Nursing preceptors are a vital component of the nursing education process. Preceptors play a role for nursing students and new graduate nurses as they orient to the floor and get acclimated to the hospital. A nursing preceptor may be involved with a preceptor for a day or several weeks. The preceptor role can vary slightly, but there are several great skills and attributes that can make you an awesome nursing preceptor.
In this article, we’ll dig into what makes an awesome nursing preceptor and how you can ensure that you’re helping new nurses start out on a solid foundation. Preceptor preparation is a vital component of developing competent nurses.
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. Originally, this post was inspired by a question from my tumblr (back in the days of tumbler. This is a comprehensive guide composed of several parts detailing what I learned in my experiences being precepted as well as what I implemented when I was a nursing preceptor. Here’s the biggest lesson that I learned and implemented when I precepted graduate nurses: being a nurse preceptor requires planning, patience, and grace.
The 3 Phase Approach for a Nursing Preceptor
Nursing orientation can be divide it into three chunks. All three require different levels of assistance that you’ll give your orientee. 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.
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.
Most healthcare organizations do no have a well-rounded preceptor development program. These phases are the best way I’ve discovered that an experienced nurse can create a fruitful preceptor experience. This guide is designed for preceptors for a graduate nurse in the clinical setting. It may b be useful for nursing school precepting, but may not 100% due to the short duration.
Phase 1: Observation & Assessment
The first few shifts of the orientation period are utilized for observation. The graduate nurse will need to see the flow and culture of the unit and patient population. The patients are still your patients, however, you will give your orientee tasks to complete. They will not be able to manage all aspects of the patient care, as they are still getting familiar with the flow of the unit and will likely have a large amount of anxiety. Attempting to assign the new nurse patients on day one would be detrimental to their progress.
Simple Tasks and Routines for the Novice Nurse
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. When they were a student nurse, much of their routine was dictated to them. The shift out of this mode will take some time.
Learning Time Management
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.
They’re craving the evidence-based practice they’ve learned all about in school. You’ll serve the role of the nurse educator a lot in phase one. It’s not one size fits all, however, and the new nurse may vary. The best preceptors are change champions who can adapt to change and be help others do the same.
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.
- Set standards for safe clinical practice and a focus on the patient outcome
- 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.
Phase 2: Training Wheels
During this phase, your preceptee take a patient on their own. After seeing how you take care of a patient, they should be able to adequately care for one person while you’re nearby for questions.
This is a critical step for a novice nurse in a hospital setting. To be an effective nurse preceptor, you’re going to have to let them spread their wings now.
They will take and give a report on their patient. They will do everything for them, even call physicians and support staff, as needed. They will complete all of the documentation. They will talk to their loved ones. They will educate them.
Again, if they don’t know how to do something, always direct them to the policy first. With one patient, they should have time to go look up the policies for everything.
Continue to give them homework. Print off information about your patient population and quiz them the next day.
During this time, I start to ask all of my why questions. Depending on their progression and knowledge base, I try to challenge them with the questions. I also try to think of questions that patients may ask about their care plans.
Questions to Inform their Plan of Care
- Why do you think they’re on subcutaneous heparin?
- Why are they on Colace and Pepcid?
- Why do we need to do a bladder scan if they didn’t void 6 hours after you removed the foley?
- Why do you think you needed to put your patient with CHF on oxygen after he got two units of blood?
- Why do you think we need a central line when initiating vasoactive medications?
- Why is it imperative that you lay them completely flat when removing their PICC line?
- Why are we still giving them IV pain medication when we have oral pain medication ordered?
How to Answer Questions from New Nurses
Whenever they ask me a question, I just ask it back to them to see what they think. I want them to develop their critical thinking skills. We need to go from being task-oriented to being big-picture oriented. While developing these skills, it’s important to not give away the answers quickly. Let them think. Furthermore, if other members of the health care team (docs, MD’s/PA’s, CNA’s, etc.) ask them questions about the patient, don’t answer for them. I’m terrible at this. I have to try really, really hard not to answer for them.
You want to encourage them to ask questions, so don’t act like they’re stupid if they get one wrong or do something incorrectly. Handle those situations with grace. Please don’t use that opportunity to make someone feel bad about themselves. That’s those terrible nurses eating their young thing.
Mutual Respect is Critical
It is really important that during all phases of orientation that you are treating everyone around you with the utmost respect. If you are talking badly about other people in front of your orientee, they see and hear that. If you’re not being respectful of the CNA’s, you’re telling them it’s okay to do that. If you are nice to someone’s face and once they leave you to talk about them, you’re not being a good role model to your orientee. They are watching how you do everything, including how you interact with others. If you want them to be a good nurse and supportive coworker, it is imperative that you model that yourself.
Phase 3: Riding Solo
Once your orientee has mastered caring for 1-2 patients, it’s time to start putting the on the heat. Phase three of the nursing preceptor process 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. During this time period, the novice nurse start to learn their own clinical competency level, but may still be over confident.
Nursing Instincts Kick In
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.
Create Measurable Goals
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.
Throw Them in the Deep End, But Bring a Life Jacket
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.
Provide Positive Feedback and Praise
Furthermore, praise is super important in all of these phases. It is really scary 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 they had a good nursing school experience, their nursing faculty no doubt provided praise when merited. Good nursing programs do not create fearful anxious nurses. However, there is a chance your new nurse did not receive positive feedback from a nurse educator and will not know how to handle this praise. So be patient with them and help them learn to accept positive feedback.
Setting Nurse Graduates Up for Success
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!
Are You an Awesome Nursing Preceptor?
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.
What tips/tricks/advice do you have to share? What’s your routine during the first few weeks? What worked and what bombed?
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