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.

[ArtClassRN, ADN, RN]

Why is she allowed to get away with not keeping up with change?

Because the manager on that unit only cares about filling beds.

[AussieCCRN]

I think that you need to go to your manager, and request an opportunity to work with an alternative preceptor. Some of the concerns you have are definitely valid and it sounds like you and your preceptor are not getting the best out of each other.

Unlike a lot of the other comments I agree with you in regards to the dressing change. While it is not necessarily a sterile dressing, aseptic technique should be used with a sterile field and a change of gloves and hand hygiene completed between the removal of an old dressing and a new dressing being applied.

Good Luck it sounds like you're going to be a great nurse and just require a bit of time and learning how to manage ward politics.

[VANurse2010]

I think that you need to go to your manager, and request an opportunity to work with an alternative preceptor. Some of the concerns you have are definitely valid and it sounds like you and your preceptor are not getting the best out of each other.

Unlike a lot of the other comments I agree with you in regards to the dressing change. While it is not necessarily a sterile dressing, aseptic technique should be used with a sterile field and a change of gloves and hand hygiene completed between the removal of an old dressing and a new dressing being applied.

Good Luck it sounds like you're going to be a great nurse and just require a bit of time and learning how to manage ward politics.

I don't disagree with what you're saying per se, but the idea that the procedure had to be a true sterile dressing change is a major misinterpretation/error on her part.

[LM NY]

I was only able to read some of the responses, but I am in the opposite situation. My preceptor is wonderful and takes every opportunity to teach me and still manages to care for her patients. I have had 2-3 patients and have been working mostly independently, but always keeping my preceptor in the loop. However, the new educator on the floor who has over two decades of experience, most of it being in critical care has been on my back about not filling in every line of the assessment on our EMR. We were in the documentation room and she was making comments and I know for a fact every single person was listening. I appreciate every thing she is trying to do for me and the organization, but I am basically her guinea pig for now. We both started orientation on the same day and she is overseeing me and two other new nurses on the other med-surg floors. I may be a new nurse, but I don't want to be talked to like an elementary school teacher telling her student to make sure to cross every "t". I know I can learn a lot from her and she is extremely knowledgeable. I guess I just had a moment where I felt like a little kid in the principal's office being scolded at. God bless all the nurses that have so many patients plus have to precept orientees or nursing students. If I didn't love nursing so much, I can totally see how people leave the profession.

[Sweecy]

I was only able to read some of the responses, but I am in the opposite situation. My preceptor is wonderful and takes every opportunity to teach me and still manages to care for her patients. I have had 2-3 patients and have been working mostly independently, but always keeping my preceptor in the loop. However, the new educator on the floor who has over two decades of experience, most of it being in critical care has been on my back about not filling in every line of the assessment on our EMR. We were in the documentation room and she was making comments and I know for a fact every single person was listening. I appreciate every thing she is trying to do for me and the organization, but I am basically her guinea pig for now. We both started orientation on the same day and she is overseeing me and two other new nurses on the other med-surg floors. I may be a new nurse, but I don't want to be talked to like an elementary school teacher telling her student to make sure to cross every "t". I know I can learn a lot from her and she is extremely knowledgeable. I guess I just had a moment where I felt like a little kid in the principal's office being scolded at. God bless all the nurses that have so many patients plus have to precept orientees or nursing students. If I didn't love nursing so much, I can totally see how people leave the profession.

Nothing sucks more than having someone talking to you like a kid. Some people don't have the art of teaching adults. They are too strong and most of the time forget that they are not molding kids, perhaps instructing adults new set of skills. You have to use a friendlier voice when instructing adults, let them ask questions, speak their minds and share their little tricks. It's not like your are trying to keep them in line because they are already in line (assuming a new nurse is a responsible adult). I can not learn from people with strong personality or those who like to show offs. Just get your done, let's have a good day while treating each other like adults and hopefully friends.

[JayHanig]

Seriously, if an orientee asks why you do things a certain way, especially when all of your clinical experience was at a different hospital, than why take offense?

One of life's little lessons is that the guiltier one feels, the more defensive one becomes. The preceptor cuts corners (hell, I did too) but the work load pretty much demands that you do. I don't agree with everything your preceptor did but I certainly understand the reasons why he or she did it that way. Understanding your preceptor's behavior may show you the answer the next time. In this case, the preceptor became defensive because you questioned his or her actions. It may not even be what you asked as much as the way you asked. For example, asking "What happened that made you decide to do it that way?" is less threatening than asking "Why did you do it that way?"

When you want or need to manipulate another person's behavior, the secret to success is understanding what motivates them, then approach it from that angle.

[kayern]

Consider this.........a hospital that has such a sloppy nurse precepting maybe isn't the right hospital for you.

I would have advised you from the onset to report some of the practices directly to the educator or manager, now it will appear as if you are covering yourself. I also read some of the other posted comments, I especially take issue with the one "I haven't done a true sterile dressing in 5 years nor have I been required to do one". Sterile is sterile......clean is clean, in the case you sight, was there any exudate in the wound? if so then I agree change your gloves, better to be on the safe side. Scanning all your IV meds at one time, stand firm because you are absolutely correct! The vaccinations = falsifying the record, better to document unable to assess and write a note unless you can go into the old medical record and abstract the info and chart that you did so. Urinary output = 10-20ml/hr at a minimum, IV contrast the previous day with rising labs, you ARE CORRECT.

I think the issues you bring up are valid and applaud you for not turning into one of those "sloppy" nurses. Hold your ground and be proud that you are trying to do right for your patient. Let us know how it turns out

[JayHanig]

I've had one more thought about if you get fired. It's my understanding you recently graduated and have only been working in this hospital for a matter of weeks. Consider this:

In this economy, it's not unusual for people to have gaps in their employment, particularly new grads. If you do get canned, is there any law that you have to report your employment at this hospital to your new employer? How will they know you were fired if they don't know you worked there at all? Claim the new job as your first job.

Some people will say that's dishonest but all I will say is, they have their agenda; I have mine. It's not like you were separated from your job for being the Angel of Deathâ„¢. Discretion is the better part of valor, as my father always said.

[LM NY]

You can never go wrong by following the hospital policy. Yes, nurses cut corners. I don't believe they do it out of laziness. They need to get the work done. I bumped into the VP of nursing at my hospital and I told her how I was feeling overwhelmed. She told me to not be so hard on myself and to actually give myself credit. She said I will have good days and bad days and I felt like a burden was lifted off my shoulders. Nothing prepares you for real world nursing and I commend every nurse for putting up with what they do. I loved nursing before I entered the profession, but I have a newly found respect and admiration for the profession.

P.S. the nurse educator I mentioned in my earlier post likes to name drop. She mentioned all these top hospitals she has worked at. That was another reason I was turned off.

[DEE S.]

I am giving you a strict WARNING. If you want to start your nursing career do what she says...UNLESS you will be held accountable. Like giving a medication without following protocol. Take the BP before giving med you will never be fired for that. Take glucose before giving insulin you will never be fired for that. However you will be fired if you call the doctor without your preceptors permission, you will be fired if you can't keep up on a med surf floor which,means getting your charting done. Doctors look at the charting so get it in there they make decisions based on your charting. Do not feed anybody or do anything extra that a tech can do, unless you have Your charting done. Please heed my warning. what you are expering over 1/2 the new nurses experience I including me. Remember you will be fired from this job before you finish orientation of you don't listen to NURSE Ratchet. Suck it up. You have to be smart enough to get out of orientation. The boss will listen to the preceptor. Once out of orientation do not do something a tech can do unless all of your work is done. I got in trouble for giving a bed bath to an obese stinking woman. I was gonna throw up on her if I did not get that stincth off of her. She is wrong on most accounts but stroke her ego. Always I mean ALWAYS ask at the end of your shift with a notebook in hand what Did you do well today and what can I work on next shift. They like that you want there opinion. Plus if she makes up stuff u can pull your notes about your progress with the dates .

[garn12]

Maybe there is no experienced staff to precept its very common unfortunately. Experienced nurses are tired of dealing with management and their unrealistic expectations and are leaving bedside nursing for the inexperienced to figure it out.

[DavidLovejoy]

Couple things people have gotten wrong: sterile technique is not required (that is so) but the 5 moments of hand hygiene per WHO standards do require a glove change between exposure to body fluid and placement of clean dressing. That is problem endemic to many practices, unfortunately.

The largest issue was the disclose of private data regarding a patient to a person not involved in their care. While sex offenders provide special problems in hospitals, our current patient protection laws still apply to them. As well, her intent in sharing that info is dubious. To be sure, there are likely corporate compliance rules that require you to report that indiscretion.

Lastly, taking multiple meds in a room, pre scanning them, and leaving them at the bedside is a 7 rights violation, an infection control concern (they cannot be returned to pharmacy after being in the room), and would be cited by any credentialing body that visited. Don't do it.