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.

[stupefyingjones]

New nurses should never be precepting new grads! I see it all the time, good never comes of it. And very very very rarely will a bedside dressing be a "sterile" procedure, they are "clean" procedures.

[stupefyingjones]

The "I know it all" attitude needs to come to a halt and the "I am brand new at this and need to really watch and learn from everyone this first year especially" attitude needs to take hold or you will never get along with the nurses you work with. You need to learn to pick your battles too, most of these aren't worth your time and just make you look bad.

[RobynDean]

1. Being precepted by someone with one years' experience is a big red flag. This should never happen.

2. As previously stated, there is school and there is real world. Do you have friends who have been nurses for a while? If so, discuss these issues with them. You will see that real world practice is very different from school practice.

3. It takes a great deal of time to figure out how to prioritize when you are new to nursing. In clinicals your tasks were mostly CNA type tasks. You now need to learn that the CNA does for you most of what you did in school. This is not to say that it is never your job to help someone to the bathroom or clean them up. You definitely do or assist with these when you can. But nursing priorities are different, and you need to figure that out.

4. Everyone develops their own style of practicing nursing, once your basic skills are in place. Until then, never judge another nurses practice unless she is being flagrantly negligent or breaking the law. You are in no position to judge.

5. The best thing you can bring with you every day to work is a positive, helpful attitude. Without this, your day will be long and difficult, and you will end up hating your job.

Good luck.

[germinariojenn]

I definitely feel your pain. My first nursing job, my preceptor was the worst. She was showing me bad nursing habits then throwing me under the bus because I was a new grad. I got chewed out for it, only to resign my position because I felt that my orientation wasn't fair to me. Trust me, you're not alone. But if you feel that your preceptor is teaching you bad habits, ask if you can be reassigned. That might remedy the situation a lot.

[germinariojenn]

Your attitude towards her, especially speaking to her that way, is completely appalling. its not wonder new nurses are scared of veteran nurses.

[Vanilla101]

The standard process for orientees in virtually all hospitals is to have regular meetings with your preceptor & a representative from your units leadership. At these meetings issues in practice may be discussed, and you will always know where you stand. Management shouldn't be able to terminate you unless they have consistent documentation of poor performance being a pattern. Management is also responsible for providing remedial education to help you perform your job competently at the new grad level. this also needs to be well documented, and it must include your success after education.

If I were you, I would request a new preceptor, watch & learn, have regular meetings with her & leadership, and frame your questions so that your preceptor doesn't get offended, but rather regards you as someone willing to learn from her. Everybody has a different practice. delegating tasks to the appropriate ancillary personnel avoids micromanagement and allows for you to complete your RN responsibilities.

[NOADLS]

Your attitude towards her, especially speaking to her that way, is completely appalling. its not wonder new nurses are scared of veteran nurses.

In all fairness, they're both "new" nurses.

I want to believe that this could have been avoided by having the OP paired with a more experienced preceptor, but the way the OP spoke of some things (particularly delegation) makes me think that this was more of a personality clash.

[ThePrincessBride, MSN, RN, NP]

When I was in DBT, I learned that when dealing with a conflict to always first asked myself: what is my end-goal? In your situation, is it to piss off and one-up your preceptor? Or is to get through orientation and start your first year of nursing? If it is the former, keep nit-picking and you will find yourself without a job. If it is the latter, however, you will need to change your approach.

I work on a busy med/surg unit. I am in my eighth month. Let me tell you: when you have 6-7 patients, multiple sitter cases and lots of tasks to complete, you WILL have to find a way to become more efficient. I highly doubt that there is a nurse who hasn't had to cut corners at some point in his/her career. Is it right? No. But is it wrong? Not necessarily. Management keeps giving nurses more and more to do with less resources and ancillary staff to accomplish these things. Naturally, nurses have had to adapt to the heavier workloads.

NCLEX hospital doesn't exist. Infinite resources and techs and 1:1 pt ratios (outside ICU) are a part of fairytales. That being said, I don't necessarily agree with the shortcuts that your preceptor is encouraging; I like to take a vitals cart with me prior to administered BP meds, I prefer my blood sugars to be checked within thirty to forty-five minutes of insulin administration, and I scan my IV meds as I give them.

Unless it is dangerous/negligent, I would keep my mouth shut if I were you and stay under the radar.

Best wishes!

[trshrn11]

I am sorry to hear you are having a bad time. Please request a change in preceptor! I have precepted a number of new nurses and always tell them to let me know if they feel we are not working well together and I do the same. Some examples you gave are smaller details that right now seem vitally important. When you are new, EVERYTHING seems important. You will learn with experience what to follow up on. Know the policies where you work and follow them. Your preceptor and the manager cannot fault you that. Stay true to yourself and develop your practice as you feel it should be.

Good luck!!

[Jwin10]

I think the main issue is that the preceptor is not an experienced RN herself. Had OP been placed with a more seasoned nurse, she would have known how to handle, or even anticipate new grads questions and concerns.

Sound changes are clean, not sterile unless specifically indicated.

Yes, always check glucose prior to giving insulin and don't go based on an old result. That is one of my pet peeves. It irks my soul when I get report in the morning and the night nurse says "their 0600 accu check was 234." I ask if it was covered and I get "no, I figured you'd cover it when they eat breakfast". :-/ which is usually 2 hours later. I tell them either cover it when you check it or don't check it and I'll do so before they eat. Ugh!!

Scanning meds. Most places have a window of an hour before and an hour after the med is actually schedule. If med is a 1000 then anywhere between 0900-1100 is acceptable. No need to prescan iv abx as many only run over an hour or even half hour. If it's a time issue then reschedule med. or ask pharmacy to do so if the RNs don't have that capability. Or ask the dr. There are work around a that are legit. Maybe the precepting RN didn't KNOW to ask to reschedule a med and thought she was doing it the right way.

Which leads back to my point that the preceptor has no business being one with only a year experience.

I'm a preceptor for my hospital and I had to get recommended by my nurse mgr and unit educator to take a class to learn how to precept and have intelligent and productive interpersonal communications.

My style of nursing and teaching is laid back. Not saying I'm lazy, but I don't get excited by many things and especially when teaching a brand new RN!! It's scary enjoy it to be a new RN and to have an excitable or inexperienced preceptor is just making it worse.

Also, I don't think I take short cuts per se, but I work smarter. I bundle many things into a task. If I'm ambulating a patient I'm also checking their skin, watching their gait, listening to their breathing and also checking their mentation. So short cuts, no. Making the most of my time. Absolutely.

OP sounds intelligent enough but it's hard to make that switch from student to RN. I hope there are other experienced RNs who OP can go with to finish her program. Any preceptor who has the best interests of the new RN at heart would encourage such, as it takes more than one person, experience or job to shape ones nursing style.

Good luck

[Jwin10]

So many typos! So sorry! :-/

[Loracs72]

I have an issue with the way the preceptor did the dressing change. An old dressing should never be put back in the wound bed. The purpose of a wet to dry dressing is to debride the wound enhancing new tissue to form. At one place where I worked we were expected to change gloves between removing the dressing and packing it. In Home Health we taught the family to only use one pair of gloves.

The nurse at shift report wanted to notify the dr. about the urine output. It's the dr,s judgement whether the output is a problem. As a nurse we have to cover our butts and report it.

The Preceptor in my opinion was unprofessional when she discussed the patient's information with other staff that were not involved in the patient's care.