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.
Honestly I feel like this hospital in general is a little insensitive to the needs of new grads, just based on observations of others' orientations. The words "sink or swim" and "let her drown" have been used to describe management's ideal approach to this particular nurse's orientation at this point, which seems very unhelpful and cruel.
How sad! It sounds like management would rather let patient care suffer or be outright unsafe, in order to avoid doing the work of supporting the new grad and/or having difficult conversations with them. You sound like you're doing an awesome job, I honestly can't see from your posts what more you can do with the situation you've been handed.
@NurseBlaq yeah, this is a med-surg/telemetry unit, ratio 1:4. We are up to four patients in week 8 per our educator's grid, and I asked if I could bring her back down to three or even two for a little while, but no dice. I also asked if there was any room to extend her orientation and was told there is not.
Thank you everyone for your feedback! I will do my best with the little bit of time I have left before she moves to nights. I took some of your suggestions and shamelessly stole your wording when we debriefed from our shift tonight. We'll see what the rest of the week brings!
We are up to four patients in week 8 per our educator's grid, and I asked if I could bring her back down to three or even two for a little while, but no dice. I also asked if there was any room to extend her orientation and was told there is not.
Based on this, and previously dismissing the concerns you and your peer have shared, I feel like your manager and educator will likely push this lady through just to have a warm body. Staffing problems solved! That's really disappointing.
If that ends up being the case, don't add fuel to the gossip fire when people bash her poor performance by telling them your concerns from orientation. Just continue being kind and encouraging when you see her at shift change. She's definitely facing an uphill battle.
I wonder ishowing her a progession time line would also be helpful.
It sounds like you have taken all of the right steps to ensure your orientee's success. I wonder if this is something where this orientee might need to be told that during a specific shift they need to do everything and you are available but for assessments, meds, balacing patient load is on them. Obviously you will be following behind the scenes but to let them not check with you for everything.
Maybe have a lunchtime check-in that shift and see where they are at.
I think being very clear on the expectations for the shift is helpful and the orientee understands that they are the RN responsible for managing time.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I have a bit different perspective as the "orientee." Hang tight, I am trying to help here.
I am far from a new grad and about 2 years ago, I applied for, and got, a new job in outpatient infusion. I was super excited as this was what I wanted for a long time. I just knew this was the last job I would do before I finally retired.
Well, about 8 weeks into my orientation, it just seemed I was not getting it as fast/well as expected. I just did not seem to learn/move fast enough. It was hard to swallow, having been a nurse for 22 years at the time, that I was a poor fit for this unit; I had to admit to myself I was not meeting expectations.
I did wind up ending the orientation, and resigning, no harm, no foul. I left on good terms with everyone, manager included.
Some people are just not a good fit for many reasons. In another unit, same specialty, I may have done better. Who can say? Sometimes, personalities don't jive. Sometimes, expectations are more than we can meet.
Rather than fight it, I moved on. I licked my wounds and found my way back to self-respect and happiness.
8 weeks in, a preceptor (and most of the nurses in a unit) can tell if a new orientee is "getting it" or not; that is the moral of my story.
It is not all you and (rarely ever is). The orientee must be a self-starter and have initiative as well as be a good fit for their unit to succeed. Hang in there, keep trying but keep in touch with your manager about how it's going and let him/her help decide if this nurse is going to work out or not.
Not everyone who passes the boards should be a nurse, nor is everyone who passes the boards is able to be a nurse.
It sounds like you've gone above and beyond- why do you think you've failed?
@Jedrnurse maybe "fail" is an excessively dramatic word choice, LOL. I've been trying my best and have put a lot of effort and thought into how to help this nurse. However, I'm also really glad I posted here and got all of these responses, because I'm seeing opportunities to do even better in the future. Hopefully it will be helpful for this orientee, and it will certainly be good for any other nurses I precept. I've also finally been able to sign up for a preceptor workshop at my hospital (have been trying for a while but it never jived with my work schedule).
I really do enjoy orienting new nurses, but this experience has me questioning my ability to do that. While I know that 10 or 12 weeks doesn't automatically turn new grads into full-fledged seasoned, confident nurses, I've never had an orientee I've worried about this much at this point in orientation. I just want to know I did everything I could to make this a successful learning experience for her. Based on the feedback here, I feel better about what I've tried to do as her preceptor; I just wish there had been more consistent involvement from our manager and educator from the beginning.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Sounds like you did a great job. The only thing I can think of is maybe meet with her at the end of every shift to go over what she did right and where she could improve. Are you meeting at the start of the shift to plan the day? That might help some. And document!
If she has a night preceptor it might be a good idea to meet with her to discuss strengths and weaknesses as well
This may sound bad but sometimes it’s important to be straightforward and honest with a preceptor and preceptee. I actually had a great preceptor when I was a new grad in the ER. She and I communicated well and for the most part, she did a lot to encourage me and help me prioritize. However, at a certain point in orientation, she was straightforward with me.....and honestly, it made me such a better nurse. I think our personalities meshed well enough together that we could be honest (sometimes to a fault) and this actually ended up helping both of us. I know I actually needed to hear my weaknesses and what I needed to work on to truly propel me forward. There is a thing as being too nice to the point of not being honest....however, some preceptors go the other way and end up crushing their new grad. It sounds like you are a really conscientious preceptor - I just wanted to chime in my two cents!
I am curious to know the orientee's perception of how she is doing.
This is tough, but I agree with the others--clear expectations, lots of follow-up. Which you are doing. Another consideration--it would be nice if your hospital had a preceptor class.
You may have already tried this, but I am wondering if the new grad. is a visual learner. They may be struggling to take new information in through auditory processing.
This problem may be exaggerated through fear of making a mistake, an overall anxiety of working in a new environment, along with the anxiety around the expectations that need to be met.
I would get the new grad. to write everything down in a time table with extra written points on the details that must be checked as part of her role.
Encouraging her to follow the documented notes of importance and a timetable may help the new grad to get past the auditory learning process.
If the new grad. is too anxious to absorb and remember verbal instructions the routines and prompts on paper may help them to get past their anxiety?
They would need to speak with you when needing help but visual learning aids may help them to learn.
LibraSunCNM, BSN, MSN, CNM
1,656 Posts
How sad! It sounds like management would rather let patient care suffer or be outright unsafe, in order to avoid doing the work of supporting the new grad and/or having difficult conversations with them. You sound like you're doing an awesome job, I honestly can't see from your posts what more you can do with the situation you've been handed.