Being a preceptor blows

Nurses General Nursing

Published

I'm with a nurse that's had 1 year experience in an ICU, who wasn't "making it", and had some complaints from doctors about her care. They put her with me for me to "observe" her, and write down what I see. I decided she would do everything, and I would follow her and be available for questions, and corrections. I didn't realize how hard this is! She can't figure out how to draw blood off a heparin line (should she stop the heparin or not?), she didn't tell me one of the patients only urinated 30 cc's for a 12 hour shift (I thought she should be doing her own I/O doc.), she didn't know whether to hold a scheduled beta blocker for a pt on Neo. She's just not engaged with her pstients, she just goes through the motions, but doesn't really care about them. She seems like she only cares about how she looks as a nurse.

Well, we made a few mistakes today that I wasn't ablle to catch on time, it's actually harder to have 2 nurses together than just 1 sometimes. How do I not hover over this girl, but still watch her so she doesn't harm anyone? Any ideas/suggestions welcome :).

DeepFriedRN

207 Posts

Sounds to me like this nurse probably shouldn't be in ICU. (which I guess isn't too helpful, because there she is, right?) However, I'm thinking that based on the mistakes she is making (after a year?!?), she just doesn't have her basics down, and should probably be sent to an appropriate area to get them. If it was me, that's where I'd be headed with it. Sounds to me like you're taking one for the team, and didn't even sign up to do it.

SurvivorRN

35 Posts

That is concerning for someone who has been an ICU nurse for a year. Some of the things u mentioned are just basic knowledge any nurse should know. I think you both need to have a long discussion and I guess if things dont start changing soon..then the manager needs to know what is going on. Patient safety is important.

Diaper, RN

87 Posts

When I was a new grad, I remembered that it was so stressful to have someone looking over my shoulder. I must be the 'dumbest' new grad and my preceptor was so frustrated with the way how I handled things. Then my preceptor reported to the manager and it made me even more nervous ! Then I had another preceptor which's wonderful because she was very patience with me and taught me step by step and gave me encouragement. Eventually, my skills improved.

My suggestion is that you should find out about the underlying problem. Is it due to lack of knowledge or nervousness? Maybe she didn't have a good preceptor to begin with and nobody taught her the correct way. Instead of letting her to do everything, maybe you should start from the beginning and let her to follow you and observe the way how you provide care to the patient. After that, you should give her some time and see if she'll improve.

Good luck.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

HOVER and document. SHE NEEDS WATCHING.

EarthChild1130

576 Posts

Specializes in Psychiatric.

I would sit down and talk to her and get HER perspective of what the situation is...how does she see herself as fitting into the unit, how does she perceive her skills to be, and what does she feel is the reason she is being precepted again? Then go from there...it could be anything from poor time management skills, poor initial precepting, poor clinical skills, or a combination...and as another posted said, she may need to be removed from ICU (perhaps not permanently) and sent to another floor for awhile to gain those clinical and time management skills with less critically ill patients. You're doing her a wonderful service by precepting her and helping her understand where the kink in the chain is, though...as well as keeping the patients safe!

braddah

27 Posts

When I was a new grad, I remembered that it was so stressful to have someone looking over my shoulder. I must be the 'dumbest' new grad and my preceptor was so frustrated with the way how I handled things. Then my preceptor reported to the manager and it made me even more nervous ! Then I had another preceptor which's wonderful because she was very patience with me and taught me step by step and gave me encouragement. Eventually, my skills improved.

My suggestion is that you should find out about the underlying problem. Is it due to lack of knowledge or nervousness? Maybe she didn't have a good preceptor to begin with and nobody taught her the correct way. Instead of letting her to do everything, maybe you should start from the beginning and let her to follow you and observe the way how you provide care to the patient. After that, you should give her some time and see if she'll improve.

Good luck.

I fully agree!

Its better to have a preceptor that gives back constructive criticisms rather than criticizes! Understanding is a must too!

The clinical lecturer that I liked the most had the following characteristics:

1. praises what I did well!

2. offered constructive advice on what I did not so well.

3. opened the floor for questions/debate

4. approachable

5. knew her stuff!!

6. was strict but really understandable.

hopefully that helps,

great work for being a preceptor! I cant wait to become one too!! YAY

DoGoodThenGo

4,129 Posts

Can only offer one suggestion, make sure you CYOA so that the new nurse's mistakes and errors don't take you down as well.

Also would say yes, it can be helpful to sit her down (perhaps after or before the start of each shift?) and sort of go through things, not only bad, but good as well. Remember as well to make her feel you are not launching a personal attack, but wish to help her grow into a capable nurse.

Maybe kind of old school thinking, have always felt the former ways of having GNs spend a period of time on the floors first, in particular Med/Surg before going onto the units. Things tend to be a little more quiet (yes I know, *LOL*) and it give a chance to address any shortcomings or potential problems before they become a habit.

Best of luck!

traumamike

38 Posts

Specializes in trauma,cvicu,micu.

I am not being mean really, but how has she lasted this long without killing someone! I mean good God, please for the patients sake get her out of the ICU. I really feel for you, I am also a preceptor. This is how I grade my nurses that I precept, would I let or want this nurse caring for me or my family! yes or no? If no then get that person out of the ICU. You tend to give more time for a GN or someone new to the unit, but a years experience! I am always patient with the nurses that I precept and take time in explaining things, because how they perform in their careers is a direct reflection of my teaching skills, but what you have said about some of the task she can't perform after a year in the ICU. Those poor patients, and you, the poor precepter. Well you know what my opinion is, Good Luck!

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

Speaking as a non-ICU nurse, it does seem to me that these are some very basic things that should not be an issue after one year. The big question I would have is, does she have any strengths that lend themselves well to the ICU, and these are some holes in her training that just need some followup, or are these things symptomatic of a general lack of aptitude for the type of nursing that the ICU environment requires?

If the former, then she just needs a little followup training to fill in the holes.

If the latter, then for the sake of the patients, she needs to be transferred somewhere with a lower acuity patient population. This need not be addressed in a heartless way that destroys her self confidence. It can be put in terms of "You have X, Y, and Z qualities that are really wonderful, but the ICU isn't for everyone, and maybe you just haven't found your niche yet."

RoyalNurse

109 Posts

Specializes in CVICU, ER.

Thanks everyone for your reply. I used to think preceptoring would be "fun", I would show some eager smart nurse everything I knew. :) It's the hardest thing I've ever done, it's like having a full patient load, plus an extra two. Probably an extra three if it's a new grad. I have the highest respect for my preceptor, I WAS a new grad in the ICU!

Ruby Vee, BSN

17 Articles; 14,027 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
when i was a new grad, i remembered that it was so stressful to have someone looking over my shoulder. i must be the 'dumbest' new grad and my preceptor was so frustrated with the way how i handled things. then my preceptor reported to the manager and it made me even more nervous ! then i had another preceptor which's wonderful because she was very patience with me and taught me step by step and gave me encouragement. eventually, my skills improved.

my suggestion is that you should find out about the underlying problem. is it due to lack of knowledge or nervousness? maybe she didn't have a good preceptor to begin with and nobody taught her the correct way. instead of letting her to do everything, maybe you should start from the beginning and let her to follow you and observe the way how you provide care to the patient. after that, you should give her some time and see if she'll improve.

good luck.

i'm sorry -- after a year, she should be able to comprehend the basics. even if she is nervous, because there is always someone or something that can make you nervous in real life. after a year, she shouldn't be re-starting orientation, and as i understand the op, that wasn't the task she was given. she was even the task of evaluating whether or not this person belongs in the icu. clearly she doesn't. document, document, document!

and to the op: you should be checking her charting as often as possible -- at the very least every two hours. that way, you would have caught the oliguria before the end of the shift.

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