I'm pretty sure my preceptor thinks i'm done

ijuanabhappy, ASN, RN · Jun 21, 2011

I'm not going to be of much help, but wanted to say I totally understand where you are coming from. The same thing happened to me. I don't know what the answer is. I was being precepted in the NICU, just trying to get my feet wet and absorb and learn. I was not guided that much on the computer charting, plus I was trying to learn a zillion things very quickly and expected to be in three places at the same time. I understand that you need to work up to that speed of multitasking, but I too felt that I wanted to be cautious and do it right. When I was expected to pick up the pace and do three or four different tasks that I had never done before, all at the same time, ... well, I felt like I wasn't really learning anything. After a few weeks, she told me that I was really not where I needed to be and didn't know if I was cut out for this, but I felt that she wasn't the best preceptor and I wasn't really given a fair chance... I ended up leaving the job.

Grandmasgirl · Jun 21, 2011

A good preceptor would realize that you need your time- too many of them want you out of the nest asap. You need to tell her that you need help with the IV's & she needs to support you. We've all been there. How long have you been a nurse? ER is trial by fire, Some places throw you to the wolves to help you learn. Had that happen to me in L&D during orientation- "you have the whole board!" Manage it! That was on the night shift too. You learn to prioritize when you don't know what's coming in the door, but they should be there to back you up. So the real question is : is it really the IV's or being nervous to do things(all things ) correctly? I asked for 2 extra weeks of orientation & got it even though my preceptor said I didn't need it. I was so overwhelmed by the great job my coworkers did that I forgot that I was the newbie & they were there for some time. Sometimes you need to go slowly for your own comfort level to improve. Because you ask it shows how much you care to get it right.

Grandmasgirl · Jun 21, 2011

RE: IV"S - warm towels, hang the arm over the stretcher. Feel gently & don't always go for the antecub. Put a little traction on the skin to stabilize the vein. Don't go in on top of the vein- try to go in the side of it-sneak it in. Watch out for valves- sometimes you can feel or even see them-try to go above a valve. Until you've more practice don't try to force a valve- yo may have to float it in. GET the labs first if you can!. Hep locks are great!

Deetermined · Jun 21, 2011

Oh my goodness. This was the only job that I wanted. I dont have thoughts of leaving. Maybe I should ask her if I'm where she thinks I should be because everyday when I leave she says, "Good Job Today"...I'm like really, good job? Because I thought I did terrible. I wonder if she"s trying not to kill my confidence or if I really did a good job or if she really cares bc she does get paid extra for having me tag along. Sometimes, I have anxiety while laying down for the night. Im always wondering if I made any mistakes, does she know, is she gonna tell me about them or let me continue on inadequately and hang myself. I have heard so much bad stuff about nurses just dismissing you, "eating their young" and at that point it doesnt matter how good of a worker you are or how much you want to learn and I dont want that to happen to me...I know everyone is not going to like me and I'm okay with that but I dont want any drama...and I dont want to have any ill feelings between my preceptor and I because she has something i need

I know I'm all over the place but I'm still a little worked up from today but thanks for the response..

bsnanat2 · Jun 21, 2011

as a new grad, i feel your pain. i have interviewed but not started working yet, so take this with a grain of salt (but do consider it). one of the main issues you may be facing is transitioning in mindset from a student to a new professional. as newbies we no longer have the luxury of taking all the time we need to learn something like we did as students. this too is a fear of mine. now is the time to tell yourself that you can step up and be the nurse. talk to your preceptor and let her know how you're feeling and ask for specific pointers. realize that this time period will be stressful and near impossible, but like nursing school and the nclex, you can do it. as far as acknowledging the new orders, she probably would not have done you any favors to just do it. she may be tough on you, but she may think you’re doing fine overall. if you don’t talk to her, you have only your fears to fill in her part of the conversation.

Deetermined · Jun 21, 2011

thank you grandmasgirl. I got my license in March 31,2011. I started working May 16th and started on the floor about a week later. I will definitely try your suggestions about the IV's. Also, she has already suggested help for me with the IV's she said that the next time we work together she will let everyone know I need extra practice so that I can stick all of there patients. So she tries to be helpful but lately I do feel her being a little condescending. I guess i'll just try to ignore it. Oh, I forgot to mention she's expecting and she's 5mo so that could have alot to do with it so I try to give her the benefit of the doubt.

StudyinginCT · Jun 21, 2011

2 things:

1.) Why don't you give your preceptor some feedback? Why don't you tell her/him this? S/he gives you feedback all the time, and it's important to let people know how you learn. What is beneficial, what is not. Let her/him know your rationale for your internal prioritization. You can learn some valuable stuff, and s/he'll know you are actually thinking about it instead of just doing things willy-nilly. It might just be a bonding experience.

2.) it's your third week. Chill. No one expects you to be an expert. They expect that you will suck and be barely competent at basic tasks. That's the definitions of "being green." It's very clear to me that you take this very seriously. Tasks are tasks - they take practice. You could probably train a monkey to start a line. If you put equally as much thought into your initial assessments and interventions, you will save lives. Eventually - you'll be able to start lines and put in foleys with your eyes closed. But being able to think on your feet and assess patients accurately, quickly, and get the orders the patient needs is what nursing is about.

This is all from someone who is now 18 months into the job and has been in your shoes. I don't work in the ED now - I did before I graduated. But every nursing job has it's own tasks. And never forget they are just tasks. I've never learned to start an IV and I'm already an advanced beginner/competent nurse.

If you weren't required to read it nursing school or haven't been reminded of it in your orientation, definitely check out Benner's Stages of Clinical Competence. Walk before you run.

Deetermined · Jun 21, 2011

@ijhappy- thank you for your words of encouragement. I do need to get out of that nursing school mode. The other day I was so nervous to start the patient on more than two liters of O2 even though the patient had her portable tank with her and she was on 4l O2 at home. Now it makes perfectly good common sense to give the pt what they are on at home but all that kept playing over in my head from nursing school was "you can start patient on 2l but anything over that, you need an order" because you can hurt a patient with O2 and essentially, it's a drug and I'm not a doctor so I can't give drugs without written, verbal or protocol orders....so when I asked her about the 2l, she looked at me crazy..I was like omg! Of course the answer was to give them what they use at home. But I dont want to just start assuming things because thats how you get burned. These are the type of simple questions I ask. But I didnt want to just turn it to 4l and then they say, "did you start the patient on 2l first, did you get an order to turn it to 4l?"

But I understand what you're saying. It's tough to get out of that student mode and step it up to professional nurse road but I'll get there.. My friend always tells me that Rome was not built in a day

Deetermined · Jun 21, 2011

StudyinginCT,

Your suggestions are great and I will do that..In fact, I'm gonna write somethings down tonight while they are fresh on my mind and try to set up a time and talk with her tomorrow. I think she will be receptive to it so I'll give that a try and I'll definitely read the link you suggested. It may help me put somethings into perspective

LouisVRN, RN · Jun 21, 2011

I have to say as a preceptor I am like yours in that orders hold a very high priority for me. Prioritization needs to be Airway, Breathing, Circulation, Pain and Orders in my book. If you don't know if you orders and meds are current you won't be able to keep from making a mistake.

StudyinginCT · Jun 21, 2011

you're welcome.

#3 - don't take anything personally. Most of the time - it ain't about you.

I had a nursing prof who used to say "even if your patient kills you - don't take it personally."