Ethical dilemma -- new nurse

[pdmt]

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.

[pdmt]

I appreciate your concern (for the patients and for me!)

As far as the charting.....she was doing the charting, and it never occurred to me to look to see what she wrote. I don't know if she charted that procedures were performed when they were not, or if she just didn't address the procedures in the charting at all.

I did tell her at the end of the second day that I would be taking some patients all by myself the next time we worked together. At the end of my school preceptorship, I was taking 4 patients completely independently, so I feel confident I can do independent patient care (and charting) and I know that at least the patients I am caring for will receive the best care I can give them. The usual patient load on this unit is usually 6, and I don't feel ready to take that on, but I can at least take 3-4 right now alone until I get back into the swing of things.

So, I *don't* know if she documented falsely, but I *do* know the care was not what it was supposed to have been. I DO know that other staff nurses are aware of her work habits. I do NOT know if this has ever been addressed before with management.

I do plan to talk to my mentor some time in the next week. I work Sat, Sun, then Wed and Thurs, and will see her some time in that time frame.

Again, thanks for the support.

[pdmt]

I appreciate your concern (for the patients and for me!)

As far as the charting.....she was doing the charting, and it never occurred to me to look to see what she wrote. I don't know if she charted that procedures were performed when they were not, or if she just didn't address the procedures in the charting at all.

I did tell her at the end of the second day that I would be taking some patients all by myself the next time we worked together. At the end of my school preceptorship, I was taking 4 patients completely independently, so I feel confident I can do independent patient care (and charting) and I know that at least the patients I am caring for will receive the best care I can give them. The usual patient load on this unit is usually 6, and I don't feel ready to take that on, but I can at least take 3-4 right now alone until I get back into the swing of things.

So, I *don't* know if she documented falsely, but I *do* know the care was not what it was supposed to have been. I DO know that other staff nurses are aware of her work habits. I do NOT know if this has ever been addressed before with management.

I do plan to talk to my mentor some time in the next week. I work Sat, Sun, then Wed and Thurs, and will see her some time in that time frame.

Again, thanks for the support.

[P_RN, ADN, RN]

Talking with your mentor looks to be your first option. Unless you can prove beyond a shadow that your preceptor did NOT do what she charted, be very careful in any accusations. The first thing you'd be asked would be "were you with her every single minute of the day?" Of course not, sometimes one of you had to eat, go to the restroom, or answer a call light or phone.

Anyway, since you are the new "kid on the block" talk with your mentor, tell her everything you put in your original post. She will probably have the connections and resources to get the story out.

You said you have her as a preceptor and work different days? I guess different places do different plans. I precepted for probably 20 years and we were always "joined at the hip." Her/his schedule was my schedule. Her/his nights were my nights. Her/his lunch was my lunch. Etc.

[P_RN, ADN, RN]

Talking with your mentor looks to be your first option. Unless you can prove beyond a shadow that your preceptor did NOT do what she charted, be very careful in any accusations. The first thing you'd be asked would be "were you with her every single minute of the day?" Of course not, sometimes one of you had to eat, go to the restroom, or answer a call light or phone.

Anyway, since you are the new "kid on the block" talk with your mentor, tell her everything you put in your original post. She will probably have the connections and resources to get the story out.

You said you have her as a preceptor and work different days? I guess different places do different plans. I precepted for probably 20 years and we were always "joined at the hip." Her/his schedule was my schedule. Her/his nights were my nights. Her/his lunch was my lunch. Etc.

[KRVRN, BSN, RN]

Consider looking into the hospital policies regarding some of the things she's not doing. Maybe policy (or dr.'s orders) say dressing changes b.i.d. (versus q 12hr) If so, technically she could get away without doing it, she could leave it for another shift... poor care but not violating policy. It's been my experience that the hospital and management REALLY don't like policy/procedures to be violated because then there's NO arguement at all. If it's just poor, not quite up to your personal standard care then it's more of a gray area and they might not come down on it as hard. I guess what I'm trying to say is that saying to your mentor that you seeing policy/procedure violations that is more concrete than she's not doing her job well.

At the very least you could tell your mentor "hey, look, maybe I don't want to get her in trouble and check up on everything she does and make an enemy... but I do want to be taught by someone that will teach me correctly." Maybe a preceptor change is in order.

[KRVRN, BSN, RN]

Consider looking into the hospital policies regarding some of the things she's not doing. Maybe policy (or dr.'s orders) say dressing changes b.i.d. (versus q 12hr) If so, technically she could get away without doing it, she could leave it for another shift... poor care but not violating policy. It's been my experience that the hospital and management REALLY don't like policy/procedures to be violated because then there's NO arguement at all. If it's just poor, not quite up to your personal standard care then it's more of a gray area and they might not come down on it as hard. I guess what I'm trying to say is that saying to your mentor that you seeing policy/procedure violations that is more concrete than she's not doing her job well.

At the very least you could tell your mentor "hey, look, maybe I don't want to get her in trouble and check up on everything she does and make an enemy... but I do want to be taught by someone that will teach me correctly." Maybe a preceptor change is in order.

[Farkinott, RN]

I like Ceecel.Dee's first point in her reply. One way of getting around a situation like that is to say "I have never done such and such......... If I help you get some work cleared can you show/watch me do this procedure?

This way you know it gets done and the offending so called colleague is duty bound to show you. I know you will make a much better prceptor when it is your turn to do it! Good luck!

[Farkinott, RN]

I like Ceecel.Dee's first point in her reply. One way of getting around a situation like that is to say "I have never done such and such......... If I help you get some work cleared can you show/watch me do this procedure?

This way you know it gets done and the offending so called colleague is duty bound to show you. I know you will make a much better prceptor when it is your turn to do it! Good luck!

[BHolliRNMS]

You know the right thing to do. But, who wants to be labeled a tattletale the first two weeks out of school, right? However, you must address the issues that you are aware of. Can you speak to this nurse first? Tell her your concerns. Sounds like she is burned out. Burn out is a leading cause of patient abuse. Maybe you could help her see her symptoms and some solutions...like requesting a vacation or just talking to you and allowing you to share the load. I bet once upon a time, she was a great nurse.

[stressednurse]

My orientation to ICU/CCU after almost a year of Med-surg was under the direction of the nastiest nurse (Bonnie) ever put in control of newbies to ICU. I quietly listened to her demeaning comments and not allowing me to do much of anything as "I wasn't ready for that yet". After my first two weeks in the ICU the manager called me to her office to ask how things were going and if I still wanted to be an ICU nurse.

My response was, I have survived 2 weeks of "Bonnie", do I pass and can I stay?

I was given a new preceptor and worked another 6 years of ICU including 4 of flight nursing on a critical care team. After getting to know staff better, everyone seemed to think Bonnie was just plain lazy but her nasty disposition kept most from even saying anything to her. (The alligator nurse....snaps for the hell of it.) Plus she had been there since dirt so had some kinda special connection in that manner with the also dinosaur administration.

It seems everyone knows what the 'bad staff' is doing or not doing but most don't know how to end it, alter it or just get away from it....management too. It seems administration is scared of hiring more than yes people for supervisory positions.

Management is in a tough spot too with the dreaded "nursing shortage"... working with a license and showing up for work most of the time is acceptable in a lot of places.

Oh yeh and when I became nursing supervisor for a large facility, "Bonnie" became an agency nurse that frequented my facility and I treated her with more diginty than she treated me. She began her old behavior of not interacting with other staff...just being nasty and we decided to not use her as a nurse after that but that wasn't my call.

My 2 cents, maybe not the advice you wanted, but it is a recollection of how I handled a simular situation.

Good luck.

[OneRN]

If you sign your name in the chart to anything, be sure that you did it. Let her sign or say whatever she wants, but don't you do the same. The time for reporting her is not now, not when you're so new and trying to gain a position there. Your preceptor is a lousy nurse. The world is full of them. If you report her, most likely nothing will be done, but they may retaliate against you. You need to first become an independent RN working on your own, then when you come in after her, you can justifiably fill out incident reports. Right now, just keep a good attitude, learn, and get yourself tied in safely before making waves. If you are a good and caring nurse, how will the patients ever benefit from your care if you get fired staight away? Remember: the life gaurd has to live.

[Tweety, BSN, RN]

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

I think this is true. If you know something that is going on is endangering patients and you don't follow the chain of command, then you could be held liable.

Good advice here, I have nothing to add.