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This is my third and final post in my nursey series about precepting new graduate nurses.

Here’s the link to the first post.

Here’s the link to the second post.

Thanks for catching up!  Onward..

Once your orientee has mastered caring for 1-2 patients, it’s time to start putting the on the heat. Phase three is where you begin to back away completely and they are running the patient-care show. They should become more confident in completing tasks and starting to think more and more about the big picture.

They should be able to anticipate obstacles. They should be figuring out their time management style. They should be appropriately discussing the plan of care with other members of the health care team. They should be delegating appropriately.

What I like to do in this phase is really step back. I have a little conference at the beginning of the shift right after report and outline our goals for the day. When deciding on goals, I think about the things they are struggling with and make those the priority.

Your goals need to be measurable so at the end of the day you can say whether or not they met the goal and discuss why. I try to stick with 3-5 specific goals.  I didn’t mention this before, but I do this goal-setting throughout the entire process.  I also document this every shift using the same sheet.  I save them, go over them at the end of the week with the orientee and we both sign them saying that we agree with we’ve discussed.  This protects you if they do not progress appropriately and you need to be able to tell your manager why.   This will help your manager determine the appropriate next steps.

Example: “Alright, today starts week 7 and we have a few goals today. First, I want you to make sure you’re acknowledging new orders that come through within 1 hour of them being placed. Our second goal will be to give all medications on time unless extenuating circumstances present themselves. And our final goal is to delegate appropriately all day today so that you are working at the top of your license consistently. At 1100, I will check your charting. At 1500, we’ll see where we are with our goals and what we can do or change to insure we’re on track to meet them. If you encounter any roadblocks, please come ask me.  However, want you to try to be as independent as possible.”

Whenever they come up to me to ask a question, I basically ask the question back to them to see what their thought process is. Typically at this point they know the answer and they just need reassurance.  And if I can tell they always know the right thing to do but just want me to confirm it’s right, I don’t reassure them.  They need to learn to trust their thought processes and critical thinking, so not giving them the reassurance is what they need to push them to be independent.

Additionally, while they’re figuring out their own time management, I let them drown a little. When I talk to them at 1100 and 1500, I talk about things I observed that could have been done more efficiently to save them some time.  I also look at how they prioritize their tasks and if there’s any room for improvement.  The tendency is to do things that they know how to do first, not necessarily the things that are the priority.  For example, if they need to hang a unit of blood or go give scheduled PO meds early.. they’ll probably head to give the meds first.  Redirect them as needed.

It’s important to empower them to take responsibility for their patient load as soon as possible.  The scariest part of being out of orientation is knowing that you are ultimately responsible for your patient’s well being without anyone checking behind you.  The earlier you can empower them to take responsibility for them, the better.  When giving and getting report, make sure the off going nurse is giving report to your orientee and not you.  Make sure they’re paging the physicians and rounding with them.  Whenever any asks any questions about the patient, refer them to your oriented and say that they are the orientee’s patient, not yours.  At this point, you’re in the background to help PRN and to double check behind charting and task completion.

Furthermore, praise is super important in all of these phases. It is really sacry and humbling to be a brand new nurse.  You’re constantly being told you’re wrong. So when they do something well or right, make sure they know it. It can go a long, long way.

If throughout this entire time you’ve been giving them homework and quizzing them on issues that face your patient population, you’ve really sown a lot into this brand new nurse. You’ve set them up for success. Not only that, you’ve set them up to be an awesome and reliable coworker. If you take the time to sow into them confidence and solid nursing skills, it’s a win-win situation.

Precepting a lot of work, especially at the beginning. You really have to be on top of them, teaching, encouraging, and holding them accountable. It can be a really rewarding experience.

However, not everyone is keen on doing things the way they need to be done during the orientation process. Stay tuned for an upcoming blog post about how to deal with people that aren’t progressing through orientation appropriately!

If you are an awesome and experienced nursing preceptor, please comment below!  I would love to hear about your routine and things that you do to insure your nursling is ready to be out on their own.

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