Advanced Precepting: Helping Preceptees Find Their Fit

I had the best preceptor in the history of nursing. She facilitated my transfer to Pediatric Intensive Care, plucking me from a high acuity pediatric unit, where I was convinced I had made a disastrous mistake choosing  the nursing profession. The level of her commitment to my training was such that she arranged her schedule so we worked the same 12-hour shifts together for an entire year. I am grateful for her commitment to my training.   Years later, a preceptor myself, I understand the sacrifice she made. Someday, when I publish my memoir, I will tell this story.

Today, I’ll point out a pivotal point in the longevity of my nursing career:  that perfect fit of personality and specialization. I learned I am a detail person. I like lots of autonomy to care for one or two critically ill patients, developing a plan for them, and carrying it out. I also liked the adrenaline rush  accompanying emergent situations.  I discovered I’m a little bit of a tech geek: managing lines, ventilators, CVVHD, peritoneal dialysis, etc… came relatively easy to me. Although the peds ward was challenging, it felt like my energy was lost amidst  the diaspora of large patient assignments, and I felt ineffective.  PICU was a better fit.

One year, in another PICU,  I precepted a nurse each shift, for a entire year. All of them became strong nursing muscle in our unit (I can’t entirely take credit for that; we hired well), but two, and I want to talk about them.

The first was a nurse whose previous experience was ER. She was new to our city, and a single mother. She commuted to work, then trained in PICU for 12 hour night shifts with me. She frustrated me no end, forgetting to check her lab values (calling a cardiologist for potassium replacement orders at 3am for a lab value drawn at 9pm is a no-no), and once I found her asleep in the bedside lounger in her patient’s room. I woke her up and asked if I was boring her? This continued for a few weeks. I met with my manager and told  her  we had a clunker. I told the preceptee too. The three of us met in our manager’s office, and I remembered something I’d forgotten about precepting. After the preceptee’s sins were laid out before her, our manager asked her if she liked PICU.

She didn’t.  She missed ER, where she admitted  patients, stabil

ized them, and sent them off to the appropriate unit for someone else to manage.  Following a patient for  entire shifts, day after day was hell on earth for her.  It never occurred to me to ask her. Our manager made a couple of phone calls, and found a job for her in an ER within our hospital system, in a facility nearer to the preceptee’s home and children. The last time I heard of her, she was happy.

I’ll write about the other “failure” in my next post.