Dear Nightingales and Friends,
Are you having fun precepting other nurses?
It doesn’t matter what unit you work on, there is a lot to teach when you are precepting new nurses.
If you really sat down to think about it and write it all down, the topic list would be pages and pages long. It might include something like: regulatory skills, skills lab, orientation to the unit, orientation to the hospital, location of important departments like lab, blood bank and the cafeteria, patient admission, administering medications, pathophysiology of the types of disease pathologies seen on the unit, patient emergencies, where the equipment is stored, taking off physician orders, getting meds and supplies, and, dare I say it… I have to hold on to something… charting! It’s a little dizzying when you actually think about all the things you need to teach a new nurse – even an experienced nurse who is new to your unit!
I have been precepting nurses for over 20 years. And I absolutely love it!
I have fun with it. I am creative in my teaching. And I have created my own method of teaching.
It’s not just me that has fun with precepting. My Orientees have a good time too. They smile. They laugh. They learn. Or, maybe they just think I enjoy coming up with strategic ways to torture [I meant inspire… ] their learning instead of just letting them mindlessly do their work… and they are afraid to tell me.
Well, I can’t say that some of that isn’t true. I do enjoy coming up with ways to make orientation interesting. And my latest strategy has me almost giddy with delight about the multitude of ways to use it.
This strategy’s particular creative birth was born out of teaching patient safety in the ICU. In the ICU, patient safety elevates to a higher energy level because most patients are confused, disoriented, dazed or sedated for a variety of organic, pathological, or treatment related reasons. No matter the reason, they can forget what day it is, where they are, or even me day to day.
Patient care areas try to devise all sorts of ways to protect patients from injury no matter what the reason for their increased risk. We have side rails, bed alarms, restraints, roll belts, enclosure beds, sitters, hourly rounds and 1:1 assignments. Our goal is 100% safety without injuries or falls. I don’t know if that is really possible, but we shoot for it.
The problem is sometimes we get lost in trying to preserve a patient’s dignity, modesty, quiet time and respect with the boundaries of safety precautions.
It differs by each patient, the resources available and the guidelines of the unit. Sometimes, my Orientees are so nicely tuned into respecting a patient’s privacy and modesty that they find it difficult to put safety boundaries on them.
In the ICU, there are significant risks to safety due to medical, chemical and procedural reasons, therefore I believe that “safety trumps everything else”. Does that mean that we don’t have to show respect and provide ways to keep a patient’s modesty and dignity? No. It means we have to find a balance. But safety trumps everything else.
My confused patient, determined to Houdini out of their lines, using creative yoga positions to untie or remove tubes would have a yoga swami stunned with disbelief. Patients will have my full attention to safety detail, using all the available medical orders and hospital policies I can use to keep them safe until their heads clear, their lines are removed, and they can remember where they are.
Where was I… dinner.
Last week, I was having a discussion with my Orientee about patient safety.
We talked about the ICU policies, physician orders and ways to treat patients for a variety of confusions including dementia, delirium, light sedation and withdrawal. All the usual regulatory and clinical guidelines.
I told her I had a ZERO history of self-extubations and patient falls. As I said this to her, I felt the storm clouds hurrying over my head, thunder roaring in my ears and imagined a visual of black thorn vines engulfing my stethescope. Everyone knows you don’t put a curse on yourself by saying the “Q” word, or hoping you’ll be the one to be put on call tonight. Fate will listen and give you the opposite.
So I protected my fate by having a little fun at the expense of my Orientee… and I think I created a monster in myself.
As I told her my history, I then said, “So… if you are working with me… and our patient self-extubates or falls… YOU HAVE TO BUY ME DINNER. And I have expensive tastes… Joe’s Crab House, The Melting Pot, McCormick’s Fish House, The Fresh Fish Company….” And we started laughing.
Later that night, I noticed she had closed the curtain for a patient after she had prepared him to go to sleep. When I asked her about it, she said that he kept pulling his gown up over his chest revealing his private areas, and because he was confused, she couldn’t keep him from doing it. So she pulled the curtain to maintain his dignity and modesty to keep everyone from looking at him.
I responded with one question…
“Do you want to buy me dinner tonight?”
She looked at me and said, “No”. We both laughed. And she went to the room, opened the curtain and then put a light sheet on him so that even if he twisted it around, would keep him covered.
But then the evil Black Nightingale Preceptor in me started thinking…
“I can use this for a lot of things! Someone is going to buy me dinner!”
I started thinking of all the suggestions I had given her to watch for during her shift to prevent problems… safety, falls, not letting your Propofol or vasopressor drips run out, have backups of all your drips for shift change. The list started to grow! I knew someday, someone was going to buy me dinner!
Over the week, we kept that humorous conversation thread going, between ourselves and with our pod mates. We were having a lot of fun with it!
And, something else happened…
She was learning numerous things at the same time… safety precautions, keeping patients occupied, thinking ahead for IV bags and drip medications and thinking ahead for change of shift. And I didn’t have to teach each thing separately or keep having to remind her. As we progressed through the shift, my answer to questions of which path to choose became, “Do you want to buy me dinner?” And she always chose the right answer perfectly, 100% of the time!
A few nights later, another nurse in our pod had a very determined patient that unfortunately self-extubated. As we all rushed to the bedside to assist with respiratory care, assessments, and assisting respiratory therapy, the nurse taking care of that patient said to me, “I am so glad I was not orienting with you tonight!” We all broke out in laughter. [The patient did fine without having to be re-intubated, in case you were worried.]
Everyone seemed to love the teaching idea! And my Orientee had not only learned a lesson about safety, but had taken it to higher level and was looking and thinking ahead to PREVENT problems and be PREPARED ahead of time for patient care needs and to prepare for the next shift.
I created a new learning tool. My Orientee learned a lesson on safety and she independently took it to a higher level of preparation and prevention. [I totally gave her a high-five that night!]. The nurses working with us caught on to the lesson and the possible consequences. And, we had a great time working and learning that week!
As preceptors… teachers… we need to be creative, industrious, inspiring and motivating in our lessons.
Nursing can be very hard at times. Lessons are about people’s lives. It is not to be taken lightly or disrespectfully. And, as preceptors, we have to know when to draw that line… and do it.
Then again… every once in a while… precepting can be fun. Learning can be fun.
And thankfully… no one is buying me dinner.
Inspire and Be Inspired, Nightingales!