Need advice on new job in ICU, not going well

[Treefroggirl]

Hi there, I just recently started a job in a 40 bed level 1 trauma center ICU. I came from a small hospital with a 5 bed ICU, so the acuity of patients I'm used to dealing with is a lot different. My first actual day in the new ICU was Monday and I had been assigned the same precepter for the full 8 weeks. As soon as we hit the floor, she said, ok, you take this patient and I will take the other. I was surprised, but figured she would be with me and there if I needed her. Wrong. I was completely on my own, no orientation to the room, unit, equipment, nothing. I mentioned that I thought we would be working together with the patients the first day or so, and her response was that she doesn't believe I would learn anything by "following her around all day". I'm trying to learn the computer charting on top of all this and was so far behind it was ridiculous, she didn't help me get caught up at all. We took lunch at 2p (had started at 7am), supposed to be 30 min. She came back 1 hr and 15 minutes later. I spent my lunch break in my car close to tears. The second day was yesterday, only she gave me BOTH patients and she spent the day on the phone talking to her friend, husband, everyone and sat there all day doing nothing or she was no where to be found. No assistance at all until about 6pm she helped give the patient a bath and clean up because she didn't want to have to stay late. (her words). So I just kept interupting her phone calls to get her attention if I had a question. She didn't even walk into the patients room unless I told her, "hey come here". I'm totally frustrated and exhausted. Does this sound extreme to you all, or am I just being a baby? I hate to go to the team leader or someone because I don't want to look whiney or something. The nurse educator who is in charge of my orientation is on vacation, so I have no idea what to do. The thought of going back there is making me sick. The problem though, this is my dream job and I know I would love it if I had someone who was willing to teach me and help me learn. I'm scared to death of when I get a patient with an ICP or something like that since I've never even seen one in my career, will I have to figure that out on my own too? (sarcasm. ) Any thoughts?

[traumaRUs, MSN, APRN]

Definitely need to lay it on the line with this preceptor. You have had ICU exp but not this high acuity and you need some help so that you can provide good and safe care. If she is not amenable to this, then I would go up the food chain to whoever you have to go to!

[8jimi8ICURN]

sounds like a horrible preceptor. Nip it in the bud, so that she knows she is supposed to orient you to the unit and not spend the day on the phone all day. Question... do you think she would be on the phone all day in front of the nurse manager?

[joyouter]

This is your first day on the job and your preceptor isn't doing her job. You need to speak with your nurse manager or replacement. Psychologically, this is poor behaviour - from another aspect, does she like preceptorship?? If not, you need to request someone else and discuss the situation realistically. This impacts your orientation assessment, patient safety and your sanity.

[Mrs.Rollins, ASN, RN]

I had a very similar experience when I started in ICU (but as a grad nurse). My preceptor wasn't as terrible as yours sounds, but she did lay far too much on me. In the end, as hard as it was, something had to be done. I actually didn't even get a chance to ask for reassignment; my nurse manager reassigned me after my preceptor was written up when a family lodged a major complaint against her. In the end, it improved my experience 100%. I've actually rotated with several preceptors, and each of them taught me something new and different. I highly advocate "buffet style" precepting to managers.

But to your original issue, I hate to say that you're going to have to go above your preceptors head. It may indeed make things strained between you, but it's the best thing for your learning and for your safe practice. You do NOT want to be thrown under the bus when something goes wrong, because in this kind of situation it definitely will at some point.

[groovy jeff, RN]

You do NOT want to be thrown under the bus when something goes wrong, because in this kind of situation it definitely will at some point.

Your preceptor sounds like the type that would throw you under the bus. I would go to the Nurse Manager ASAP.

[newstart08]

In your heart you know the answer to your question. Of course this is wrong, not only unsafe, but just plain wrong. Go to whoever you need to go to, and get a new preceptor. Please let me know how it all works out. I started out as a new grad in the ER one year ago, and I start an ICU training program in 2 weeks. If this was me, Hope it wont be, I would definately talk to whoever I needed to. Good luck and keep us posted.

[RN1982]

My advice: GET A NEW PRECEPTOR. Talk with your manager and tell her what has been going on. When it comes down to it, you will be responsible if something goes wrong with the patient because YOU will be thrown under the bus.

[Treefroggirl]

Thank you everyone for your replies. The nurse manager who is in charge of my training is back from vacation this week so I will get to finally talk to her on Wednesday. My precepter actually told me she likes to orient because she doesn't get assigned all the hard trauma pts. Sad. You are all right, she would be the type to throw me under the bus, I don't doubt that for a second. And this doesn't feel like a safe situation to me. Thank you again and I will definitely keep you posted on what happens.

[clarkheart]

As a charge nurse in a CVICU, I have seen these types of "preceptors" before. They are not interested in teaching and guiding new nurses to their unit. They volunteer to be preceptors because they look at the opportunity to have easy days with no direct patient care and be able to read and talk on the phone all day. Go to your team leader or even higher if you have to and voice your concerns. Just be diplomatic since you're the new kid on the block. You never know what alliances your preceptor has. Your concerns are very valid.