In need of a confidence boost!

[Emm_RN, ASN, BSN, MSN]

Hi all,

Background: I did adult med-surg for one year (mostly ortho). Jumped to NICU where I spent a little over a year, now am in my third month of PICU.

I have two preceptors, one who has been there for going on seven years, is a great nurse, but very particular about little things (like how the IV pumps are facing and where things are laid out on the unicell). I'd been told that she was tough and hard to work with, but I've found we actually get along decently well. She told me up front that she would let me know if I'm not doing well or not progressing as I should be, and she so far has said that I'm doing well and adjusting well, that she thinks I just need to get comfortable with pediatric diagnoses. She mostly lets me do my own thing unless it's something I haven't seen or done before, then she will explain it and have me do it and she watches.

My other preceptor, well, has only been there about 13 months and I'm her first orientee. I'm with her less than half of the time I'm on orientation, but she is difficult to work with. The communication...is pretty awful. For example, one night we were getting ready to take a patient to MRI. The patient was still awake and my preceptor told me to draw up a dose of rocuronium because the fellow wanted her to have some, to which I asked if she also wanted fentanyl prior to the roc because this patient was still awake. She raised her voice and said "Just draw up the roc." I drew up the roc, brought it over to the bed and had her double check it. She then says "What are you doing. I already drew up the roc. But okay just give it." Just to clarify (because I was being given conflicting information) I asked "Okay, so they want the roc now, correct?" and she goes "Okay, no, don't give it. She's still awake just WAIT." At this point I was so frustrated and annoyed that I just stepped back and got her transport monitor hooked up. The fellow comes in and asks if we gave the roc, and my preceptor asks me "Well did you give it or not?" and I said I was waiting to give it, like she told me to. And she goes "Oh my god Okay I'll just give it since you forgot to." I was SO CONFUSED. Even some of the nurses in the room helping told her afterwards that she wasn't making any sense. Every shift that I've been with her, she has been doing these kinds of things and making me feel like an idiot.

When I leave my shifts with my night shift preceptor, I feel like an absolute idiot, and I feel like a new grad again. I'm trying to tell myself it's not me, but it's really not making my transition any easier. My question is, does it seem like maybe they gave her an orientee prematurely and she wasn't ready for one? And should I go to my educator about it? I'm only with her for two more weeks then I'm with my main preceptor for the last 5 weeks, but I am having trouble dealing with these issues every time I work with her.

[NotReady4PrimeTime, RN]

Your educator definitely needs to know about this, and the sooner the better. This just validates what I've been saying on my own unit about preceptor assignments - new staff members with no prior experience not only need but deserve a preceptor who knows the job well and is able to guide them to become strong nurses. I can see why you're frustrated and feeling unsupported. This nurse seems not to understand the value of closed-loop communication, something that is essential to safe care in the PICU all the time, but especially so at night. So in my eyes, you're not the idiot... Props to you for asking about sedation ahead of the paralytic. Imagine how horrifying it would be to get a paralytic and be aware of everything but unable to move. (I had an epidural that went north instead of south so I can relate.)

My advice to you is to ask to see the educator privately where you can describe the kinds of things that happen on your night shifts. Then ask for an evaluation with the educator and the night preceptor, to see what she'll say about you and your performance. My guess is that she'll be incapable of providing an accurate assessment of your skills or your knowledge base because the gaps in her own are too glaring. If you're not documenting things as they happen, you need to start now. And whenever possible, have a witness to her behaviour. Best wishes to you.

[KeepinitrealCCRN]

some people are just not going to be good preceptors no matter how much experience they have. it takes a lot more than experience to be a good preceptor. i would try to get more shifts with your first preceptor, the one you get along better with. it is hard to be new and learn on top of dealing with a difficult personality or someone who cannot communicate. not worth your time, try to get switched.

[MGMR]

It's pretty common, at least for my unit, to get a relatively inexperienced nurse for your night shift preceptor. Unfortunately there's not enough of a balance of experienced nurses on night shift to give all the incoming nurses on orientation, so they typically settle for the most experienced among the inexperienced.

But I definitely echo what NotReady4PrimeTime and SICUMurseCCRN said. It's important that the educators know because you need to ensure you're getting the best orientation as possible. It's also important because if nothing is said, they'll start giving that nurse more and more orientees since, as far as they know, it went so well with you. If you phrase it as a safety issue to your manager and educator, I think it will go over best.

[Emm_RN, ASN, BSN, MSN]

Thank you all for your advice! It is hard to learn sometimes and I'm already nervous enough to take care of these kiddos! I have a meeting coming up with my educator and unit director so I'll bring up the topic then. I appreciate all of your responses!

[audreysmagic, RN]

As a staff educator, I would DEFINITELY want to know if you felt you weren't getting a good learning experience with your preceptor. NotReady4PrimeTime is absolutely right - people deserve a good, solid orientation that they feel comfortable leaving to be on their own.