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Topics About 'Preceptors'.

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  1. Do they still exist? Ones with assigned clinical sites/preceptors? The schools I have spoken with all claim they "help" but I see coworkers that cant progress through their degree due to lack of preceptors. I move a lot due to my husbands job so I do not have a big network and online programs are my best bet. But I do not want to invest in a program and get stuck without preceptors. I would prefer a school in the Southeast and I am curious if any still actually do assign preceptors or if that is a thing of the past. Anyone know of any?
  2. Nurse Beth

    How to Give Constructive Feedback

    Angela’s preceptee, Lindsey, kept being late to work. Not terribly late, sometimes just 3-4 minutes. Other times, maybe 5-7 minutes. Typically Lindsay would rush in, all smiles and apologies. From the first, Angela was annoyed while she waited for Lindsay to put her backpack in her locker, her food in the fridge, and grab a report sheet, but it seemed petty to say anything. This morning, though, Angela was more than annoyed. It was a pattern. Why couldn’t this new nurse just get to work on time? Weren’t they taught in nursing school anymore to be ready to work at 0700, not to just show up at 0700ish? Angela liked precepting, so why was Lindsey forcing her into an uncomfortable position? Angela’s friendly feelings towards Lindsey were fading fast. It was a little thing that was turning into a big thing. Addressing performance discrepancies is part of the preceptor’s role. Performance discrepancies are when the employee is doing something one way, but the organization expects him /her to do it differently. It’s the preceptor’s job to help close the gap-the performance gap. Avoidance is one way to deal with conflict, but there are better ways. Here’s how to give constructive feedback respectfully and effectively... STEP 1: OPEN Be respectful and ask for permission to meet and to talk. “We need to talk for a couple of minutes. Is this a good time?” Find a private space where no one can overhear. As the old saying goes, praise in public, criticize in private. Don’t beat around the bush and do get to the point, because your preceptee may well be nervous. Start with “I have noticed”, or “I have observed” and then describe the behavior. Give a couple of specific examples if possible. Just the facts, without judgement or opinion. “Friday you clocked in at 0703, Saturday at 0705 and today at 0704”. note: What do you do if 2-3 credible colleagues have noticed the behavior and reported it to you, but you yourself have not seen it ? For example, maybe another nurse noticed Lindsey left the room to grab a catheter but left the bed in high position. As the preceptor, it’s your job to address the performance discrepancy. In this case, start by saying “It’s come to my attention” or “It’s been reported to me”. If the preceptee asks who said something about them, do not divulge any names-nothing good can come from that. Just re-focus the conversation back to the subject at hand- the preceptee’s performance gap. STEP 2: CLARIFY You never know the other side of the story unless you ask. You really do want to understand the thinking behind the decision for the behavior. “Can you tell me what’s preventing you from getting to work on time?” and “Are you aware of the policy?” The preceptee may tell you that she heard there was a rounding time, and that getting to work up to 7 minutes before or after the start time was acceptable. Or she may sheepishly acknowledge that it’s always been a challenge getting places on time, or she may present excuses. The important thing is that you listen and strive for understanding. STEP 3: State the Consequences In this step, you list the possible consequences if the performance discrepancy continues. “Getting here late delays the night shift from starting handoff report.” Whenever possible, frame your concern as either a patient safety issue or a concern for the preceptee. “I would hate to see you get in trouble for being late” or “Leaving the bed in high position could result in a patient falling out of bed.” Let her know you’re on her side and want her to succeed. STEP 4: CLOSE As the preceptor, you need to do this final step, which is to bring closure. It may feel natural at this point to smile with relief and say “Good, then! Glad we had this talk!” but this last step is important. Seek agreement, clarify the next step, and include actionable steps if appropriate. Seek agreement. “So can we agree that you will be ready for work at 0700, meaning ready to get handoff report?” Next step and action. “We’ll check in next week to see how that’s going” Finally, close with an offer to help “Is there anything else I can do to help you?” You will feel good about your communication skills once you try this! The great thing is, you can use aspects of this in your personal life as well. What tips do you have for giving constructive feedback? Articles You May Find Interesting Tips for New Grad Nurses 10 Essential Tips for New Grad Preceptors Reality Shock and New Grads. It's Real.
  3. When I'm ironing the wrinkles out of my nursing scrubs before going to work, I often think of them. When I'm performing a procedural nursing skill at the bedside, I often think of them. When I'm explaining the purpose of a medication to a curious patient, communicating with a nervous family, or using the SBAR format to report a change in condition to a physician, I often think of them. Who am I thinking about? I often think about the nursing instructors and professors I had while I was a student. I regularly think about the seasoned nurses who oriented me and patiently transferred their nuggets of expertise to me. During the course of our days at work, we carry out procedures, perform skills, and engage in a certain way of thinking. While all of these things might appear clear-cut and routine on the surface, the majority of what we do calls for skills and knowledge that various people have transmitted to us. The most successful teacher that has certainly touched all of our professional and personal lives is direct experience. However, our professional experiences are rooted somewhere, and it is mostly from the formal nursing education we received as students and during our years of accumulating informal education at our places of employment. As we drift through our hectic days at work, some of us go into autopilot and might not always remember that our specialized skill set and fund of knowledge were introduced to us by some of the most special people in existence. Critical To Nursing Profession Nursing instructors, professors, preceptors, and seasoned nurses are critical to the nursing profession, because without them, no one would be around to transmit vital knowledge and skills to the next generation of nurses. In spite of this, the healthcare community does not always place a high value on the contributions made by nurses who educate. This is evidenced by the meager salaries that colleges, universities, and trade schools offer their nursing faculty members. After all, a nurse who has earned a master of science degree in nursing (MSN) or doctorate (PhD) can earn significantly more money by securing employment somewhere other than a school setting. The low value that the healthcare community places on nursing education is also demonstrated by the numerous hospitals, nursing homes, clinics, and other settings that fail to pay preceptors additional money for the arduous job of orienting brand new nurses to the floor or unit. I admit that I disliked a couple of my nursing instructors. However, I still appreciate them to this very day. Keep in mind the advantages that nurse educators bestowed upon you, and then return the favor by transmitting some of your expertise to a new nurse. The future generations of nurses are the lifeblood of our profession. The foundation of every competent nurse in existence today was formed by nursing instructors and built upon by experienced preceptors. Without people willing to educate, the nursing profession would cease to exist. I am expressing my deepest gratitude to the nurse educators who have selflessly passed the torch of knowledge and skills to the future cohort of new nurses because, without you, we would be lost. Thank you from the bottom of my heart. You rock!
  4. 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 Responsibility This 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 Patients One 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 Skills As 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-Life If 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 Patient You'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 Judge Always 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 Important Taking 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 Most You 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-Workers Make 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 Help Be 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 Patients Becoming 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
  5. nurse grace RN

    What Precepting Means to Me

    I was asked to be a preceptor by my manager and at first I was unsure of whether to take on such a responsibility. Did I have the skill? Was I proficient enough? Did I have the patience to do this job? Could I be successful in this new task? Preceptor Qualities A preceptor is an exemplary person who can teach but also sit back and review new grads as they progress through training. A preceptor will always be available whenever needed. Preceptors should follow and adhere to a learning contract to insure that the preceptee has successfully learned all of the tasks. Preceptors also must meet a certain criteria to be allowed to precept other nurses. They should attend inservices and be knowledgeable about personality types and the different phases of reality shock for the new nurse. The preceptor should feel a strong sense of accomplishment and pride whenever the preceptee graduates. I did a lot of soul searching and decided that I would accept the challenge. I became a preceptor and jumped in with both feet because I wanted to be the best preceptor possible. I wanted to be a preceptor that any new grad would want to have and to be very different from what I received as a preceptee. I knew that to be a brand new grad on a med-surg floor could be an extremely scary thing and my first task was to have my preceptee trust me. I knew trust was key in a successful relationship. I began by developing an open and honest communication style with my preceptee. I stressed that she could come to me with anything and that "no question was stupid". I also was not afraid to praise her when she did well and to never criticize her in front of others. I also emphasized that I was always there to help her out if or when she needed it. My preceptee soon blossomed into an eager, caring nurse and she was enjoying her days as a med-surg nurse. She started out with one patient and soon was able to handle two and then three. I could see her growing into the confident nurse that she would be. She began to develop her critical thinking skills and to learn to listen to her intuition and know what " the hair standing up on the back of her neck', was telling her. She soon was drawing blood like a pro and began starting IVs with ease. She was rapidly progressing from novice to beginner. I watched her as her confidence grew in her interactions with doctors and residents. She soon felt confident enough to make suggestions about patient care. She also started to question medications and procedures and if they were appropriate for the patient. She also took on more and more difficult assignments because " she wanted the challenge". The weeks went on and she continued to grow and become more confident everyday. Soon she was handling the entire assignment of six patients on her own. She had also learned to delegate appropriately and to prioritize her care. She also was eager to take a new admission when they came to the floor and to even help if she was caught up. It was soon ten weeks into the program and soon she would be on her own. I wanted to be sure that she was ready. We reviewed all of her documents, we discussed -"what if" scenarios. We had practice codes and practice METS, we had skill tests and talked about medications and interactions. We had covered it all. And now my preceptee was ready to go on her own. I had watched this young nurse as she went through all of the phases of reality shock during her orientation from the honeymoon phase through resolution and she was soon going to experience it all over again as a new nurse. I watched her as she began her first day on her own. She was a bit scared as she started out but soon a resident came to the desk and asked- " who is the nurse for 456 bed a"? She stood and said " that would be me, how can I help you? I knew she was going to be fine, she was spreading her wings and flying solo and I was proud of her and also thankful to have such a noble opportunity.
  6. It feels as though I have always had one or more angels watching over me as I have progressed throughout my nursing career. I managed to get pregnant in my junior year of college...not in the plan for sure, but I had wonderful roommates who were extremely supportive of me at a difficult time. The nursing instructors were my saviors as well, supplying maternity uniforms, allowing me to borrow text books etc. I got married, had my son and managed to graduate just a year later than the original planned date. There was a job available in a teaching hospital near my hometown and my son and moved back to so I could start as a graduate nurse and study for the boards, while still gaining some practical experience. We stayed with my folks until my husband got out of the service and moved to be with us. When he did, we got an apartment near my parents and I began work. Orientation was not too bad as I could take the city bus to and from work, but once we were done with that, it was on to the dreaded night shift. As a family, we had one car, so the juggle of me working nights while my husband worked days was a challenge. One of the nurses who broke me in as a graduate was my savior. She had worked with mom on the same floor I was orienting on and was a graduate of that hospital's school of nursing. As a diploma grad, she could have resented me but was old enough and secure enough to not feel threatened by my newly minted BSN degree, yet young enough to understand the challenges of raising a family. The (sometimes) quiet time on the night shift allowed for us to get to know each other and talk a little bit about our lives and families. I was struggling with the possibility of not being able to leave when my shift was over, thus delaying the time my husband could leave for work. She understood how important it was for me to be able to work on a regular basis and not have to worry about how I would get there or how I would get home. One night she offered to pick me up and that meant going WAY out of her way to come and get me for the night shift. This continued several nights a week for a couple of years until I was able to get on the day shift (Wahoo!!). I started at that hospital in June of 1983, took my boards in July of that year and heard six weeks later that I had passed! To this day, I credit her willingness to go the extra step and help me. There is not a doubt in my mind that I never would have passed the NCLEX on the first try if not for the clinical experience but even more so, a mentor who cared. I have long since relocated but she and her family vacation in the same town where I have lived since I moved away that hospital, so we get to see each other once or twice a year. I recently have had the opportunity to again pay it forward to an LNA I work with. She lives (sort of) within walking distance of the LTC facility but whenever we work together I am more than glad to save her the effort, especially this past summer when it was so hot and humid and again now that winter is upon us. She asked several times why I would go out of my way (and it really was much less than had been done for me) so I shared my story...
  7. There are several additional points that I would like to make at this time. The concept of students finding and arranging their own preceptorships in advance nursing is an unsustainable and unethical one. For one thing, there is an unequal playing field in the process. Students that have greater access to medical professionals due to their previous experience or background will have a tremendous advantage in securing preceptorships. For instance, the son of an ICU physician would undoubtedly have almost no problems finding all his preceptors due to his father's connections. However, a first generation, aspiring nurse from a disadvantaged inner city that is pursuing an advanced degree will face significant difficulty securing preceptors. Furthermore, students, in general, have almost no leverage when trying to secure a preceptor. An advance practice student, being one of the lowest in the medical hierarchy, is in essence trying to get a highly paid medical professional (Physician, PA, NP) to teach him/her a skill or profession without any type of compensation whatsoever. The natural question is of course "Why would anybody want to do that?" And the answer to that question is that "hardly anybody" and understandably so. In addition, medicine is practiced in a highly regulated and litigious environment. Even if a student secures a preceptor (most likely due to personal connections), there are nowadays a myriad of institutional regulations by hospitals and clinics that provide significant hurdles. What kind of incentive does a hospital or medical clinic have to allow just anybody to walk through its door and provide that person with the opportunity of becoming a highly skilled professional? In the case of advance practice nursing, they have none. With the increased concentration and buyouts in medicine, many more practice environments are now regulated by big corporations. Mostly gone are the days, when a nurse could walk into the office of the local town doctor and ask him to train her. Now even the local office might be owned by XYZ Inc. which has regulations, and a lot of them. Certainly, the leaders of physician and PA programs understand this and that is why they arrange clinical experiences for their students. As nurses, we expect the same of our leaders. Unfortunately, our nursing leaders and schools have shortchanged us as students in the past, but this got to change. Most physicians and physician assistants express general satisfaction with their education. I haven't met many nurse practitioners yet that came to the same conclusion. As NP students we pay the university to provide a service to us - education. One of the most important parts of this education is the clinical experience. It is not sufficient for the university to charge tuition, write a plethora of rules about the clinical experience and to abandon students to find their own preceptors, knowing well that many will not succeed. Key Element III E of the CCNE Standards for Accreditation of Baccalaureate and Graduate Nursing Programs (2013) states, "To prepare students for a practice profession, each track in each degree program and post-graduate APRN certificate program affords students the opportunity to develop professional competencies in practice settings aligned to the educational preparation. Clinical practice experiences are provided for students in all programs, including those with distance education offerings." It states, "clinical practice experiences are provided for students in all programs..." It does not say that students shall provide their own clinical practice experience. I believe that the CCNE should start enforcing this rule. Schools that are not willing or able to provide this most important aspect of NP education should not be accredited by CCNE. Obviously, this accreditation agency has lacked in enforcing its own standard in past times. However, I believe as an officially recognized national accreditation agency by the U.S. secretary of Education, it needs to step up to the plate and do its job. It is unfair towards the schools that follow the rules and provide clinical experiences when other schools skirt their responsibility, getting by with it. Our physician and PA colleagues have shown us that providing clinical experiences for their students is not that difficult and results in a superior educational experience. I thank you for your time and appreciate any constructive feedback.