Need Advice

[procrastin8r-RN]

Hello fellow RN's- I need your help preferably from experienced nurses but any advice is welcomed. I am a new grad RN and am on week 4 of a 6 week orientation. The first 3 weeks were going fine. I had one preceptor who was fabulous. I have now switched to a different floor (higher acuity) and will be there for the remainder of the 6 week orientation. The new preceptor is a good nurse but not such a good preceptor in my opinion.

I feel that the purpose of orientation is to understand the flow of the floor and to gain some form of order as in my time management and how to handle my patient load. Does anyone agree?

I feel the best way for me to accomplish this would be to take on a small patient load like 3 patients so that I can get an understanding of how to manage my time and get all of the tasks completed. In doing this I will begin to form my own way of doing things and how to prioritize my day. Does anyone agree?

I'm finding it hard to get my preceptor to understand this. I find that I'm constantly interrupted by my preceptor pulling me off of my concentration. I find that I'm making mistakes because of this which makes me look incompetent. I know that mistakes will be made but some of them have been made because I got thrown off by being asked questions or to do things that have nothing to do with what I'm focusing on at the present time.

i would like to do my tasks then have the preceptor critique not critique every single thing while I'm doing it because it throws me off. Also add to it the preceptor has there own patients. I don't think it should be that way. I'm new and yes I will be slow because I'm new. But to make sure that they're not behind they pull me to help them with their patient. I'm pulled to help out others. Then i look up and my focus is lost and I'm behind. So that they're not late getting out they'll pass my meds or put my patient back to bed and etc. In the end I still haven't established my own time management and prioritization skills.

I understand about being a team player and all but during orientation I don't feel that it's a priority. I need to know how to manage my own before I can help others right?

i would like to have check points so to speak. Certain times of the day where I should have things completed and check in with the preceptor. I would like for the preceptor to allow me to provide nursing care first while she watches and then critique (unless of course they observe a drastic error like meds) but if I forgot to take the bp cuff off they could say did you forget to do something and I take a look and see oh i forgot the bp cuff. During the check ins we can go over what all i should have completed by that specific time. In doing this I am creating my time management and prioritization skills. Do you agree?

I can be shown all day how to do a procedure or task but it means nothing if I can't manage and prioritize my shift. I feel that this is what the preceptor is for-to help me with time management and prioritization and not getting hung up because I don't do procedures or tasks the way that they do. There is more than one way to skin a cat and I need to find my way not there's.

Please help me out!!!!!

[merlee]

Write out your expectations as neutrally as possible, go over them with someone in Nursing Education. Do not name names, point fingers, etc.

Suggest that the two of you 'team up' with only the number of patients one nurse would have, and by the end of your orientation you should be carrying most of the team!

[iluvivt, BSN, RN]

Unfortunately not all preceptors are good. There are definite principles that should be followed to make it a success for all parties involved. Many hospital have preceptor classes to train nurses how to achieve this. The other BIG mistake IMO is to force nurses to precept others when they do not want that job. It always should be on a volunteer basis..some really love to do it. I have a few nurses that just hate it and I rarely ask them to do it unless we are desperate that day. OK now that that is out of the way..recognize that it is NOT all time management...its everything that you need training on...skills you need to master and perfect...work flow organization..communication skills in such a dynamic and often stressful environment ..dealing with other departments..assessment skills....everything!!!! The real world of hospital nursing is interruption during tasks...it is your phone ringing and your pager going off all the time.....it is climbing over some people during a code to get to an arm to get an IV in...it is upset pts and families....It is having to reschedule the pts CT scan for awhile b/c no one can get the IV in and now you have to wait for the IV nurse.....it is having to wait for PT to finish so you can get the dressing change done...it is having to call pharmacy and ask where the abx is that was due an hour ago.....yes and that is the easy stuff

So meet with your preceptor...have a specific list of what your goals are....share your strengths and weaknesses and concerns

Now she needs to do the same...what are his or her goals for you...how can they meet them..keep in mind they may be quite different..but hopefully you can come up with a plan .

It is very unfortunate that they expect the preceptor to carry a full lode of pts and precept you...that is CRAZY and cheats you and the patients. You may not be able to change that if that is their ineffective and stupid system..if that is the case you have to make the best of it. You can also ask for another preceptor...but i would definitely have a sit down with the current preceptor and see if you can resolve the issues

[Orange Tree]

You can't really find "your" way until you're completely on your own. And I agree 10000% with the person who said, "the real world of hospital nursing is interruption". Unless your preceptor is horrible to you, it would be a good idea to pay close attention to everything she teaches and maintain a good relationship. In the end, you can "take it or leave it".

[roser13, ASN, RN]

My main thought after reading your post is that perhaps it's not your place to decide how you should be oriented. I mean this in the nicest way possible, but it seems to me that you are getting in your own way by having a set idea of how you should be precepted. Every single paragraph in your post starts with..."I need," "I want," "I feel," etc.

Of course not all preceptors are good at precepting. But most if not all have had some training and have a structure that they're following. As a new grad, I think you should make a serious attempt to put aside your preconceived notions of how orientation "should" be and make an effort to allow yourself to be precepted.

Drawing up a list of "issues" after one week on the floor will not endear yourself to your future co-workers. And don't forget that learning to work with and for all types of personalities and all types of nurses can be considered part of orientation and will serve you well in the future.

[flyingchange]

The data supports you, OP.

The Stages of Transition © model incorporates a journey of becoming where NGs progress through the stages of doing, being and knowing.

The initial 3-4 months of the NGs’ journey is an exercise in adjusting and adapting to, as well as accommodating what they find in the realities of their new work, professional and life worlds. For the new graduate, there is little energy or time to lift their gaze from the very immediate issues or tasks set before them, and their “shock” state demands a concerted focus on simply “surviving” the experience without revealing their feelings of overwhelming anxiety or exposing their self-perceived incompetence.

The second stage of professional role encompasses the next 4-5 months of the NGs’ postorientation period and is characterized by a consistent and rapid advancement in their thinking, knowledge level and skill competency. As this period progresses and the NGs gain a comfort level with their professional roles and responsibilities, they are confronted by inconsistencies and inadequacies within the healthcare system that serve to challenge their somewhat idealistic pregraduate notions of the profession. An increased awareness of the divergence between their professional “self” and the enactment of that self in their new role motivates a relative withdrawal of the NGs from their surroundings. The primary task for these graduates at this stage is to make sense of their role as a nurse relative to other healthcare professionals and to find a balance between their personal and professional lives.

The third and final stage of evolution for these nurses during the initial 12 months of their careers was focused on achieving a separateness that both distinguishes them from the established practitioners around them and permits them to reunite with their larger community as professionals in their own right.

http://www.nursingthefuture.ca/transition_theory

[hcox1975, BSN, RN]

I too hate to be interupted but this comes with nursing. Take it as a learning experience. Being interupted will prepare you for what is to come. It takes time to establish your way of doing things. Everyone gets stressed during orientation.

[procrastin8r-RN]

Thanks for all of the advice I truly appreciate it. I do understand that the real world of nursing is sooooo much different than nursing school. I do understand Brenner's stages of nurse development also. I know that I am a novice and will be for a while. This is not my issue. My issue is the preceptor having their own patient's and interrupting me doing stuff with my patients to come and help them with their patient and then wondering why I haven't done this or that yet. Or why I'm forgetting this or that. I just feel that if they didn't have their own load things would go better for me.

So I'm not interrupted with issues with the patients that I have, I'm interrupted with the patients that the preceptor has to come and assist her. I'm aware that interruptions occur. I know that you can plan as much as you want but nothing rarely goes the way you expect for it to go. I feel that those are the things that I will have to learn how to adjust to on my own. But I still would like to have some understanding of how it is to have a load without the assistance of the preceptor doing anything to help me out (like pass a med or change a dressing or hook up a tube feed). If I keep getting help I feel that I will not truly understand hoe to manage my time and prioritize my work.

Let's not miss also that this is my 4th week of orientation but my first week on a different lower acuity level floor. I've had 4 patients by my self on the third week of orientation and was doing well with that particular preceptor.

Anyway I will take the advice in sitting down and talking to the preceptor, I will take the advice to take what I get from my orientation or leave it. I just feel that this preceptor should have established goals and certain marks of where I should in this stage of the orientation and what is expected of me and they haven't.

Thanks for your replies.

[AprilRNurse]

As a new grad they don't expect you to know everything, and they certainly won't be expecting the best time management from you yet. But- I guarantee every co-worker you have DOES expect you to help when needed. I've never had a shift yet where I'm not interrupted to help another nurse, answer a bed alarm, or talk to a dr/surgeon who just can't wait. Learning how to handle interruptions is IMO one of the most important parts of nursing. Even after 3 years sometimes I catch myself thinking "grr... I was planning for xxx.." but then have to stop myself. You have to be flexible.

You also have to understand different people have different ways of teaching. Also- many places preceptors take their own patient load. Is she taking a full load or a lightened load? Where i work the preceptor and new grad take a lighter load together first..but after awhile they expect the new grad to take patient's..and the preceptor to take patient's. She should be available to you, but maybe not every minute of the shift.

As far as her stopping you before giving you a chance to think...I get that- really I do. My preceptor did that as well. I kept thinking "how am I EVER going to remember or set up a routine if I'm reminded of everything before being given 10 seconds to realize it"... but some people are just hypervigilant and can't handle seeing it for those 10 (or more) seconds.

Just look at your preceptor like nursing school. Just get through it, learn as much as you can, and know you don't have to do everything her way when you're finished.

[Ruby Vee, BSN]

my main thought after reading your post is that perhaps it's not your place to decide how you should be oriented. i mean this in the nicest way possible, but it seems to me that you are getting in your own way by having a set idea of how you should be precepted. every single paragraph in your post starts with..."i need," "i want," "i feel," etc.

of course not all preceptors are good at precepting. but most if not all have had some training and have a structure that they're following. as a new grad, i think you should make a serious attempt to put aside your preconceived notions of how orientation "should" be and make an effort to allow yourself to be precepted.

drawing up a list of "issues" after one week on the floor will not endear yourself to your future co-workers. and don't forget that learning to work with and for all types of personalities and all types of nurses can be considered part of orientation and will serve you well in the future.

i agree. as a new grad, you have no idea how much you don't know. the preceptor, no matter how abysmal her precepting skills, knows all of those little things that you haven't even thought of yet. she's also someone who will be participating in your evaluation, perhaps even doing your evaluation. and you're going to have to work with her after you're off orientation. unless she's being blatently mean to you or her practice is truly unsafe, suck it up and do things her way as much as possible.

[NotFlo]

I'm precepting someone right now. It's really hard because I have my normal full load plus I'm trying to precept a new grad who has never even seen a paper MAR before or set foot in a facility like mine. I haven't had a lunch since I started with her and I've been staying over 2 hours late every day trying to finish my (our?) work because I get so behind. I'm finding it impossible to properly orientate her while I'm still trying to manage caring for over 20 people. I'm sure she thinks I'm lacking as a preceptor but I don't know what else to do.

[BluegrassRN]

I don't understand precepting and taking your own patients. That needs to be seriously evaluated.

In our orientation, the preceptor and new nurse *together* take a full load, 3-5 patients. They decide how to divide them up, so the preceptor will often have a couple of patients, but it is a much lighter load than the rest. Once the orientation is up, however, the orientee is on her own and no one has a lighter load to help her out.

OP, if I were you, I'd pick one or two tangible items that you would like to improve in your precepting relationship. Address those with your preceptor, and let the rest slide. First of all, the preceptor has to balance your needs with her own needs, those of the patients, and the rest of the floor. Secondly, while you may think you are fine in one area and need help in another, the preceptor's perception of your strengths and weaknesses may be vastly different.

Finally, just like each student has their own style, so does each preceptor, and rather than trying to bend her to your will or concentrating on the negative aspects of her style, you can concentrate on the positives of her style of precepting. It may be fine to ask her to change one or two ways of doing things with you, but to give her a list of "This is how I want my precepting done" is completely unreasonable, and asking for trouble. This person will be your resource for years to come, and if you are nit-picky and unreasonable right now, you are souring that relationship. Sorry, in short what I'm saying simply is tread carefully here. Your words and actions now will affect your and your relationship with the rest of the floor for months and months. We had a new gal start off on the wrong foot with all of us, and now, a year later, she's still repairing all that damage. There are people who won't lift a finger to help her, ever, because of how she behaved during orientation and her first couple of months on our unit.