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I was very fortunate to have some amazing preceptors both when I started nursing and again when I transitioned into critical care. I’ve also had the privilege of precepting people myself. I pray I was a tiny fraction of the awesome that my preceptors were to me.

Because of an awesome question I received via my Tumblr (http://nurseeyeroll.tumblr.com), I am writing a three-part series on the process in which I have been precepted and also how I’ve done it myself.  It is much more involved and requires planning, patience, and grace.

When I look at orientation, I divide it into three chunks. All three require different levels of assistance that you’ll give your orientee. I’ll go through each of them in a series of three posts. The duration of each phase depends on the entire length of their orientation as well as their personal progression. As a rule of thumb, phase one is the shortest and phase three is the longest.

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After 2-4 years of learning that everything is important in nursing school, your job as a preceptor is to get them to focus on what is important for your patient population.

Something to keep in mind is your newbies will be entirely task focused. This is the normal progression. They will be focused on completing tasks, not critically thinking/anticipating problems. Again, this is how it should start. We will add the critical thinking piece later.

Phase One:

The first few shifts are utilized for observation. They need to see the flow and culture of the unit and patient population. The patients are still your patients, however your orientee is going to be given tasks to complete, all while getting familiar with the flow of the unit.

During your patient care, have them perform simple tasks; drawing up medications, calculating dosages, administering IV/subcut medications, starting IV’s, putting in feeding tubes, documenting appropriately, using foley insertions, putting people on telemetry, etc. When they ask how to do certain things, show them how to look up policies and procedures. You’ll find yourself saying, “what does the policy say?” over and over again, but you need to get them into that habit.

Another important thing to remember is to give your orientee a consistent routine.  Once they’re out on their own they can start to improvise and change how they manage their time.  But right now they don’t know what all of their options are so they can’t make an appropriate judgement on what they like best.  During phase one when you’re showing them the ropes, show them your awesome and efficient time management skills, and your routine of how you walk through your day.  They can decide what they like and what they don’t like for themselves once they’ve gone through it a few times in the later phases.

Something that expert nurses forget (because they’re experts!) is the “why” behind everything.  The things we do become so normal and natural, we just don’t have to think about the “why” anymore.  Remember, these newbies need to know the “why”.  This is important in their professional development into a safe care provider.  Even if it seems menial, you must explain the “why” behind everything.

Things you need to do in Phase One

  • Formally introduce them to everyone. CNA’s, MD’s, PA’s, NP’s, transporters, etc. They are now part of your team and what better way to welcome them and make them feel part of it all than by you taking the time to introduce them to everyone.
  • Explain your time management technique and why you do things in the order that you do them.
  • Explain your prioritization that is ever-changing throughout the day.
  • Demonstrate appropriate delegation as well as accountability when tasks are delegated.
  • Have them observe how you interact with patients/families, physicians, and support staff.
  • Get them familiar with documentation.
  • Have them take report right along with you so they can choose the report sheet they want to use and get familiar with it
  • Get them familiar with your IV pumps and tubing.
  • Find information specific to your patient population, print it off, and have them read about it at home. Quiz them on it the next day. Start building that foundational knowledge about the disease processes that affect your patients.
  • Show them how to look up policies and procedures.
  • Get them familiar with the house phone numbers and departments. Take them wherever you go in the hospital to show them around. Again, introduce them to people.

Depending on their progression, this can last 2-3 weeks before you move on.

In my next post, I’ll discuss Phase Two of the nursing orientation process!

Are you an experienced preceptor?  What’s your routine during the first few weeks?  What worked and what bombed?

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