MCN Learning: Preceptorship – The End or a New Beginning?

Posted on February 21, 2012 by stayalert


The new colleague has been working with the preceptor for several weeks or months by now and it is time for the new nurse to begin providing client care independently, ending the formal relationship. The trainer has a few extra steps to complete before this relationship officially ends:

• Meet with the Preceptor for a final evaluation of the new nurse’s abilities, skills, and areas for improvement
• Meet with the new colleague for a self-evaluation and evaluation of the Preceptor’s guidance and support

The Unit Director will most likely be pleased that this relationship is ending because the new nurse can now be counted as active client-care providing staff member. The Preceptor will most likely be pleased to return to providing client care without having to stop and teach or supervise ongoingly throughout every work day.

The new colleague however may have different feelings which can include:

         •                  I’m not ready!
         •                  I need more time!
         •                  I don’t know what I’m doing!

These feelings are indicators that the new nurse is aware of areas that need improvement and does not feel prepared to handle care issues independently. I had faced this situation when serving as a staff development trainer. One new colleague worked consistently well with the Preceptor but began acting out when informed that the preceptor relationship would be coming to a close. The Preceptor became concerned and the Unit Director reached out to me to intervene and problem-solve the situation.

I met with the new colleague to investigate the change in behavior only to learn that the new colleague was “afraid” of working independently. After several additional meetings with the new colleague, Preceptor, and Director, a schedule was created where the new nurse would be weaned from the Preceptor over a period of weeks. The weaning schedule was put into place and after an addition period of time, the new colleague was functioning independently and was performing well.

The Preceptor program is a valuable mechanism to support the ongoing orientation needs of new colleagues even though a significant amount of time is invested during the planning stages. The role of the trainer is pivotal in the success of the program.

Next week’s blog will begin discussing current issues around the perceived nursing shortage. See you then!

Contributed by:
Dawna Martich, MSN, RN
Director of Education
MCN Learning

Posted in Miscellaneous (MISC), Uncategorized | Leave a comment

MCN Learning: Preceptorship – When Things Go Wrong

Posted on February 21, 2012 by stayalert


Up to this point the planning and implementing of the Preceptorship program has been relatively painless. The new colleagues are working with the identified preceptors, weekly goal sheets are being submitted and follow-up sessions have been occurring with the trainer and unit director. There’s only one issue that has come up and it is creating havoc on a care area: the new colleague and preceptor do not “get along.”

The trainer is unable to plan ahead for a personality conflict between a new colleague and preceptor. It is impossible to predict who is not going to be able to work and communicate with whom. What the trainer can do is provide information to both preceptor and new colleague on ways to handle problems. A process that can be used is as follows:

• Define the nature of the problem.
• Identify possible causes of the problem.
• List a number of possible solutions for each cause: identify the evidence for each one.
• Select the best solution.
• Decide on necessary actions and implement them.
• Reassess, evaluate and re-plan as necessary.

If this process does not successfully reduce the conflict between the new colleague and preceptor, the trainer can utilize the following approach:

• Identify the conflict.
• Talk with the new colleague and preceptor individually to assess the conflict.
• Recognize what actions have been done to eliminate the conflict.
• List compromises that can be used to eliminate the conflict.
• Schedule time to discuss the conflict with the new colleague and preceptor.
• Provide solutions to alleviate the conflict.
• Plan strategies to alleviate the conflict

Unfortunately personality conflicts occur between nurses more often than not and there really is no way to predict when a conflict will occur. When employed as a trainer for a disease management company I was responsible for coordinating and implementing the preceptor program. Since the current number of staff was small, I needed to use the same individuals as preceptors several times a year.

I recall a situation where a new colleague was assigned a preceptor who had been serving in the role for several months. The preceptor never talked with me or the unit director about the expectation to serve as a preceptor but acted out this anger with a new colleague. It did not take long for the new colleague to walk out of the organization, never to return. The time, energy, and resources invested in the training of this new colleague were wasted because one preceptor was tired of functioning in the role. The preceptor was placed on probation and a remediation plan was put into place to address work issues and expectations. Unfortunately, the new colleague would not return and a potentially outstanding employee was lost to the organization and to the clients. There were no winners in this situation.

The preceptor-new colleague relationship continues until a pre-determined period of time has passed. The relationship will end and the new colleague will begin providing care as
an independent nurse. Next week we’ll focus on bringing this relationship to a close. See you then!

Contributed by:
Dawna Martich, MSN, RN
Director of Education
MCN Learning

Posted in Miscellaneous (MISC) | Leave a comment

CDC 2012 Child, Adolescent and Catch-up Immunization Schedules Available

Posted on February 17, 2012 by stayalert

Vaccination

Earlier this month the Centers for Disease Control and Prevention published the 2012 child, adolescent and catch-up immunization schedules. Vaccination providers are being advised to use all three schedules and their respective footnotes together and not separately.

Changes to the previous schedules include the following:

• Updates to Recommended immunization schedule for persons aged 0 through 6 years:
° Quadrivalent meningococcal conjugate vaccine (MCV4) purple bar has been extended to reflect licensure of MCV4-D (Menactra) use in children as young as age 9 months.
° A wording change has been introduced in the hepatitis A (HepA) vaccine yellow bar; wording now states, “Dose 1.” A new yellow and purple bar has been added to reflect HepA vaccine recommendations for children aged 2 years and older.
• Guidance is provided for administration of hepatitis B (HepB) vaccine in infants with birthweights
• Rotavirus (RV) vaccine footnotes have been condensed.
• Haemophilus influenzae type b (Hib) conjugate vaccine footnotes have been condensed, and use of Hiberix for the booster (final) dose has been clarified. Guidance for use of Hib vaccine in persons aged 5 years and older in the catch-up schedule has been updated.
• Pneumococcal vaccine footnotes have been condensed.
• Guidance is provided for use of measles, mumps, and rubella (MMR) vaccine in infants aged 6 through 11 months. Footnotes in the catch-up schedule have been condensed.
• HepA vaccine footnotes have been updated to clarify that the second dose of HepA vaccine should be administered 6–18 months after dose 1.
• MCV4 footnotes have been updated to reflect recent recommendations published in MMWR.
• Influenza vaccine footnotes have been updated to provide guidance on live, attenuated influenza vaccine (LAIV) contraindications.
• Influenza vaccine footnotes also have been updated to clarify dosing for children aged 6 months through 8 years for the 2011–12 and 2012–13 seasons.
• Figure 2 (“Recommended immunization schedule for persons aged 7 through 18 years”) has been updated to include number of doses for each vaccine. Information regarding the recommended age (16 years) for the booster dose of MCV4 has been added.
• Tdap vaccine recommendations for children aged 7 through 10 years have been updated.
• Human papillomavirus (HPV) vaccine footnotes have been updated to include routine recommendations for vaccination of males.
• Varicella (VAR) vaccine footnotes have been condensed.
• Inactivated poliovirus vaccine (IPV) footnotes have been updated to include upper age limit for routine vaccination. IPV footnotes in the catch-up schedule have been condensed, and relevant wording added to Figure 3 (“Catch-up immunization schedule for persons aged 4 months through 18 years who start late or who are more than 1 month behind”).
• In the catch-up immunization schedule, HepA vaccine and HepB vaccine footnotes have been removed. Relevant wording has been added to Figure 3.
• MCV4 vaccine has been added to Figure 3 along with corresponding footnotes.

The recommended immunization schedules for persons aged 0 through 18 years and the catch-up immunization schedule for 2012 are approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The release of the updated 2012 immunization schedules is an excellent time to review the vaccine administration process with immunization providers. You will want to ensure providers are familiar with your organizations process as well as Federal requirements for the provision of vaccine immunization statements.

Posted in Center for Disease Control and Prevention (CDC), Uncategorized | Leave a comment