What’s a Preceptor’s Duty When a New Nurse Doesn’t Fit the Unit?

Challenges and joys.

square peg, round hole

Precepting new graduate nurses is challenging but also exhilarating. To guide a new nurse to a point of safe, confident, independent patient care requires a different level of critical thinking and relational skills. How do I delegate tasks and responsibility to my preceptee safely? How do I teach in a way that connects well with my preceptee’s learning style? How do I reassure the patient and family that they are safe in the care of these new hands under my watch?

Despite the challenges, it is inspiring to play an integral role in someone’s growth. I experience pride and joy watching my preceptees evolve from nervous trainees to skilled and compassionate novice nurses.

While I am always seeking to build up the new graduate nurse I’m precepting, the ultimate goal is always patient safety. There are rare times when new nurses have not not found the ‘right fit’ in our unit. We are a pediatric ICU unit in a level one trauma hospital. We care for very sick patients, are very fast-paced, and rarely have lulls in our census.

When a preceptee struggles.

I recently had a preceptee who struggled with the basics in caring for even our most stable patients. […]

2019-01-09T12:17:49-05:00January 9th, 2019|Nursing|4 Comments

Safety Starts with Self When It Comes to Giving Chemo

The way it was.

cyclophosphamide IV

When I was in graduate school in the mid-1970s, I had a part-time job working for a physician group that treated patients with blood cancers, mostly leukemia and lymphomas. I started the IVs and administered chemotherapy, which typically included drugs such as vincristine, nitrogen mustard, doxorubicin, and cyclophosphamide.

I drew up the medications in a utility room—there was no special fume hood to clean the air. Initially, I did not use either a protective gown or gloves; after a bout of contact dermatitis on my hands, I used gloves, but I never used a gown. At that time, there were no guidelines for those of us who administered the drugs. Given what is known today about the reproductive toxicity of many of these drugs, I was fortunate that my exposure was short-term and before I became pregnant.

Do nurses follow today’s guidelines?

Today, there are clear recommendations for using personal protective equipment (PPE) like gloves and gowns when administering these hazardous agents. Yet, surprisingly, many nurses—even pregnant nurses—don’t follow them, according to a study published in AJN’s January issue.

In Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns,” the researchers used data from the Nurses Health Study 3 to assess the […]

January Issue: Antineoplastic Drug Administration and PPE Use Among Nurses, Helping Students Be ‘Gritty,’ Much More

“Grit is an essential component of a great nurse. Hardy, tenacious, tough nurses are the result of experience and knowledge.”—Linda Koharchik, author of the January Teaching for Practice column

The January issue of AJN is now live. Here are some of the articles we’re pleased to have a chance to publish this month.

CE: Original Research: Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns

Despite longstanding recommendations for the safe handling of hazardous drugs, it’s not known whether nurses—including those who are pregnant—wear protective gloves and gowns when administering chemotherapeutic drugs. This study examines this practice among nurses in the Nurses’ Health Study 3.

CE: Addressing Food Insecurity in Vulnerable Populations

The authors discuss the factors that contribute to food insecurity and the populations at greatest risk, as well as screening tools and resources for vulnerable patients.

Teaching for Practice: Helping Students to Be Gritty

Strategies for fostering grit—a trait marked by perseverance and resilience and associated with success—in nursing students.

Cultivating Quality: Early, Nurse-Directed Sepsis Care

This article describes a single-center, multiyear quality improvement initiative designed to promote early recognition and treatment of sepsis and examines its effect on sepsis-related mortality rates, bundle adherence, and the need for rapid response team calls.

Book of the Year Awards […]

2019-01-02T09:30:30-05:00January 2nd, 2019|Nursing|0 Comments

Delegating: A Crucial, Sometimes Tricky Nursing Skill

Knowing where you fit in with the team.

Ralph Hogaboom / Flickr

As a new nurse I was entranced with my role. Throughout my schooling, I had worked closely with nurses and nursing instructors I admired, but out in the real world I was only beginning to understand how I fit in with the rest of the team. From those early years, I vividly remember two separate run-ins I had with nurse aides. I was so frustrated that they didn’t simply follow my instructions! Looking back, I think these disagreements were mostly about experienced workers “testing” me and our working relationship.

Delegation is not simple.

In “Delegating as a New Nurse” (free until January 10) in this month’s AJN, Amanda Anderson offers a wealth of practical information to help new and not-so-new nurses learn the art of delegation. I could have used her guidance back then. As she notes, delegation is not a “simple” task:

“It requires an appreciation of nuance and insight, both of which new graduates may lack. Delegation often requires skills that aren’t taught in nursing school and are difficult for preceptors to teach in the clinical setting.”

[…]

2018-12-26T10:34:48-05:00December 26th, 2018|nursing career, nursing roles|1 Comment

A Few Notable Nurse Voices of 2018

A wealth of nursing voices.

I’m always amazed at the number of powerful, wise, courageous, funny nurse voices we have a chance to publish on this blog. Looking back over the past year, here are the links to a few posts by working nurses that stood out as worth another look.

Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine

“‘I told her I’d take care of her,’ he whispers. ‘She took care of me. Now it’s my turn. I made her a promise. I don’t want to do the wrong thing.’”

A Day in the Emergency Room for a Nurse Who Loves Her Job

“I put my shoes on in the car like always. The shoes never go inside, as they bear remnants of the day before. I walk in to meet my tribe. We laugh off the previous day’s challenges as we start over.”

Comforting Our Patients: The Importance of Well-Chosen Words

“There’s seldom an opportunity to edit or revise on the floor of a nursing unit. Words cannot be unsaid.”

The School Nurse

“They march into my heart like little soldiers. There are lads and lassies, rich and poor, sporting bling and brawn.”

Reexamining Resilience

“I find that I have been so transformed […]

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