I'm i expecting too much from my preceptors, please help? - page 2

Hi everyone , this is "monica" a new latino grad, thought these nursing discussions. Today was my second day with my preceptor. Last week I had one nurse to follow everywhere. She was very sweet most of the day sharing a lot of... Read More

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    The student nurse worker must be enrolled in a BRN approved student-worker course developed through collaboration between a Board approved nursing program and the health care facility employing a student.

    The student nurse worker must be directly supervised by a RN preceptor and can only perform those functions taught in the basic nursing program. Remember that the student nurse worker has not passed the licensing examination and therefore has not met the minimum nursing competency requirements to practice as a licensed RN.

    The supervising direct care RN preceptor is present and available on the patient care unit (not simply in the same building) while the student nurse worker is rendering professional nursing services.

    The supervising direct care RN preceptor may assign to the student nurse worker only functions for which the student nurse worker has learned theory and acquired clinical practice either through a basic nursing program or additional planned learning experiences in the practice settings, and has demonstrated clinical competence.

    Nursing management has ultimate and ongoing responsibility for establishing the student nurse worker competence prior to assigning the student nurse worker to a direct care RN preceptor for clinical supervision.

    The supervising direct care RN preceptor judges that the student nurse worker is competent to perform the function before making the assignment.

    Note: The nursing service administrator (director of nursing), the supervising direct care RN preceptor, and the student nurse worker are responsible for adhering to all the above stated conditions.

    Caveat: The BRN holds nursing management responsible for making nursing assignments in accordance with the Nursing Practice Act. Assigning student nurse workers to practice under conditions different than those specified above may place patients in danger, and RNs who make the assignment may be subjecting their license to disciplinary action by the Board.

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    Thanks, it is really hard to have an opinion at all when I cannot see you Your reply makes me wonder what the unit culture as a whole is like. You sound enthusiastic but inexperienced in nursing, maybe you don't feel quite comfortable in dealing with different personalities- I don't blame you but it sure makes orientation harder.

    I agree with previous posters that a consistent assignment with one nurse would be helpful for the first few weeks. It would also give them some accountability to teach you. For example someone leaving you to complete the first admit by yourself sounds unprofessional not to mention dangerous. He doesn't know anything about the pt, has left you to do assessment by yourself. I would feel that that situation needs to be reported so you are not left hanging again.
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    This is to PhantomRN. It is Monica. Thank you for your reply and feedback I really appreciate it. He gave me three pts the first day b/c the second preceptor had giving me two the last time. I did great I love cardiac. This is a cardiac unit. He told me at the end of the day “ I think your good today, you are going to be a great nurse, you really are, the knowledge is there. Today was an unusually busier day but you still did well. I do think that they have not told you about the computer, sending orders and just things about the unit. Once we get this out of the way you’ll be just fine”. I went home so happy, I knew I had impressed him w/ my answers about med, medical problems, rationale of Tx and the way I interact w/ the pts. The next day, he was a totally different person. Gave me the pt with a peg tube, tracheostomy, ESRD, pre/post dialysis, bellow knee amputation and so on. I definitely learned a lot w/ her but he did not couch me, he was more of a resource than a preceptor. i hope i did fine. I did everything i knew from school and another nurse pointed something for me to do that i did not know. i wnt to him a few times asking him about handling the tubes and stuff but he came in did it him self real quickly and answered yes or not to my questions about how to do it.

    This one is to betts, thank you for your reply; I am not a student nurse. I am a registered nurse who is very eager to become and experienced, conscientious, and knowledgeable nurse.

    And This one is for canoehead, thank your for your second reply. I hope your impression about me changed a little. You are calling me “you” now instead of “she”. Thank you.!! The culture in my unit is one third traveling nurses including my preceptor, one third African American, and the other third is some Caucasians and Philippine. About being inexperienced, I think I am as inexperience (hands on) as a new grad can be. But I think I know my stuff, books wise. I would help me a lot if you please tell me what you mean about me having difficulty w/ different personalities? This is exactly what I need to know. If I am being too critical. As with the example with doing an admission an admission alone, I have other stories similar to it and I don’t think it has anything to do with personalities. As you said, it is dangerous. I DON’T WANT TO BE A SLOPPY NURSE.
    . I am just asking for supervision at least once for each task. Would you believe that no one has watched me doing a head to toe assessment? When I asked them they said “just do the lung sounds, the BS, and some pulses. I was asking about listening to any S3 or S4 sound and getting really good at recognizing diff adventitious sounds. i hope I have been doing it ok. Oh well!
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    Hi Monica, I am a relatively new grad (May, as my name suggests ), and have been working on my unit since July.
    My preceptor is WONDERFUL! When I first started working there, I followed her for a day or two. We "bonded" and got to know each other's personalities. We also discussed the areas I felt I was weak in (like IV starts) so she had a clue about my strengths and weaknesses.
    Now here I am, going on my own in a week (I am in the ICU so I had an extended orientation). I still have so much to learn, but I also have come a long way since drawing up that insulin on my first day, scared to death.
    The impression I get about your preceptor is that he doesn't really want to be your preceptor! I bet he didn't volunteer for the job, I bet he was "assigned." Still, you deserve a thorough orientation. I want to remind you of something---you have your own license to worry about now. Even if your preceptor is supposed to be "responsible" for your actions, in a legal issue, you BOTH would be held accountable. If you signed it, you did it and you are held accountable too. I am telling you this because you NEVER should have done that first admission by yourself!!
    You are in a difficult situation, new to the unit so you want to get along with everyone, you don't want to **** off the preceptor or be made to feel incompetent. But at the same time, you want to learn the things you need to know with that "safety net" a preceptor provides. And it sounds like your preceptor doesnt' want to be bothered with a new nurse. I feel so bad for you!
    The next time he ditches you, tell him you have never done such-and-such, and that you feel uncomfortable doing it by yourself for the first time. If that gets you nowhere, then go to your charge nurse, that's what she is there for.
    On the flipside, if you have done an accucheck before, go ahead and do it on your own (or a dressing change, piggyback, or whatever). As time goes on, you will find yourself becoming more and more confident.
    Still, your preceptor should be checking the chart behind you, asking you questions, making sure you are comfortable with what you are doing and asking if YOU have any questions, and keeping a close eye on the patients!

    Okay I am writing a book here! Good luck with everything. Have a heart to heart with him.
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    i was not being critical of you at all. at least that was not my intent. sounds to me like you would be a great orientee. some of ours dont like being told what to do. it makes them very difficult to orient.
    no..you dont HAVE to go home and read but if you want to be a great nurse you do.
    some of the preceptors on our floor are horrible. i was lucky because i had two very very good nurses and i try to adopt their styles.
    sometimes preceptors resent that they have to precept. at our hospital they dont get paid extra for it and its more work. some of them just expect the new grad to already know everything...ive seen excellent new nurses being hollared at for making mistakes. thats no way to teach someone.
    i guess what im trying to tell you is that no, you are not expecting too much from your preceptor. BUT if you are finding that you are having trouble learning from him...because of HIS messed up teaching then you need to go to your MANAGER.
    what i have seen happen is a new nurse goes through orientation with a crappy preceptor, gets on the unit and is a crappy nurse because she/he hasnt had the proper training. and they dont blame the preceptor...they blame the new nurse.
    its unfair.
    thats all i was telling you because i didnt want that to happen to you.
    i hope you didnt take what i was saying wrong.
    it seems like your orientation has taken a turn for the better. im glad for you.
    good luck on the rest of orientation. seems like you are doing just fine
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    hi thisnurse. it is monica. please never, never think that i felt that you were being critical. your feedback was excellent and very well taken. you were sincere and i need to hear the truth not what i think is the truth. thank you for thinking that i would be a good orientee.
    I also want to thank RNinMay for your great feedback and support. I do have an update for you guys.
    i thought about this situation all weekend. i had desided to keep this lousy preceptor who does not want to be bottered or even to be alive. i was also going to watch other nurses to see if there was someone real good and ask for that one or use him/her as a resourse. well, HE fancyed him self to call the charge nurse over the weekend and ask for a change. THE NERVE!!! i felt very relieved b/c he is not in the picture anymore. but who is going to be now? well, my luck is very weird. i had this guy who has always being helpful and down to earth. he doubled checked everything i did and explained things to me extensively even more than i need it. he was also funny and though that i was very enthusiastic and dedicated "i like that" he said. the bad news is he is going to India on vacacion for a month on wednesday. they already asigned someone else for the rest of my orientation.
    As much as i usually tend to criticize and blame my self for things i think that this other preceptor who had the nerve to quit on ME was too intimidated w/ my questions for which he did not always know the answer and as RNinMay said, it is too much work to train a new nurse. I think it is a big responsability. i am scared! i think i am not going to get good, strong orientation and i don't want to be a sloppy nurse, lose my license or what is worse neglect or harm my pts. Oh God help me! thank you guys. monica
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    you are NOT going to be a perfect nurse when you finish orientation. you won't know everything like we wish we could when we finish. most times the hospitals give you an inadequate orientation and throw you on the floor. if you are lucky you will have nurses who will help you when you finish.
    your former preceptor actually did you a favor by asking to not precept you. now it looks like HE is the one with the problem and he is. your other preceptors will tell your manager a different story about you than he will. he will look like the bad preceptor he is. hopefully, he wont have to precept anyone else.
    do you know who your new preceptor is yet?
    how long is your orientation?

    mine was 8 weeks. everyone who oriented at the same time as i did asked for a longer orientation. they were denied. i did not ask for more time. i knew i wouldnt get it.
    i did the best i could during orientation. it would have been better if the orientation was 12 weeks but it wasnt.
    i was fairly confident in my judgement but not my skills. i knew if an emergency situation came about i would be able to handle it and know what to do.
    the other things, like blood draws (im still not good at them) and iv starts, i could always get help on. there is always at least ONE nurse on the unit who will help and who i feel comfortable asking.

    good thing i was confident in my judgement. my first night off orientation i had a patient go into respiratory arrest.
    although his vitals were all within normal range, there was just something that did not look right about him. his breathing was heavy but regular. just something that bothered me about him.
    he was a bit less arousable than he was the night before. (he was not my patient that night but i did answer his call light a few times)his lungs sounded ok but he did have crackles in his left upper lobe.
    i found out that this patient had been like this ALL day. the experienced nurse on daylight did nothing but monitor him.
    i called the doc and told him what was going on. i asked for an order for a breathing treatment.
    i got it and the doc came up. the patients lungs started filling with fluid. he started going downhill very quickly.
    while the docs treated him, i followed their orders, foley, breathing tx's, lasix, etc.. we prepared for a code.
    got him down to ICU (i went with him) and he coded just after we got him in the bed. he survived.

    the purpose of telling you this story is so that you will know that although you might not be experienced with your skills YET, you have been trained to THINK like a nurse. your judgement is what counts most. you will be just fine.

    if this preceptor does not work out for you, as ive said before, talk to your manager. maybe she/he will find a better match for you. after all, they do want you to learn.

    best of luck....and dont be hard on yourself
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    Hi Thisnurse. Thank you for latest reply. I’ll first answer some of your questions. HE does have a new person to orient. A young lady who is not brand new like me and has been a nurse for a year. I absolute had some joy watching him having the girl following him everywhere as he looked miserable as if he hates life and even himself. It is interesting that I had told my self not to complaint about him, but to do my best and ask other people when I had too and even talk to him again. But you are right. He did me a favor. ##&&##@@!!!!!.
    Well, there is a guy in this unit who went to the same school I did, only 2 and half years ago. He is dedicated and very meticulous. He liked my attitude a lot and told me he likes being my preceptor b/c I am enthusiastic, hard worker and I like to learn. I was with him Monday and I was scheduled w/ someone else Tuesday. He liked it so much that he asked me if I wanted to come in on Tuesday so he can help me. I did, and he helped me yesterday. THE BAD NEWS? He is going to India for over a month on vacation. Yesterday was his last day until then. My luck! I am going to a fifth person tomorrow Thursday. My orientation is supposed to be for 12 weeks but a lot of people told me that they later cut it short telling them that it is time. My biggest concern and what is making me very discouraged is that there is no one nurse that has been there long enough or that I watch and hear working and feel like “this is how I want to be in a few months or years or so on!!. There is a huge turn over on this unit and the average time for them to be here is one year. Your story was very interesting and makes me proud of you. I not sure I’d do that well. There have been times where I notice things of the pts and the (one year experience) crew tells me that it is ok and normal and I never know if I was right. It seems to me that this particular group of nurses is task oriented and not pts’ advocates.
    I find myself taking forever to do a little thing for a pt (b/c of their disorganization everything is a project) and they just let it go and tell the pt. they need to wait or just do not get done. I did another admission yesterday and the preceptor revised my paper work done. He told me that with time I’ll be able to do it in 10 minutes or so. This was a 76 year old lady and she tock a long time to answer each question. I could not rush her. What do you think? monica
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    hi monica...i think you are right on track. your preceptor who is going to india will be back and he will be someone you can rely on for help. 12 weeks orientation is pretty generous. youve already learned a lot and you should do very well

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