New Grad RN Orientation

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    I'm currently orienting on a busy Medical unit. Like any other hospital, I have a preceptor with me... However, it's not been the best experience. I wonder if it's me or my preceptor. I've only had experience working at a LTC facility, but I did have 3 semesters of clinicals at the hospital that I am currently employed at. It's been exciting and frightening, all at the same time.

    New Grad RN Orientation

    I've only had experience working at a LTC facility, but I did have 3 semesters of clinicals at the hospital that I am currently employed at. It's been exciting and frightening, all at the same time.

    My first day orienting, I was 'shadowing' my preceptor.

    On my second day, I took on one patient and she wouldn't let me get into the charting until after we had given report off to the night shift. I offered to go ahead and chart and she could look over it once the shift was over with, but she kept telling me to wait to do it with her. Every time she went to do something, she asked me to go administer her meds or hang a bag of IV for her. So I felt, like I was missing a lot of the things that happen 'behind the scenes.' That second day, we did not leave until 9.

    The third day, I took on 2 patients, but we still did not leave until 8:30. I've always been 'on top' of my interventions/assessments/charting when in school. And this bothered me a lot. I've always been thought 'real time' charting was the best (for the patients and for myself). The following 2nd and 3rd week passed pretty much the same. I would go about thinking that I was doing alright, but she would notice that I didn't do something and 'teach/criticize' me. That was the only time that I actually learned.

    I understand that she wanted a 'hands-off' approach to let me learn the ropes. But I thought that she was there to help and guide me.

    Routines were never explained to me. Correct charting/acknowledging of new orders weren't discussed, until she actually saw me doing it wrong. Most of the time, I am asking another nurse where to find equipment.

    After 5 days working on the floor, the unit secretary finally told me why the charts are placed in certain cubby holes and why I can find them there (new orders, orders need to be placed in, new orders need to be acknowledged, everything is 'up to date' and 'acknowledge'). She has never gone with me to do an actual assessment!

    If I ask questions, she tells me what I need to do, but leaves me to figure out how exactly I should go about it. Almost every time I ask her for help or to actually show me, her reply is usually, "I need to go hang/give this med/antibiotic and you're going to have to wait." I understand the patients come first. But honestly, if I'm taking 2 or 3 patients of the 5, wouldn't she have time to show me a few things?

    My last day there, I took on 4 of the 5 patients. They were a set of patients that were very complicated. I had one on heparin drip, in status epilepticus, encephalopathy, and a guy that had to be transferred to tele unit because he was going to need a cardizem drip. I was drowning even before it was noon! Sadly, I did not do any charting until I reported off and did not get home until 10PM!

    And here is my big question, is it me? I've wondered if it's all in my head or not! She isn't ugly to me, and very intelligent, as well as great with the patients. But the entire time I've been with her, I've felt like I'm just 'winging it.' And by no means, do my patients deserve that! I'm really frustrated and feel like I've been thrown under the bus. I would just like her to take the time to explain the policies and procedures before I dive straight in and attempt to do something. It would make me infinitely feel better if she would just watch me do something once, before assuming that I know how to do it. I'm deathly afraid of harming my patients, simply because "I didn't know."

    Sorry to make this so long, I just needed to vent out my frustrations. I hope that I'm not the only one who has gone through this!
    Last edit by Joe V on Jan 8, '15
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  3. by   Mully
    It takes a long time to get good at doing everything at once. It sounds like your preceptor isn't the best. There are good ones and bad ones everywhere. You've just got to take responsibility for your own learning, just like in all of life.

    Give it more time. You need a lot more time, and that's normal.
  4. by   Jory
    For now...let it go. At least she isn't mean to the boards and you will consider yourself lucky.

    I wouldn't allow someone that had been out of orientation for two days chart for me either. The shift is taking longer because even though you claim you did everything, consider the fact she is still responsible for the patient and she has to go behind and double check everything because she doesn't know you--she would be foolish if she didn't.

    Get through this part and you can time manage how you wish when you are on your own.
  5. by   mamagui
    Some people are born teachers- others are not. Sounds like your preceptor falls into the latter category. Mully makes a great point when saying to "take responsibility of your own learning." Ask questions about why things are done a particular way. If you want her to watch you do something, ASK her to observe you. As far as charting goes, try asking her what is the best way for you to be more efficient/ proficient/ accurate, etc. with the charts. Ask her how you can get more practice at charting. Ask, ask, ask! If you are too passive or quiet, perhaps your preceptor does not realize that you do not understand something or she assumes that you already know the reasoning for doing certain things. Good luck!
  6. by   IEDave
    Evening, mollie.v:

    Just to add to the discussion - what you're seeing with your preceptor is sometimes known as "rule by exception". From what you described, she's expecting that you know enough after 3 semesters of clinicals to know processes & procedures as performed at that site. Which tends to explain the whole "rule by exception" - the technique is typically used with more experienced & intelligent staff members.

    Is it you? Yes, and no. Yes, in that you want to move ahead as fast as possible; no, because your preceptor probably barely knows you at all. They don't know what you don't know, and more importantly you're in the process of finding out what you don't know. How to get around this? Try being a bit more proactive, and keep in mind that it takes time not only to go through the learning curve, but to build a sense of trust between you and your co-workers. It'll happen - but it's going to take more than 3 days to do it.

    ----- Dave
  7. by   NPOaftermidnight
    I'm a new grad as well - I'm on my third week in the SICU. We have had very high acuity lately and I've been feeling very overwhelmed and have felt that I'm winging it every day. Last week we had a particularly busy day and I ended up making a fairly serious error. Luckily everyone was ok and I did not get in huge trouble but we spent a while discussing what we can do differently since I didn't feel that my preceptor's current approach to my orientation was working for me and I was scared to death of making another error. It worked out wonderfully and I feel SO much more confident now. However - I honestly could have killed someone with the mistake that I made and I really wish that I had spoken up BEFORE something happened.

    As my preceptor told me - this is YOUR orientation and YOUR learning experience, if things are not going well you should speak up. If she isn't willing to work with you, I would suggest talking to your manager about getting assigned to a different nurse.
  8. by   Lev <3
    From personal experience with an incompetent preceptor, I think you should share your concerns with the unit educator or nurse manager. Not in an accusatory way. Just give her the facts. See where that takes you. You don't want this to come back at you toward the end of your orientation "oh we don't think you are cut out for this floor"..."you are barely keeping up."..."clocking out too late." Goodbye. You want to get a preceptor who is suitable for you ASAP.
  9. by   Jory
    Quote from Lev, BS, RN
    From personal experience with an incompetent preceptor, I think you should share your concerns with the unit educator or nurse manager. Not in an accusatory way. Just give her the facts. See where that takes you. You don't want this to come back at you toward the end of your orientation "oh we don't think you are cut out for this floor"..."you are barely keeping up."..."clocking out too late." Goodbye. You want to get a preceptor who is suitable for you ASAP.

    I think she should talk with her preceptor before taking this far they are getting along and if she goes straight to the manager, the OP is going to be labeled as a tattletale and that isn't going to blow over well with the rest of the staff.

    No way would I go straight to management...think about it...TWO DAYS? I think the first WEEK was observation, helping...I didn't start charting until I got the tasks down first.

    I think the OP is jumping to conclusions and expecting too much, too soon.
  10. by   kayern
    OK, we do not allow our new grads/hires shadow. The take care of the entire assignment with their preceptor at their side for the entire 12 hour shift. They are joined at the hip for 12-15 shifts. They assess together, give meds together, chart together, etc. How in the world is a new grad/hire suppose to learn to manage an entire assignment?
    Who selected this preceptor? Has she ever preceptor before? I suggest you sit and have a heart to heart discussion with your preceptor and share your concerns/feelings. If nothing changes then go to your manager.
    Good Luck
  11. by   mmc51264
    I had some issues with preceptors and the way I do things vs the way they do things. we had at least 6 different preceptors so we could see how different people did things. I talked with the preceptors that I didn't mesh well with and I did discuss with my clinical lead when we had conferences.

    I was basically shadowed by my preceptors and they interjected as needed. As I got more independent, they backed off and were more support.

    hang in there, it gets better!!!!!!!
  12. by   HouTx
    Gosh, I know that everyone gets tired of my same old rant . . . but here I go again.

    Orientation should be structured - with specific goals and objectives along with a timeline for accomplishment & criteria that will be used to determine 'success'. Orientation is not about teaching clinical skills (that is what nursing school was for), it is about 'validating' skills & teaching "this is how we do it here". So, orientation must include all of the department routines such as how charts are managed - which the OP did not have. Obviously, it should not include 'bad habits' such as block charting and incurring overtime for routine charting - sheesh, don't know why that is even tolerated. Finally, everything should be documented so that OPs progress can be measured and validated.

    I also beg to differ- the preceptor is NOT responsible for the OPs clinical practice. Each licensed person is accountable for her/his own practice. So why in the world would the preceptor need to review all charting before it is done is OP is documenting the care that was delivered? I know it is early days yet for the OP, but it seems as though OP would greatly benefit from greater clarity.
  13. by   llalpine
    Have you heard of "Nurses eating their young?" Welcome to the real world dear. People don't like nor do they have the time to train new grads. Like it or not it is a dog eat dog world out their in the REAL nursing world. You're experiences are why many new nurses don't even last three years in the career field. If you're going to survive you have to be head strong and tough as nails. Do the best you can and expect to go home crying for at least the first six months. Things in the world of health care aren't getting any better. Nursing students are coming out of college with less and less hands on skills and expected to do more and more without experience. I don't encourage anyone to go into nursing anymore. It isn't at all what colleges make it out to be and the money isn't as great as people think given the hours, liabilities, and pay. I know many people who have just quit nursing and sought other careers given its challenges these days.
  14. by   canigraduate
    As a preceptor, some things you posted are bothering me. I think the current approach that you are taking is a little self-centered and very passive. I have had preceptees with similar attitudes to the tone of your post, and had to almost shock them with a cattle prod to get them to do anything without me holding their hands.

    At this point, you should definitely require lots of guidance. I am NOT saying you should be super nurse and know how to do everything. However, you should also be very assertive by this point and able to get help on your own. Use your resources. If your preceptor isn't available, ask the charge nurse or another nearby floor nurse. If no one is available, get out your unit references and policy and procedure manual. If you don't know where they are, ask someone and find out. Get comfortable with speaking up.

    Make sure you are communicating, communicating, communicating. I had a preceptee once who was extremely passive aggressive and I only found out that she needed extra help when other nurses told me after hearing her speaking behind my back. Make sure your preceptor knows that you need help. Discuss your concerns with her. If this doesn't lead to a resolution, then speak to the person who coordinates preceptorships, then kick it up the ladder.

    Your orientation is up to you. If you passively sit back and let it be crappy, it is on you. If you assertively (NOT aggressively) take control of your orientation, you are more likely to have a great experience.

    Best of luck to you!