10 Top Preceptor Tips

Nurse Beth, MSN

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.