Oh the paperwork. Trust me, I hate it as much as you. Honestly, it’s the bane of my existence. There are check-lists, skills validations, pathways, policies, lists of required CBLs, etc. It seems never ending.
The best advice I can offer here is to accept the fact paperwork is necessary to document your progress during orientation. Keep the paperwork organized, complete it as you move along, and keep a copy of anything you turn in. It’s terrible to struggle at the end of orientation to fill out paperwork that should have been done weeks ago. It’s even worse to find out the work you did was lost and try to re-create it from memory.
As a preceptor, I have a huge responsibility to keep track of all the new experiences we’ve had together, the new skills you acquire, and all the teaching I do throughout orientation. It’s also essential for me to document anything with which you may be having difficulty mastering, as well as the attempted interventions to help. My least favorite part of the job is when any nurse struggles during orientation despite me striving to do my best to help. Logically, I know that not everyone is meant for neuro critical care, but I am always concerned it’s a failure on my part.
Making an assignment
Making an assignment is probably one of the most challenging things I do as a preceptor. The general guideline is to start with the simple and work toward the more complex. Sound easy? I can assure you that it’s not. These are just some of the considerations I think about when making an assignment:
- Where are we in orientation?
- Is this Day One with a new grad?
- Are we nearing the end of orientation when I need to assess your readiness to be done?
- Are we at some point in between?
- What experiences have we had so far in orientation?
- What types of patients have we cared for?
- A fresh stroke who received alteplase?
- A patient with an aneurysmal subarachnoid hemorrhage?
- A seizure patient?
- What kinds of assessments have you done?
- Do you have a good grasp of a “normal” neurological assessment?
- Are you proficient at assessing a comatose patient?
- Have you cared for a patient whose exam is worsening?
- What kinds of equipment/technical skills do you need to experience?
- Have you cared for a patient on vasoactive medications?
- Can you efficiently care for a ventilated patient?
- Have you assisted physicians with bedside procedures like a central line or ventriculostomy insertions?
Remember the general goal of increasing the patient acuity level as we advance through orientation? There are many things that will have an impact on this progression.
Experience level: New grads are expected to progress slower than experienced nurses.
Patient population: The patient assignment I choose is the best I can, based on the patients in that unit that day. There will be times when the overall acuity of the unit is higher or lower than what we ideally need.
Dynamic patients: The reality of nursing in an acute care setting is that patients are dynamic… meaning they can (and often do) change at any point. What started as a “simple, stable” patient, can become one whose condition is critical and unstable.
I always hope I make the right decision for the assignment every day, but reality is that sometimes my choice turns out to be less than ideal. While on the outside, I will assure you that sometimes things happen, and point out why teamwork is so essential to nursing… inside I tend to beat myself up when I see you overwhelmed or frustrated.
There are A LOT of technical skills that need to be developed during orientation. This can be things like, starting IVs, drawing blood, changing central line dressings, and inserting feeding tubes, among many others. They are things that are easily checked off on a list… and add to the feeling of accomplishment. For this reason, you may tend to focus on these tasks. It’s normal.
My job as a preceptor, is to break through that task-based focus and find ways to teach more theory/disease based topics. For example, why are we drawing this blood? How are these lab results going to help us better care for this patient? In addition, it’s important that we talk about general anatomy/physiology of the disease processes for the unit.
The tasks are important, but the ‘why’ behind the task is what will really help put the pieces together. Finding a balance between the two is challenging, especially when neither you nor I want to be at work any later than necessary. And, does anyone really want “homework”?
I’m always looking for signs of success as well as signs of struggle.
Sometimes I am better at this than others….
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