feel that way, because I am loving it, and I have had such great feedback. I also had my team switched on my third twelve hour day and two of the patients were very upset that I wouldn't be taking care of them and their families talked to the charge nurse about it. Any feedback you could give me would be great. I am open to any comments or suggestions, because this is all new and I am wondering if this is the norm. Thanks.
Sounds like you are doin' your thang!!
Keep up the good work.
I had ONLY 3 pts to care for in school during clinicals and I WAS HOPPING!!
Your the BOMB!
Do you feel that I am taking on too much, or am I being used? I really don't feel that way, because I am loving it, and I have had such great feedback. .
If you are having fun and feeling comfortable I say do what you are comfortable with. It does sound to me that you are taking on quite a bit of responsibility, but that is not neccesarily a bad thing. Just be very careful not to accept responsibility that you cannot handle to please other nurses and get "positive feedback". The most important this is to know when to say no. You need to make sure that you can take care of your patients adequatly, make them your top priority.
She sounds like an excellent preceptor to me, as long as she's approachable when you are having difficulties. You will be leapyears ahead of your classmates.
purplemania, BSN, RN
sounds like a lawsuit waiting to happen. Since when is it ok for non-licensed staff to do assessments? We encourage our externs to "practice" assessment, but that does not excuse the RN from doing it and documenting same. I would talk to the unit manager or staff development or even risk management.
traumaRUs, MSN, APRN
Although it sounds like you're comfortable with this - as the RN I wouldn't be. I know that in Illinois unlicensed assistive personnel can't do assessments nor would they would be able to call the doctor with an assessment. I would be very cautious continuing in this capacity. You have no license to back you up. I totally agree with the above poster - it is very dangerous. Please talk to risk management and obtain a WRITTEN job description for nurse extern. Good luck...
missnurse01, MSN, RN
a agree with above on the legalities-it sounds scary!
about the actual work:
I don't know-I feel different. As an extern I think that I personally would not want to take a team, shadowing the nurse and helping is one thing. I always feel that if you don't have a pt assignment while you are learning, then you are more free to learn and do other skills that come up. Like if another nurse has something to do that you really want to learn or practice on-then you can go do that rather than be tied down with charting, etc. I know that everytime i worked somewhere new all orientation was geared for taking my own pts-which was fine after i was a nurse for a while. As a new nurse I would have loved to extern to learn more skills and techniques-the things that you need to know that you won't have much time for with your own pt load...it was always, wow i want to watch, do that, but i have to chart, or assess, or pass meds, or... Really think about using this time to be a sponge as they say, not necessarily take a team. That's my opinion anyway. good luck!
I have the same thoughts.
Initially reading your post I thought you were a GN. That is not the case (you have one more year or nursing school???). You do not have your license yet and you are taking on quite a lot that you should not have to be at this point in your career. In my facility, the interns w/your education experience function as "high" functioning techs; start iv's, foley's, ngt's, etc., but always have a competency test first. They absolutly never pass meds and do assessments which only licensed personnel are legally prepared to do. Calling doctors??? Are you taking orders too? How are you signing them (GN, RN???)?
Please be careful, I wonder what your school would do if they found out???
My first thought was that your preceptor had things pretty darn good!! I am thrilled that you are feeling comfortable and that you are enjoying nursing! You are certainly getting an introduction to the "real world"! In our institution, the preceptor is not just supposed to turn the team over to her preceptee! The whole idea is to have the two of them working side by side to gain valuable "on the fly" tips and benefit from the expertise of the preceptor -- assessments are not supposed to be completed by unlicensed staff. In fact, our organization even goes so far as to state that LPNs are gathering data as opposed to assessing patients -- that seems like splitting hairs to me, but students are NEVER left to go off on their own here. Watch your back -- talk to a manager, risk management or someone -- just to cover your behind!
I AM proud of you for doing what sounds like an incredible job -- don't stop being fantastic -- just make sure you are being fantastic within legal parameters.
During my preceptorship we were allowed to do almost everything. Reading some of these posts has made me wonder if that is the way it should have been. We did assessments without RN present, passed meds, performed skills, and charted. It was of course up to the RN to do her/his own assessment and to sign off on all meds I gave and all charting I did or orders. When I took Dr's orders I signed my name and then NS for nursing student. Unlike the original poster this preceptorship took place in my last semester of nursing school, not one year before I graduated. I feel like it sounds the original poster is doing a great job, but it is definitely up to the RN to do her own assessments, etc.
Thanks everyone so much for all of your comments. Like I said I am new to this so I thought that maybe this was the norm. I am so glad I posted. The next time i work I will ask my preceptor to come in with me for assessments. I'll just tell her that I would feel more comfortable if she were there, and to please do the assessment after me to make sure I am accurate. I wonder if she is assessing pt. number 1 while I am in patient number 2's room? I am going to have to find out. I am so naive. I have taken phone orders from a physician for labs to be drawn. I really don't have to worry about waiting for other nurses to find me something to do, because I have been drawing blood, inserting/pulling foley's, inserting/pulling NG's, dressings, and so much more on my own patients. It is a wonderful experience, and now I know for sure that I am entering the right profession. Again thank all of you for posting. I will be much more careful and alot less naive from now on.
Tweety, BSN, RN
Sounds like you are an excellent nurse and because of that your preceptor has an extreme amount of confidence in you. But she is responsible for the assessments and the outcomes of all of your actions and sounds like she should be a little bit more aware of what's going on. Keep up the good work. You are going to be so ready when you are on your own.
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