aggravated during orientation

[cubbynurse]

I am having two issues currently during orientation and I don't know how to go about either of them.

Issue #1: I'm not sure if my preceptor is always following proper procedure.

Sometimes my preceptor will do something that she has recently told me I can not do (i.e. excessive verbal orders, putting in orders, such as for a diet, without ever talking to a doctor, taking orders from a med student when the resident is in the middle of surgery). This always confuses me completely because she will have just recently told me I specifically cannot do this thing. I'll ask her for an explanation but I don't really get one. My mom (who is not a nurse) said it sounds as if my preceptor is not supposed to be doing these things and that is why she can't give me a good explanation. I'm concerned that I'm learning incorrect shortcuts and I thought that part of orientation was to learn proper procedures for that hospital and unit...and I don't feel like that is happening. I don't want to get anyone in trouble here but I also don't want to learn the wrong thing, make a mistake, or cause harm to a patient. Does anyone have any suggestions of what I could do here?

Issue #2: I cannot delegate.

I know this has been brought up a lot....but my situation is a little bit unique. While in school I was a nursing assistant on the same floor where I am now a nurse. I loved the unit and despite my concerns about this transition, I wanted to stay with this same patient population. While I was a student many of the other NAs would complain to each other and me that the nurses were "lazy" and that was why they were making the NAs do their work. I would never complain like this and tried to point out that we were all busy and all trying to take care of the patients. The only time delegation bugged me was when I actually would overhear a certain nurse refusing to do something a patient requested, like take out her garbage, because "that's not my job, I'll send in the NA" (technically not my job either, but if a patient asks me and I can physically/legally do it I'm not going to refuse to do something!). Even in school I did not have a full concept of how much charting I would have with a full load of patients. I was very nervous to delegate but my preceptor encouraged me to practice doing so, so that when I was too busy to do all the RN and NA work I would feel comfortable delegating as appropriate. I am polite when I ask (and having been an NA on that floor I know very well what can be delegated to an NA) and always say to please let me know if it cannot be done. Last night I asked an NA to check a blood glucose on a patient. She said okay and when I went to check it had never been done. I asked her what the result was (thinking maybe she just hadn't charted it) and she said she hadn't done it. I asked her to please let me know, next time, if she is unable to get it done so that I can go and do it. She just looked at me and walked away. I did the chemstick myself, which wasn't a huge deal as I am fully capable of doing it but I felt like my attempt at delegation was completely ignored. I don't know how to word my delegation any better....and I am scared that I am going to be labeled as a "lazy nurse" if I continue to delegate but I also know that if I do not ever delegate I will be swamped. Any thoughts?

[DreamingTree]

I think it's fairly common that an experienced nurse may teach a new nurse the right way to do things --- even as she takes unorthodox shortcuts. My preceptor has done this at times, but I know to follow proper procedure. The only time this becomes a problem (for you...) is if she doesn't teach you the right procedure.

As for issue 2, I think many of us new nurses struggle with delegation. It's obviously harder for those, like you, who have to do so with former peers. Pay attention to how you act when it comes time to delegate. There's a fine line between being nice and being a pushover. I always ask nicely, using please & thank you liberally. Plus, I'll often offer to help, or do the task myself, when I have time. However, I'm careful to carry myself with confidence so that I'm taken seriously.

You realize that you won't be effective in your job unless you prioritize & delegate. No one worth worrying about will accuse you of being a lazy nurse for doing this. I don't mean that to sound rude -- it's just a reality. Those who complain the loudest & point fingers are usually just stirring the pot.

[KourtneiNurse]

My preceptor takes shortcuts too. Most times she will tell me that it is a shortcut and sometimes I can tell that she is soley doing the "right thing" because I am there. The tuth is, no matter how strongly you feel about doing things as you were taught in school, there will be times when that just isn't practical. As a new grad, I have run into that myself.

I work nights, a patient has been on his call light all night, super anxious, whining about every little thing. Complains of slight pain, too cold, too hot, nausea, well not nausea, a tummy ache, no, phlegm in my chest, no, heartburn with a little nausea. etc. He asks for tums, but there is no order for it. Its about 3A. He is fine as far as F&E and 1 little tums never hurt anyone. Do I borrow a tums from the pyxis or tick off a doctor at 3 in the morning for a tums, you know? I think as we go along we will anticipate what needs to be done and we can either wait for the docs to tell us exactly what we already knew, or we can wait. Some things, by all means, I'd rather wait (more serious meds, some treatments, etc) but a pt who is NPO for surgery in the morning but the pre-op stuff hasn't been ordered yet-go ahead and initiate it.

As for the delegation. Thats a tough one. I have a similar problem except I never worked with the NA's. I look very young and I am very small in stature. Until I am fully comfortable in my surroundings, I can come off as soft spoken and shy. So they didnt want to listen to me at all. Its getting better though. You have to take time for them to transition in their mind that you are not an NA anymore. Say what you have to say and leave little room for protest. Sometimes you have to come off as if you mean business to get them to take you seriously. Then later smile and talk with them. Thank them and praise them for things that you would think need no praise or thanks. Ignore the attitude, I act as if I dont even notice it. And I stay on them til they do what I ask. The reality is, you need them and without you they wouldn't be needed either. I'd rather be seen as the "lazy" nurse by the techs, than to be the "incompetent" or "disorganized" nurse by everyone else.

Good luck.