WEEK BY WEEK GUIDE TO CLINICAL PROGRESS IN PRECEPTORSHIP 1. Clinical Experience

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Rosalind Isabel Turner
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1 WEEK BY WEEK GUIDE TO CLINICAL PROGRESS IN PRECEPTORSHIP 1 During your first discussion with your preceptor, the following topics may be useful: Decide on the starting date and shift for your first clinical week if you don t have this information Orientation to the hospital and to the unit Parking, uniform, dress policies, lockers, and procedure for reporting illness Common diagnoses and medications seen on the unit. Clinical Experience Week 1 Day 1 1. Buddy with your RN for the first shift to get a sense of the unit routine. 2. Think about how you can begin to establish a trusting partnership with your preceptor. 3. Familiarize yourself with the physical environment. Identify the location of fire and emergency equipment and procedures. Locate hard copy or on-line resource materials: medical and nursing references, policy and procedures, ward manuals, in-service programs. Find the location of allied services in the hospital: laboratories, dietary, social services, pharmacy etc. Identify methods of obtaining supplies and equipment on the ward: linen, drugs, sterile supplies. Identify the method of organizing nursing care on the unit: team, modified team, primary, and the skill mix of RNs, LPNs and RCAs. Read any orientation information that would assist you in understanding nursing s role in the delivery of care on the unit. Identify established channels of communication: reporting and recording, assignment sheets, kardex care plans, timelines, OR slate, flag sheets for other disciplines etc. Review charting requirements. 4. Clarify with your preceptor the types of emergency situations that may occur. Ask about policies that guide nursing action. Examples: a. Hypoglycemic episode procedure to follow, what is given to patient, and where are the food items kept. b. Aggressive behavior how to pick up on early cues, what interactions are 1

medications seen on the unit. Clinical Experience Week 1 Day 1 1. Buddy with your RN for the first shift to get a sense of the unit routine. 2.

2 Week 1 Day 1 effective, and what is the restraint policy. c. Respiratory emergency first nursing actions and who to call. d. Cardiac arrest policies, procedures, and who to call. e. Change in LOC first nursing actions, who to call. f. Chest pain what protocol/procedure is followed immediately and who to call for assistance. 4. Identify clinical techniques (skills) that you need more experience in completing. A list of these skills can be posted on the ward so that other staff is informed. 5. Meet the other staff on the unit, explain your role, and share your learning objectives. Week 1 Day 2 1. Arrange with your preceptor for a patient assignment of one patient. The assignment should increase gradually as you gain familiarity with the unit and you and your preceptor become comfortable working together. 2. You should start writing or taping the end of shift report with the first assigned patients. 3. Use your time wisely to continue to explore the unit, resources, and communication tools in the unit. Begin to work on establishing interpersonal relationships with members of the health care team. Week 2 1. You should have a patient assignment of two to three patients in the second set of shifts. This assignment could gradually increase to three or four patients depending upon your preceptor s assignment and the acuity of the patients. 2. With team or modified nursing, your assignment might look like any of the following: primary care for two patients, plus medications for several additional patients. medications for a portion or all of the patients on the team. primary care for several patients, working into the team responsibilities gradually. 2

A list of these skills can be posted on the ward so that other staff is informed. 5. Meet the other staff on the unit, explain your role, and share your learning objectives. Week 1 Day 2 1.

3 3 to 5 3. Become aware of how health promotion is facilitated on the unit by: Assessing the learning needs for your assigned patients. Identifying incidental teaching required. For example, information about a diagnostic test, dietary change, activity post-op, or reasons for medications. Consider the continuity of care for each of your assigned patients. How is health promotion incorporated? What learning needs do your patients have and what activities will promote health? Think about discharge planning. For the acute care patient who is being discharged, what concerns does your patient have about managing at home, and how will you help your patient deal with his/her concerns? Identify the formal teaching required. For example, ostomy care, administration of insulin, discharge teaching, or cardiac teaching. Participate in meeting patient learning needs by exploring the teaching resources available in the unit and sharing these with patients. 4. Gain increased awareness of the general functioning of the ward and how the work is facilitated. If all is going well clinically, you could spend a day with the unit clerk to participate in some of these activities if possible. The preceptor will help in arranging this experience. Learning activities could include: Reviewing RN, LPN, and care aide job descriptions to assist in appropriate assignment of duties. Becoming familiar with the transcription of doctors orders along with all the appropriate follow-up. Learning the methods of requisitioning and/or arranging for diagnostic tests, therapies, referrals, discharges, and transfers. 5. During Week 4 complete the midterm clinical evaluation form and give it to your preceptor for his/her comments. The BCIT Instructor will meet with you and the preceptor to review the midterm evaluation and learning goals for the second half of the course. 3

How is health promotion incorporated? What learning needs do your patients have and what activities will promote health? Think about discharge planning.

4 5 to 8 1. In the second half of Preceptorship 1, you should begin to assume some leadership activities related to the management and care of a group of patients. This includes, but is not limited to: Developing effective collaborative relationships with the other health care workers who are providing care for your group of patients. For example, discussing a patient s housing issue with the social worker, or initiating a referral to a pharmacist or dietician. Paying attention to inter-professional collaborative practice initiatives. This type of practice supports the participation of each discipline in patient care. For example you may attend ward rounds or contribute your nursing observations during multidisciplinary discharge planning meetings. Taking an active role in managing care for a group of patients. Finding out what tasks need to be done, who is qualified to do them, what can be assigned to the LPN or RN, and figuring out how the various participants work together to make sure that quality nursing care is safely provided in a timely manner. For example, take note of how the staff on a day shift organizes themselves to manage the nursing care required. Who does what? Is there someone in charge of the bigger picture? What do the charge nurse, unit manager, and patient services coordinator do? Negotiate with your preceptor, LPN and/or other students so that the workload is reasonably distributed and assignment of tasks is appropriate. You will be gradually taking on the preceptor s assignment, and assigning some of the work back to the preceptor and/or to the LPN. Seek feedback from the team members who worked with you as well as from your preceptor so that your ability to manage increasing workload increases with each set of shifts. Learning how to work with other students who may be assigned to some of your patients. Think about how you will approach other students and how you will partner with them to give safe care. Also, think about how you will assess the knowledge and ability of these students to ensure safety and when you will need to collaborate with the student about the care given. Gaining experience in checking charts on a night shift and learning what to question and clarify. This activity promotes thinking about what orders are current, what orders have been missed, and what orders need to be re-evaluated by the doctor. 4

For example, discussing a patient s housing issue with the social worker, or initiating a referral to a pharmacist or dietician.

5 5 to 8 1. The following additional actions reflect the beyond the bedside roles and responsibilities included in an RN s scope of practice. Initiative and assertiveness are required to manage a group of patients and includes: Informing co-workers promptly of changes in the patient s plan of care. Taking the initiative to consult with the patients physicians. Introduce yourself when they arrive on the unit. Use the SBAR format. If your requests are not supported talk with the physician or preceptor about why. Clarifying issues or doctors orders that you are unsure about. Make sure you understand what orders mean. Participating in the sharing of information with other health care workers in a professional manner. Initiating or revising information on the kardex. Preparing for change of shift report by gathering information from team member(s) and then giving report to oncoming staff. Informing patients about BC Nurse Line and when to call 911 when discharged. 2. During Week 8, complete the final clinical evaluation and then give it to your preceptor for comments. 3. By Week 8, you should be attempting to assume all of the preceptor s workload/responsibilities, identifying when you require assistance, and then assigning back to your preceptor or other health care workers up to 25% of duties. 4. During Week 8 or 9, the BCIT instructor will meet with you and your preceptor in the unit to review the final clinical evaluation. 5

Taking the initiative to consult with the patients physicians. Introduce yourself when they arrive on the unit. Use the SBAR format.

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