New NICU nurse, feeling very disheartened ;( Question to Preceptors

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    I had a question for nurses who have been preceptors to new nurses, whether you liked it or not Did you spend all your time with the new nurse as she took care of her the patients or did you leave the new nurse alone most of the time (as in left the floor for 30 minutes to hours). If you did can you please tell me how far into the training of the new nurse you did this.

    I ask because I am a brand new nurse in NICU and I find that my preceptor is leaving me alone for longer, and longer periods of times. She is very sweet, smart, and encouraging, but I recently found out from the shift that I gave report to that my pt. got an infiltration. I checked the IV site and I didn't see it blanching or swollen or red. I will learn from this even though I feel terrible right now, but I just want to know if it is the norm for me to be doing a 3 patient workload on my own and I havent even finished my 1st month of training.

    I would appreciate any input or any comments, since right now I feel completely defeated by my mistake and how this will make me look to other nurses.
    Joe V likes this.

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  3. 17 Comments...

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    Hi there!

    I am not a NICU preceptor so I can't really tell you for sure, but I am inclined to think that it is not appropriate for your preceptor to leave the floor for that period of time. Even if she feels you are very competent and will be fine to be alone( which is probably why she is leaving you), They should still be close by in case you have questions.

    I mostly wanted to respond becaue I can completely relate to you because I also had an infiltrate on orientation!!! I know exactly how you feel, I went home and cried, it was all I thought about for days. Believe me, you will be OBSESSED with checking your iv sites from now on, and that is a good thing . You will get over it, I did. And you will learn from it. I have been on my own in the NICU for a couple months now, and it is tough. But I ask a million questions. We have a few nurses on nights who are very seasoned and know everything but don't like orienting or helping new grads. I get some pretty snippy replies sometimes, but I don't care. I still ask! Rather that than make a mistake.

    You will be fine. Almost every NICU nurse I know has made a mistake that "haunts" them. I still think about that TERRIBLE feeling the day I saw that infiltrate. Those who say they never made a mistake are either lying or perfect.

    The important thing is learning from your mistakes. It does make you a better nurse, it made me aware of how sensitive the patient population is. They can't tell you their IV site is hurting, like an adult could.

    So, don't worry. You aren't the only one to have that happen to you! The important thing is to take care of yourself as much as the babies! I got totally stressed and could barely eat and sleep for a few days. That made it so much worse, get plenty of sleep, go for a run, go shopping, whatever you need to do relax!

    Good luck!
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    Thank you sooo much for your post!!! You don't know how much what you just wrote helped this new nurse ! I do feel bad and I have shed my tears over it, I've been obsessing over it and you are right I will be watching those IV like hawks. I've spoken to my mother (a vet. nurse) about it too and she told me that I need to talk to my preceptor about how I feel. That I need her to stay with me, especially after what happened. Thanks again
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    If she isn't on the unit, she isn't precepting you and should be called on it. She does you not a lick of good by leaving you there alone. If you're capable of handling that patient load without your preceptor by your side, then you don't need her anyway. They might as well end your preceptorship.

    Where is your charge nurse while this nurse is gone for hours?
    karnicurnc and Always_Learning like this.
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    It is hard for us to say anything exact because we are not in your situation. However, I've been a NICU RN for almost four years now and have precepted many nurses...

    The IV infiltrate is on her as well as it is you--or at least that is what my educator has told me, since the preceptor is still responsible for the patient. Of course you will be checking all IVs hourly, but those pIVs, you need to be on the dot on the hour, every hour. If you make a flow sheet for yourself where you list what times you give meds, etc, then you can add that to each hour to remind yourself. IV infiltrates shouldn't happen, but they do. Learn from your mistake, figure out what you're going to do so that it never happens again, forgive yourself, and move on.

    If you have been on the unit for 4 weeks, you should be able to take care of 3 patients fairly independently. People do move at different paces, of course, but at the end of 4 weeks, it should be tight, but manageable for you. Your preceptor should always be available to you, although they should not be actively doing any of your cares. 3:1s can be tough (can you imagine 4:1? Luckily I only do that when I do agency nursing and not at my home place) and it takes awhile to get the knack down. You just need to be very organized from the get go and leave no time to waste--every minute that you're waiting for a feed to beep off or for a mom to change a diaper, you should be doing something else like catching up on charting or listening to breath sounds, etc etc. It is a learned skill and nearly all new grads have this problem at first. I know I did and many nurses spend an extra week or two on orientation just getting to organize their care in a 3:1. If it hasn't been a full 4 weeks (a little confused? how many weeks of actual time with bedside care have you done?), there is a bit more leeway and you should be able to utilize your preceptor more.

    Don't beat yourself up; this is what 99% of new grads go through. Even if your prceptor doesn't actively do care for you, they should be around to answer questions and if things get more emergent like a patient crumps. Talk to your educator, talk to your fellow new grads and see how things are going for them...

    Keep us posted on how things go as this sort of thing does get asked a lot about what it's like to be a new grad and your experience could be invaluable to future new grads reading this. Best of luck!
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    I'm a float and work in NICU, I noticed most of the preceptors do leave the new nurses on their own. They are there as a resource. Make sure to check IV lines every hour and document it, if your unsure get your preceptor .
  9. 1
    How can she "get her preceptor" if the woman is off the unit for long stretches of time?
    RugbyPrincess likes this.
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    I guess she would have to go to the charge, and ask her. Then the Charge could ask "where's your preceptor?" it is hard to be a new grad but I also think your preceptor should give you the sense of being on your own. If you aren't ready to
    Be left alone then talk to your preceptor. I'm just saying I see preceptors leave new nurses while they go
    On there breaks or Help other nurses . I don't think it's that uncommon.
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    Quote from Nursingluv101
    I'm just saying I see preceptors leave new nurses while they go
    On there breaks or Help other nurses . I don't think it's that uncommon.
    And I don't think that's the case based on what this new nurse is posting.

    She said,
    did you leave the new nurse alone most of the time (as in left the floor for 30 minutes to hours)
    That is absolutely unacceptable, IMO. And it is amazing to me the nurses some hospitals choose to use as preceptors...especially in a critical care unit like NICU.
    karnicurnc likes this.
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    By the end of 4 weeks that is an acceptable assignment and you should be doing it with minimal help. As for the preceptor...we back off when you are in with feeders after that time frame. We are watching to see if your time management is good and if you are struggling thru anything. As for the should be checking your IV and line reconcilation with each hand the IV to the on coming nurse, say it has looked like this, it flushes etc and trace the line back to the pump and check the label with her. IV infiltrates can happen within an hour, the IV can look fine and then boom it looks bad. Just remember to check hourly and with handoff especially.

    Now the preceptor...we will go help out if needed when our orientor is at this stage, but she should be available to help you and answer questions. Do you have a review with the CNS or manager alone? We do and then the orientors can express any concerns they have. Also, I find it hard to believe that no one would say something to her...we do if we see someone struggling and the preceptor is off doing something else. She needs to be close by, esp when you are taking vents,etc. At this point, the preceptors don't stray far. Or say to her,"I'm not comfortable if I can't find you to help me or when I have questions" . Doesn't matter how nice she is , she needs to be there for you.

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