Who You’ll Hear
Kati Kleber, MSN RN CCRN-K – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, speaker
Melissa Stafford, BSN RN CCRN SCRN – Highly experienced and currently practicing nationally certified neurocritical care nurse
Elizabeth Mills, BSN RN CCRN – Highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center
What You’ll Learn
- When is the best time to become a preceptor?
- Phases of Orientation
- Role of the Preceptor
- Precepting and Mentoring
- Different personalities and learning styles
- Tracking progress
When is the best time to become a preceptor?
- Advanced beginner nurse
- Has just gone through the whole process themselves
- Policies are fresh in their head
- Feeling comfortable on unit and ready for a new challenge
- Familiar with the questions that run through a new nurse’s head
- For a brand new nurse, “you don’t know what you don’t know,” but a nurse early in their career still remembers what you don’t know
- Very experienced nurse
- May have lots of precepting experience
- Able to assess the new nurse’s critical thinking
- It may be beneficial for a new nurse to have different preceptors at different phases of their orientation.
- There is no best time to become a preceptor because each individual has different levels of comfort in their own practice, and not every nurse is well suited in the preceptor role.
Phases of Orientation
- Phase 1:
- Brand newbie
- Very task oriented
- Learning the basic tasks and gradually becoming more efficient at them
- May be discouraged that they are still learning the basics even after graduating nursing school (many of these basics vary from facility to facility so there is no way they could be masters at this already)
- Phase 2
- Taking own patients, preceptor very nearby
- Still learning tasks (more complex or less common)
- Documenting interventions appropriately
- Phase 3:
- Leading the care for the patient
- Continuing to utilizing preceptor for questions and concerns
- Checking in first, but paging and talking with physicians themselves
- Preceptor should be backing off, giving new nurse some independence
Role of the Preceptor
A preceptor is a professional question asker.
- Throughout, you can be offering higher level questions– not with the intention of interrogating, but to ask why, stir the conversation, and lay the foundation for thinking critically about what might be going on with this patient.
- Tone of voice is important! Curious, not shameful
- An opportunity to affirm their plan and thought process
- “Have you considered this…?”
- Be there to help them figure it out, but don’t just figure it out for them
- Your observation skills are incredibly important as a preceptor. You need to know everything that your preceptee is doing, how they are thinking through the disease process and new issues, and how they are educating patients… and then speak with them tactfully about it all.
Your goal should be to maximize every shift and get as much as you can out of each patient load.
- Teaching skills
- Just because you told a new nurse something, doesn’t mean they are going to remember it the first time… or the second time. Be patient.
- Allow the preceptee to show their competence in a skill, by having them teach it back to you step-by-step.
- You are there to ensure no harm comes to the patient, but it’s OK to let the preceptee experience the feeling that their previous plan could have gone poorly or that they are so behind because they are doing tasks in an inefficient manner.
- Empower the new nurse to trust their own judgement and successfully manage their time– they cannot do that if the preceptor is constantly operating as their crutch.
- Create the coworker you want to work with.
- You are setting an example for the new nurse.
- They are watching and learning from your attitude, what you prioritize, how you act, how you speak to others, etc.
Your engagement is a delicate balance.
- Too overbearing
- Doing things for them because it’s faster
- Telling them when to page vs allowing them to decide that for themselves
- If you are overbearing, your preceptee will not become independent.
- Too disengaged
- Kickin’ it at the nurses station
- Being unaware of patients’ conditions
- If you are disengaged, your preceptee will become disengaged.
Precepting and mentoring are two different things.
- tasked with making sure this new nurse is going to take safe care of patients
- involved with checking off skills and formal performance evaluations
- offering constructive criticism can become difficult if the relationship has become too casual
- offers encouragement
- helps to make social connections and navigate relationship with preceptor
- Help your newbie find a nurse mentor (that is not you).
Preceptees will have different personalities and learning styles too.
- The perfectionist
- You need to help them to have more realistic expectations.
- The goal is not perfection, improving is a win.
- Otherwise, they will feel as though they are failing (even though they are probably doing quite well).
- Be assertive in your interactions (respecting both yourself and them).
- Make sure your feedback is objective, otherwise may be taken personally.
- The disengaged
- It’s difficult to make someone care.
- They might just be scared that they aren’t in the right department/specialty.
- Open the door for crucial conversations from the very beginning.
- Weekly Document Form
- Note types of patients cared for
- Log skills completed
- Make SMART goals
- Over time, look back at accomplished goals as wins
- If a new nurse is struggling, this is objective data to help them reflect
- Some new nurses begin with the mindset that, “I need to be perfect.” The reality is there are so many skills to learn and a new nurse won’t be perfect at all of them right away. The preceptor is there to teach and coach them through their orientation and, over time, get better and more efficient at all these skills.
- Nursing is a practice. It is not something that you can reach perfection and just coast there for the rest of your career. Every shift you are practicing nursing, always working to learn and improve.
- Ensure a relationship of psychological safety with your preceptee from the very beginning. And when they come to you with concerns, respond appropriately and do not gossip about what they shared with you.
- If you need help as a preceptor, seek out advice from other preceptors on your unit: “I’m having difficulty with this, do you have any suggestions for what else I could try?”
- Unrelated, though important tangent: There is not a hierarchy of nursing where the ICU nurses are better nurses than med-surg nurses. There are exceptional nurses in every department/specialty. Wherever makes your nurse heart sing is where you need to be.