My preceptor is everything they taught us NOT to be...

[Live..&..Learn]

I was hired on a med-surge floor, and have been working with a preceptor for several weeks. After questioning some of the things she is "teaching" me, I've been given a "final warning" and am facing termination over complaints made to my manager "per preceptor".

I a new grad from an excellent, small hospital based program where the instructors have tons of professional and life experience, and we leave feeling like confident, competent New Grads. I was assigned to a preceptor who has just over a year experience, and was impressed by my clinical skills, stating she didn't learn anything in school. I've noticed the following things that have caused me to question her practice and ability to precept. I would like some opinions on whether I'm over reacting, or valid in my concerns...

Pt has a stage 4 pressure ulcer on her coccyx, wet to dry dsg changes ordered q day. I observed while she changed the dressing. No sterile field, no sterile gloves, out clean gloves on, removed the dsg and packing, never changed the gloves, soaked the packing with her gloves hands, repacked and dressed the wound.

If my pt has multiple IV meds ordered for the same time she told me to scan them all, hang one, and leave the rest to be hung when it finishes. I don't sign for meds that haven't been given.

Non verbal pt has orders for blood glucose monitoring and insulin sliding scale. 0630 fingersick done, pt does not score for coverage. 0800 the tech who came on did another finger stick and pt needs 2 units. At 1000 preceptor says that pt needs coverage, I never signed off on the task (he didn't score when it was ordered). 1030 administering meds, recheck fingerstick and pt needs 2 units. I signed off on the 0700 order (outside of parameters), charted the new reading, gave the insulin at 1030 for the 1100 order. That's wrong, I should have covered him for 0700 and rechecked at 1100. I told her I don't think I should give insulin 2.5 hours after a fingerstick without a recheck. Or cannot even tell us if he's feeling off, and is npo with tube feeds.

New admission two days post discharge. Dementia, not a good historian of her medical hx. Form asks "has pt had a flu shot". Preceptor states "I don't know for sure, but they must have given it on d/c. Charts that she had it and pneumonia vax on date of last d/c.

We were told that no blood pressure meds are to be given without a. BP within 30 minutes. She was not there that day. It is 0920, pt has a bp charted for 0811, but the techs do vs at 0700, it was charted at 0811. "Give it, it's fine". Next pt is on a beta blocker, calcium channel blocker, and 80mg lasix. I rechecked the BP and she seemed quite annoyed.

I heard her giving report in the hall outside a pt room. Openly discussing hx of drug abuse, etc. Another pt is a registered sex offender, I overheard her telling a tech from another dept. His reason for being a sex offender.

I had a pt who was on two iv and, including vancomyicin. The day before she had IV contrast. Her BUN and Creatinine were elevated, GFR was around 40 the day before. She told me in the am that she is usually up four times a night to void but hasn't been up once. I report this to preceptor. After a little bit, I got her up to the commode where she voids 40mls. At lunch I got her up again and she voids 60. I went to preceptor who tells me that she went for her. I asked if I should call the doc just to be safe, she says she will take care of it. End of shift I asked, she said pt is fine, no need. RN I am reporting to ask about output, I explained it to him and he called provider.

I could keep going, but I feel like a vindictive crazy person. I know these are bad habits, and refuse to adopt them into my own practice. She wants all of my tasks and charting to be done by 10am. I often do not reach that because I choose to assist pts with am care, breakfast, ect. The charting can wait in my opinion, as long as everything is done on time. I have one foot out the door anyway, and will likely be fired today. I can deal with that, I definitely can, but I was advices by a mentor to approach her, I tried, and yo go to the manager, I asked him to meet with me, and he told me that he has continued to receive negative feedback from my preceptor and will discuss it with me. I know I'm being fired, and there's not much to do to change that, unfortunately being fired means I will not be eligible for 're-hire at the one hospital near me. But, what do I do about this preceptor? Let it go so the next new nurse can learn these poor habits, or try to bring it to someone else's attention?

Thanks for listening, sorry about the extremely long post...I refuse to adapt bad habits just yet, or sit back while patient safety is compromised, unless of course I'm being an over reactive cry baby.

[historylady, MSN, RN]

There will always be the way you are taught in nursing school and the way things are done in the real world. But often times the way things are done in the real world are also not the way things "should" be done in the real world. The things that are taught in nursing school are all put in the curriculum because they are evidence based practices. They are they way things "should be done".

First, you need to get through the preceptor orientation. Watch what they do and learn from them. Are the things they are showing you time savers or are they just the way that has become habits? Are the way they doing things harmful to the patient? Once you are through orientation and working on your own, you make decisions for yourself on how and why you do the things do.

But the flip side is, do not jepordize your morals and integrity. You have to do what is right for you. If you are asked to sign-off on things that others have done, don't do it. When you have to sign off for doing things, do it your way. Do what you believe is right and stand by what you do. I use "am not comfortable doing it that way, so I am going to do it the way I was taught" Any nurse worth there license will respect that. I have watch a number of nurses, who do things their way, get caught in the book way versus the real world way dilemma. The real world way always loses when it comes to state nursing boards, JACCO and other nursing regulatory agencies. After all it is your license. IF you do it this way or that, it always comes done to choice.

I have watch nurses do nasty dressing changes without using sterile technique. I have watched nurses do foley insertion without sterile technique. I have watch nurses do a dressing change without ever switching to clean gloves. Are these things right or wrong? You have to make the decisions about you practices. Just remember facility policy is written for a reason. In the end, it is your license. Don't compromise your integrity, you have to live with your actions.

[Garden,RN, ASN, RN]

Welcome to the culture of nursing, sadly. The first three months of my nursing career i went home and cried everyday, convinced I had made the bigger mistake of my life by becoming a nurse. I was not the traditional student fresh out of high school. In my thirties I entered nursing school. Prior to that I had worked in Banking, Real Estate, had my own business and had been in supervisory positions. The working environments there were so pleasant by comparison. The hospital environment I was in, was like stepping back into high school where the, yes, mostly women were less logical and more emotional. In real estate the only thing that matters is the math so now confronted with people worried about liking each other an little struggles for power devastated me. I was working with very intelligent nurses, capable of saving lives at the drop of a hat, able to titrate cardiac meds and yes, guide a physician through a code, yet the cattines was horrible. When I worked with mostly males in the other areas there was competition but it wasn't personal, but with females. Perhaps the males interact differently with each other, I would not know that experience and it wasn't all a bed of roses. I just find it so much easier when we remove the personal and the drama from work relationships that I don't understand why we do it. I have the opportunity to interact with young adults and high schoolers often in teaching capacity. My students are quick to point out when I am doing something wrong, and it makes me proud of them. It tells me they are learning and absorbing and they help to sharpen my skills too. That preceptor has a lot of knowledge but she isn't open to a dialogue and should not be a preceptor. You cannot expect that what we do will be textbook clean and beautiful like school I would encourage you to do your best and not lose your idealism because the patients need people with that passion. To the practical side, it is a cultural problem, if this is someone you are going to be working with, is that going to work? Have you annoyed her to the point that she will give a bad report about you? Most important of all, sit down alone and analyze the situation and write down what part you have done wrong and fix that part. Do toughen up because eventually you find your own unique place. Learn as much as you can from your preceptor, but do keep in mind the culture around you and evaluate if it someplace you want to work. I hope this doesn't offend anyone but it has been my experience.