I don't think any of the preceptors I've had are good... but no one else seems to see it?

Nunya, BSN · Oct 1, 2020

No, this might be how it is in an adult ICU but this isn't how it should be. And it's not like this in the numerous NICU's I've worked in. This sounds like a dangerous place to work, dangerous for the patients AND your license.

MunoRN, RN · Oct 1, 2020

"Silent care with vented patients", I'm not sure what you're referring to.

I don't doubt that at least some of what you've witnessed in your precepting is bad practice, although there's still value to you as a learning experience since it's important for new nurses to see what 'seasoning' can do to some nurses and their practice so that you can avoid the same path.

When I get feedback from new grad nurses on their preceptors, I'm always leery when a new grad is quick to assume their preceptors are engaging in bad practice or that they assume they know more than they do. New grads who feel like they know less than they actually do is something I can work with, new grads who feel like they know more than they actually do is often an unsalvageable situation.

A couple of examples, the gel in a capsule is the liquid form of the medication, changing it to a liquid-in-a-cup form doesn't change much and depending on the medication might not be a good idea since some of these have a large amount of sugar and flavoring added which can clog up a feeding tube. When placing a foley, it's quite common to touch the foley "in the lady partsl area" since particularly in older women that's where the urethra is, there's no reason to get a new foley because of this.

Some of your other complaints are hard to judge without more context, but you may very well have accurate criticisms, there are bad ICU's out there and bad nurses in good ICU's, it's just as important to learn that as anything else.

Guest1158260 · Oct 1, 2020

1 hour ago, MunoRN said:

"Silent care with vented patients", I'm not sure what you're referring to.

I don't doubt that at least some of what you've witnessed in your precepting is bad practice, although there's still value to you as a learning experience since it's important for new nurses to see what 'seasoning' can do to some nurses and their practice so that you can avoid the same path.

When I get feedback from new grad nurses on their preceptors, I'm always leery when a new grad is quick to assume their preceptors are engaging in bad practice or that they assume they know more than they do. New grads who feel like they know less than they actually do is something I can work with, new grads who feel like they know more than they actually do is often an unsalvageable situation.

A couple of examples, the gel in a capsule is the liquid form of the medication, changing it to a liquid-in-a-cup form doesn't change much and depending on the medication might not be a good idea since some of these have a large amount of sugar and flavoring added which can clog up a feeding tube. When placing a foley, it's quite common to touch the foley "in the lady partsl area" since particularly in older women that's where the urethra is, there's no reason to get a new foley because of this.

Some of your other complaints are hard to judge without more context, but you may very well have accurate criticisms, there are bad ICU's out there and bad nurses in good ICU's, it's just as important to learn that as anything else.

Like I mentioned above, I most likely don't even have some of 1/4th or less of the knowledge these nurses do so I definitely don't fit into that category of new grads you are speaking of. People can develop bad habits and still have a wealth of knowledge over me.

However, I can tell you with certainty that I am more caring than all the nurses I have precepted thus far. By silent care (which is discouraged in my facility a lot) I mean providing care for a patient who is intubated without talking at all, when coming into the room or throughout the shift. From what I have learned, it is important to communicate with patients and this can help prevent ICU delirium or even PTSD that patients can face and at one point she even said something negative about a patient about how it was her fault she got hurt in a traumatic incident.

Also the foley was inserted in the lady partsl area, left there while getting more supplies and then reinserted with the same catheter twice until finally placed. I thought that we were supposed to leave it in the lady parts if we inserted it incorrectly and get a new foley not use the same catheter to prevent infection. Just genuinely explaining what I thought should be done and why I wrote that...

I don't even mention these things to my preceptor unless I can suggest something helpful I can do instead. But either way, thanks for your input and I will work on being less harsh...wasn't my intention to come off like a know-it-all or something. Just want to be a good nurse.

LovingLife123 · Oct 1, 2020

OP, I think you are wrong about some things and maybe right on others. But it doesn’t matter what I think. These are your preceptors. If you want to continue to work there and be an ICU nurse, I’d keep my mouth shut.

FYI, I absolutely do not wake up my vented and sedated patients for oral care q2. Then you have to bolus the heck out of them to sedate them again and that’s not good for them. I don’t know what sedation meds you use, but propofol gives people amnesia. It’s extremely scary for them each time they wake up and self extubations become frequent.

You don’t have to switch all PEG tube meds to liquid.

Start focusing on big picture things. Focus on your patients. Are you taking an active role in their care? Why are you not inserting foleys, doing oral care, and calling physicians? When I precept, I expect my orientees to be proactive. They shadow me shift one, I closely teach and monitor the next couple of shifts, then I expect them to start taking one patient. ICU is rough. Especially for new grads. I know, as I was once a new grad in the ICU.

londonflo · Oct 3, 2020

On 10/1/2020 at 3:58 PM, Guest1158260 said:

Yet...I don't see things being done right or explained to me well. Im starting in the ICU as a new grad and I've only seen a "senior" nurse auscultate lungs once, and that is where the assessment ends.

Time for some self assessment.

If you need explanations, perhaps it would help to review some of your texts or do a quick internet search. The ICU is not known to be a 'teaching spot' except for some very short explanations. BTW what is a 'senior' nurse? One of advanced years, much experience or both? Why are you classifying those you need to work with. Would you like them to label you as a 'newbie'?

On 10/1/2020 at 3:58 PM, Guest1158260 said:

I've found myself pretty disappointed that these people are my resources. I don't want to be that problematic person and say anything to my higher ups because everyone seems to think all these nurses are great.

For starting a new position with unfamilar co-workers I wonder if you are comparing yourself to them and their rating is lower than yours, in your opinion. Turnabout is fair play. Maybe they are disappointed that you are the new hire. A little humility may go a long way. In another topic you posted that you 'shocked' the instructors in the simulation lab with how you could solve the patient's problems so fast, some almost right after report. Are you accurate in your own assessment of the 1/4 knowledge that you do have?

Follow the advice of those here who have actual hands on, advanced experience in the setting. You will learn far more and actually may earn the respect of those you are working with. They seem to have lost your respect already.

Guest856929 · Oct 4, 2020

Choose whatever positive aspects you like from the preceptors and negate the bad habits that you witness. Thereafter, customize your own care however you deem fit once you are independent. Otherwise, you are testing the depth of a river with both feet with your sanctimonious disposition. You might be a good swimmer from the onset, but the ICU rivers have crocodiles that will not let you cross to the riverbank, even if you feed them.

NotANewRN, MSN, RN · Oct 6, 2020

It sounds like you may have a chaotic orientation with different preceptors which leads me to believe you are in an understaffed unit. Every nurse is not great at precepting. Also every nurse is not great at being precepted. The ICU is not the best place for a new grad and certainly not one who is focused on being more "right" than all the nurses that actually know how to do the job. Maybe this job is not the right fit for you.

fblackwell · Oct 7, 2020

I have to say that being someone who is particular and detail oriented as you are, this indicates you are a good fit for the ICU. From what you have described, you have some valid concerns. But what I would do is make mental notes about what NOT to do. Also, there is no reason to not ask questions. I would never work on a floor that would deter me from asking questions. There are no dumb questions. I started out working in an ICU at a level one trauma center. I was encouraged to ask questions. Just remember if you see bad habits use them as a lesson. But if you see something that your preceptor or another nurse is doing that is truly harmful and I believe that re-inserting a foley can lead to harm, I would say mentioning it to management is warranted. At the end of the day, you have been hired to take care of your patient. The only way that a unit’s culture remains safe is to be part of that culture. Listen to your gut. Just because you are a “newbie” does not mean you don’t know anything.

SansNom · Oct 7, 2020

I would say the most important lesson to learn here is that everyone's practice is their own to hone and refine as they see fit and safe for the patient. What you are comfortable with may not be what your coworker looks like. Nothing you mentioned (except maybe the foley) seemed like anything that actually endangered the patient.

ICU nurses have often been doing it for some time, which doesn't justify sloppy nursing, but they have developed ways of narrowing down care to what actually matters to the patient and not just what the textbook and protocols say to do. "The spirit of the law", so to speak, instead of "the word of the law". Other times they ARE actually just jaded, sloppy nurses and it's not always clear which case it is. The most important question is always, "did it endanger the patient in any way?", not "is this what nursing school taught me?" Frankly, ICU nursing frequently requires thinking outside the box.

As for the "they should have used a gun" comment, in case you haven't noticed, many nurses have a sense of humor that sometimes come across as calloused and even maybe cruel to anyone who is not in the field or hasn't done it long. Some people never develop this kind of thing, which is fine too, but just because some nurses make seemingly inappropriate comments or jokes to other nurses and staff doesn't mean they don't care about the patient. I've been in codes before while people were talking about last week's vacation while doing compressions, or something else that to an outsider would seem cruel and heartless, but it's part of our familiarity and coping mechanisms. Again, you may not develop this, but always keep the bigger picture in mind and don't fault others for doing it if they're not endangering or hurting the patient.

And that really sums it up: keep the big picture in mind. After caring for patients for 10-20 years, you have a much different perception and understanding of the job. Even your way of doing assessments evolves with time. If you see a nurse doing something that is actually endangering the patient, then question it. If it's just something against protocol or that seems sloppy or not "by the book", then just don't do it yourself if you don't feel comfortable with it. You get to shape your own practice and comfort zones.