The Olden Times of Preceptorship
By Jose Irizarry, RN, BSN, P-PCA
In May 19, 1987, Ponce, Puerto Rico; there I stood with my head held up high in The Santa Maria Catholic Church of Ponce. There were a little over a hundred nursing students. As we all recited the Florence Nightingale Pledge in front of our family, friends and nursing professors, I was very eager to find a position as an RN in any hospital.
In August of 1987, I was hired to work as an RN at Andres Grillasca Oncology Hospital in Ponce, Puerto Rico. It was a 40 bed Oncology Unit. There were 3 RNs per shift—one charge nurse and the other 2 RNs had to divide the workload between 40 patients. I was told by my Nursing Director that I would get a 2-week orientation before I was to be left on my own. At that time, that was the standard time for onboarding orientation for new grads.
I can remember my first day of onboarding orientation. I was really nervous, yet anxious to gain knowledge with regards to my job description. I was assigned an experienced nurse to explain how to obtain medical orders, receive admissions, discharge patients, and administer medications all in the first few days of an 8-hour shift. I didn’t understand what the role of a preceptor was back then; but I was afraid to express my feelings of fear, anxiety, and sentiment of working in an unsafe, unprotected environment. I was expected to learn promptly and to keep up the pace. Every shift that I worked, I would leave 1-2 hours after my shift trying to stay up with my work.
I knew then that this wasn’t right. I would weep and feel frustrated driving back home, thinking “will I ever learn and work as fast as my peers?” Now I understand that expression “Nurses eat their young.” I was considered a slow nurse; I wasn’t part of the crew of experienced nurses. I had to create my own squad, which consisted of LPNs and other new grads that came subsequent to my hire.
I will never forget my first night shift on my own after a few days of orientation. It consisted of the sturdiest nurses. The night shift crew consisted of 2 RNs per shift. My heart was pounding so hard and fast, I was shaking in my pants. The night shift nurse asked me what I preferred “giving oral or intravenous medications to all the patients?” I wasn’t prepared for any of this! I hesitated for only a few seconds and all I heard was "you administer the IV Meds" and she vanished. I stood there, not knowing what to do. Then and there I said to myself, ”I will overcome this obstacle and be the nurse that I always dreamed of being by devoting myself to the welfare of those committed to my care.”
I survived a year at my first position. I knew it was time to move on and explore the world of nursing at other hospitals. I swam and did not sink, even though I swallowed a lot of water during my first year as a nurse. I swore to myself, if one day I was a preceptor, I would never treat any new employee—it didn’t matter what position they were hired for—as I was treated during my first few years in nursing. As I kept moving forward, there were always nurses eating their young. There was no organized structure for onboarding nurses and making them competent in their new roles until the late 90s.
In the late 90s, hospitals began presenting competency forms to preceptors and pairing them with newly hired RNs. I was under the impression of being protected, safe, and being socialized to my peers. Today, I know that wasn’t accurate. Even though I experienced a safer environment, there were many times during my preceptorship, I was left alone because my preceptor wanted to converse with other peers or mistakenly thought I was ready to be on my own.
The onboarding process throughout the years for new hires has been enhanced. However, it had not in my opinion been perfected after 20 years of nursing until I commenced my journey at Baptist Health South Florida in Miami, Florida with Yvonne Brooks, Solimar Figueroa, and the excellent team of clinical educators and preceptors there.
In September 2007, I was hired for Tamiami Urgent Care in Miami, Florida. I received a week of Nursing Orientation without seeing a single patient! I was already astonished with my orientation. Back in the day, I was already receiving admissions and giving report in that first week. However, in Miami, my nursing orientation wasn’t over yet. I was going to shadow a nurse for 3 weeks! I never felt so protected during orientation as I felt then. I had 2 decades of experience, but I was being introduced and being signed off as if I were a new grad. I was always at the forefront of the game, clocking in and out on time. Never again would I clock out 2 hours after my shift. After being released from orientation, there was nothing more that I wanted than being a preceptor in the Urgent Care.
After attending the Preceptor Class at Baptist Hospital, I was assigned a newly hired nurse to precept. I remembered my promise, that “I would never treat anyone as I was treated.” Numerous nurses were under my wings being hired for the Urgent Cares. I was very proud of the progress each nurse made as they began their journey with Baptist Health and with me. At the end of the year, I was nominated as Outstanding Preceptor for Baptist Outpatient Service (BOS) 2009. I wasn’t a winner for the award in the year, but I was delighted with my certificate of accomplishment.
The following year, I was introduced to a Versant Resident. I was unfamiliar with the term Versant Residency. It was explained by the Clinical Educator of Baptist Outpatient Services that it consisted of an 18-week training for new grads using the Married State Preceptorship Model. My jaw dropped to the floor! I was dumbfounded with regards to the timeframe. I told the educator “where was this program 20 years ago?!” Nevertheless, I was eager to start the training. It was the best experience ever for me as a preceptor. I felt so jealous of my preceptee’s 18 weeks of training but yet so blissful for her. The 18 weeks went by so quickly. My Versant Resident was ready to be on her own, and all her competencies were signed off.
In 2010, I was nominated again as Outstanding Preceptor for BOS. This time I took home the plaque! I finally felt that I was awarded for fulfilling the roles of a preceptor, which consist of educator, leader, facilitator, evaluator, socializer, role model, and foremost, protector. I was nominated for the third year in a row but resigned from participating in 2011 because I was going to be one of the judges for the 2011 Preceptor of the Year award. The award was just the beginning of a new journey of preceptorship advancement for me and many others like me.
In February of 2011, Yvonne Brooks and Solimar Figueroa from Clinical Learning approached me. They had a vision to create a community of preceptors for the Baptist Health System. They wanted me to be the Chair of this Sub Committee. I hesitated at first, but then I remembered what happened to me 20 years ago when I hesitated. I accepted the position. We presented our ideas to all the Chief Nursing Officers (CNO) and the hard work paid off. We became an official system-wide approved committee currently known as The Council for Preceptor Nurse Practice (CPNP). The CPNP holds a debriefing forum for preceptors to enhance, share and network best practices for preceptors throughout all entities of Baptist Health System.
I have currently stepped down as the Chair of the CPNP when my term expired. Monica Roca, a graduate of the Versant Residency, is the new Chair. She has the same passion and will continue with the same journey to improve preceptorships throughout all entities of Baptist Health System.
I can’t believe 2 decades have passed. I do believe in preceptorships and assuring new graduates and newly hired staff members are qualified correctly without time restraints. Now I stand in Baptist Outpatient Services as an Educator, always searching for new preceptors for the future. Are YOU one?
For more information on CPNP, email me at: Joseiri@baptisthealth.net.