Should a Preceptor/Orientee team be treated as twice the manpower?

[JennaJ]

A little background. I work in a Surgical ICU taking care of mostly pre-liver transplant patients. Our patients are usually intubated on several pressors and CVVH is a very common practice. Without the teamwork on my unit, there's no way that any of us would make it through the day, and teamwork is usually very good. Lately we've been experiencing an influx of many high acuity patients along with many new nurses on our unit and stress levels have been high. We also recently doubled the number of beds on our unit and staffing has been short. I feel that these things have contributed to my issue.

I've come to my manager a couple times and said that I'm tired of hearing "you have an orientee" when used in the context that the patient we're caring for is essentially a 2:1. I was talking to my boyfriend and he said, "No, it's not like you're doubled, it's more like you're cut in half." This is so true! Something that would take me only 5 minutes to complete myself takes 10 minutes with an orientee because: I have to demonstrate to them, explain the rationale/policy behind the task and the consequences if the action is performed incorrectly; then wait while they demonstrate the action back to me, which they aren't going to perform as quickly because they are new. I then also need to take the time to make sure their documentation is correct because there can be legal ramifications to being a nurse, also there can be miscommunication with many because charting is incomplete.

I know that many of you know all of this, but I feel like a lot of staff on my unit doesn't and I just need to say it out loud.

Today I got yelled at by the charge nurse for not helping others on the unit more than I did. She ultimately called me "lazy" because she was neglecting her own patient to help others when I was not. I don't know if I'm being perceived as an "inept" preceptor, or "lazy nurse" because I am unwilling to leave an orientee on their own when I am ultimately responsible for the patient, and the practice of this new nurse. I know that I haven't been in this role as long as others, but I take this role very seriously!

In the case of today with my orientee; I know that she's not brand new to the orientation process. There are many things that she may have been capable of doing on her own but, it was my first day with her. I have not seen her practice. I don't know how complete her charting is. I need to be available to her, and need to trust her practice and documentation with a patient that again, I am ultimately responsible for.

Have any of you others ran into this problem when precepting on your units? Am I the only nurse who feels this way?

Any guidance on this matter is greatly appreciated. Thanks for your time!

[jadelpn, LPN, EMT-B]

Precepting in a specialty is difficult. If staffing is such that you need to help, then I would ask the NM what it is that you are to do with the preceptee--are their competencies that the preceptee can show that would allow her the opportunity to do some things on her own? Or are you to bring her with you when you are interrupted to assist other nurses? This is a tough one. And inappropriate for the NM to yell at you over it. It is this kind of thing that makes a preceptee feel like they are not supported, and that their preceptor "doesn't like them" perpetuated by the NM. Puts both the preceptor and the preceptee in a bind.

[HouTx, BSN, MSN, EdD]

[sigh]

It all depends on how "productivity" is calculated at your organization. Traditionally, the paid hours that are devoted to educational activities (including orientation) were not counted in the direct care totals... and did not have any effect on productivity. But now I am seeing a horrible trend... education hours are being counted the same as direct care hours and the productivity metric is based on total worked hours, which includes all the indirect (non patient care) time spent in activities such as education, committee work, quality projects, etc.

If so, the result is depressingly predictable. New staff cannot be properly oriented. New staff are dissatisfied so they leave very quickly. Incumbent staff are overworked and they don't even want to work with orientees. Orientees are treated badly. Incumbent staff become very dissatisfied; they leave if they can, otherwise they just burn out and become far less productive. Patient satisfaction plummets. "Management" yells at nurses telling them to make patients happy. More nurses quit. . . . and so it goes.

[Do-over, ASN, RN]

I just had this conversation... I hate when the CN expects an preceptor/orientee to move with the same speed as an experienced ICU nurse. How on earth do they expect anyone to learn anything?

My preceptor was sometimes away helping others. I wasn't a new nurse, but I would have liked her close by more often. I really didn't like it when I needed help or had a question and couldn't find her.