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I've been a nurse for the past 5-6 years; back ground PH, Ambulatory care, and case manager for patients that are transferred to acute care inpatient/obs, snf, and back etc. My new job is hospital inpatient cm. This hospital is very new to me; services, protocols, programs - I have 6 wks of training. I've been a nurse for a while so I've learned not to take bad comments to heart. However, my trainer has been horrible. After my 3rd or 4th day she ridicules me, gets irrate, irritable, lacks any kind of patience. Right now I'm on my 8th day - she continues to refuse to teach me, expects me to know(despite not showing me), and has tried to blame me for things as a trainer shouldn't have been missed (she says, "I guess I'll take the blame"- referring as if its my fault when she forgets something. I'm just happy to be done with her as I train in another shift. She even makes snide remarks on my background as a nurse; of course I don't have 30 yr experience as her. As someone who has trained staff in my prior position, you just don't conduct yourself in such a unprofessional manner. I'm thinking she stresses her whole family out daily. Anyway, please remember not to eat the young new nurses or ones you are training. Your energy projects onto them and its not a healthy learning experience.
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Throughout my orientation, I found not just a preceptor, but a mentor, a colleague and a friend. I am forever grateful that, for me, she provided a safe environment free of hostility and judgment - but one conducive to teaching, learning and growing. I ended my orientation with many of her pearls of wisdom, nuggets of knowledge and the confidence to know I am on my way to one day being the nurse God created me to be. I only hope she knows how truly special she is! To my preceptor: With your many years in nursing, I know I am just another face; just another mindless new grad - clueless, jittery and slow. Although my face will soon fade from your memory, yours will forever be present in mine. Your razor sharp intelligence, your thick gritty exterior, your invaluable experience, and warm, compassionate heart have helped mold me into the nurse God has called me to be. The worst kept secret in nursing is the difficulty transitioning from 'student nurse' to 'real nurse'; and boy is that transition rough. No amount of schooling, studying, or clinical time will ever truly prepare you for 'real world nursing'. It much reminds me of the military. Basic training is absolutely essential in laying the foundation for a good soldier, but it will never prepare him for the gruesome reality of war. The process of such a transition is quite difficult and at times extremely painful. For this I am forever grateful for your willingness to help me weather the blustery storms that blow through the trenches of nursing. Thank you for being my battle-buddy. Thank you for sharing your wealth of knowledge with me. Thank you for showing me how to prioritize in the real world and explaining that not everything is a crisis. Thank you for nurturing my fragile, almost non-existent confidence. Thank you for not making me feel absolutely incompetent for asking silly, mindless, and seemingly basic questions. Thank you for teaching me to pop in a piece of gum when I feel the urge to cry in front of my patients. This will hold the tears at bay until I can make it to the supply closet; with this I can hold it together and remain a strong pillar of strength for my patients in the midst of highly emotional situations. Thank you for showing me what it really means to be a patient advocate. Thank you for forfeiting those sacred moments of 'down time' you rarely seem to find to instead graciously help me better understand those wonky tele strips. Thank you for always reassuring me and reminding me that everyone makes mistakes - even you. Thank you for reminding me that every mistake, every error, ever near miss must be taken as an opportunity to learn and to grow. Thank you for pushing me, for giving me just enough rope to feel uncomfortably independent, but not enough to hang myself. Thank you for reminding me that this unnerving phase in my nursing career is much like a jigsaw puzzle - the pieces are there, but figuring out how they fit together takes a little time. Thank you for your incredible patience with a bright eyed, bushy tailed, green-as-green-can-get new nurse. With this I must say, you were so very right. The tears, the long hours, the doubts, the frustrations and fear are all worth it when your patient tells you that yes, you were the calming presence in a painful, scary situation. Yes, to you I am just another face, but to me, you are the physical embodiment of the confidence, focus, peace, compassion, and patience I prayed for in a preceptor every night. Although I am only a few steps out of the gate and have many, many more to go- thank you for helping this turtle come out of her shell. I only hope that someday I can provide a scared, inexperienced, doe-eyed novice the same guidance you have provided me!
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Being a preceptor is one of the most important roles a nurse can fill. It's a vital role as nurses transition to practice whether new grad or experienced nurse. allnurses.com's Community Manager, Mary Watts, BSN, RN interviewed Kelly Powers, PhD, RN, CNE and Julie Pagel, MSN, RN, CCRN, SCRN, CNE-cl at NTI about precepting Important skills that new grads need to learn when they take on their first nursing job include: Prioritizing care for the included population Becoming a team member and integrating into the unit Learning or further perfecting procedures needed to care for patients Becoming familiar with Institution organization: how to page a provider, who to call for specific issues Charting in an electronic medical record Preceptor experience depends on several factors: The type of unit The acuity of care Type of patient Experience of the preceptee Individual learning styles The Transition to Practice Study recommends "6-12 months for a successful experience. Hospitals using established programs had higher retention rates, and the nurses in these programs reported fewer patient care errors, employed fewer negative safety practices, and had higher competency levels, lower stress levels, and better job satisfaction. Structured transition programs that included at least six of the following elements were found to provide better support for newly graduated RNs: patient-centered care, communication and teamwork, quality improvement, evidence-based practice, informatics, safety, clinical reasoning, feedback, reflection, and specialty knowledge in an area of practice." Skills that a good preceptor needs include: Being supportive of new grads and new employees Ability to adapt to individual preceptee's previous experiences Knowledgeable about unit/hospital policies Willing to admit they don't know everything and provide resources for the preceptee It's very important that there is a helpful and supportive environment for the new grad and new employee. It can be a stressful experience for both the preceptor and preceptee and it's very important to match learning styles with the information provided. There is a national nursing shortage so it is imperative from a business model to have a successful preceptor program. Training is, of course, necessary for the preceptors in order to provide a positive learning experience. This is necessary for many reasons. Preceptors need clear expectations, solid training in the educational model and how to teach. Role-playing is one part of this training. In order to improve programs feedback is important. Preceptors need training in order to be successful and to improve their experience. By contrast, new grads look to the preceptor to be their role model and provide clear expectations. Precepting can be very challenging, exciting and rewarding. One of the pluses discussed in the interview includes, "It's so great to see the "aha" moment from new grads." It is also important that the organization rewards and recognizes preceptors. The preceptor/preceptee relationship is often the key to nursing retention.
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Hi I need help on making a wise decision. I just started my career as an LPN and my first week has been hell. I was hoping this dream job would focus on patient care but so far it has been gossiping, a lack of respect from colleagues due to my preceptor trying to make me look incompetent. I was put with this preceptor to train but so far the preceptor leaves out important details as far as where to chart important information therefore the doctors are complaining to management that I'm not doing the job correctly. Management believes everything the preceptor says and gives her high fives and congratulates her on doing a great job. I'm thinking the preceptor is making up lies about me behind my back to make me look incompetent. Management and the preceptor seem to be good friends. The manager makes her the leader in the area and totally disregard that we both are LPNs. She prefer to treat me like a tech. Management makes these huge announcements in front of other team members that the preceptor is the leader and we must follow her lead. I've tried to talk to manager but she always says, ask your preceptor if you have questions. When I am seeing patients, the preceptor interrupts my time with the patients and states, speed it up with your assessments In front of the patients". She also will whisper to the doctors that I take a long time with assessments so now the doctors have started to interrupt my time with the patients. The preceptor sits and gossips with the techs and since her influence on them, now they don't have conversations with me and have no respect. When I took this job as a new grad, I was hoping to focus on patient care and just being there for my patients as well as a positive welcoming atmosphere but it has been drama and backstabbing. I graduated at the top of my class and for someone to try and make me look incompetent because I'm not being trained correctly and because I'm the new employee is unacceptable. Being that this is a dream job for me, should I leave or stick it out and just ignore this behavior?
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As a relatively new nurse, I have few contacts with potential preceptors and intend on utilizing a service to find my preceptors. Obviously, these are costly and was wondering if there was anyone who had utilized either of these services with success or not success. Of course, the website has some reviews, but I have been unsuccessful in finding many.
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Hello everyone, I am in my last semester of RN school and we will precept this semester. We have to come up with 10 learning objectives that I am definitely having trouble putting down on paper. I will be on a Med-Surg floor for (7) 12 hour shifts. This will be my last time as a student and I want to learn all that I can. IF ANYONE HAS ANY SUGGESTIONS I AM OPEN TO EVERYTHING!!!!!! PLEASE HELP!!!
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Welcome student NPs and prospective student NPs! Part 2 This is the second part of a two part series, if you haven't read the first installment, start there, if you have, welcome back. First off, a little about me. I am a board-certified Family Nurse Practitioner and I work in a mixture of both inpatient and clinic settings with a small independent adult internal medicine practice. I live in a state that requires a collaboration agreement but I practice almost fully independently (as fully as I am comfortable with, see below). I have been on the clinical and didactic faculty at a local NP program as well as a lecturer and clinical preceptor for a local medical school. I have been an active preceptor for most of my NP career. I am active in the local and national NP association. I am not, however, the be-all-end-all of NP advice, so take everything as the opinion of one person with some experience. 5 Questions I Hear From Students In School/Practice:What is the most important goal for my first clinical rotation?What do I do if I am not sure about something?How do I handle a disagreement with a preceptor?What if I make a mistake?What if my preceptor does something different from what I have learned in school?This is the second installment and I will address the latter five questions from above. If you have questions/thoughts/comments, please share. What is the most important goal for my first clinical rotation?At the start of each semester I sit down and discuss two goals with each of my students; their goal and my goal for them. For first semester student my goal is that they start to think and act like a safe provider. To me, a safe provider:1. listens to the patient,2. asks the appropriate questions regarding life threatening issues,3. identifies critical abnormals,4. rules out critical differentials,5. formulates a simple plan,6. knows when to ask for help.Listening to the patient is crucial for novice providers, especially now with the distractions of EMRs. Providers need to train themselves to really listen to what patients are saying, not giving a patient complete attention can lead to missing something important. It is also important to take patients seriously when they tell you something isn't right. After a patient tells you they don't feel right two things can happen: they can live or die. The latter is obviously what we want to avoid so take every complaint seriously. Patients can also give you important insights when you are new: have they had this before, what worked for them, etc. Learning to ask appropriate questions is one of the most important aspects of the role transition. It takes experience and time to develop the skill. In the beginning, I stress with students that they needs to ask the appropriate questions to rule out life threatening concerns. What do you need to ask to ensure that the patient's cough is not a manifestation of PE or pneumothorax? What should you ask to make sure that a patient's vertigo is not brain metastases? If the right questions aren't asked then your risk of missing a life threatening diagnosis is elevated. As I mentioned above, in the first semester my focus is on the student identifying normal versus abnormal; in my view this is essential for entry to practice. Identifying critical abnormals spans the triage, the history, the physical exam, the diagnostics review, the plan, and the sum of all these components. When we are in clinic I expect students to identify a critical abnormal at any and all of these stages. You can be safe if you miss critical abnormals such as crushing chest pain on triage, a history with suicidal ideation, a surgical abdomen on exam, a hemoglobin of 6 on review of the CBC, or a major interaction of a medication in the plan. The best tip here is to take your time and be very cautious, just like you should be in practice. Just as alluded to above, I feel strongly that when a patient leaves a visit there needs to be no question about a life threatening diagnosis. It will never be absolute but there needs to be no reasonable doubt. If the patient presents with a cough, if you are going to diagnose him with bronchitis you should be able to clearly articulate why it is not a PE, acute heart failure, or pneumothorax. Developing a simple plan based on current EBP and guidelines develops with time and I don't expect first semester students to be able to do it all the time, but I expect them to at least try, and when they can't, I expect them to ask for help. The most important (in my opinion) still a novice provider can learn is to understand their own limitations and overcome any fear of asking for help. What do I do if I am not sure about something?As a student you are not expected to know every answer; once you are in practice you (hopefully) realize that you learn new things every day. With that in mind, the student should learn to handle this as a provider would. You will forget things you learned. You will see things you have never learned about or seen before. You will see complex and atypical presentations of common illnesses. You will be confronted (frequently) with things you don't know from clinical presentations to physical findings to lab tests to medications and dosages. You should have readily accessible resources at the point of care, there are many of these available, I use UpToDate constantly but that is my personal preference. As a student you should use these resources before talking with your preceptor; it's good habit. I spend the first week or two with my students saying "look it up and tell me, one day I won't be here to ask". Once you have researched then it's time to talk to an experienced provider or colleague/mentor. Don't be afraid to call radiology and ask, call the specialist and ask. It's ok to not know, it is not ok to pretend you do. Another phrase I use on my first day with students is "no more faking-it-till-you-make-it": when a provider fakes it people can die. If you don't understand then you need to ask. How do I handle a disagreement with a preceptor?Disagreements with your preceptor, just like disagreement with your colleagues or your patients, may happen from time to time. The most important advice I can give to students is to handle these disagreements like a professional. Stay calm and objective. If you can, sit down and discuss the issue from a perspective of gaining understanding of your role in the issue and the opposite point of view. Remember you are a guest of the clinic you are in. Never escalate the situation. Speak immediately to your assigned faculty member without making accusations, again as calm and objective as you can. These can be a challenge, however, it is a challenge you will experience again and again in your career. I have to be honest, with some students, I will create a superficial disagreement and let it play out in a safe environment. What if I make a mistake?Mistakes are a part of life, we all make them, some are small others are tremendous, and I have yet to meet someone who has an absolute technique to avoid them. You and your preceptor will work very hard to avoid mistakes, but should one happen, there are a few important things to consider. The first thing you need to do when you realize you have made a mistake is admit it and get you preceptor and whomever you need to involved in fixing it. Maybe you just sent a medication to the pharmacy that a patient is allergic to or maybe you just missed a STEMI on an EKG. You can never, ever try and hide your mistake or hide from your mistake. The second thing to consider is how to make that mistake into a learning experience. You can learn from every mistake you just need to engage in self-reflective practice. What if my preceptor does something different from what I have learned in school?In all likelihood, during your first clinical rotation, you will see a preceptor do something different from what you learned in the classroom or from your textbook. There are a number of potential reasons (your textbook or lecture is out of date in their practice, your preceptor is out of date in his/her practice, your preceptor has adapted their practice to the specific patient or patient population, or the theoretical doesn't translate to the practical) but is likely multifactorial. First and foremost remember that you are their to learn the practical application of your theoretical knowledge. If you notice a difference, try and establish a dialogue with your preceptor about it. This dialogue is the cornerstone of your relationship: you learn from your preceptor and your preceptor learns from you. You may develop a relationship with your preceptor where you can challenge a him/her on these topics, but don't start that way! That concludes my thoughts on 10 (five in part 1 and five in part 2) of the most frequently asked questions relating to a student nurse practitioner's first clinical rotation. In closing I want to again reiterate that clinical rotations will be the foundation your career is built on and should be a fun. interesting, challenging, and active learning process. The habits you build during rotations will shape your practice. I know many students have commitments to family, school, and work, but I honestly feel that outside of family, your clinical rotation should be your primary focus. The more effort you engage the more you will get out of your rotation. I hope this has been some help to you and I wish you the best of luck as you move forward and transition into a role so many of us love.
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I'm an FNP and I want to share some advice that I assumed was obvious, but apparently is not. I started precepting students this fall and I had four over the semester. Two were rock stars - one is just graduating and I recommended her for a job with my practice and she was hired, the other is graduating in May and I told her that I would love to recommend her for a job as well. Student 3 was very good, and I would have been happy to recommend him as well, until his last day. I see patients in nursing homes and assisted livings and go to several facilities each day. On his last day, we made the morning rounds, and then I told him to meet me at the last place after lunch. About a half hour later, he texted me and asked if he could skip the afternoon since it was going to be a light load, and he had a lot of studying he wanted to get done. You do not ask a preceptor if you can leave early or skip a day etc. unless it is for something urgent (a sick child or such). Right there my opinion of him changed and I wouldn't recommend him for a job now. Then there was student 4. She's been a psych NP for five years and is getting her FNP certificate, so you'd think she'd understand the basics of professionalism. First, she was late every day except one, often over 30 minutes. She had a long commute, so I even told her to meet me at my second stop instead of my first (about 45 minutes later) to make it easier for her. She was still always late, and usually never notified me at all. Then on her last day, she went to the skilled unit at the facility, even though we always started on the assisted living side, and saw a patient without me even knowing she was on-site. It was a new admission who I had never seen, which makes it even worse. She finally came over to find me an hour and 15 minutes after her scheduled start time. She did not contact me at all to tell me she would be late or that she was at the skilled unit. This was so far out of line. I was tempted to fail her for the rotation, but I'm probably too nice and passed her with a poor evaluation. 5 STEPS ON BEING A GOOD PRECEPTEE STEP 1 Your preceptors are doing you a favor. They usually do not get paid for this. You need to respect their time. STEP 2 Show up on time. And that means early. Allow time for traffic. Think about how you feel sitting in the waiting room when your provider is running late. It sucks. So be on time. STEP 3 Do not go off on your own unless your preceptor tells you to. It is completely unprofessional to see patients without permission from your preceptor. STEP 4 Treat every rotation as an extended job interview. At a minimum, you want your preceptors to be willing to provide references for you, and you might find it's a place that you would like to work. If you leave a bad impression, you will definitely lose your chance of working there, and will likely lose your reference as well. STEP 5 When a preceptor has a bad experience with a student, they are less likely to take students in the future. I know how hard it is to find preceptors, and if providers stop offering because they have bad experiences, it makes it harder for everyone. I'm not going to stop precepting (although now I definitely understand why providers do stop), because I had some great preceptors who really went out of their way to help me, so I'm going to keep paying it forward. But I'm really frustrated right now. Please, I ask everyone to be professional on their rotations - show up on time, follow professional standards and norms, work hard, and generally act like you want to be there.
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Many nursing students make the transition from regular, group clinical rotations to working one on one with "real nurses", or preceptors, during their senior year. Preceptors put a lot of time, energy and heart into helping teach the students during this formative point in their nursing education. Sometimes the lessons learned are intentional, such as communication or assessment tips. Other lessons occur naturally as the students constantly observe their preceptors in every situation. Some of the most memorable lessons come from the patients the preceptors and students care for together. This list serves as a tribute to preceptors everywhere who dedicate themselves to helping grow the next generation of nurses. "What I learned from my preceptor"Take On More ResponsibilityThis is [usually] the last clinical you will have before you are a RN with your own patients, so don't be afraid to take on a little more responsibility. Your preceptor [should always be] there for you and you should be able to trust that they won't let you take on more than you can handle. Spend Time With Your PatientsOne of the best things you can do for patients is just spend time with them. A lot of people are lonely, anxious, or just need to verbally process what is happening. If you are safely able to, spend extra time with patients. It allows for ongoing assessment and really takes care of a lot of their psychosocial needs. Learn New SkillsAs you are learning new skills, verbalize what you are doing and the rationale behind it. It is an extra safety check for you and your preceptor and helps your preceptor to assess your knowledge level. Explaining what you are doing and why also helps patients to be knowledgeable about their care and feel safer with a student. BRING SNACKS!Stuff your pockets with nuts or granola because you frequently do not have a chance to sit down during your shift, and a quick handful of something can save the day. You will think more clearly and will be in a happier mood if you make sure that your body is well nourished. Spend Time With Patients Nearing End-of-LifeIf you find yourself in a situation with a patient nearing the end of his or her life, you should take the opportunity to spend extra time with this patient. It may be the most emotionally taxing situation you will ever experience; however, if you are there when they take their last breaths, this means more to the patient than you know. At times it may be difficult to process the situation, but you should take advantage of the support and guidance that preceptors provide during your clinical. In the future you will be able to provide the same support to your nursing coworkers if faced with a similar experience. Do The Most Important Things For Your PatientYou're not always going to be able to do everything you would like to do for your patient, but you can do the most important things. This will show them you care about them and that they matter. Don't JudgeAlways try to see the patient's side of the story - don't judge anyone based on the opinions or perceptions of others. Time management Is ImportantTaking care of patients holistically can be a challenge because time management is so important and is such an influential factor in nursing. Time management is important, but it only takes a few minutes to talk to your patients and find out more about them. Appreciate The Moment When Needed The MostYou will have good days and bad days and there will be patients who have good and bad days, but remember you are caring for patients at their most vulnerable moments and you should appreciate that you are a part of that moment when they (patients and families) are vulnerable and need your help. Tell Your Co-WorkersMake sure other nurses on the floor know you're precepting and will be graduating soon - a lot of them will let you do different skills for them if they know you want more practice! Don't Be Afraid To Ask For HelpBe on time, fully assess each patient, ask questions, seek advice when you need help (don't be afraid to ask for help), and document, document, document! Value Your PatientsBecoming a nurse means much more than starting IVs, pushing medications, and delegating care. Being a nurse means valuing each patient no matter the circumstance, and building positive relationships with colleagues in order to initiate change and save lives. The above list based upon the contributions of four senior nursing students from the University of North Carolina at Chapel-Hill BSN Class of 2015: Jaden Moore, Keoyona Ray, Kimyona Ray, Morgan Springer & Julia Winslow
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Guest posted a topic in Career Advice ColumnHi Nurse Beth, I hope you're doing very well! I've been working as a new grad nurse for over 2 months now. I feel like quitting due to toxic environment that I am in. I have had different preceptors at the hospital that I currently work at. There is this specific preceptor that always gossips about me at the nurses station for being so slow and lacking time management. She has been teaching me how "time management" should be done, but I believe she's teaching me how to cut corners. For example, we were giving blood transfusion to the patient. In nursing school, I learned how important it is to stay with the patient for the first 15 minutes. Instead, my preceptor told me to leave the room, to complete my physical assessment on another patient and then to come back after 15 minutes to the patient's room with blood transfusing. I did not feel comfortable. I did not follow what she told me to do. My preceptor found out and said that "nobody really dies from blood transfusion after carefully checking all important information" in her 15 years of experience as a nurse. Yesterday, I overheard her talking about me using profanities to other nurses. She said that I was "***ing slow" and "do extra steps that do not make any sense." One of the nurses also said that the hospital should not be hiring any new grads because we "waste the company's time and money" after getting that 1 year experience on med/surg. I confronted my preceptor saying that I overheard everything she said and I do not feel comfortable. She immediately changed her behavior and tone in a professional way. She told me that it "was not a big deal". I do not know if this is really the type of experience that new grads go through wherever we work. I would like to get your opinion on it. Thank you! -
Thank you for the feed back. I have now been training in the nicu now for a little over two months and it hasn’t gotten any better. I was really hopeful that it was going to be a better environment for me to work in. My preceptor is really nice but she can be very controlling. She never lets me go into rooms by myself and she will critique everything I do. Yesterday I was changing out an infant’s nasal cannula and redressing it and she was criticizing the way I cut my tegaderm because it was 1cm shorter than it needed to be. I always listen to her input and will redo things if she is unhappy with how I am preforming tasks. I am always open to feedback and constructive criticism but it’s gotten to the point where it feels like she critiques everything I do and that everything I’m doing is wrong. A lot of times she will take over things I’m doing or take medication out of my hand to do it. It’s very discouraging and I feel like I’m having a hard time accomplishing anything because she is always upsets about something I am doing. I’m new to the nicu but I was a nurse on a renal transplant floor for 2 years prior so I do have some skills that translate over. Last night we had a kid that was very sick and vented and she told me that she would be doing everything and that I could watch her. I was very discouraged and disappointed because I wanted to be apart of this kids care and it felt like she was indicating that she didn’t think I was competent enough to do so. The kid ended up coding and I tried to get involved in the code as much as I could by getting supplied/suctioning/decompressing the stomach. I was pretty upset after the code because it was my first one and it’s horrible to see your patient that way and she never debriefed with me. We were able to get the kid back and started a blood transfusion. I pointed out to her that it looks like the IV is infiltrated and she told me it looked fine. I was concerned so I was checking the site every 30 minutes. The IV ended up infiltrating pretty badly and when we went in together to asses she asked me if it looked like this 30 minutes ago which I responded no. She then asked me if I was sure which I was very insulted by and told her I would never keep something infusing through an infiltrated IV. My patients are everything to me and I work really hard to learn as much as I can to be the best nurse I can be for my patients. When I was in the nursery training I received very positive feedback and was told that they could tell I was a good nurse on my other unit and that I was doing really well. I even got thank you cards from families I had while over there. I was with a different preceptor the other week and she told me that I did an amazing job and gave a very detailed report. My other preceptor often talks over me while I’m giving report and makes me practice with her before giving report. I’m more than happy for any opportunity to learn but other preceptors have never had a problem with how I give report on this unit and when I’ve ask for feedback they always tell me that my reports are good. I decided to talk to my preceptor about why she wouldn’t let me help with the sicker kid because it was really bothering me. This week she has been especially critical of everything I have been doing and won’t let me do anything on my own so I wanted to clear the air. I was hoping to get feedback on how I can improve and if I am where I should be at this point in my orientation. She basically told me I’m lacking critical thinking skills and time management/prioritization. She told me that if she had let me have more control in the assignment last night that the kid wouldn’t have been recovered. Which really made me sad when she said that. I really want to improve and do better but it seems like my preceptor has no faith in me and thinks I’m a bad nurse who shouldn’t be there. Her response broke my heart and it made me feel like I’m a terrible nurse. It even made me consider transferring to a different floor. The nicu has always been my dream job and I’ve worked really hard to get a job on this unit. I’m devastated that this has been my experience on this floor so far. I know the turn over rate on the floor is very high due to bullying and the senior nurses make it very clear that newer nurses are not welcome there. I’m looking for advise of any kind. I’m just completely devastated and questioning if I should even be a nurse at this point. Thank you for reading and sorry this post is so long!
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Guest posted a topic in Career Advice ColumnI am a student of Grand Canyon University, presently enrolled in masters in Nursing program with emphasis in Public health. I am in need of a preceptor. I live in Georgia. The requirements are that the Nurse must have a masters degree with an unencumbered li cense with two experience. The practicum is scheduled to begin
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Guest posted a topic in Career Advice ColumnHi all, Needing a little advice, hopefully this is aloud to post For background, I have been a RN 4 years with my main background of medical surgical nursing for 3 years and at my current position of a cardiac step-down with medical overflow 1 year. The step down unit I am currently on is 50 beds and I have found the nursing culture to be quite toxic at times. I also try to stick to myself and do my job as I love being with patients. My goal as a nurse has always been to eventually go to the ICU and I was looking to transfer this coming month. Most recently I was asked to precept new employee's on my current unit. Precepting has also always been one of goals as a nurse as I love teaching people and the patients that I get to take care of. However, with the toxic culture on my unit I am very worried that I will have my clinical decisions undermined/redirected. I see that I am already precepting within the coming month. Can you give me all the precepting tips/tricks? I took the online class my hospital has provied me and did not find it all that helpful. Also, should I just apply to the ICU and forget precepting all together?
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For some unknown reason my supervisors have selected me to be a preceptor for the nurse interns coming this Summer. I have only a little over a year of experience and have never been a preceptor before. Also, as a new nurse, I had THE WORST experience with my preceptor so now I am kind of scared to be precepting someone. Does anyone have any tips on how to do this? I work at a teaching hospital so I guess I already teach students...but now it is more official and I'm scared/nervous I won't be a good resource to students since I am kind of new myself
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TIP #1: Check your own practice Over time you most likely have adopted, adapted and normalized some work-arounds or shortcuts into your practice. Maybe you carry a pocketful of NS flushes in your pocket, but know you shouldn't. Since you are now a role model to a new grad, go back to the basics, do a self-inventory and know your policies and procedures. TIP #2: Be patient This is the most common feedback I get from new grads and residents "Please be patient with me. You have done this many times, but this is my first time.” It is crushing for a new grad to be asked "Didn't they teach you this in Orientation?” Just assume that you will have to repeat yourself a few times because everything just does not sink in one pass. Isn't there a saying that long-term retention takes seven repetitions? TIP #3: Let your preceptee learn by making mistakes at times Most of us remember making the rookie mistake of hanging and programming an IV antibiotic but forgetting to unclamp the rollerball clamp. Meanwhile the primary solution continues to infuse, so there's no alarm. Chances are you only made that mistake once, right? If you observe your preceptee about to make this mistake, and you jump in with "Be sure and unclamp the rollerball!” it will have far less impact than if you let them make the mistake, wait a few minutes, and then send them back in the room for them to discover what they missed. TIP #4: Hands off Literally, keep your hands behind your back and clasped together. Don't jump in and "do for" them on the computer or during a procedure because you are impatient and want to do it yourself. Instead, coach them. This is not to say you can't demonstrate a procedure- you can, but that's different than doing it for them. TIP #5: Having a preceptee is a lot of responsibility It's like having another patient. You will not be as available to your co-workers once you have a preceptee. For example, if you are the go-to person on your unit for starting IVs, you may have to "give up" your role as the expert IV starter temporarily in order to focus your energies on your preceptee. Some preceptors who get a lot of gratification from being the "go-to nurse" may find this difficult. TIP #6: Give plenty of feedback Preceptees crave your feedback. If your preceptee is frequently asking you "How am I doing?” it's a sign they are not getting enough feedback from you. Find time every day to touch base with them on their performance. A good time can be walking out together after your shift and debriefing your day. TIP #7: Give specific feedback Saying "I noticed how you used teachback with Mrs. Wolf when you were telling her about symptoms she should call 911 for when she gets home. You used plain language, too, no jargon. Good job!” is more meaningful than "Good job on the patient education with Mrs. Wolf!” TIP #8: Give constructive feedback When giving constructive feedback, frame the gap in performance as a patient safety issue (if it is), with a rationale, such as "Not confirming NG-tube placement with an Xray can put the patient at risk for aspiration" rather than "You forgot to order an Xray.” It's a slight but subtle difference. You can also frame a gap in performance as wanting the best for your preceptee, such as "I would hate to see you get in trouble for coming to work late. Can we talk about you getting here at 0700?” TIP #9: Speak up... ...when the Charge Nurse sees you and your preceptee as two fully functioning nurses instead of one unit, and expects one of you to admit a patient, while the other one discharges a patient. You are one unit, especially in the first few weeks. Consider you and your preceptee to be "joined at the hip" to provide the most teachable moments. Your primary job is to teach your preceptee, and the best way to do that is when you are together. Recently a nurse I know left her preceptee alone to go help a colleague extubate a patient. A doctor and procedural team then rushed in to the preceptee's room to perform a bedside procedure, barking questions and orders at the preceptee. It did not go well, and could have been avoided if the preceptor simply said "Come with me and watch while I extubate". TIP #10: Encourage critical thinking For example, if your preceptee asks you "What is a normal pH for ABGs?" you can say "Good question! Where could you find that out?" After a Rapid Response or a code, ask "Let's talk about what happened. What questions do you have?"
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OK so here is the background: I'm a new grad starting in the ER were I worked as a CNA for the last year of school. I am 40 years old and a guy. I was assigned a preceptor who I knew would be tough but I have discovered that she is an abusive ***** (she actually said " my little sister who is not a nurse could get this!"). also she is not teaching me anything, just telling me how incompetent I am. Now I know how to stand up for myself and all that, but I have a feeling that she is vindictive as hell and she is also one of the charge nurses. I am not sure that complaining will help me because she will just say that I can't handle the job and that I am blaming her. She has won awards and is a big deal in the eyes of the higher-ups.... She has also accumulated a lot of enemies in the ER with her abusive behavior but they all seem to be to scared to say anything... So should I risk it? I can probably survive, but have this annoying need to not let her get away with her bullying and abuse. By the way I can totally handle the job .... What I can't Handle is keeping quiet about all that I am witnessing and experiences. Tell me what you think.
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Hi experienced nurses. I’m a 5 year med/surg tele nurse at a community hospital. It’s A large unit. I just started precepting a new hire/rehire about three weeks ago. She’s at week six already. I’m told she’s been working at an office as a health coach, but was in hospital several years ago. shes been out of the hospital 8 years. Any tips on getting her better up to speed? She doesn’t seem to be getting it! She’s very good with the routine head to toe assessment and charting the routine daily required documentation, but that’s about it. It gets as basic as making sure she pulls two pills instead of one...always has to run back. Minimal critical thinking, time management skills, Where to find meds not just stocked in pixie, and some other everyday skills (discharge education, secondary bags often antibiotics, especially when not with current fluids and programming flush bag is needed) Responses to attempts at guidance is usually me repeating five times for her to still not get after multiple times with skill.... next day, five times explanation of same common skill. And “oh!” Like she’s heard it for the first time. I’m frustrated. Prior preceptors of hers experience same frustrations. I’m starting to keep a log of these to turn into educators and manager.
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Unfortunately, I was late to clinical with my nurse practitioner preceptor by thirty minutes. I forgot to call. The reason I was late was due to a family death. I know it was unprofessional. How do you recover from this faux pas? She told me if I was late again, I would need to find a new preceptor. I understand why she did this. I am asking how to recover and prove to my preceptor that I am a professional, hardworking individual who made an honest mistake.
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By 0900 on the first day of orientation with her preceptee, Sheila knew, and groaned inwardly. Her preceptee, Kyle, was a know-it-all. During rounds on their patient in the designated COVID-19 ICU unit, the intensivist musingly mentioned transfusion. Kyle spoke up excitedly, "Oh, you mean convalescent plasma transfusion? It looks promising. I read that it can be useful in the treatment of critically ill patients with COVID-19. I understand more than 6,000 patients have received...” Sandra jabbed him with her elbow and tried not to roll her eyes. She knew for sure that Kyle had not so much as seen a blood transfusion, much less a convalescent plasma transfusion. Everyone has encountered a know-it-all in the workplace, maybe a coworker or charge nurse, but what if you're the know-it-all's preceptor? A new grad who doesn't know anything but thinks they know everything is scary. They don't know what they don't know, they may not be appropriately cautious, and they may not even be teachable. Variations Some know-it-alls are posers and inwardly feel like fakes who haven't yet been outed. Others genuinely feel superior to others. They don't listen and they aren't concerned with what you have to say. They are busy thinking about the next smart thing they are going to say, and anticipating how impressed you'll be. They monopolize conversations, like to hear themselves talk, and love to have the last word. Know-it-alls want to be seen as the smartest person in the room. It's a driving need and it didn't start with their first nursing job. Their need comes from a place of deep insecurity and their defense to feeling insecure is acting superior. Their insecurity is triggered by being in a new group and starting a new job because they must prove themselves. They crave attention and hate to be ignored or disregarded, often steering the conversation back to themselves and their accomplishments. Choose Empathy Be mindful of the dynamics between the 2 of you. Your job is to ensure a learning environment, which is built on mutual respect. Watch that your preceptee doesn't trigger your defenses. If you have a very strong reaction, examine yourself. It's a sign that you also might also be a know-it-all. Instead of anger, choose empathy. Find a connection. Above all else, your preceptee seeks acknowledgement. So give it to him. For example, you can give acknowledgement and respect by congratulating him on graduating at the top of his class. Sincere acknowledgement and genuine recognition may be all that's needed to reduce some of his anxiety, and help him listen to you. Hold Them Accountable Avoid asking yes or no questions because a know-it-all will not admit they don't know something and will not say "I don't know". Instead of asking "Have you read the Lippincott procedure on removing an arterial sheath?” or "Do you know how to remove a sheath?” ask "Tell me 3 complications of arterial sheath pulls and what your plan is for each one if they happen". When your resident presents information as fact, ask them for their source so they know you are going to hold them accountable. Over time they will learn to be sure of their information before speaking up, at least around you. Likewise, be sure of your facts. The surest way to lose respect with a know-it-all is to lose your credibility. When you say "it's policy to do thus and so",.…make sure it is policy. Set Boundaries Make it clear that they are not allowed to practice independently until you say so. Make sure they understand your facility's process around being validated on orientation competencies. Have them repeat the process back to you (teach back). For example, you have to observe, validate and document them passing medication or starting an IV competently before they are deemed independent. Make sure they know that even when they get off orientation, they are to seek help when performing a procedure for the first time. Constructive Feedback Many know-it-alls lack self-awareness and cannot read social cues. As their preceptor, you have an obligation to give them meaningful, constructive feedback. When giving feedback, give specific examples. "I want to let you know how you come across to others. Today at lunch I looked around the table and watched when you were talking about taking the NCLEX. A couple of people tried to jump in the conversation but you interrupted. I'm concerned because it could prevent you from succeeding here, and I would hate to see that happen". Summary Think of it as a challenge to orient a know-it-all, but a satisfying one if you succeed. Most know-it-alls are actually smart people, some of whom go on to be leaders. The ones who are teachable can end up being good nurses, and you can be a part of their success.
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I am set to be done with the PMHNP program at Herzing Univ after my Spring 2023 semester (Jan-April). However, my clinical preceptor I had lined up just fell through. Now I need a PMHNP for 180 clinical hours. My application deadline is early October, so I have less than a month to find a new preceptor. I am in Racine, WI. I can use telehealth for all 180 clinical hours.
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It's OK to be a new nurse and a preceptor. Sometimes nurses 1-2 years old have impostor syndrome, feeling like they don't know enough to serve as a preceptor. They only have to look down the hall at clinical students in their school-colored scrubs to remember how far they've come. New nurses know more than they realize and know enough to help onboard a recent grad. Actually, young preceptors have unique advantages. New nurses may find it easier to relate to a new grad because they can still recall their own recent experiences. Connect with your Resident Learning is relational. New grads learn best when they feel safe and supported. Connect with your resident personally by asking about their interests and family. Sometimes the bond between preceptor and new grad lasts a lifetime. Have their back Introduce them with pride to co-workers and doctors. Inform them of the social mores on your unit (e.g., if the manager's door's shut, DO NOT knock). Don't compare them to other residents- word gets around, and they will feel betrayed. Motivate New grads are typically highly motivated, but here are a couple of insights on adult learners. Adult learners are problem-centered and are motivated by "How does this benefit me?". No one is interested in a review of intrinsic clotting factors, but your resident will be highly interested in precisely what they should do if their patient develops sudden and profuse GI bleeding. Adult learners respond to what is relevant, the immediacy of a problem, and the utility of a solution. Adult learners are goal oriented. "You must pass the Arrhythmia exam with 85% by the end". "Re-assess your patient's pain within one hour." Need to Know vs. Nice to Know Too many details provided too soon is overwhelming. Don't be tempted to grace them with clinical nuances at this point. Watch out for that deer-in-the-headlights look on their face. You've shared too much. Normal to Abnormal New grads often do not have a clinical baseline reference point. Teach them normal first and then abnormal. Explain normal ABGs before abnormal ABGs and how an average post-op patient presents before one with complications. Educational versus performance problem If a resident is not progressing, it may not be an educational issue. As the preceptor, you are responsible for their learning needs but not for poor attitude or performance problems. For example, if your resident is repeatedly late to work, it's a behavioral problem, not an educational one. The preceptor addresses educational problems. The manager addresses behavioral problems. Always confer with your manager early on when there is a behavioral problem. The worst scenario from a manager's point of view is to reach the end of orientation only to be told for the first time that there's a performance problem. It creates a problem for the manager when the orientation should be extended, but there's no supporting documentation. Document It's not unusual for poor-performing residents to have weekly notes saying "performing well" or lack documentation. It can be hard to articulate when they are "just not getting it." If you have difficulty finding the words, and it can be challenging, get help from the unit manager, resident program manager, or your educator. They have the skills and perspective and can help you be more descriptive. Being Task Oriented Is Not a Bad Thing Using the term "task-oriented" as a criticism is easy, but it's how we learn. Being task-oriented is not bad when you're first learning a task. Think about a youngster learning to tie their shoelaces. Five-year-old Ashley is learning to tie her shoelaces. She is doubled over and fully engrossed in the task. A fly lands on her arm, and she is not aware. Next to her, nine-year-old Jeremiah is tying his shoelaces in double bows while talking to his friends and watching a plane fly overhead. Expect residents to be task-oriented. They must concentrate fully when they are acquiring a new skill. Later on, when mastered, they can multi-task (better called cognitive stacking). Feedback The new graduate is eager to learn and typically wants to please you. Your feedback is all-important to them. If your resident frequently asks, "How am I doing?", chances are you are not giving them enough feedback. Walk out together to the parking structure and debrief the day, as there may not be enough uninterrupted time during the shift. Learning is facilitated by immediate feedback. Feedback should be specific. The more specific, the more meaningful. The number one thing your resident wants from you is feedback. The other number one thing your resident wants from you is patience. Let them Fail—a Little. We learn through our mistakes, and most mistakes are not life-threatening. Allow them to learn through their mistakes when it is safe. If you notice that Aaron failed to release the roller ball clamp when hanging Zoysn, do not reach across and unclamp it. Let it be. Leave the room. Wait a few minutes. Ask Aaron to go back into the room and discover what is wrong. He'll find it. Then congratulate him because he will NOT make that same rookie mistake again. Do not do for them Do not do for them. Clasp your hands behind your back and keep them there. This will be hard because it calls for inaction, not action, and most of us are wired doers. This is your new stance as a preceptor. Do not reach over and tape the dressing or grab the computer mouse. That would only show that you know how to do it...but they already know that, right? Far more effective to coach them through it. Hands behind your back. They will forget Some educators believe you must hear something seven times or do something seven times before it's learned. The point is that they can forget just because you told them once yesterday. They will forget. Do not shame them with "I told you that yesterday" (patience). When you were brand new, you forget things, too. It's just that you don't remember. Be patient and be kind. Enjoy your experience precepting, and I hope these tips help you.
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Hello all. I am enrolled for an MSN in nursing informatics at chamberlain university and I need help with finding a preceptor for my practicum. Can anyone on here be of help?
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I have been an OR nurse for almost 7 years. I became burnt out and decided to move into the ED. My current preceptor (who has been an RN for 9 months) has become increasingly annoyed with me. I have not made any medication errors or caused any patient harm, but she complains to my manager that I am asking the same questions over and over and that there also seems to be a "disconnect" in my brain. She reports that I am slow and cannot prioritize. The last straw occurred when (under her supervision), I began to start an OG tube. I have only seen one done before and had mistakenly assumed that all OG tubes were marked at approximately the 60 mark. She corrected me and showed me how to measure. In hindsight, I realize how stupid this was, but at the moment I thought this was right. She went straight to my manager and explained the situation (she has been in his office constantly complaining about my questions with charting). He has now moved me to a new preceptor but states that "this is my last chance". I am terrified. I feel that she simply does not like me, but maybe I am not right for the ER? Please give me some advice. I am very concerned. Thank you ❤️
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I'm precepting a new grad who will be on nights (I'm day shift - lack of evidence staff on nights meant that I was chosen to precept for her first several weeks). We are in week eight by now, and I'm starting to feel like I've failed her. ? I'm hoping to hear any advice you guys have; I've got one more week with her and then she'll orient on nights for two weeks, then be on her own. Our biggest issues, apart from normal stuff like time management, is retaining knowledge and being self-directed. She comes to me with the same questions over and over again, she wants help doing the same skills we've already practiced several times, and even balks at going into rooms by herself or recording her own assessment until she's talked to me about it. After eight weeks, not only am I exhausted, but I sort of feel like I can't trust her to do anything on her own. I have been working so hard to turn her questions around on her (I.e., "What do you think we should do next?" "What supplies do you need?" "What are your priorities this morning?") and to let her figure things out as much as possible without severely delaying or interfering with care. It's not just that she needs a lot of direction, but most of the time, she will not, say, draw labs or start new meds or whatever, until I remind her to look at her new orders. Another coworker precepted for me last week one shift during a pre-planned vacation, and she is reporting the same issues. She said she spoke to our manager about it, and I also have been talking to my manager and our unit educators. Nothing is helping. My manager seems to think I'm being too nice, but I'm doing everything I can to let her work things out herself; there are times, though, where if I don't step in eventually, things won't get done at all. I've precepted new grads before and typically enjoy it, but I feel like this is just not going well at all. I've also never gotten any formal training in precepting, so I'm wondering if anyone has any other thoughts or ideas? She is a very sweet woman, very earnest, and I know she was going through school at the height of the pandemic - but I don't know that this unit and hospital are going to give her the time and training she needs to succeed, and I worry for what will happen when she's off orientation.
