Being a preceptor blows

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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 :).

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

i see all these responses about how the preceptor needs to mold this nurse, she needs better mentoring, more orientation, different learning experiences . . . it seems that it's all about the precepting and mentoring this nurse has or has not gotten. at what point does the nurse have to take responsibility for his or her own learning and own practice? if not a year in, then when? at two years, when many new nurses start believing they know everything, when they start precepting themselves or doing charge? when they're in a position to start passing on their bad practices? or maybe it's at 18 months? seventeen months and three weeks? when do we conclude that this person just isn't getting it? when do we stop blaming the mentor? how many "second chances" should one nurse get?

most hospitals have a probationary period. maybe the second chances need to end when the probationary period ends.

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i see all these responses about how the preceptor needs to mold this nurse, she needs better mentoring, more orientation, different learning experiences . . . it seems that it's all about the precepting and mentoring this nurse has or has not gotten. at what point does the nurse have to take responsibility for his or her own learning and own practice? if not a year in, then when? at two years, when many new nurses start believing they know everything, when they start precepting themselves or doing charge? when they're in a position to start passing on their bad practices? or maybe it's at 18 months? seventeen months and three weeks? when do we conclude that this person just isn't getting it? when do we stop blaming the mentor? how many "second chances" should one nurse get?

we're probably both gonna get blasted ruby, but i gotta say, i agree. perhaps this particular nurse is just not cut out to be a unit nurse. perhaps it's too much for her. i see a lot of people assuming that she got the shaft in her initial orientation, but what if she didn't? what if her preceptor was great, and she just didn't get it? look, even if she did get the shaft, at what point within the last year, after how many scary mistakes/md complaints (per op) does this girl need to say to herself "maybe this isn't working out for me.."? i'm just saying, yes, sometimes new grads get hosed. but sometimes they have just bitten off more than they can chew, as well. it's a lot of knowledge you need, to work in icu. i've been a nurse over six yrs, and i sometimes think, "well, maybe now i'm ready..".

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Specializes in Pediatrics.

As a recent new grad and soon to be preceptee I understand both sides. I believe that preceptors should understand that its a challenge to teach just as it is to learn under such conditions. Patients lives are at both of our hands and everyone wants the same/best outcome. For myself, I know that I would appreciate a direct, however, caring/understanding preceptor. I would like someone that can tell me what I'm doing wrong or at least guide me to the answer if I dont know it instead of writing me off as an idiot new grad that 'should know!' I take full responsibility for my mistakes and seek help when I feel necessary, however, knowing that you could potentially hurt someone else's license, your license and a patient is a lot to deal with when you're in a precepting position.

I think that to be effective you may want to have a 'coffee chat' with her and talk about her past experience(in that year that has passed) and work from there. Telling someone what they do wrong all the time will get nowhere and will completely make her feel like a failure. For those that have had an AWESOME preceptor please think about those who have not. In speaking with her, I think it wise if you lay some framework for her taking responsibility for things that she has learned with you at least and has not yet conquered. Ask how you can help and go from there.

What happens if you only suggest she gets moved and the cycle continues?? If she doesn't stay on the ICU floor, she will end up on someone else's. None of us woke up one morning and just remembered everything and knew the answers 100% of the time. We all need help, some more than others and as a nursing community we should do what we can and stand up as leaders and not kick each other down:D.

Good luck in precepting!

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Specializes in CVICU, ER.

I have to agree with RubyVee and DeepFriedRN. After 12 months of working on her own after orientatuon, she should have figured out not to give a beta blocker to someone on a vasopressor. Even if her preceptor was horrible, she still kept quiet and agreed to come off orientation not adequately trained, (if that was the case). Every job requires some accountability from the employee, and she is responsible for herself. I'll just be the objective observer, and document.

I probably should have picked a better title, it was the end of a very long shift when I wrote it, not thinking clearly.

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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.

Agree that the nurse needs some "seasoning" on a less demanding unit and the manager needs to be involved, but I think now rather than later. From what the OP said, Pt safety sounds like it's already compromised, and is an incident report just waiting to be filled out. :twocents:

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Specializes in ICU/Critical Care.

So does anyone have any advice on what I posted earlier about my co-worker. I go back to work tomorrow night so I will be speaking with my manager in the a.m.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
so does anyone have any advice on what i posted earlier about my co-worker. i go back to work tomorrow night so i will be speaking with my manager in the a.m.

i thought this whole thread was full of advice -- was there some specific advice we missed?

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Specializes in ICU/Critical Care.
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!

That's exactly how I feel. Drawing from a heparin line or a line with TPN line should be basic nursing 101. Thats how I feel. If you don't have the common sense to flush the line or stop the infusion and flush another port then there's a problem. It should be rather obvious to any nurse that you would flush a port that had heparin or TPN infusing before drawing blood or the labs will be off. Personally, I flush with 20cc of NS and waste 10cc of blood. I've been asked how to calibrate a ventric drain, ok, if you don't know "how" don't take the patient. Ugh, I'm frustrated thinking about it that I don't know how I'm going to explain it to my manager. Lets not forget that this co-worker can't even function in an emergency. So far its going to be "There are some issues with said co-worker. here are the issues and concerns..."...

Oh, I failed to mention that this co-worker tells families and patients that he's a brand new ICU nurse, which is not true. He's been for about 8 months but he should at least know whats going on instead of being totally clueless.

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Specializes in Neuro ICU and Med Surg.

All I can suggest to you Turn Left Side is to go the the ANAM or NAM or even the unit educator with your concerns. Maybe the unit educator can work with him on what he is lacking skill wise.

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Specializes in ICU/Critical Care.

I'm gonna talk with the nurse manager on Weds before I leave. I've made my concerns known to our 'educator" and she's useless. I made a list of concerns regarding this co-worker so I can go over them one by one with my manager. I'm not doing this to lambast my co-worker. I would like to see him succeed but he needs some serious mentoring.

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Specializes in Critical care, neuroscience, telemetry,.
i see all these responses about how the preceptor needs to mold this nurse, she needs better mentoring, more orientation, different learning experiences . . . it seems that it's all about the precepting and mentoring this nurse has or has not gotten. at what point does the nurse have to take responsibility for his or her own learning and own practice? if not a year in, then when? at two years, when many new nurses start believing they know everything, when they start precepting themselves or doing charge? when they're in a position to start passing on their bad practices? or maybe it's at 18 months? seventeen months and three weeks? when do we conclude that this person just isn't getting it? when do we stop blaming the mentor? how many "second chances" should one nurse get?

most hospitals have a probationary period. maybe the second chances need to end when the probationary period ends.

amen, and amen.

precepting, good or bad, will only take you so far. i've done a lot of precepting in our icu, and i've been told that i do a good job. i like having new staff come aboard, and i remember my own days as a new grad. kindness is always warranted in any of our interactions.

that being said, some folks do not make it through our icu orientation. sometimes, i'm the one who has gone running to the nurse educator to demand that the person in question not be turned loose on the night shift. ususally, i've sat through report with them and realized, to my horror, that they don't know enough to safely take care of a patient. we had one poor soul who kept reminding us that she "was a slow learner", and that she needed more time. i feel for you, darlin', but you don't need to be taking care of people with multi organ failure if you can't distiguish levophed from nipride. not on my watch.

it's a steep learning curve, and getting steeper all the time. i've been pushing for extended orientation time for our new staff, because i don't think they can reasonably be expected to perform at the level we expect in the time frame we are currently allotting for orientation. the flipside to this is that we need to expect basic competency as a nurse of anyone off orientation without having to watch them like a hawk. not everyone can do the job. those that can't should be reassigned out of the icu.

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Specializes in ICU/Critical Care.

So an update about my co-worker:

I talked with my manager. I told her I felt that he was not a good fit for ICU. I let her know that despite education of protocols and ICU procedures, it just doesn't seem to be clicking in his brain. These are protocols he should know by now being that he's been off orientation for 8 months and had an extended orientation. I told her that I don't think he would be able to function well in an emergency. He got an admit the other night, the educator had to go through everything step by step with him and his admission was still a mess by the time the day shift arrived four hours later. Doesn't know which Svo2 monitor is which even though we use these things on an almost daily basis. He's uncomfortable bathing female vented and sedated patients, I told him to get over it, he's a nurse. Not responding to vent alarms, someone else had to call RT because he didn't and/or wouldnt. There's a whole slew of other things he has done that's made me question him...such as not properly flushing the yellow port of the Swan after drawing a mixed venous gas because "The charge nurse said not to flush anything through there"...what she really said was don't flush any meds through that port..we flush that port anyways when we zero the transducer.. So if nothing happens, if management doesn't start keep better tabs on him or move him to days so they can observe his practice, I'm not going to say anything anymore.

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