What makes you nervous about or irritated with a new grad or orientee?

allantiques4me · Jan 14, 2007

I agree with you guys that feel the know it all nurse is the worst.Ive always found that the person that thinks they know it all, are the first ones to make a serious mistake!how much ya wanna bet shell be one of the first to make a serious,or small mistake.I always thought that was just one of my pet pieves,but it looks like a lot of you feel the same about know it alls.

twistedpupchaser · Jan 14, 2007

I have only just finished a four week clinical practice where I had a variety of preceptors. At the handover a nurse would be given responsibility of "the students" (said in a variety of tones) to work with for the shift.

There was a young nurse who wouldn't get out of her own way and thankfully we only had her for 2 shifts. All of the others ranged from good to great through to excelent. There was bitching and moaning about the level of skills that we bought to the ward and the fact that we had to have everything checked and countersigned but apart from that the mood was great throughout all of the staff.

My favourite gripe coming from the preceptors was that we were there at the wrong time because there was nothing interesting happening on ward at the time. Talking about favourites, my favourite preceptor was an old lady who trained in the old hospital (apprentiship) system with the stern matrons and harsh discipline, these she spoke of in a romantic light through rose coloured glasses. Even at her age (we joked that she trained with Florence Nightingale) she was up to date with her practice and could explain why procedures are done, not to just do them.

I have to say that these good preceptors made my placement enjoyable as well as educational, so to all of you with the patience and attitude to precept us trying-to-be-competents.......THANKYOU!!!!

Marie_LPN, RN, LPN, RN · Jan 14, 2007

look you guys been there before too

In orientation, yes, but i paid attention during mine and didn't use the time to flirt with the doctos, though.

truern · Jan 14, 2007

Now ... you've got to go find the aide and get them to do their job. They still think you're being a primma donna when, in fact, you've got a lot of catching up to do because you helped them in the first place. So, I learned the hard way that I've got to get my RN work done first, no matter what the aides think.

Absolutely!! After all, we can help them get their tech tasks done, but they can't help us complete nursing responsibilities.

I don't take a break or lunch without making sure my tech is caught up and can take a break as well. Funny thing though: I've often been up to my eyeballs in work and find my tech knitting or surfing the net.

Jen2 · Jan 14, 2007

I have not read all of the responses, so I am sure a few of these have already been posted but here are mine:

1. When I ask a new nurse if she/he wants to go see or help with a procedure and they tell me that they saw that once in nursing school.

2. One of the first things I do with an orientee in the ED is have them follow a nursing assistant around so that they can help them stock rooms, IV baskets, go to materials and pick things up etc. They look at me like I have three heads and are highly upset. I politely tell them that half of the battle in the ER is to know where everything is at and how to get it in a pinch and this is the only way you will learn. They seem to think that stocking is above them. Sorry but it's the only way you learn where everything is at.

3. When a peds patient or neonate needs an IV, meds, or a straight cath, and the orientee has watched you do about 20 and still refuses to try. Sorry but there has to be a first time. You will be off orientation in 3 weeks and will be expected to do it.

4. This one is not only for new nurses, but all new ED nurses. When you get argued with that putting IV's in the AC's is stupid, becasue the floors don't like them there and the patient can't bend their arm. Just not too long ago had a orientee that had been a nurse for a year and worked on the floor. She was putting #22g IV's in the hands of all patinets. Argued with me that it was the best place, because she worked the floors and how it caused less trauma to the patients, and how these patients were not even sick or being monitored (we start orientees on the non-emergent area of the ED). Well after our back pain turned out to be a leaking AAA, that eventually ended up being intubated and transferred to the CTU, she saw how worthless that #22g in the hand was when we had to resuscitate the patient. Please don't argue. I will tell you the rationale of why we do things. You can either listen or find out the hard way.

5. I am very hands on with orientees at first. After they learn where everything is at, what doc is what, have followed me around for about two weeks, etc. etc. If I am assigned to six beds I like to give them three of the six patients, and tell them if you need me I am here, ask for help. I have been acused of setting on my rear end and not helping by one particular new nurse. When I told her thats not the case, that I was doing this so that she could learn how to prioritze and know when to ask for assistance from co-workers she said she understood. I'm not just being lazy here.

6. All time favorite is "Thats not how they showed us in nursing school." I don't need to explain this one.

Ruby Vee, BSN · Jan 14, 2007

i've noticed alot of threads lately from new nurses who seemed quite stressed out, which i can totally understand, i've been there for sure. so i thought i'd start a thread from the other pov. this shouldn't be an opportunity to be sarcastic or uncharitable, but maybe it can help a new grad to see the other side of the story.

i've noticed a tendency among new nurses to personalize stuff that really isn't personal. if a preceptor or co-worker corrects them, no matter how tactfully, the new nurse assumes that she's being eaten, that the preceptor is mean or that the co-worker is evil and hates them. then they complain about how they're being picked on, forced out of their work places and driven out of nursing and everyone rushes to comisserate with them. (ok, i've exaggerated a little -- but only a little!)

how about the new grad who has left three jobs in five months and is now leaving nursing because she has a "cloud of mean people following everywhere i go"? perhaps this person's choices are informed by the fact that she's currently married to a man who has enough money to support her and their coming child. i wonder what her choices would be if she were a single mother struggling to pay the bills, pay pack the loans and support her child on her own. perhaps with a little more maturity and a little less fiscal comfort, she might conclude that her preceptors were tough but had a lot to teach her and that she could stand to learn a bit more.

how about the new nurse who was driven out of the er by mean, evil nurses who were old dinosaurs and shouldn't be running things anymore? this nurse was convinced that they all hated her because she was beautiful. perhaps with a little more maturity and a little less self-involvement, she would analyze her interactions with these nurses to see that maybe she got off on the wrong foot with them, and perhaps there was a way to improve relations with her co-workers short of leaving. communication is a two way street, and i have no doubt that both sides of this story have something to apologize for.

not all nurses are cut out to be preceptors, to be sure. not everyone's communication style meshes with everyone else's. sometimes a preceptor is just a really good nurse with a lot to teach and an ineffective means of teaching it . . . and sometimes these nurses don't get to choose whether or not they will precept. sometimes, however, when a preceptor says "we do our i & o's differently here," what they really mean is "we do our i & os differently here, and let me show you how" and not "you stupid little twit! how did you ever get through nursing school? you'll never make it here, and i'll make sure you get driven out on your a$$!"

a preceptor who goes all out to humiliate and demean an orientee is wrong. anyone who curses at, insults or calls an orientee names is wrong. but a preceptor who says "did you give that potassium?" in a tense voice when the patient is having longer and longer runs of vt is probably just a tense, stressed out nurse who wants to know whether you gave that potassium and whether that could be the reason the patient is having vt. maybe she didn't take the necessary time or make the extra effort to make sure that you weren't percieving an insult where none was intended. or maybe she just thought you were mature enough and professional enough to get it.

there are bad preceptors -- sometimes they're really good nurses and the right orientee can learn an awful lot from them. sometimes they're just bad nurses. there are lazy preceptors, and i don't doubt that there are even a few mean preceptors. but in reading these boards, it seems like the overwhelming majority of nurses and preceptors are mean, evil people out to humiliate and terrorize innocent, well-meaning new grads who have never done anything to bring this on themselves. i have difficulty believing that. the majority of nurses i've met in my long career are good people. sometimes they're bad nurses or bad teachers, but most of them are good people.

communication is a two way street, and if you're having difficulty communicating with your preceptor, look to your own communication skills first. those are easier to change than anyone else's. you don't have to like or feel liked by a preceptor to learn from her or him. it helps, but it isn't necessary. if you feel like your preceptor is always picking on you, perhaps it's because they think you have a lot of potential and they want to help you become the best nurse you can be in the shortest time possible. or perhaps it's just because they're anal-retentive and have poor teaching skills. you can still learn from them, even if it's only what not to do when you eventually become a preceptor.

and lastly, preceptors were new nurses once. they remember what it's like. in all liklihood, you have never been a seasoned nurse with a newbie to watch over and to teach while you still carry a full assignment and patience isn't your best virtue and those docs keep writing orders and that new nurse has so many questions and you haven't had a break all day and your bladder is about to erupt and your blood sugar is about two. so before you start bemoaning the idea that your preceptor has forgotten what it's like to be a newbie, think about the idea that you have no idea what it's like to be in her shoes!

i have no doubt i'll be flamed for this post -- but my intent was to help new grads understand things from their preceptor's point of view. if one or two orientees or about-to-be orientees stop and think, i'm glad. let the flames begin from the rest!

TazziRN, RN · Jan 14, 2007

4. This one is not only for new nurses, but all new ED nurses. When you get argued with that putting IV's in the AC's is stupid, becasue the floors don't like them there and the patient can't bend their arm. Just not too long ago had a orientee that had been a nurse for a year and worked on the floor. She was putting #22g IV's in the hands of all patinets. Argued with me that it was the best place, because she worked the floors and how it caused less trauma to the patients, and how these patients were not even sick or being monitored (we start orientees on the non-emergent area of the ED). Well after our back pain turned out to be a leaking AAA, that eventually ended up being intubated and transferred to the CTU, she saw how worthless that #22g in the hand was when we had to resuscitate the patient. Please don't argue. I will tell you the rationale of why we do things. You can either listen or find out the hard way.
6. All time favorite is "Thats not how they showed us in nursing school." I don't need to explain this one.

YES!!!!!! I have been at this long enough that most of the time my instincts are right. If I have something telling me to sink an 18g into the AC of someone being admitted, don't argue with me, especially not in front of the pt.

I've actually had nurses on the floor change the IV site as soon as the pt got to the room, to a smaller gauge and more peripherally, only to call a code later in the shift and the AC line is gone. Or, when I call report the nurse asks me where the IV is, and when I answer "AC" they ask me to change it before sending the pt! Almost always it's the newer nurses who do this.

Roy Fokker, BSN, RN · Jan 14, 2007

4. This one is not only for new nurses, but all new ED nurses. When you get argued with that putting IV's in the AC's is stupid, becasue the floors don't like them there and the patient can't bend their arm.

Curious you should mention this.

Last night (I work nights) we had a new admit come in. We were already full (7 pts. a piece) but my two other co-workers were already dealing with fresh admits/post-ops so I volunteered to take on my 8th patient. While I'm assessing her, I see that she has a #20 in her Left AC ... good catheter, just no J-loop. So I tell her that I'm off to get her a J-loop in place.

She said "I know you floor nurses don't like it there". I knew she was an ER nurse (who worked in our ER). I gently patted her arm and said "Yes, we prefer if it's not there - but I know the reason ER puts it there."

See, I'd precepted in ER before I graduated and on my first day I'd observed my preceptor put IVs in all day. At the end of the day, I asked her as to WHY does she put them in there when there were better sites lower on the arm? After all, isn't it prudent to start there and work your way up? She told me that "Well, in the ER you never know who or what you're going to face. The safest bet is to place as large an IV as you can in as large a vein as you can - so if someone suddenly needs a lot of fluids/meds dumped into them, they have a good site to get it from".

I never forgot that lesson. And I pass it along to all nursing students who show up on our floor.

My only gripe is with folks who start IVs, Tegaderm OVER 'em - but don't bother adding a saline lock!

Please folks! If you can't add the J-loop, it's fine... but please, please add a saline lock!

cheers,

TazziRN, RN · Jan 14, 2007

Roy, all my pts get locks with a loop, then I plug the IV in. I learned that trick from a peds nurse who told me it's much easier to start pedi IVs that way. I started doing that with all pts because I lost a few when the weight of the tubing pulled the IV out before I had it secured properly.

nurseinlimbo · Jan 14, 2007

I'm sure that the first message that every new grad gets when they start on the floor is how little they actually learned in school. We never got to start even one IV before we graduated, had very limited experience with catheterization, none with NG tubes, and were only allowed to watch an RN do TPN or central lines, picc lines, etc. We were not taught how to do IV push, retrograde meds, etc. etc. etc.

I was an adult student who had already worked in the health field for some time, and I realized how limited our experience was. I was very frustrated by the fact that we weren't better prepared to graduate, and to add to that frustration, when I started preceptorship, the message was, "you should know that already". It isn't a new grads fault if they aren't taught things that they will need to know once they get out in the real world, it is the systems fault. I'm not saying it is like this in every workplace, but in my city hospital, RN's go out of their way to make sure that interesting procedures occur when the clinical students are occupied or on break, but yet will be the first to call a student when a depend needs to be changed. I have had a seasoned nurse turn her back to me in her chair at the desk when I asked her a question. I stood there, and she turned to see if I was still there, and then turned her back AGAIN. Same nurse pushed down to the floor one of my colleagues who found a patient on the floor. This is what we face as students and new grads.

TazziRN, RN · Jan 14, 2007

Limbo, the "you should know that" comment probably comes from older nurses who did learn most of those things in school. When I was in school many years ago we did caths every time we turned around, same with NG tubes. We didn't start many IVs because of the lack of opportunity, but we did a lot of blood draws so we got venipuncture experience. I was surprised to find out that grads in the last few years do not get that experience.

PANurseRN1 · Jan 14, 2007

nurseinlimbo wrote:

I'm not saying it is like this in every workplace, but in my city hospital, RN's go out of their way to make sure that interesting procedures occur when the clinical students are occupied or on break, but yet will be the first to call a student when a depend needs to be changed.

Yeah, you've got us there...we have so much control over what goes on that we can diabolically scheme to have the interesting procedures come up when the students aren't around. We intentionally make sure that students miss out on unusual experiences.

We're just that evil.

:uhoh3: