Preceptorship Reflection

So recently I was asked by my manager to become a preceptor to a new staff member. I've never trained anyone before to this unit, and I thought those with plenty of years of experience would qualify to teach. I'm not a veteran, so it came to me as a shock. But I accepted it since, well, you can't argue with a manager.

Now, the hardest part was to figure out how I was going to guide this new member. Preceptors usually have a guide of some sort (or maybe their previous experiences combined) and would teach in a timely manner. To enter the program, one must go through 3 weeks of theory classes and a final exam, before qualifying to practice on the unit for 3 weeks with a preceptor, and then being on their own after that. This member had 1 week of practical training and I would take her for weeks 2 and 3.

By week 2, it is expected that the trainee assesses and connects 2 patients to their machine for treatment in a timely manner. It was not happening with this member. So I told myself, ok I need to figure out a way that information can be retained. I made up a cheat sheet chart for her to keep and read over as she performs treatment. I altered it along the way when I noticed some difficulty remembering steps, but overall I was told it helped with the learning process.

By the end of week 2, I was grinding her with questions, and having her repeat the steps over and over to me. Throughout the week I never acknowledged her efforts, but rather scolded her for the bad practice. Finally, she made me proud. And I commended her, which I believe she started to cry. I told her my expectations for week 3, and she understood and agreed. Maybe this is the Asian side of me coming out.

With the start of week 3, the member is suppose to assess and connect 3 patients to their machines in a timely manner. It was not happening. As the week progressed, I was getting more and more nervous for her, as I saw her struggle to follow steps and retain information, even though it was right in front of her.  I reminded her about the cheat sheet. I practiced priming machines from the very beginning to the end. Anything I could think of, I would apply to a real life situation to make it visually easier to learn. But the member was having great difficulty remembering. I remembered as the week ended, it was frustrating for both ends. Her for not getting it and me for feeling like I've failed to have an excelling member.

This happens especially if a member comes from a different unit, with a whole different experience. It is difficult to relate this particular unit to another unit and say "It's exactly the same!" No, it isn't. Priorities are way different. In the case of this particular unit, time and efficiency is key. One bad screw up and it could push the entire day's worth of treatments behind, which means a lot of angry patients, cut treatment times and missed rides home. Time and efficiency were explained and mentioned many times during training but yet, it was still not being followed or absorbed.

As I look back to see what could have been done better, there are maybe a few things. I was told it's best to be nice to the trainee, and to not overwhelm them with information. Don't teach in a military style, and always act approachable. Well, I did that just fine. I was nice in the beginning but got more strict as the weeks went by. Especially when you see them not retaining information as much as you wanted, you will scold them for not remembering. I believe it is good to still be nice, but not too nice. Leave the compliments until the very end.

I think a lot of it stems from how I was trained. I was hired into the unit as the youngest team member at that time. My preceptor was a strict one, but she had to be good because half the staff members were trained by her when they got hired. People had warned me to be prepared, but I had no idea what they were talking about. The first day of practicum came and went, and by the end of the day, I wanted to quit. I went home to cry and just didn't get why I had to suffer through the torment of her scolding me at every step of the way. There were no compliments. Instead, there were constant scolding, making me feel like I didn't know anything, and I got death stares from her when I didn't know something that I should've known from theory class. There was hardly any smiling from her (and for the longest time, I had no idea how she looked like when she smiled). I just felt like I didn't belong to this program.

However, I have to thank her for scolding me and for being super strict. If it wasn't for her, I wouldn't be practicing on this unit. By the end of week one training, it is expected that the new staff member can connect one patient and assess them properly. She had me putting on all 3 patients on day 1. No wonder it was stressful. But by the end of week one, I was comfortably putting on 2 patients. By the end of my practicum, I felt very comfortable with the 3 patient assignment. And when I was on my own, it didn't feel any different. To this day, I know she is happy and proud of who I have become.

Part of it too is the person's own discipline and taking the initiative to learn everything and put it into practice. I wanted to be on this unit, and pushed myself to learn. I was scolded almost everyday in the beginning, but it made me try and work harder to be better at what I did. If a trainee lacks that, then they will have a very difficult time adjusting and working on the unit. They have to want to learn. As a preceptor, you can only do so much to teach them, but if they are not willing to learn things on their own and on their free time, then you really can't do much except to keep scolding at them. But even then, it only goes so far. Even after days of scolding, the only thing I said was "I'm disappointed that you were still unable to do this or that. After doing this repeatedly. You are not going to do well on this unit."

The trainee should have the passion, the want to be on the unit, the compassion to help people, the empathy, the discipline to remember a lot of information, taking initiative to learn. If they are in it for the wrong reasons (eg. money, being pushed down from another unit), then they will not survive the unit. It's the wrong area of specialty to be in. And they will be torn apart by staff and patients.

The preceptor needs to have a plan from day 1 and what expectations are, and verify with the trainee if they understand those expectations. If they are fast learners, then it makes everything a lot easier. If they are slow to retain, it makes it harder to teach because that's when your creativity comes into play. Finding different ways to help the trainee retain the information is key. If they are visual learners, then find time to show them everything from step 1. Tell them to take notes, or video record if they need to see it. I wouldn't show short cuts though because it would just confuse the heck out of them, but I would stick to the basic steps and make sure they understand. Helping them create a chart (or cheat sheet) to have with them when they are on their own would help. Not all preceptors would take time out of their day to stay up and type up notes for their trainees, but if you really want to help your trainee excel, you will do anything to help them. It is stressful because the trainees rely on the more veteran staff to show them how the unit is run, and how to properly assess patients. The future of the unit basically rests on our shoulders and how well we lead the new staff.

At the end of the day, it's also a reflection of how well I know my stuff as well. It's also a great review for me, and there's always a learning curve on both ends. It definitely brought back memories of when I first started, and to share that experience with my fellow trainee:

-You're never alone.
-Help is always around.
-Do not be afraid to ask for help.
-Ask questions when you don't know something.
-Every successful patient connection or cannulation will bring up your confidence.
-Be confident. You know your stuff. It's a matter of creating a routine for yourself to remember every step.
-Do not let the negative words from patients get to you. If at any time their machines run late, acknowledge them while they're still waiting and inform them the machine will be a bit late, sorry for the delay. They might feel angry at first but most of the time when I do that, they are alright with it. They feel better that they were told something versus being left in the dark and wondering if we forgot about them.
-The goal is patient care, and efficiency. In the end, it's the patients who suffer if they don't get proper treatment. And that includes the race against time to put them on in a timely manner.
-Set your priorities. The unit is all about proper time management, organizational skills and prioritization.

Not everyone can handle a fast-paced unit. It all comes down to the mind set and the motivation to learn. But learning is always a life-long experience. You never stop learning.