Precepting: Revisiting Ground Rules with My New Grad RN

A return to precepting.

By Suzanne D. Williams/Unsplash

There is no question that precepting new grad RNs requires a lot of extra thought, time, and energy for bedside nurses also looking to take care of our patients and their family members. But even as an introvert who finds it challenging to talk nearly nonstop for an entire 12-hour shift, I have in the past still enjoyed precepting. I’ve found it deeply rewarding to watch someone under my mentorship grow in skill and confidence as a young nurse.

When the pandemic hit and sent my young children home for distance learning, I took a break from precepting, as my capacity for additional mentoring at work had shrunk significantly.

Now that my children are back on their school campus, I am preparing to precept a new grad who is part of a cohort that went through nursing school during a pandemic with considerable limitations to their clinical experiences. As I dust off my own preceptor hat, I have found myself revisiting what I want to lay out as a foundation for my new preceptee. […]

2021-10-14T09:47:10-04:00October 14th, 2021|career, new nurses, Nursing, nursing career|3 Comments
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The First Injection

A nursing professor, now administering Covid-19 vaccinations as a volunteer, looks back on her 40 years of giving injections. The first one was the hardest. 

‘I could have easily given up that day.’

I reviewed the chart the night before—“40 units of NPH insulin subcutaneous before breakfast”—then went home to practice the technique. With a tiny needle and a small volume of medication. I used an orange to simulate the skin and gain confidence in how to puncture the skin and push the plunger to inject the medication.

As I entered the ward with my fellow classmates the next morning, I felt prepared to give my very first injection. I removed the insulin from the refrigerator and began to warm the vial between my fingers. I carefully selected the 100 unit insulin syringe. As I slowly drew up the dose, nervously flicking the air bubble out of the top of the syringe, my clinical instructor watched from the side.

Before we went into the room I checked the record for site rotation—right side of belly. I swallowed hard. We knocked and entered the room, introducing ourselves and our plans for the patient’s morning insulin. The older man lying in bed nodded approvingly. When I pulled up his gown and searched the right side of his belly, I began to have doubts. I hadn’t practiced an injection in the belly and the man’s skin was dry and wrinkled—nothing like the smooth skin of the orange I’d used the night before.

I swabbed the area with the […]

2021-03-12T15:19:08-05:00February 10th, 2021|Nursing|2 Comments
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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
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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
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The Bigger Picture: A New Nurse Embraces Her Ability to Still Ask ‘Why?’

Sarah Szulecki, BSN, RN, is a telemetry nurse at a hospital in New York State.

karen eliot/flickr karen eliot/flickr

As a new graduate nurse, I’ve found that adjusting to the microcosm of the hospital floor—its SBAR reports detailing a ‘here and now,’ its constant exchange of admissions and discharges, its wide spectrum of emotional extremes—has been challenging.

The experienced nurses on my telemetry floor tell me that it generally takes about one full year to start feeling as though you know what you’re doing. In the meantime, I find myself catching glimpses of scenes I hope I’ll someday be able to handle with grace—rather than with my current bumbling clumsiness.

A patient’s granddaughter is escorted into the hallway as staff flocks to her grandmother’s code blue, and I think of all the wrong things to say as she starts to cry.

As I examine his excoriated skin, a depressed patient looks humiliated and struggles to tell me that his home is infested with bedbugs—in my gut, I feel a grim helplessness about his future when he’s discharged a few days later.

A patient who has a sky-high hemoglobin A1c level admits that he has neither the desire nor the money to care for his diabetes. My pleas for change sound childish and naive to even my own ears.

These first few months of being a nurse amalgamate feelings of failure […]

2016-11-21T13:01:26-05:00February 17th, 2016|career, Nursing, nursing perspective|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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