Is it legal/ethical for preceptor to sabotage student?

Nurses Relations

Published

My wife recently posted about the difficulties she has faced in a new ICU job. She is recluctent to leave because it was tough to find the position that she now has. However, just the other day when her preceptor asked her how she thought she was doing and my wife answered "fine" the preceptor basically said "well I've laid some traps for you that you haven't caught." For example (and this was the only specific that she admitted to) the preceptor said that she had disconnected one of client's chest tubes for four hours and that my wife had not caught the error. My response would have been "so you let a patient go without benefit of a chest tube for four hours due to a deliberate act?" . However, my wife simply smiled, said she would try harder, and learned to focus on the "floating ball" that indicates suction. My question is doing stuff like this (introducing errors to test whether the nurse will catch them and then letting those errors be implemented into patient care) ethical and legal?

One other issue that already raises a red flag to me is the little mention that your wife has already had six or severn other preceptors. That alone means that there have been some other type of issues going on with her as well. That is normally not done in the ICU setting.

Suzanne, I had 15 preceptors in an ICU setting! (I'm not there anymore, BTW). Some ICUs seem a little clueless about how to precept new grads.)

A friend of mine is also going through the "preceptor a day" experience at another hospital. This is after her preceptor told her she wasn't sure if my friend was "salvageable", and wasn't sure what the heck my friend learned in nursing school.

Your post makes it sound like it was Roland's wife's fault that she had so many preceptors. (I apologize if that was not your intent). Believe it or not, there are ICUs who give new people just whoever is around to be a preceptor.

Oldiebutgoodie

Up Vote Up Vote ×
Specializes in ICU, step down, dialysis.

Sounds like the preceptor stopped the suction, if you are talking about that little orange ball not being there. That is on a Pleurevac I believe, and if it's not there, means the suction is not on and it's only to water seal.

I've unfortunately seen ICU orientees with several preceptors.It's not good in any area of nursing.

Frankly, from what I read of your post here and on your wife's thread, she needs to quit. I think things have gone too far in this situation.

There are just some units where if you don't fit in (not that this is your wife's fault at all), or the place is just too toxic, it's just best to leave and find another job. It's not worth getting sick over it or feeling this bad. She can find something else much beter; hopefully you could possibly get some advice on a good place to work at. I've worked in both kinds of places; one very toxic (although it did not cause me to leave, I could see where others would), the other (my current job) which is very supportive of both management and staff.

Up Vote Up Vote ×
Specializes in Critical Care, Pediatrics, Geriatrics.

After reading this thread all the way through, I am a bit confused.

The OP's initial statement said the Preceptor removed the chest tube. Then it refers to the suction. So did she disconnect the tube from suction or d/c the tube.....two totally different things. I have a feeling that she removed it from suction....which is not right, but a little more believable.

But if she d/c'd the tube without an order she would not only need a buddy buddy relationship with admin, but with one p***** off doctor, and a good lawyer:rotfl: .

I believe that if this indeed happened...the patient being removed from CT suction for 4 hours to see if new nurse could catch it.....that something needs to be done immediately!!!!!! No turning your head on this one.

However, if this is some sick psychological game this exp. nurse is playing at, then I suggest your wife leave. I didn't get into nursing to play mind games with co-workers, walk around paranoid that they are doing things to 'test' me which may be putting my patients in danger, and then sitting back watching me squirm trying to figure out if I can take them seriously or not. There should be no playing around when it comes to training a new ICU nurse.

Up Vote Up Vote ×
Specializes in Case Management.

I have read your wife's post and your post and it really sounds to me like you both need to step back and decide what is more important, your collective sanities, or keeping on schedule for CRNA school. I think she is in a dangerous situation both for the patients and for her professional career. She needs to step back and set priorities. If I were her, I would go back to the preceptor with a hidden tape recorder and have her explain in detail how she "trapped" your wife by disconnecting a chest tube. Crazy!

Up Vote Up Vote ×

When a nurse is on trial for malpractice the first question to decide is "Did the nurse have an obligation to the patient?" Next, "Was harm done?". Last, "If harm occured was it due to an overt/covert act on the part of the nurse?"

Seems to me the preceptor wanted to be the hero and rescue the patient if they went bad. On the other hand, if a patient had a chest tube not functioning for 4 hours and no harm was done--sounds suspicious to me. Anyway, I believe your wife needs to get some backbone and go to the supervisor and explain how difficult it is to learn nursing and the level of difficulty is increased by the fear of being sabotaged by a co-worker. Does this co-worker sabotage other people whom she deems needs to be "taught a lesson"???

Up Vote Up Vote ×

Most important point here, is why the CT was not checked every hour?

This is where the problem lies, most ICUs have a place where you document hourly what the suction was at and if it was working. Either way, for it to go for four hours and not be caught by the nurse is not acceptable. It needs to be checked. And especially in the ICU. It could have come off suction because the bed was moved, or for any reason, but it needs to be observed closely. Or just that the patient left the unit for a procedure. Either way, it needs continuous monitoring.

And if you look at the iniital tone of the poster, it looks like his wife has had six or seven different preceptors but not on a daily rotation, I get the impression that it has been issues between her and the other preceptors, this may just be knowing some of the oither history in the past, but again, I am using an educated guess and assuming. Sorry, if I am wrong, but I do not think so.

Up Vote Up Vote ×
Specializes in Emergency & Trauma/Adult ICU.
Most important point here, is why the CT was not checked every hour?

This is where the problem lies, most ICUs have a place where you document hourly what the suction was at and if it was working. Either way, for it to go for four hours and not be caught by the nurse is not acceptable. It needs to be checked. And especially in the ICU. It could have come off suction because the bed was moved, or for any reason, but it needs to be observed closely. Or just that the patient left the unit for a procedure. Either way, it needs continuous monitoring.

And if you look at the iniital tone of the poster, it looks like his wife has had six or seven different preceptors but not on a daily rotation, I get the impression that it has been issues between her and the other preceptors, this may just be knowing some of the oither history in the past, but again, I am using an educated guess and assuming. Sorry, if I am wrong, but I do not think so.

:yeahthat:

Up Vote Up Vote ×

The Mrs. is still asleep, but I will try and get her to do a quick reply (or at least read the above posts) when she awakes, but before going back to work. First, let me clarify the chest tube suction was removed, but not the chest tube itself sorry for the confusion on that issue. Second, yes it appears my wife did "drop the ball" by missing this fact (assuming the theory about the preceptor lying to test my wife is not accurate). I have not asked her "how she could miss that" because I know that she is very busy often with two CRITICAL patients on many shifts (they have hourly glucose stablizers, many times 15 minutes vitals, lots of titration decisions et). Either because she is new or hasn't been taught she wasn't particularly "attuned" to that little ball and how important it is. Also, I know that some of her chest tube patients have had very low output, which would make disconnected suction less noticeable. However, at the end of the day it is also HER error for not catching the disconnect of suction and she takes responsibility for the error (and knowing my wife all it takes it one error and she almost never makes it again she is also "anal retentive" and will no doubt be checking suction on chest tubes a billion times per day for the rest of her life, like I said she is a perfectionist my exact opposite). My wife is an excellent nurse many of her nursing school instructors and her former Med/Surg manager commented that she had among the BEST clinical skills that they had witnessed in a student or newer nurse. Have there been other possible "deliberate acts" well the preceptor said so, but didn't say what they were. It is my opinion that the preceptor is not the type of person to make this up as somesort of "morality test", but I could be wrong.

As to why she has had so many preceptors? Well they started her on days (even though she was hired to work weekend nights) and on days she had two or three different preceptors. Originally, they tried to accomodate her schedule for her one night a week class, and my nursing school schedule (because obviously she has to work on the same nights as her preceptor, and I had to leave for nursing classes at 0500 due to the two hour commute). This meant by necessity that she have different preceptors. Then in late Oct. they told her that they would no longer accomodate her schedule (which is when I withdrew from nursing school classes despite having the highest grade in my class of 60).

She has had the same preceptor for approximately the last month. This particular preceptor is considered to be a good, experienced nurse, BUT also very anal retentive and something of a "busy body" (because she will often go all over the floor pointing out various charting errors, and ways that she would do a particular procedure better to other nurses). It is my impression that if my wife challenged her on this that the preceptor would take the attitude "so you want to play that game do you" and then "find" a million issues to get my wife in further trouble. Note also that she called me on a payphone shortly after her preceptor had confessed to doing this. I had warned her that this was a possibility, but frankly she considers me a "paranoid conspiracy theorist" (there is a saying that I like "just because you are paranoid doesn't mean that someone is NOT out to get you").

In addition, I didn't mean to imply that Med/Surg nursing was a "step back" in terms of professinalism or knowledge. However, it is a "step back" in terms of our CRNA school/ life plans. It would also be a shame in my opinion if the last four months of hard work and critical care classes go into some sort of "black hole" that cannot even be mentioned on her resume (because no one would consider it a plus to work for four months in an ICU internship only to have to leave again for Med/Surg). The current "master plan" calls for her applying to CRNA school with three years of ICU experience, her CCRN, a GPA of around 3.75 and GRE's which will probably like her SAT's be in the top 5% of all those who take the exam (note this will put her well above the minimum for most schools). Thus, if she has to do an extra year in Med Surg it will take a year longer to get that three years of ICU experience. My other point was that $50,000 per year or more in extra income that she could earn as a CRNA is "gone forever" if she loses a year. I also pointed out that $50,000 invested at 7% interest is worth more than 200K after twenty years so it is ALOT of money (more than many retire with). Is this over ambitious? Well, she graduated first in her highschool class, had 1500+ SAT's and wanted to be an M.D., but her father a fundamentalist minister didn't believe in women being alllowed to go to college let alone be Dr's.

Also being in our mid 30's "time is of the essence" since right now we are no more than a couple paychecks from being homeless. Thus, even starting a retirement fund cannot come until she graduates from CRNA school. We also have about $60,000 in student loans ($38,000 of which is mine) so income is not a minor point (ideally as most of you know you should start saving for retirement no later than your late 20's). However, I also realize that it is ultimately in God's hands and that man's will (or women's) and plans will not overcome a destiny that he has in mine. Maybe that it part of the problem/answer in that I'm not sure that we have prayed about this issue the way that we should have(or at all for that matter).

Up Vote Up Vote ×

I'm confused!!!!

I'm in orientation right now and I know that my preceptor is just as responsible for the pt as I am. I just don't understand why she would intentionally put a pt in harms way to "test" your wife. Also, I know from my few months of experience that I'm more likely to catch mistakes that I make. If I were in a room and checked the chest tube and it were fine, I would not expect another nurse to go in and turn it off. I would do the regular checks, but it wouldn't be logical for there to be a problem so I would be less likely to notice it. If I, for some reason, turned it off, perhaps if it were an accident, I would know that I had been touching the knobs and would be more likely to check. Now this is just me in my "newness" and maybe I'm wrong, but I don't see the logic in teaching a new nurse that way. I know that with my preceptor, if I missed something important, that she is double checking my work. She wouldn't fix it for me, she would say "maybe you want to go look at your pt again".

The issue that concerns me the most is your wife wishing to be in an accident so she doesn't have to go to work. I've been there and it is bad. You can't work in a place that makes you feel that way, at least not for long. At least for me, I would be sick more often because of the stress and I couldn't concentrate at work. It was a bad situation and I got out of it. I'm currently working as an RN on med/surg and am a single mom supporting two kids. I have sacrificed some luxuries, like I don't have cable TV right now, but I certainly have enough money to pay the bills. It sounds like you need to add your health and wellbeing to your life goals.

Jessica

Up Vote Up Vote ×
I'm confused!!!!

I have sacrificed some luxuries, like I don't have cable TV right now, but I certainly have enough money to pay the bills. It sounds like you need to add your health and wellbeing to your life goals.

Well said...

you obviously know the answer to your sought out question...50 Grand for one year 200 grand ..how about no grand....and if this continues either your wife will have enough and eventually leave and will have "wasted" even more time or something bad will happen in terms of licensure and those "dreams" of CRNA will be gone...forever:uhoh21:

Up Vote Up Vote ×

Jessica, my wife read all of the replies except for yours (she had to get ready for work) and she promises to write her own response tommorow night (she has a meeting in the morning with her manager, preceptor, and unit educator about her progress/future). She said that I had one thing factually incorrect. Specifically, her preceptor admitted only to disconnecting the vacuum on the chest tube for two hours not for four. I am sorry for that error.

You make a good point about health, but money is part of that equation as well. My wife, son and I have all been suffering from a cold that turned into bronchitis since early November. She has gone through three rounds of antibiotics and is much better (although she still has a slight intermittent cough) however, mine has grown progressively worse to the point where it feels like I have fluid in my lungs and in my ears (compounded with recent onset hypertension and daily nosebleeds). The difference of course is that she has health insurance and I don't so while they (my son and wife) take antibiotics, I take goldenseal, echinacia, tea and occassional garlic (not much because she says it makes me stink). The money that she had to give up to meet their schedule demands (because it meant working during the week, and giving up the weekend shift differential that she made for week end work in her old Med/Surg job) would more than pay for me to have health insurance.

As to why her preceptor thinks that she was using an "acceptable" teaching method (assuming she was telling my wife the truth and not subjecting her to some sort of moral test as some here have suggested). I can only suppose that she doesn't believe that disconnecting a chest tube for a couple of hours places the patient in any sort of significant risk ( or that any risk is outweighted by the information that she believes it gives her about my wife's competence to care for patients in the ICU). My wife is actually dealing with the situation much better psychologically than she was even a few weeks ago. It used to be that I knew that every shift would be a battle just to keep her from telling them that she was quitting. Now, she seems to have somehow created some sort of "psychological space" where she goes in with the attitude that she's just going to do her best and "let God sort out the details". I really admire her and consider her to be a role model for myself in how she has dealt with this situation ( I didn't even mention that her mother who had been living with us for many years and helping with child care in exchange for living rent free, returned to her abusive husband this semester who also abused my wife as a child. So that is one more thing she has had to deal with in addition to going to school full time, having bronchitis, and providing much of the care for our son and her brother's infant daughter whom the parents have pretty much abandoned). She has also had to deal with a husband who after going into debt almost $40,000 in student loans drops out of nursing school (for reasons previously discussed) and has all of the earning power of a Wall Mart worker to show for his efforts (I do plan to go back and become a rad tech to support her through CRNA school, but even that will be difficult for the same reasons previously mentioned). Honestly, I think that many people would have cracked and either left in a fugue state or ended up in an asylum if subjected to the same stresses she has faced. I can't speak for her, but this experience has made me appreciate just how spectactular a person she is even more. I just want to see her standup for herself, speak the truth and let "the chips" fall where they will.

I'm confused!!!!

I'm in orientation right now and I know that my preceptor is just as responsible for the pt as I am. I just don't understand why she would intentionally put a pt in harms way to "test" your wife. Also, I know from my few months of experience that I'm more likely to catch mistakes that I make. If I were in a room and checked the chest tube and it were fine, I would not expect another nurse to go in and turn it off. I would do the regular checks, but it wouldn't be logical for there to be a problem so I would be less likely to notice it. If I, for some reason, turned it off, perhaps if it were an accident, I would know that I had been touching the knobs and would be more likely to check. Now this is just me in my "newness" and maybe I'm wrong, but I don't see the logic in teaching a new nurse that way. I know that with my preceptor, if I missed something important, that she is double checking my work. She wouldn't fix it for me, she would say "maybe you want to go look at your pt again".

The issue that concerns me the most is your wife wishing to be in an accident so she doesn't have to go to work. I've been there and it is bad. You can't work in a place that makes you feel that way, at least not for long. At least for me, I would be sick more often because of the stress and I couldn't concentrate at work. It was a bad situation and I got out of it. I'm currently working as an RN on med/surg and am a single mom supporting two kids. I have sacrificed some luxuries, like I don't have cable TV right now, but I certainly have enough money to pay the bills. It sounds like you need to add your health and wellbeing to your life goals.

Jessica

Up Vote Up Vote ×

Roland, i can see this happening especially in specialty units for new grads. Nurses "eating their young" is true and does exist. Absolutely not--- now way is this prudent practice, placing a patient in jeapordy to "test" a novice's skill or aptitude. Apparently this preceptor is nerotic---- Oh let me inject potassium into the pts heart to see how quickly you can respond to a code. She must be nuts. I can relate w/ your wife. I did 4 months in an ICU with a preceptor from hell. One day we had an admission and she sent me off the unit to transport another patient. Well she began to page and holler all over the unit for me and chastised me when I returned---- for what? to insert a foley. Ohhh Wow--- a foley big deal. Needless to say I hauled !@# out of there and took a travel assgn great move for me $$$

This too set me back I too plan on CRNA school, but when i do return to the ICU i will have to screen the joint inside out. Hope your wife can be precepted by someone else who has her best interest in mind or go to another hospital.

Up Vote Up Vote ×
+ Add a Comment