Thursday, May 31, 2018

Precepting, Part 1

I've posted before about precepting, but have had the most interesting opportunity and result over the past few months. This post will be part one of a two, maybe three parter. Let's talk about it!

A new grad in my department was recently given the shit end of the stick for her orientation. On a 16 week orientation, she had TWELVE different preceptors. Twelve. Many of her shifts were spent in triage, where her preceptor was assigned for the day. Other times she was in the fast track/clinic area. Many of her preceptors weren't actually preceptors - they were just staff nurses there who only found out she was with them when they showed up for work that day.

There are some new nurses who are inherent badasses and can overcome such trials, but not everyone is able to do so. This new grad was not one of those badasses. She was sweet and nice and bubbly and also scatterbrained and dangerous as hell because she seemed to lack time management and the recognition of sick patients. She came off her orientation and had one week on her own, and it went...poorly.

This new grad was called into manglements* office, where she was met by the Boss, Big Boss, HR, and new grad program director. "We think you're not safe to be on your own, and you need to fix this," they said.

Well, no shit. You set up a new grad to fail, and then blame her when she fails? The job of orientation is to teach a new grad rhythm, good practices, consistency, skills, and time management. When you're with a different preceptor every week, it's impossible to grow overall - you become a task person, because the new preceptor doesn't know you and can't let you take the lead. It takes weeks to months for a new grad to find their own pace and way of doing things. They need the consistency of the preceptor to be their backup and make sure they don't kill anyone while figuring their own shit out. They need a preceptor who can actually teach, not just someone to direct them to various tasks.

It's horribly unfair to skip all of these critical steps and then act shocked when the new nurse isn't safe on their own.


Precepting sucks. It's twice as much work, because you're teaching a new nurse how not to kill people, and you're managing a full load of patients while trying not to drown but also let the new grad do everything. You've got to find the time to actually teach, yet you have to keep your patients happy and press ganey bullshit certified.

You have to find the right way to call out your orientee when they do something wrong, but do it in a way that is constructive, not punitive. You have to encourage them, but also be aware that real patient's lives are in their hands. You have to let them fly, but not out of your sight. You have to let them make mistakes, but not ones too big. It's hard.


Next up: how to fix a failed orientee!

*manglement was a term I first saw used by a nurse blogger, and for the life of me I can't remember who to credit it to. Nurse K, maybe?


Old FoolRN said...

Jo at Head Nurse Blog used that manglement terminology quite frequently. I like to think of them as "office sitting busy bodies," and that's showing lots of restraint!

Shrtstormtrooper said...

Yes! It was Jo! Thank you for figuring that out, it was gonna drive me nuts .

EDNurseasauras said...

Our new grad ER orients get 6 MONTHS with a designated preceptor. They coordinate their shifts. It is a BIG DEAL to have them with another preceptor, who is asked specifically to mind the orientee and given detailed briefing on their strengths, weaknesses, etc. and where they are in the process. Know that in my ER, the new grad hires are kind of sacred cows who have worked as LNA's or unit coordinators while in school. They are not allowed to fail nor are they given the opportunity to do so. Alas, not all new grads are afforded this kind of structured and nurturing environment. I think it would be a a better world if they were, then we would have more committed excellent clinical nurses instead of management types.

Kylie Gerstein said...

I've read you're precepting posts (all in reverse order) but I will be graduating in August and you provide some really great insights and sound like you care a ton about your job and orientee. I love the part where you break down time budgeting because in a clinical day when we have just one patient there isn't that aspect of nursing to consider.