am I that "b" nurse? or am I being an advocate?

[guestnurse]

Ok I am not perfect and I don't expect every one else to be either. I wrote myself up just the other day for missing an order for Solumedrol. Last night I had a hellacious night. Followed behind a new nurse/orientee and his charge nurse preceptor. I am flex pool nurse so I work all units at all 4 of our hospitals in this area. (love it) I usually don't work this unit as it is a med/surg and I usually work ICU/stepdown. When I was getting report from this orientee I could already tell he was lost with no direction or "precepting" being done. I soon quickly realized how lost he was when I came upon numerous missed orders, meds not signed off, iv infiltrated. So I spent the first part of the night sweeping mines. Finally began to chart at 130am. Had to do 2 incident reports due to iv which was infiltrated and pre-op orders for patient going to surgery which were not taken off and were written at 1400. I don't like to write incident reports. Was told by night shift charge nurse I had to for the iv infiltration and missed orders. My biggest problem with all of this was that this was a NEW nurse. Fresh out of nursing school who was receiving no guidance and teaching from his charge nurse preceptor who had no patients of her own, except to follow and oversee this orientee. So by the morning I am thoroughly p.o. I have already emailed my suprevisor about my hellacious night. When day shift came on and I was about to give report I told the new orientee that I had to do 2 incident reports last night and there were numerous missed orders and meds but that in no way was he to blame. I told him that as a new nurse and orientee it was the responsibility of his preceptor to oversee and go behind him to make sure all was done. I told him it was clear to me that she did not check behind him or oversee him. This charge nurse quickly piped up that "Oh yes I did check behind him!" to which I replied "well if you checked behind him how were there medications on every patient's mar left unsigned off and orders missed?" I told him that the incident was in no way to place blame on him only to ensure that procedures and policies can be improved and carried out in a way to ensure patient safety. I then talked to the nurse manager of that unit when she got there to which the first thing she said was I was "unprofessional" by bringing that up at the nurses station and confronting the charge nuse about her precepting of the orientee. If this had been a nurse I followed behind I would have cleaned up the mess and not said anything. The ONLY reason I was irate and made a big deal was because this poor orientee is being thrown to the wolves with no direction or teaching. I felt bad for him and I could see he was totally overloaded and overwhelmed. He had to stay until after 8pm to finish charting because he had been so busy. His "preceptor" charge nurse clocked out at 708pm. I was darn glad I confronted her face to face. It's about time someone stood up to her and let her know that she isn't doing her job.I"m a flex pool nurse, I work all over and I"m not tip toeing around any charge nurse or anyone else for that matter. If I make a mistake and have screw ups I gladly would like for any nurse to confront me face to face and let me know so I can apologize or make ammends as best I can. I don't expect everyone to be perfect cuz lord knows I"m not, but to throw a new nurse 6 weeks out of school to a busy med/surg unit taking 5 patients with admits and crazziness is just not right. I guess I will get the Bioatch label at that hospital because a few weeks ago I called the nursing supervisor because a patient from the other end of unit kept calling out for pain medicine and no one was answering her call bell or giving her pain medicine. When the nursing supervisor got up there he found out the charge nurse had left to go get food the other RN left to go on smoke break and left only an LPN on that hall with a nurses aid. She just didn't answer the call bell or do anything because she couldn't give the ivp pain med ordered. When nursing supervisor got there and I found out what was going on I told the LPN all she had to do was come get me and ask me to give the pain med, I would have gladly given it despite being busting butt busy with my 6 patients. Then when the charge nurse got back he was furious that I had called the nursing supervisor. OK so am I a bioatch nurse or am I being an advocate??

[Nccity2002, MSN, RN]

Kudos to you...your assertiveness is admirable!!

I think it was very brave of you to advocate for that new graduate. I am sure this is not a new situation with that particular "preceptor", hopefully your actions will help her realize, that she needs to step up her game.

Good for you!!

[rn/writer, RN]

I think confronting the issue during report was correct, but the OP's account seems to undermine the preceptor with the new nurse. I think it would have been more important just to note objectively what was left undone and what incident reports had to be written. If the OP felt it was necessary to critique the preceptor's performance, it would have been courteous to do it privately, away from the orientee.

My thoughts exactly. You don't want to set the orientee up to disrespect/blame the preceptor or cause the preceptor to react defensively and take it out on the orientee. It's usually a good idea to allow the higher ranking person to save face by taking them to task privately so as not to undermine them in front of someone they're supposed to be teaching.

[SkiMama]

Roger that. I am learning a great deal just from reading about so many of your experiences. I am sure in the heat of the moment - being utterly frustrated at having to bust your butt for a long shift while feeling bad for a new nurse who OP felt was not being lead in the best possible way - it would be hard to remain objective and not let the precepting nurse know how she felt, even if only to a small degree.

[guestnurse]

that's what I thought...I"d much rather some one come directly to me with my oversights and issues than go to my manager. She got defensive because she knew I was right and called her out on her lack of precepting this new nurse.

[guestnurse]

When I got to work this morning and checked my email.. That charge nurse preceptor had gone over my charts and mars with a fine toothed comb and wrote me up for failure to document outcomes after I gave a benadryl and colace lol! After the night I had fixing all the mess left I'm just glad that was all she found. I knew she was out for blood and couldn't wait to go find something to write me up for. When really I would never have written anything up if the night shift charge nurse hadn't told me I had to.

[guestnurse]

you're right but all I did was start reporting to the day shift nurse,the new orientee, and told him the write ups I had to do and told him not to feel bad that it was in no way his fault that his preceptor was suppose to be going behind him and following up and checking everything. She overheard and immediately jumped in and got all defensive. My response was "well go look at the Mars and charts and see all the meds not signed off and orders not taken off and then tell me you followed behind him and checked everything." To which she went to her manager and told her I was being unprofessional at the nurses station.

[guestnurse]

I feel like I"m just stating the facts and truth and if she has a problem with it then maybe she needs to change the way she precepts and nurses. I"m not out to get anyone or write up anyone. I only felt bad for this orientee and wanted to make sure he didn't feel like he had failed or anything.

[rn/writer, RN]

you're right but all I did was start reporting to the day shift nurse,the new orientee, and told him the write ups I had to do and told him not to feel bad that it was in no way his fault that his preceptor was suppose to be going behind him and following up and checking everything.

The greater share of the blame does indeed go to the preceptor. But I would not have told the newbie that the errors were in no way his fault. They are his errors, and he needs to learn to take responsibility for them. That said, the preceptor should have caught them, corrected what she could, and then educated him in a non-condemning way so that he would develop greater awareness and better organization. Bottom line is he needs to own what he did (or didn't do) and feel a little bit bad (but not crushed) that he missed some things.

I also would not have said anything negative about the preceptor in front of him. He'll figure out her deficiencies on his own. I can see why she jumped into the conversation at that point, but even after that happened, you could have taken her aside and asked her why so many things got by her as well as the orientee.

It sounds like you were correct in saying that the preceptor really dropped the ball, but I very much disagree with blaming her in your conversation with him. You can be plain spoken and tell the truth without undermining her position as preceptor in his eyes. If you speak with someone privately and they get defensive and refuse to communicate further, then you go to someone above her. It isn't fair to either the new nurse or the preceptor to criticize her in front of him and basically invite him to blame and disrespect her.