At the core of a functioning nursing unit is a preceptor program that supports the educational development of new nurses. Nurse managers wanting to smooth out this process may find it advantageous staying familiar with their own preceptor program. As a preceptor columnist for StressedOutNurses.com, Sarah Jane, an ICU nurse from Ohio, gives us a glimpse of her first experience as a preceptor after transitioning from being a new nurse.
The time had come when the leadership on my unit thought I would be able to handle a new grad nurse. I had seen her around the unit earlier in the year as she had gone through the critical care internship program that my hospital offers to give new grads the chance to try out several units to figure out where they want to work. She had been working days for a couple of weeks when they decided to put her on nights with me.
The first night she was with me, we had two empty rooms, which is really odd on our unit. To pass the time, I gave her a refresher course on where everything is in the unit and how our unit is broken down into four pods. We helped out the people around us and I introduced her to everyone. Then, I showed her how to set up a room for any kind of admit that we might get.
Our orientation in the ICU for new nurses is broken down into different phases of patients: phase I, phase II, and phase III. Phase I patients are sedated, intubated, and have a little tube feed running. Phase II patients have pressors running, a ventric drain in their head, and/or a stable bolt. Phase III patients are unstable heads with regular or Lycox bolt, pressors running, CVVHD (continuous dialysis via Prisma machine), pentobarbital comas, and or organ donors. Phase II and Phase III patients usually have SWANs and A-lines in to give us continuous hemodynamic monitoring. Phase III patients are also usually monitored on a 1:1 ratio, sometimes 2:1 if we have adequate staff to do that. Usually our really bad traumas end up being a 2:1 for the first few hours, one nurse to chart while the other one is helping the docs line the patient.
During the first few weeks of the preceptorship, we got mostly phase I patients and, occasionally, a phase II patient that was on a pressor. I let the new nurse go in and take care of the patient, but was right by her side in case she needed help. Then, during her fourth week, a situation arose where we had gone to the resident and told him something was wrong with the patient. He ignored us, so we went above him and called the doctor on call that night. (I work at a teaching hospital so we have new residents coming through all the time.) I told my preceptee never to be afraid to go above the resident's head. I also told her we can do the same thing with trauma patients; that if you feel you aren't getting the best thing for your patient, don't be afraid to go up the chain of command until you feel you are being heard and your patient is taken care of properly.
Finally, we got our first big bloody trauma and boy, was it fun. She wasn't overly keen about it, but enjoyed the learning experience. That night, she learned that each patient that comes in with a head injury and or head bleed that you care for is different. Some like to be turned, while others can't tolerate turning. Each has their own preferences that make them comfortable and keep their ICPs (implanted cardiac pacemakers) down. I showed her the basics of taking care of these patients, but told her that much of it she would learn through experience. I told her that so much about nursing care is a touch, that you learn what the patients like and don't like.
Time flew, and suddenly the new nurse had only two weeks left with me. But during the homestretch, we had two very memorable patients that were great teaching opportunities for me--and great learning experiences for her.
Editor's note: Send questions or share your experiences with Sarah Jane, the columnist behind The Preceptor Place, at firstname.lastname@example.org.