Am I over reacting? what to do with my preceptor?

[dann023]

*Sorry for the LONG post in advance.. but I really appreciate for any suggestions/advice*

I am a new grad, 3rd day on the floor. Today was just a disaster! I don't feel like my preceptor is assessing me accurately and is pushing me too hard and too fast. But he wouldn't listen to my concern, keep saying "you're ok~ you're ok~".

I would like to hear more opinion, to see if I am over reacting or I am really okay. I am really concerned for myself and patient safety, and wonder if I should speak up for myself or even involve the educator to have them help me communicate with or change a preceptor.

A quick overview of our floor, it's a floor with heavy/unstable patients, mostly on vent & telemetry, lots of wound care need, mainly elderly, we get lots of rapid response team call - nickname "tower of terror". (I work in acute care hospital btw)

About me -old grad from May 2011, last clinical adult Med-Surg experience was 2^nd semester was in spring 2009. Precept in pediatric, so really unfamiliar with adult med/surg since it's been sooo long.

About my preceptor - known for "good nurse, never see him have to stay overtime, he's FAST, efficient". I'm his first preceptee.

My first two shifts, I had 2 patients, and the same patients for both days. Both very stable, not many med. First day was mostly observing and gave some med, 2^nd day - since we had same patient and both of them were improving, it went smoothly and easy, he had time to show me things and explain. We got everything done on time.

Today!

Pt #1 - came in for GI bleed, on 2 IV med, pain med round the clock, was NPO/prep for EGD & Colonoscopy. Needed Platelet transfusion before GI procedure. Diabetic - need to check BS & insulin. Activity independent.

Pt #2 - Obese, Total care, turn q2h, with a leaking ileostomy, has F/C, couple PO and IV's with a PICC, multiple DTI and a healing stage II ulcer. And discharged at 6:30pm - right before shift change!

Pt #3 - Came in for DVT - on heparin drip and warfarin, bilateral foot ulcer require dressing change, couple other DTI. Also diabetic - need to check BS & insulin, Many PO med, some IV. Bedside commode with assist.

It was a nightmare!! I was running around like a headless chicken the entire day, besides knowing what time I had meds due, I had no clue when or how do to dressing change, what to do regarding procedure prep, how to give transfusion - I have never done any of these things in school.

In the morning, after report, my preceptor literally went "OK - today I want you to tell me what to do - you be the boss". The 1^st day, he taught me his routine - get report @ 7 - 7:30, read up chart @ 7:30 - 8.. so I did that. We sat quietly in front of computer no talking just reading up our own chart. Usually he talks me through, but today was just silent! I felt soooo lost. NOT familiar with the new computer system, the med, the Dx, the treatment. He had the look when I try to ask him question after report - "what question could you possibly have? What part of the report don't you understand?" When I tell him my plan - for who to see first, he just said "ok". 80% med I gave today, honestly I don't really know why patient need it, so I tried to look them up, but when I'm in the med room looking up (takes long time) he just went "what are you doing?" as in - "why are you taking so long?". And SO MANY time he end up having to just grab the med for me and tell me "it's for ____". Or it's for ___. I go into patient's room scared that the patient would ask me why he/she's on the med... cuz I am not even sure how it is related to their illnesses!

40% of the time today, because we are SOOO behind, he often go - go chart, go finish charting, "I will give this med for you", "don't get the call light - I got it, go chart!", "I just called the doc, he said ___, ___, are you done charting?" if I'm not charting, I'm giving medication, and it was like he telling me to do everything. Besides this morning, the entire day became the telling me to do 80% of the things - "after you give this med, go to room 14 and do that, and then to room 15 finish that, then you can chart. OK?" "I'm gonna call the doc for ___, you go chart." "I'm gonna help room 14 turn and change the ileostomy - its okay, you stay and finish charting, I don't want you to be distracted." OMG - I hate this! Not that I mind being told what to do, but I'm so anxious the whole day because I feel this is NOT OK. When I'm by myself, I am not going to chart all day, chart become less priority. I won't have someone there do all the things for me, handling all the call light and phone calls just so I can chart!! I mean I finished charting all the medication on time - the assessment, I will do it when I have time. But I really feel my preceptor is controlling my time, when I have some free time, he's CONSTANTLY behind my back and tell me now go to this room and do this, then you can chart. Or don't chart right now - that's not important, do this first!

I feel I didn't learn anything really today, I mean yes I got to see dressing change, I saw him did ileostomy change, I saw him did PLT transfusion, etc. But he took over most of everything because we were so behind - he had to do it to speed everything up. I never got to talk to the doctor the past 3 shifts. When I tell him I am scared to talk to the doctor - "oh its ok, you just talk to them.." - (very helpful = =)

WORST of all, when I was in med room opening up the eMAR about to do 3 check 5 right on medication, he told me "it's okay, you already know the patient, you don't need to check here with the computer, just go to the patient room and check there, saves time!" - you can tell he really want to rush to get all the things done. It's FREAKING ME OUT that even doing 3 check I'm being rushed.

We stayed 40 minutes after work just for me to finish charting. I try to tell him today was too much for me. I need to have 2 patient, and open for new admit. He insist he will let me have 3 patient still, he kept on saying it's ok.. you didn't make mistake today, it's good. I have too high of expectation for myself, blah blah blah ..at the end he said what I think it's the real reason.. "I won't let you go back to 2 patients, because you'll eventually need to care for 4 patient, and today is only 3 STABLE patient. You gonna need to adjust to it"

I am so anxious and I want to quit just because I feel so unprepared. I have 6 more shifts only and I am on my own. I do not think I can survive. and feel he's not listening.

Am I over thinking? Is this normal? Should I speak up and call the educator to step in? (btw, don't get me wrong, my preceptor is indeed a good nurse, experienced, compassionate, and follow good practice when not rushed) But still.. I am not sure if we are best fit for each other.. what do you guys think? Should I go in next Tuesday (my 4^th shift) and try another day with 3 patient? Or Try to get a hold of nurse educator on Monday hoping she can talk to my preceptor or someone before Tuesday.

I feel my confidence is really crushed today. Feel like a 1st semester nursing student, even giving PO med I'm being watched. if it continues, I think I will doubt myself more and more.. I need quality preceptorship time, not just focus on quantity...

[loriangel14, RN]

It does sound like the preceptor is not a good fit. I would question him rushing you and not giving you time to look up meds.Telling you to cut corners in order to save time is not right either.He may be a good"fast" nurse but I don't think he is a good preceptor. I also think they are not giving you enough time before expecting you to be on your own. 6 more days is not nearly enough.If I were you I would bring my concerns to whoever can help you.

[vcastio]

So first of all, are you a new grad? Or new to the hospital? Because you said you graduated 2011. If you are an experienced nurse, it sounds like you are over reacting. There's no reason why you should not be able to take those pt's, especially with his assistance. You got some really good experience today it sounds like, so don't freak out, be happy! What if this situation had occurred once you get off orientation? At least now you have had some good exposure, learn from it! You might not have hung the platelets, which is incredibly simple, but at least you saw how it's done! That combination of pt's sounds fairly common in my experiences, but I have seen much worse! Try not to over think everything and work on time management, I think that's what your preceptor was trying to get through to you, and sounds like your main issue. Also, when you are in the thick of it is not the time to be looking up every med, he's right, you need to come prepared! Look them up at home or before your shift starts. If you are that inexperienced you need to show up early and become familiar with these things before the shift. As far as the 3 checks, you should already have your first check done long before a med is due. Then if you have the eMAR and pyxis up to pull meds, that's your second check, so I don't understand the problem? My advice, get there early and address some of these issues before you shift starts, and work on time management. Listen to you preceptor.

[staffing24]

Wow, sounds like you had quite a day! :) Congratulations on surviving! I am working on pre-reqs for nursing school, but I remember the first day on my own in CNA training. The CNA I was with said, "go to room xx and get the patient up and ready to go to Activities." I walked into the residents room and looked at him, and I honestly had no idea what to do, where to begin. I was terrible! I think you should give yourself a break, and just keep on trying. Does your preceptor treat you basically with respect and treats you ok? If the preceptor was actually mean to you or made you really uncomfortable I may consider switching, otherwise I would stay with the current preceptor. Can you go in early to prepare? Either way good luck. I have been new at many jobs and it just takes time to know the ins and outs. Good luck!!!

[Nurse ABC]

I think dann023 is NOT an experienced nurse in med-surg which is why she's having trouble. Your preceptor is NOT a good fit and I would go straight to the educator and ask her for another preceptor that is more patient with teaching and/or to give you more orientation time. I had a very similar experience and was so overwhelmed I was ready to quit but then I got mad and thought no I didn't start this to quit and went to my clinical manager and explained the problem and they found me someone else. I had to even go on a different shift for a while but it made all the difference in the world! I only had 3-4 shifts with my original preceptor as well. Everyone said she was a great nurse and she was but not a great preceptor at all! I think she was relieved as well to no longer have me and has been very nice to me even after requesting someone else. No matter what happens hang in there because it DOES get easier and once your on your own you can do things in your own way to make you feel safe and you can ask anyone for help or with questions (not just your preceptor). Good luck!

[albsRN]

Hi,

I'm a new grad as well into my second month of orientation on a critical care floor. I know very much what you're feeling! I remember during weeks 1-3 my preceptor was the same way: at the beginning of the shift, she'd say she wants me to be in charge of stuff, take initiative and have responsibility over everything. Then it would end up with her doing most of the patient care and telling me to chart constantly! I felt so discouraged and thought I wasn't learning- I was disappointed in myself for not being able to do everything and also felt she expected too much of me at the same time.

Now that I'm a couple of months in I realize she needed me to become very fast and good at charting. In reality you have to be able to do everything and also chart what you did well and I think it was actually good to get the charting skills out of the way so now when I do care I know in my head how I need to chart it. She was just stepping in to help, and things balanced out as time went on.

Also, I found out that a lot of the times that I felt I was doing barely anything- turns out she just thought our pt's were too critical or complex for a new grad and she herself was stressed out caring for them. I think sometimes preceptors seem mean for taking over but the reality is that the assignment is very busy and they just know it needs to get done. Hopefully you two can have a more appropriate assignment that allows for time to teach and learn. I wouldn't complain about it to your educator yet- you've only had one bad day so far. Trust me I know sometimes our confidence is just totally shot after a shift like that but in a few days you'll be able to go in there again optimistic. Write down the drugs you didn't know and look them up with you get home if you need to. Sometimes there just isn't much time for questions. Now, if it was a relaxed assignment and your preceptor acted like that then I'd say you may have a problem there. Good luck and I hope things start to turn around for you sooner rather than later! :)