Tuesday, June 12, 2018

Precepting, Part 4

Thank you guys for the feedback on the previous few posts. I appreciate hearing the reactions to my teaching style, and based on your responses it seems I should stick with what works!

I'm so very happy that The New Grad is doing better. She is a completely different person than the one I inherited - she's much more confident, she gets her work done, and most importantly she is able to manage critical patients.

We had one shift near the end of her reorientation where I got to witness it all click together. For HIPAA reasons, I can't even share the basics of the trauma we took care of, but suffice to say it was real bad. I took over charting since it was a giant cluster and didn't have time to teach, but I made her the primary taskmaster (I know, I know...after all my talk of how she needed to direct and not task...) because I wanted her to be right in the mix of blood and trauma surgeons and chaos and also because we're all probably going to be called into court over this sad case.

TNG just...got it. I don't know exactly what went through her head, but she absolutely nailed everything she did. She put in a clutch IV. She dropped an OG tube and foley, right in the mix of RT's taping up an ET tube and XR getting their shots. She verified and helped give emergent blood. She grabbed the monitor and extra IV pole to get the patient to the OR. I didn't direct her to do any of these things - she just did them. She listened to the verbal orders from physicians, identified needs for the patient, verbalized her actions so I could chart them, and managed to function in a trauma room that was packed with staff. It was beautiful.

We got the chance to debrief afterwards, and when I asked her what changed she just sort of shrugged and said she kept reassessing and doing what was most important at that moment. I could have cried.

She was on her own just a couple shifts later, and it's been going tremendously well. Just the other day, she relayed to me the most recent shitshow she took care of: while giving blood to a severely anemic patient, another patient of hers coded. It was an out-of-the-blue code, where they went from fine and talking to CPR. She did everything right - her charting leading up to the code was impeccable, and showed that she had been in the room multiple times, had the patient on the monitor, and reassessed him frequently. When the code was in progress, she documented everything well, called out for things she needed people to do, kept track of times for code medications, and made time afterwards to console the family. Our director singled her out later for the outstanding work and documentation she did. When I asked TNG how she felt afterwards, she said she was freaking out inside but just kept doing what she needed to do - and let's be real, that's all critical care ER nursing really is at first, isn't it?

I am truly honored to have made a difference in her career. I've precepted before and felt that I did a decent job but turning around what seemed to be an unsalvageable situation makes me realize that I'm actually pretty good at this. Much of the credit has to go to TNG though - she's the one who kept at it, listened, learned, and pulled through.

I'm so, so proud of her.

Thanks for listening, y'all.


Carolyn said...

I am SO GLAD this story had a happy ending!

Anonymous said...

What a great result! Well done to both of you, I hope she has a great career.

Anonymous said...

That is amazing. I can't wait until it clicks for me. I hope I get a preceptor like you.
You mentioned court. If you don't mind me asking, have you ever been and how scary is it? I'm really afraid of that ever happening. Especially as a new nurse.

Shrtstormtrooper said...

I've been to court a couple of times, although it's always been to testify for legal blood draws - fortunately though, all the people plead guilty so I never actually had to get on the stand.

Christina RN LMT said...

Incredible job, both of you!

Sarah Jelgerhuis said...

I love this story, thanks for being the nurse new grads, patients and hospitals need! Even when they don't all realize or appreciate it

Anonymous said...

So many people give up on new grads because they don't know how to teach them.

Not you!

You are a natural teacher. Great Work!

Aesop said...

Just caught up to you again...

You get another cluster on your Badass Certification Ribbon, and a first award of the Nursing Larvae Medal, for taking a new grad from pupae to actual functional ER nurse.

Strong work, kiddo.
Lather, Rinse, repeat.

Adam said...

Some of your most important work! You saved TNGs career, you may have also saved her life. Do you know how many nurses in America kill themselves? Yeah, I don't know either and that's because no one knows - just ask Google. I know 5 nurses who successfully committed suicide; I also know a couple more who've tried and that's just my little world. I wonder what role we play as preceptors in making or breaking these people. Thanks for the series -- a lot to think about!