I have many responsibilities as a nurse preceptor. I need to teach, observe, and ensure my orientee is practicing safely. I need to be present and supportive, but I also need to avoid micro-managing. Essentially, I have to be able to keep an eye on what’s happening with the patient, while enabling you to become independent. It’s a delicate balance.
For example, at the beginning of orientation, I will be present in the room while you perform a detailed neuro exam. However, as things progress, I may not be in the room while the assessment is done, but yet I’m still observing from afar.
Another example, a patient has a BP above a set limit. In the beginning, I would immediately ask what we should do next, what medication would we give and why. Towards the end, I will be stepping back to see what happens. How was the issue addressed? How quickly did you address it?
Nearing the end of orientation brings about a slightly different challenge. It may appear to the nurses who do not precept that I am essentially a “free” nurse available to help anytime. However, reality is… this is a time when I’m pushing you.
You have a challenging assignment while I’m stepping back to see how you handle it. Are you putting the pieces together? Are there any learning opportunities that I missed, or skills that we need to hone in on before orientation is complete.
While it is extremely difficult for me to sit on my hands and not step in, it’s important that you and I both recognize any opportunities for improvement. Ideally, this is the time when you recognize all the progress you have made during orienation and feel ready to fly on your own!
The goal with the completion of orientation is not that you know everything or have seen everything. Rather, I want to see that you know your resources, recognize (and ask!) when you need help, and practice safely.
Juggling Competing Responsibilities
I can’t begin to tell you the number of times I have felt pulled in different directions. I’ve been a preceptor at the same time been the lead nurse. You deserve to feel completely supported, but sometimes I am also the only nurse in the unit capable of handling the “lead nurse” responsibilities. As the lead nurse, I’m the resource for other, less experienced, nurses on the unit. I’m also the nurse that manages the admissions and discharges. Additionally, the physicians look to me to keep up with the overall issues in the unit and provide them with whatever assistance is needed.
You may be a new orientee, but a patient in the unit crashes so another nurse needs help. While it may be possible for you to step in and help, sometimes (especially early in orientation) this will likely be a time where you need to be an observer. Patients will always come first, and sometimes finding a way for you to safely participate in an emergency is difficult. Especially in the heat of the moment.
Another challenge I face occurs when I am precepting on days the unit is short staffed. Here, I feel both a responsibility to you, as well as a responsibility to my co-workers. When the unit is short staffed, everyone feels extra pressure, and people often look to the most experienced nurse for help. Sometimes, that means that I may take on a patient in addition to your assignment. Although I try to take an “easy” patient, for reasons already discussed, it may not work out according to plan. Patient conditions change; that is the nature of critical care. Unfortunately, this is another scenario when I may have to focus on direct patient care rather than teaching.
These are just a few examples of the many times I have experienced conflicting responsibilities.
Supporting you is very important to me, so on days like these I often feel like I let you down. Although I do try to find the positive “teaching moments” in these challenging situations, I do not deal well with feeling like I did not do my job to the best of my ability.
Sometimes I am better at this than others….
Although I’ve just spent a great deal of time discussing the challenges I face as a preceptor, the last thing I want for you to think is that precepting is terrible. I assure you it is not. The personal satisfaction that I get when I see a new nurse thriving far outweighs every negative.
Every. Single. One.
I just hope that you will grant me some patience and understanding on the days that I, myself, seem frustrated or overwhelmed. I do have days like that, but it is most likely NOT a reflection on you but rather related to one or more of the issues above. I do try to recognize when I am having a bad day and do my best to shelter my orientee. Nevertheless, I am human. I make mistakes.
Becoming a nurse, for me, has been one of my most rewarding experiences. Helping patients and their families through some of their most challenging times is both an honor and a privilege which I take very seriously.
The bottom line is that, I choose to precept because I enjoy teaching. I hope to help new nurses find the same joy and fulfillment in the nursing profession which I have found.
I wish you all happiness and success as you move ahead in your career! Maybe some day, you will be the one teaching the next generation!
Melissa Stafford, BSN RN CCRN SCRN graduated from nursing school in 2000, and after a short time on a medical surgical floor transitioned to neuro critical care. During her career, she has precepted multiple nurses, taught classes ranging from neurological/neurosurgical specific subjects to general critical care medicine, been involved in shared governance and resides as chair for nursing peer review. She has received various recognition’s, including the Great 100 Nurses of North Carolina and DAISY Award. Melissa enjoys spending time with family, painting, watching sports, visiting the beach whenever possible, and vacationing at Disney World.
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