Ethical dilemma -- new nurse

pdmt · Jul 1, 2004

I am a new RN who has worked two full days on a med/surg floor. I did my preceptorship on this floor as a student, 6 weeks with a wonderful, caring, conscientious nurse.

The preceptor I have been given as a new grad is not so wonderful, caring OR conscientious. The first day, we had a patient with an infected PEG site, sacral decubitus, rectal pouch (for feces), s/p stroke, etc. Sad case. The nurse didn't even LOOK at the PEG site dressing. She would not have changed the rectal pouch were it not for the doctor coming to debride the sacral wound (30 minutes before end of shift).

The second day, she stated in report that she had changed a patient's foot dressing. If she changed it, I didn't see it done -- and I'm working right with her.

As new grads we were given, as well as a preceptor, a 'mentor' who is a member of management, and not affiliated with the floor we are working on. When I had met with her during orientation, she had told me that I could talk to her about anything, especially anything that she might need to intercede about on my behalf.

Here is my dilemma. I'm two days on a new job, on a floor that I'm planning to be working on for some time. I will be going to night shift when my orientation is over, so I won't be working with my preceptor after about 4-5 weeks. Other nurses that have worked behind this nurse know she is not doing her job. How do I approach this problem.

I know that the honest and ethical thing to do would be to talk to my mentor about this. Being the person that I am, I don't think I could stand myself if I didn't talk to her about this. I just don't know HOW to do it.

Can anyone give me advice?

thanks.

jnette, ASN, EMT-I · Jul 1, 2004

Wow.. how sad, and what a difficult situation to find yourself in so new into your position there. I feel for you.

Yes, I would indeed find the courage to discuss your concerns with your mentor. Obviously you want to do this tactfully and FACTfully... just the facts, please ma'am.

It would help if you had these things documented as to time, place, etc... It would also behoove you to ask your preceptor why she has chosen not to perform a given procedure or tx., so she would be aware that you know what IS expected, and are aware that she is not following through.

You might ask for another preceptor should this not improve or if she were to then take it out on you.. discuss these concerns with your mentor as well.

I'm sure others here would have all kinds of sound advice for you.. I've never been in a situation like this, but others here most certainlyt have been... hang in there as I'm sure more and better suggestions are forthcoming !

jnette, ASN, EMT-I · Jul 1, 2004

Wow.. how sad, and what a difficult situation to find yourself in so new into your position there. I feel for you.

Yes, I would indeed find the courage to discuss your concerns with your mentor. Obviously you want to do this tactfully and FACTfully... just the facts, please ma'am.

It would help if you had these things documented as to time, place, etc... It would also behoove you to ask your preceptor why she has chosen not to perform a given procedure or tx., so she would be aware that you know what IS expected, and are aware that she is not following through.

You might ask for another preceptor should this not improve or if she were to then take it out on you.. discuss these concerns with your mentor as well.

I'm sure others here would have all kinds of sound advice for you.. I've never been in a situation like this, but others here most certainlyt have been... hang in there as I'm sure more and better suggestions are forthcoming !

mother/babyRN, RN · Jul 1, 2004

That is a difficult situation but you are ( and others that allow this lack of care to continue) allowing neglectful care to continue and actually in doing so could be considered an accessory or at fault if something that is supposed to be done isn't done and it results in a problem that comes to court. You sound like a thoughtful , honest person. Maybe you can sit with your mentor or nurse manager and express your discomfort at the behavior or lack of care given by this preceptor...What an awful position to be in. Good luck to you and many hugs as well.

mother/babyRN, RN · Jul 1, 2004

That is a difficult situation but you are ( and others that allow this lack of care to continue) allowing neglectful care to continue and actually in doing so could be considered an accessory or at fault if something that is supposed to be done isn't done and it results in a problem that comes to court. You sound like a thoughtful , honest person. Maybe you can sit with your mentor or nurse manager and express your discomfort at the behavior or lack of care given by this preceptor...What an awful position to be in. Good luck to you and many hugs as well.

ceecel.dee, MSN, RN · Jul 1, 2004

The way I see it, you have 2 options.

#1 - If dressing changes, bag changes, IV tube changes, diaper changes, or whatever are needed...and you know it...tell her you will do it (so that you can live with yourself) and ask her for help if you need it. This option may be desireable only if you are trying to stay with this preceptor until your time is up. Then, eventually, you must speak to someone in management about her because that is the right thing to do.

#2 - Request a different preceptor without shouting your high standards of excellence and high moral standards from the highest mountain. State facts only, avoiding the "that's not how I want to nurse" and "it's just not right" inuendos, so that you are not pegged as a troublemaker or a "holier-than-thou" type. Then allow the management to proceed as they will (or won't) per institutional policy. Then your conscience will be clear, without having to be the one to "stir things up" for your so-called preceptor.

(I realize there are more options than these 2, but these are what it would boil down to for me.)

ceecel.dee, MSN, RN · Jul 1, 2004

The way I see it, you have 2 options.

#1 - If dressing changes, bag changes, IV tube changes, diaper changes, or whatever are needed...and you know it...tell her you will do it (so that you can live with yourself) and ask her for help if you need it. This option may be desireable only if you are trying to stay with this preceptor until your time is up. Then, eventually, you must speak to someone in management about her because that is the right thing to do.

#2 - Request a different preceptor without shouting your high standards of excellence and high moral standards from the highest mountain. State facts only, avoiding the "that's not how I want to nurse" and "it's just not right" inuendos, so that you are not pegged as a troublemaker or a "holier-than-thou" type. Then allow the management to proceed as they will (or won't) per institutional policy. Then your conscience will be clear, without having to be the one to "stir things up" for your so-called preceptor.

(I realize there are more options than these 2, but these are what it would boil down to for me.)

Rhoresmith · Jul 1, 2004

I am still a student but couldn't this get the poster in trouble and possibly make her lose her licsence also? she know that false documentation is going on (dressing changes should be charted correct?) and is allowing it? They keep telling us to guard our liscenses with our lives and that we can lose everything we own to malpractice so things like this worry me and I am worried for pdmt too

Rhoresmith · Jul 1, 2004

I am still a student but couldn't this get the poster in trouble and possibly make her lose her licsence also? she know that false documentation is going on (dressing changes should be charted correct?) and is allowing it? They keep telling us to guard our liscenses with our lives and that we can lose everything we own to malpractice so things like this worry me and I am worried for pdmt too

leslie :-D · Jul 2, 2004

i think we all know what SHOULD be done but there is a chance of repercussions. it really sux because it's those nurses that stand up for what is right and aspire to high standards of nursing care, who are the ones that are often victimized or retaliated against. and it burns me to no end when nurses chart their txs as being done when i know damn well they haven't been. i just wish they'd leave nursing. as for advice? as jnette indicated, documentation of said incidents is very important, then i would go to the mentor about it, relaying your concerns/questions. good luck to you.

leslie

leslie :-D · Jul 2, 2004

i think we all know what SHOULD be done but there is a chance of repercussions. it really sux because it's those nurses that stand up for what is right and aspire to high standards of nursing care, who are the ones that are often victimized or retaliated against. and it burns me to no end when nurses chart their txs as being done when i know damn well they haven't been. i just wish they'd leave nursing. as for advice? as jnette indicated, documentation of said incidents is very important, then i would go to the mentor about it, relaying your concerns/questions. good luck to you.

leslie