Being a preceptor blows

Virgo_RN, BSN, RN · Jul 30, 2009

You know, if she's struggling to make it this hard after one year, maybe it'll be a load off her shoulders if she's transferred elsewhere. She may feel some sort of internal pressure to stick it out and not be a quitter. Besides the obvious service to the patients, it may also be a kindness to her to send her elsewhere.

RN1982 · Jul 30, 2009

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 :).

I'm going through the same thing with another co-worker. He doesn't know the ICU protocols even though its been months since his orientation. He asked me the other night how to do a sedation vacation. I pulled out the protocol and showed him the guidelines and explained it to him even though I have explained it to him twice before. He also asked me if he should stop the TPN when he drew midnight labs. He also asked me to assist with bathing his vented and sedated female patient stating he didn't feel comfortable because he didn't want to be sued. I kindly told him to get over it and explained that bathing an alert/oriented female patient was quite different than bathing a sedated/vented patient i.e. the sedation. It was just frustrating. To top it off, he only seeks out people he is comfortable with to ask questions, which is fine. I'd rather him ask than not ask and kill his patients, but it has been to the point where his constant questions and needing of guidance has begun to interfere with my care of my patients. One night, it was about every 10-15 mins..."Can you help me with this, can show me how to do this?"...It makes me wonder how he got off orientation...

RN1982 · Jul 30, 2009

Anyhow, my co-worker is a nice guy, just low confidence and self-esteem. I'm gonna call him out on it because it's to the point where other co-workers are being snarky towards him. I've done it a couple of times out of frustration, I admit. But really he needs to grow a pair and stand up for himself.

nslpriv · Jul 30, 2009

It sounds like being a preceptor to this particular nurse blows but I must say that being a preceptor is usually a very positive experience. In this case you must document your concerns and bring them to your manager's attention. Patient safety always comes first. If this nurse hasn't been able to grasp the basics by now my guess is she never will. Maybe she looks good in the mirror but her lack of mastery of the basic skills and poor development of critical thinking skills leave her, you and your institution wide open to potential problems. Now is the time for you to take positive, forward action to getting this nurse out of the ICU. She deserves someone sitting down and being very honest with her and pointing out the areas of concern. Don't give up on precepting. You sound as though you have your act together and have alot to offer other nurses. Good for you.

TigerGalLE, BSN, RN · Jul 30, 2009

Oh brother...

Well I've learned that a lot of new grads just need a confidence booster. Now the things you mentioned do seem basic. But sometimes new grads will ask questions to things when they already know the answer. They do this to boost confidence. If you give them the answer and it was already what they were thinking then YES up goes their confidence. Many new grads will do this for about a year until they are consistently making the right decisions. It is okay for new grads to ask questions. Even if they seem stupid and silly to you. Most of the time it is just to boost their confidence. Now it sounds like this particular nurse wasn't asking questions and it got her in trouble. Those are the scary ones. You need to teach her that it is okay to ask. Better to ask than not to ask 100% of the time.

When new grads come to me to ask questions I usually laugh and tell them some story of something stupid I did as a new grad. This makes them laugh and they learn that it is okay to not know everything. OR I will walk them through figuring out the answer on their own. Like if they ask me a question that I really think they should know the answer to. Then, I'll quiz them back with info that will help answer the question. All of a sudden you see that light bulb go off. BOOM they've rationalized and figured it out. The more you do this the more they start putting the puzzle pieces together on their own.

Yes being a preceptor is much harder than just having your own patients. That is why only certain nurses are chosen to precept.

wooh, BSN, RN · Jul 30, 2009

It sounds like she's been taught the tasks but not the thinking. Because this stuff seems basic. But it's all a symptom of not thinking through the whole picture.

I do best with people almost off orientation, as the "substitute" preceptor. Because I'm actually pretty good at the stay in the background kind of orientation, and suck at the showing everything. And I think that you're right with the let her do everything approach. But with that approach (and why I think I'm good at it and others aren't), is you have to keep a close eye on her doing everything, and discuss with her on a regular basis, why is she doing this (not an accusatory "why on earth would you...?" but a "what's your thought process right now?"), and a discussion of why you would instead do x or y. You can't just check her charting at the end of the day with a checklist of did she complete all her tasks for the day. I constantly think through what *I* would be doing for my patients. Sometimes the orientee is on track with exactly what I'd do. Sometimes what they're doing is better, and I think to myself that I need to add that to my orificenal! Sometimes it looks like they're falling behind, and I give a short amount of time to let them catch up, see if they'll catch something that they're missing given a bit of time and maybe some hints. The hardest part is remembering that a lot of things I think are priorities are really preferences, so recognizing they don't have to be exactly like me, but making sure that in the end what they're doing will still result in a good outcome.

I think you need to watch her even more closely, and discuss on a regular basis, "why are you thinking this?" or "Have you noticed x and y? And how would that affect what we're going to do here?"

RoyalNurse · Jul 31, 2009

Oh brother...
Well I've learned that a lot of new grads just need a confidence booster. Now the things you mentioned do seem basic. But sometimes new grads will ask questions to things when they already know the answer. They do this to boost confidence. If you give them the answer and it was already what they were thinking then YES up goes their confidence. Many new grads will do this for about a year until they are consistently making the right decisions. It is okay for new grads to ask questions. Even if they seem stupid and silly to you. Most of the time it is just to boost their confidence. Now it sounds like this particular nurse wasn't asking questions and it got her in trouble. Those are the scary ones. You need to teach her that it is okay to ask. Better to ask than not to ask 100% of the time.
When new grads come to me to ask questions I usually laugh and tell them some story of something stupid I did as a new grad. This makes them laugh and they learn that it is okay to not know everything. OR I will walk them through figuring out the answer on their own. Like if they ask me a question that I really think they should know the answer to. Then, I'll quiz them back with info that will help answer the question. All of a sudden you see that light bulb go off. BOOM they've rationalized and figured it out. The more you do this the more they start putting the puzzle pieces together on their own.
Yes being a preceptor is much harder than just having your own patients. That is why only certain nurses are chosen to precept.

She's not a new grad, otherwise I would fully understand how the "basics" would seem complicated, but nope, not a new grad.

wooh, BSN, RN · Jul 31, 2009

She's not a new grad, otherwise I would fully understand how the "basics" would seem complicated, but nope, not a new grad.

But if she's only a year in, that's almost worse. I remember at a year in for me, that was when all of the sudden I knew enough to see that it wasn't cut and dry "do this when this happens" but didn't have the experience yet to make those iffy decisions. At a year in, people start acting like you should know what you're doing, but you've still only got a year of experience, which really isn't much in the grand scheme of things.

Even if she "should" know more than she does, be more capable than she is, the fact is that she's not. And you've got to take her at the place that she currently is, and try to make the best of that and grow her into the nurse we want her to be. I certainly don't envy you that job, but obviously you've got something special about you, or you wouldn't be chosen to to fix her. :nurse: (Either that or you made someone really mad!) Good luck!

JustEnuff2BDangerous, BSN, RN · Jul 31, 2009

Having a year's experience doesn't mean squat if you never actually got the "experience" to begin with. It is entirely likely that she got shafted by the first person who inherited her as a preceptee and there is absolutely NO substitute for a great preceptor, especially with new graduates. It is extremely hard to compensate for the knowledge gap you acquired during your orientation, knowledge you weren't blessed with because maybe your preceptor just wasn't a born teacher (and we all know not everyone has the gift of teaching).

Personally I recommend starting from square one with her and acting as if she were a new grad. That's the only way you're going to find out what she knows and doesn't know, and that's the only way you're going to teach her anything new. If she doesn't know the basics she should absolutely not just be turned loose, and it is your duty now as her preceptor to protect her, you, and your patients. Patient safety comes before personal pride; you're doing everyone a favor if you intervene and take over, and start over.

But also do her a favor. If you are one of those people who just doesn't like to be a preceptor, if you don't have the inexhaustible patients that preceptors have to have sometimes, and if you're just going to end up publicly embarrassing her by going off on a frustrated tirade in the middle of the unit about how much knowledge she lacks (or you're going to talk about her behind her back to your coworkers), go to your manager and request that she be given another preceptor. It will be exceedingly harder to teach her if she feels like you think she is stupid and doesn't know anything, because all she will be thinking about as she's doing something or listening to you tell her how to do something is, Oh man, I hope I don't screw this up. Speaking as a new grad, please be kind to her, you will make or break her future career (as we've already seen).

I RN A · Jul 31, 2009

I'm a new nurse and I have been trying very hard to make it and I feel as I'm not making it. I make mistakes and forget things. I'm not in ICU, but the floor I'm at is very busy. I had a preceptor who expected me to remember things right away. I'm not this kind of a person. I need incouragement and positive reinfocement. I need some one to tell me, that I have made a mistake and I will do better next time, instead of going to the managers and telling them that I'm not a safe nurse, because I misplaced a thermometer probe by throwing it on the floor,and not in the trash, or I touched a urinal and never changed my gloves, or I refused to do IV (I just didn't want to hurt my patient), or making me look unsafe on the front of the patient and yelling stop, stop, pulling things out of my hands and making me look like an idiot. I thing the main thing you have to consider, the new nurses lack the experience and they are scared and nervous, they are not used to dealing with 5 patients and million distructions. They are stressed out and vulnarable. Try to be supportive and caring and she will open up to you.

CrystalClear75, BSN, RN · Jul 31, 2009

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.

:yeah:

CrystalClear75, BSN, RN · Jul 31, 2009

I agree if being a preceptor "blows", then maybe you shouldn't be a preceptor in the first place. I can understand how stressful it could be to have patients,then in addition, finding the time to teach someone who is lacking in the basic skills of nursing after a years worth of experience, but like others have said, she may not have been "taught" right. Something is definitely wrong here, and someone needs to teach this poor girl right...or maybe she has a problem but it's gonna have to take a patient person to be this girl's preceptor and I'm sure they're out there.