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Topics About 'Nurse Preceptor'.

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  1. 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.
  2. J.Adderton

    The One-Minute Preceptor

    Being a nurse preceptor can be very rewarding, but it’s sometimes a rough gig. If you’ve ever been a preceptor, you probably had a “we’ll get to that when there’s time” task list that seemed to go on forever. A big hurdle for nursing preceptors today is finding enough time to coaching during the busy workday. Imagine if there was a way you could effectively precept even when the only available time is 5 minute blocks (or less) throughout the workday. Enter….The One Minute Preceptor. What Is It? The One-Minute-Preceptor has been a tested and valued teaching tool for over 20 years. Instead of becoming overwhelmed with the “whole” of orientation, the One Minute Preceptor method makes the most out of time-crunched teaching opportunities. The Five Microskills The One Minute Preceptor method focuses on five microskills; skills that also teach clinical reasoning. Get a commitment Probe for supporting evidence Reinforce what they did well Give guidance on any errors or mistakes Teach a general principle It’s Easy (Really) Now, I realize “five microskills” sounds complicated, but the One Minute Preceptor is really easy to use. Let’s take a look at just one snapshot of the precepting day and apply the five microskills. Case Study You are precepting a new graduate nurse on a busy inpatient rehabilitation unit. A nursing assistant reports Mr. V (one of your 7 assigned patients) is asking for assistance to the bathroom for the 3rd time in the past hour. You tell the nursing assistant that you and the student will take Mr. V to the bathroom to assess what’s going on. The patient is 72 and is 3 days post stroke- with left sided weakness. Assessment data Afebrile Urine frequency Voiding only small amounts No burning or itching with urination Pt obese and unable to palpate bladder Denies abdominal pain No history of prostate issues States “my bladder feels full” Microskill 1- Get a commitment to the issue Preceptor Review the assessment findings with the new nurse Ask them what they think the is going on with the patient Examples “What do you think is going on with Mr. V?” “Why do you think Mr. V is experiencing urinary frequency?" Microskill 2- Probe for supporting evidence Preceptor Ask what evidence supports the new nurse’s opinion Ask what other alternatives were considered and why they were rejected Examples "What findings lead you to this conclusion?" "What else did you consider?" Microskill 3- Teach general principles Preceptor Use the opportunity to provide education To make more memorable, phrase as a general rule “when this happens, do this” Example “Mr. V’s symptoms, other than urine frequency, do not suggest a UTI. Some stroke patients experience urinary retention following the event. When patients feel a strong urge to urinate but void little, it could be because they are not emptying the bladder fully. When this happens, the next step is to scan the patient’s bladder.” Microskill 4- Let them know what they did right Preceptor At the first opportunity, tell the new nurse what they did well. Be Specific Share the effect it had Example “You asked the patient great questions and were able to gather helpful subjective data. Mr. V appreciated your interest and concern.” “You didn’t jump straight to the conclusion of a UTI and used deductive reasoning to eliminate what wasn’t the problem. We were able to address the issue faster without unnecessary legwork.” Microskill 5- Correct Any Mistakes Preceptor If a mistake or omission is made by the new nurse, as soon as possible find an appropriate time and place to discuss: Let the new nurse critique their performance Then discuss what was wrong How to correct in the future Example “You may be right that Mr. V’s prostate is enlarged. But, we still need to assess to determine if the patient is retaining urine” “You correctly performed the bladder scan, but you need to be sure to explain the procedure to the patient” Putting it All Together You may be thinking… “This will take forever to get through”. But, the One Minute Preceptor is patient-centered and uses your nursing duties throughout the day to teach. This approach allows you to provide meaningful coaching in five minutes or less. Have you used the One Minute Preceptor method for coaching? If so, what was your experience?

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