View Full Version : Being the Preceptor

08-05-2007, 01:22 AM
I wasn't sure whether this question belonged here or under Critical Care, but I figured any advice was better than just a specialty.

So, I am precepting for the first time. It's a lot more stressful than I ever thought it would be. (Thank you to my preceptors and to everyone who has precepted!) I never realized how much you have to slow down and verbalize/scrutinize your routine!

What I need are tips on getting my preceptee to focus and prioritize. She gets distracted by minute details and I'm constantly redirecting her. I've started to feel Ms. Grinch and I am not the kind of person that gets cranky. I'm also not that far out of school/orientation to remember how overwhelming the critical care environment is. I just don't know how to get her to see the "big picture" when it comes to what needs to be dealt with immediately and what can be put on the back burner for awhile.

And, that having been said, I keep asking myself, "Is this my fault? Have I not done this or that right? Am I screwing up this persons whole nursing career? I feel like I'm a pretty good nurse, and that I'm developing my clinical judgement skills pretty well. So why can't I help her?")

So, in order to prevent me from eating my young or feeling like I failed her... any tips would be greatly appreciated! (Even if they're not on getting focused...)

Thanks in advance!

08-05-2007, 01:07 PM
It is frustrating when they don't know how to prioritize. All I can say is to keep helping her with critical thinking and at some point it will click.

Like you said, the CCU environment is overwhelming. She may be focusing on minute details that are manageable for her instead of looking at the big picture, which is not so manageable.

With some time and encouragement she'll gain more confidence.

Make sure you point out her mistakes in private and acknowledge her accomplishments in public. Not like you need to make a glowing red sign, but you know what I mean.

Keep asking her critical thinking questions - it's helpful for her to start thinking that way even if it makes her uncomfortable to not know the answer.

Keep saying stuff like, "I know that you're focusing on x, but can you think of another aspect of this patient's situation that is more important than x?"

I hope some of those suggestions helped!

08-05-2007, 01:14 PM
I wanted to add one more thing. In the morning after we got report on our patients, my preceptee and I would discuss immediate goals and day-long goals.

Immediate being getting an order to replace a K+ of 3. Long term meaning getting the patient to sit on the edge of the bed. That sort of thing.

It always felt like I should have been using that time to go see the patient, but if you think about it, all during report you're prioritizing your day. Your preceptee is not able to write down the patient's details AND organize her day at the same time yet.

So that extra few minutes where you're both discussing the patient(s) and getting on the same page are invaluable. Always let her determine the priorities first and then you help her to organize them if necessary.

Ask her WHY she wants to do A before B. That'll get her thinking and may encourage her to see that B should be done before A.

I ask a LOT of questions when I'm precepting. I even ask when I know that they're doing things right, so that I know that THEY know the reasons for why it's right instead of them just getting lucky on a guess.

08-10-2007, 08:21 PM
Geena had some great responses. New nurses seem to have a hard time prioritizing and they need re-directed often. I think the only thing I would add to Geena's recommendations is that you write specific examples down on paper (good and not so good) and discuss your comments with her so she knows exactly what you mean.

08-11-2007, 11:31 PM
Thanks for your responses. This week went so much better than last week (and we had a family from hell!). I let her plan her own "schedule" and backed off a little, letting her direct the way her night goes. From about 0500 on is where we struggled most. It's always so stinking busy. (I remember feeling overwhelmed at that time too-like I had about 4 million things to do and only two hours to do it!)
She also told me that she's perfectly aware of her inability to focus and that she's always been that way. We discussed changes in her practices that would help her finish one task before starting others (like finishing charting before stopping to give scheduled meds!)

We technically only have one left though and have yet to have two vent pt's for an assignment. I have notified my supervisor that we'll probably need at least one or two additional weeks until I feel comfortable letting her be on her own. (To which he pointed at the day on the schedule in two weeks where there are only 5 RNs scheduled, including her, and said, "Well I could really use her here." Great idea.)