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

thisnurse · Nov 30, 2001

monica,

some of us forget what it was like when we started.

You will find that when you are working the 7 am to 7pm shift, you tend to get cranky around that time because you need to finish so much before you go home.

you asked your preceptor for challenging patients and he gave you one. maybe you werent ready for that yet.

if you feel you are not learning from this preceptor then tell him how you feel. say what you said here.

they are responsible for teaching you but YOU are responsible for learning. if you still feel frustrated and like you arent learning, you should sit down with your manager and talk about the best

ways you learn things. this can all be worked out.

the first week or so of orientation is very hectic. so much to learn. i cant imagine being bored. you have charting to do and looking up labs, checking your charts...all the paperwork needs to be learned as well as the computer programs. there is always something to learn.

good luck to you. hope you can work this out.

what is iv certification?

Genista, BSN, RN · Nov 30, 2001

Hi Monica,

I think the hardest time is when you are a new grad. On one hand, it's nice for you to precept w/ several different nurses b/c you can see different styles and different ways of handling things, but on the other hand, it's not as consistent. I have oriented several new employees. One of the things that helps for me & for them, is to 1st clarify what they feel comfortable doing & what they do not. If you aren't comfortable even doing the basic med pass by yourself (and some new grads are not...and want the preceptor RN to supervise) then please say so. I had a new grad who was so nervous even signing out meds, so I did it w/ her for awhile. Some of your preceptors may have a different expectation of you than you have for yourself. You two need to talk & make sure you both agree on what help you will need. Don't feel pressured to do anything by yourself EVER if you need help. I still bring in my coworkers on issues that I am unfamiliar with.

I could also relate to some of what you described w/ the nurses being very friendly & open at first, but later in the shift very matter of fact & down to business. I enjoy orienting new people, but sometimes I feel like it really crunches me for time...and I am responsible for all the nursing care as well as orienting & teaching the new grads/new staff. So, sometimes, I do that too, not meaning to come across as "not as open" but really feeling like it's time to wrap up my shift & "that's all the lessons I have time for today." Try not to take that sort of thing too personal...your enthusiasm is great.

Regarding pushing IV meds...I would advise you not to do anything that you are uncomfortable doing or have not passed a competency in. Talk w/ your nurse manager if you have questions. We usually have new grads/new nurses get supervised a certain # of times per skill & "signed off" on it. Some will even ask to be supervised a few times more, until they feel "comfortable." Every one is different, so don't be afraid to ask if you don't feel ready to "fly solo."

If you feel like they are giving you too much too soon, please let them know. It is so hard in the beginning b/c everything is new, and it can feel overwhelming sometimes. But taking on new skills does give you experience; just ask for help if you feel you need it. The key is to talk to your preceptor & manager. Let them know what you need. Then they can help you meet whatever short term & long term goals you have.

I am curious how much total orientation you have? Have you set any goals or areas that you need to work on during orientation? Just a few thoughts...

Good luck to you! Being a new grad is a hard time. It does get easier! ;-)

P_RN, ADN, RN · Nov 30, 2001

I am so very distressed at your description of your orientation!!

You passed meds ALONE on your third day? Who checked you off on meds?

And why on earth are you being passed around among different people to be oriented?

Do you have a skills checklist? It should have nearly EVERY skill you are expected to have to be a competent nurse.

For example: suctioning, post dialysis care, etc.etc.etc. You should demonstrate EACH skill before you do it alone.

A new employee should work with the same preceptor, on that preceptor's schedule! The length of time varies, but I would think would be at least 3-6 weeks!

You should have gotten IV starting skill out of the way before you even hit the floor. You then should be observed several times each (we did 3) with EACH type of IV task.

For example: 3 IV starts, 3 IV minibags, 3 IV bolus, 3 tubing changes etc. etc. etc. !!!

You should NOT be expected to get this out of the way on your own. All the reading in the world will not take the place of a preceptor who is right there with you all the time.

**canoehead, BSN, RN** · Nov 30, 2001

Maybe I am just being cranky...but she asked for more challenging patients, said her initial two pts were slow, so they gave her more challenging patients (with a preceptor). That increases her discomfort level, and the need to put the pt before learning needs (remember the pt comes 1st). But that's what she asked for. Also she said she was comfortable with med passes, I assume they observed the first few times, then let her go on her own. Then when she is on her own complains of not enough observation.

Maybe the preceptor is getting double messages, I am. I hear that she wants to do more, and be more independent, but when it comes to responsibility she does not take it on along with the tasks.

Maybe a shared expectations conversation regarding tasks required for each patinet would be a good idea before each shift.

psnurse · Nov 30, 2001

I am confused about IV push meds and IV certification. Where I live only LPN's are required to have an IV certification. Even after that, they still can't push meds. So if this is the case, the preceptor is requiring something outside the scope of practice which would need to be addressed.

mcl4 · Nov 30, 2001

Originally posted by wrkoutgirl
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 info and very friendly. By 3pm (7a-7p shift) she was not as cooperative or informative and started doing things fast and by her self. She was though very sweet and I got several good tips. The second and third day I had a traveler nurse who had been in this unit only 3 months. I got one patient first day, two the second day. I was bored b/c both pts were very low maintenance. She was somewhat knowledgeable and I learned a few other tips with her. She got me very upset at the end of the second day by telling me that I am "too eager" and that I don't need to go home and read all the time, "it will come to you" she said. wouldn't you think that a preceptor is like some sore of a model, an inspiration for the new nurse, someone very professional, knowledgeable and ethical. When i met my real preceptor on monday, I asked him for challenging pts. I showed him that I was active and conscientious and he was impressed that I answered a lot of his questions, and in general I have some knowledge. At the end of the day he told me that I am going to be a very good nurse, "today was an unusual busy day, but you did well, the knowledge is there, but I think I need to go back a little to show you some things around the unit like the computer, the system and so on, b/c once we get these out of the way you'll be just fine" he said.
Today, (two days later) he is so different, apparently I missed given 2 meds and someone was nice not to write "us " off. QUESTION NUMBER ONE TO YOU COLLEGES = as much as I should take responsibility and be assertive and competent, shouldn't he have been watching after me? We had and incident that day where I showed him the meds I was given earlier and he hardly looked at the kardex, a few minutes later "I " caught that it was the wrong time and did not give it

What is the policy of your hospital? I tend to think most expect the preceptor to be watching you while you give medication to ensure you are doing it correctly. I'm assuming the preceptor doesn't have his/her own patients?

wrkoutgirl · Dec 1, 2001

Hi guys! thank you all so much for replying to my post. I did asked for challenging pts, I did not asked for the sickest pt in the unit. . I didn't back up on it b/c judging by how cooperative and informative he was the day before, I expected as P-RN said on his/her reply "You should NOT be expected to get this out of the way on your own. All the reading in the world will not take the place of a preceptor who is right there with you all the time" and this is exactly what happened, he did not watch me, explained, did it once in front of me or anything. I figured things myself, asked someone else or If I had no clue I called him (he appeared annoyed by it) :o Then he did it w/out telling me what he was doing, giving short ended answers to my questions. To answer to 'THIS NURSE"s reply, I did talk to my preceptor even from the first day, I told him how I am so eager to be a great nurse, I don't want to be a sloppy nurse and how I love my pts, I told him how immensely important it is for me that he gives me a goal every day, (takes one minute, doesn't it?) and feed back at the end of the day. I also told him not to feel uncomfortable about criticizing me b/c I want to learn and I am very open to criticism I told him yesterday (third day w/ him) that we should be able to talk things out and that i some times asked questions from other people is b/c I don't want to overwhelm him so either i asked who ever was near me. Yesterday I was very appreciative that he called me a few times to do dressing changes to 2 of his pts so that I practice and he even gave me a compliment. At 6pm they gave me a new admission and I asked him If he was coming w/ me, he said yes, came in, introduced him self to the pt and left. Never saw him again until later when I went to ask the charge nurse some questions and he was sitting next to me asking me to get ready to give report b/c he is leaving at 7 tonight. He left w/out saying good bye probably b/c he knew that for the third time I was going to ask him for that famous feed back that I have not gotten from anyone in my 6 days of clinical so far. The sweet and very knowledgeable charge nurse stayed w/ me correcting the endless list of questions from the admission form that I was doing for the first time. . I hope this also explains things better to you, canoehead. You all must know that because my pts should always come first, is why I posted this subject, I am asking to be taught and I am trying to do my best with the little support that I am getting. I don't think I am giving double messages to my preceptor, I am taking initiative but I am also asking when I am not sure. But I will consider your suggestion canoehead . Oh! , IV certification means that I take a one day class (you practice on dummies, Oh god!) and then you must start Ivs on three "unfortunate" pts correctly and bumb! You are certified!

Thank you so much for your support.

monica

wrkoutgirl · Dec 1, 2001

Oh i forgot one thing, about your suggestion saying that " the first week or so of orientation is very hectic. so much to learn. i cant imagine being bored. you have charting to do and looking up labs, checking your charts...all the paperwork needs to be learned as well as the computer programs. there is always something to learn". In my original post i told you how during my "boring time" w/ my second preceptor, I tried to be productive looking up meds on the drugs books, following people around to watch them doing procedures, trying to figure out drip calculations, looking at pts' kardex to get familiar w/ the meds and so on. My 2nd preceptor watching me doing all these told me "don't worry about it. you will get it. you don't need to home and read all weekend, you'll get it w/ time. this is going to sound funny but you are too eager, come down! about getting on the computer, unfortunally i did not get my code for it until yesterday and charting is done by hand on these endless forms that someone invented and which many of us including the physicians find unclear and incomplete. please don't take me wrong i want your feed back guys but it seems lilke i have tried must of your suggestions. by the way, yesrterday i had the sickest pt again plusss another one and i did fine, besides other procedures on my preceptor's pts. again he mostly watched, he did not do it first as some of you suggested and i would expect so. any way i welcome any other feed back i am receptive to all your opinions and i will practice them on monday at work . thanks again, monica

:eek:

PhantomRN · Dec 1, 2001

After you have some experience these patients that you believe are the sickest on the floor will become a piece of cake.

I agree with Canoehead you did ask for sicker patients, and stated that you were bored with the ones you started out with.

The thing is usually a preceptor starts out giving an easy patient at first to allow you to get a feel for the floor, the culture of the unit, get your feet a little wet and allow you to focus on paper work. The preceptor will do that for another important---(at least I do) --- so I can gauge the knowledge base of the orientee to better fit experiences with her. If she is weak on cardiac pts I can make sure she gets that( but later) conversely, if she is really strong on cardiac maybe we would start with one of those the first day or so, because of the familiarity and then move on to patients she is not familiar with.

betts · Dec 2, 2001

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.

**canoehead, BSN, RN** · Dec 2, 2001

Thanks, it is really hard to have an opinion at all when I cannot see you :confused: 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.