New Graduate RN having preceptor commucation problems

[Kaytayxx]

I started my "orientation" on my unit July 31st. I am now past 5 weeks of solid orientation and taking responsibility for a 4 pt team on my own. In the beginning of my orientation my preceptor and I got along great. When I would make a mistake or take too long on a task she would communicate with me and we would discuss how I could improve. Mind you, when I say make a mistake” I mean simple charting errors, such as going too fast or putting down the patient had 4/5 strength on the RLE when it should have been 3/5. I take heed in everything she teaches me because she is experienced, I am not, and this woman knows her stuff! I love being able to learn new methods, ideas, and different ways of doing nursing tasks and I listen to and absorb everything she says. This might seem long but I have to introduce the situation so I can hopefully get good advice.

About 4 days ago, everything seemed to go downhill. My preceptor used to wait for me to do my assessments and then she would do her own. She started interrupting the middle of my intial assessments with hers so I had to stop what I was doing to let her do hers (as the patient is looking even more confused because of this). There was a pt that was intermittently confused and forgetful. She was incontinent and taking Lasix so she was going quite frequently. We would change and clean the patient and 20 minutes later she would tell us that nobody had been in all day to change her and she was wet, we checked, she wasn't wet. Needless to say, this patient kept me busy the whole shift. Aside from everything else, I asked her on every round if she was in any pain. She stated in the morning she was in pain, I asked her where, she replied, I think my leg.” I asked her if it was a specific part of her leg, she said, No, actually, I am not in any pain.” This happened all day. The other patient I was assigned right next door was ordered neuro checks q2 hr. My preceptor had made me unchart one of my q2 neuro assessments because it was 1 min past the last time I charted on her. That was not a big deal because she explained the importance of charting to the T on time for the neuro checks because if something were to happen to the patient and my charting was late (or worse if I hadn't charted it yet) or if there was a chart audit I could get in big trouble for not being exactly on time with documentation. During my final round before night shift came in, I performed my last neuro check on one patient and walked into the other patient's room to see if she needed to be changed and to ask if she was in any pain. She stated she was not in any pain at that time. 15 minutes later, I come in to the room with the night nurse to do hand off report with my preceptor. My preceptor asked the pt if she was in any pain and she said, Yes I am In pain I could really use Tylenol.” After leaving the room, my preceptor told me chart your last neuro check and grab the tylenol and then we are all good to go for tonight!” I sat down and began charting the last neuro check (on time) and she walked up to me. She snapped at me and said, are you going to get the Tylenol? Are you just going to sit there and chart? Okay I guess ill go get the Tylenol and don't worry about charting ill finish that too you can just leave.” She stormed off, the nurses around me were just staring at me with their jaws dropped. I don't even want to know what they were thinking about me.

I was done charting before the med room door closed behind my preceptor, she never gave me a chance to speak or get a word out. That night, I tried sending her a message asking if she could communicate with me better about what I am doing wrong. I apologized if I made her angry for any reason that night and that I really wanted to be able to talk about where she thinks I am lacking or what I need to do to improve. I never got a response. She never spoke about it the next morning on our next shift. The next day was better, I was able to call rapid response on a patient that I noticed was deteriorating and I was proud of myself (as a new nurse) to be able to accomplish that on my 4^th week. The only thing that happened during that shift was when I was putting in an order I had just received from a doctor. My preceptor walks up to me and says we just received stat labs lets go. I said ok and went to sign the order and close out the chart It took a matter of 5 seconds.. She again, snapped, and yelled stat labs” over and over quickly about 5 times. I was already up out of the chair by the 4^th repeat. She explained to me, stat labs are important they need to be done immediately, hence the stat” part. And again, I completely understand that aspect, I told her that I was signing the order so that if I was logged out of the system the order wouldn't be saved. She didn't reply. Finally our 3^rd shift, crazy, chaotic, but ended GREAT. We had a mass amount of orders coming in for 3 patients and she even said shes never had so many new orders in one day. One doctor that had rounded told me his plan, what he was ordering, etc. I went to write it down and repeat it back to him. He said oh no Ill put it in the chart I am already here. I asked him if he wanted me to put any orders in at all, he replied to D/C a medication. I repeated back what he asked me to do and I did it. He ended up putting a fluid restriction in for my patient, I grabbed a sign to hang outside the door that stated Fluid Restriction 1500mL for 24hrs”. Another patient I had called a doc for to get parameters for her BP medication. My preceptor had shown me a few times how to put orders in already so I had a good idea of how to put the orders in. I started writing in down the in paper chart and she said no you have to do it this way on the computer for something like that. So I did what she said and put it in the computer as she instructed to do so. At the end of the shift, we pulled out all the charts we put orders into and I asked her if everything I had done was correct and included. She said yes.

The next night on my day off. I get a call from the hospital and texts from my preceptor. I called the unit back and they said the doc never put in the fluid restriction and the BP parameters weren't ordered. I gave the nurse authorization to put down my name with hers to cosign the orders that never made it in. My preceptor is texting me telling me I messed up bad and it looks bad if work is calling me on my day off to verify something I was supposed to do and said I did. I apologized and said there is no excuse for this from me and that I thought we had gone over all the orders with a fine tooth comb before we left that night. I felt so discouraged and useless that I messed up. I thought I had done everything as she told me to. I thought when I asked her to double check that our mass amount of orders were put in correctly that she had actually checked them as she stated she did. My nurse educator called me the next day. She was telling me she was concerned because of all the errors my preceptor told her I was making. She twisted around what actually happened to a big heaping mess. My preceptor told my educator I blatantly ignored her when she asked me to get Tylenol because I was charting. She didn't mention that she asked me to chart the neuro assessment first and the stress she put on the neuro assessments. She also told her I don't do my assessments or charting correctly after mentioning and explaining it to me. She told the educator she had to ask me 6 different times to do stat labs, when she repeated stat labs” over and over quickly multiple times in about 5 seconds, because I was charting (not putting in orders). Lastly, she told my educator that I forgot to put in a fluid restriction that a doctor told me to order, when the doctor said he was doing it himself and I put in BP parameters incorrectly.

Yes, I made a mistake. I should have checked and verified the doctor that said he would put orders in to make sure. I should have given the Tylenol first because pain is more important than charting. I was doing what she told me to so everything went smoothly. My educator told me that I am to follow what my preceptor says and does, assessments included, I am not to develop my own technique until I am on the floor alone. But what if what she does doesn't work for me? I thought this training time was to learn from my preceptor and build upon a routine that will work for me when im on my own. She won't communicate with me, she does not tell me what she thinks I can improve upon, instead she directly takes it to my educator as to where I don't have a chance to fix any deficits. I have gotten great evaluations since I started and now this one weekend has put it all down the drain. I am hoping to talk to her on my next shift and try to work out these problems. If not, I hope I can get another preceptor who can communicate appropriately with me. I have never felt so embarrassed in regards to having stories exaggerated to my educator to make me seem careless. I dont want to risk losing the only job i have ever dreamed of having. I have never felt so defeated.

[loveSBK]

Perhaps your preceptor is stressed and has been keeping things under the radar that maybe she should have talked to you about but decides not to to not discourage you. From what you wrote, seems like things were great in the beginning. 5 weeks before her demeanor changes is a long time, maybe something happened that you don't know about that made her upset. Try talking to her again, don't text her, have a face to face conversation. If that does not work, can you get a new preceptor?

[Kaytayxx]

I am going to try to talk to her again on my next shift. I have tried a few times to talk in person but theres either not a good time or no time. I dislike texting because you can't always convey a message how you'd like to, sometimes it is interpreted differently, and because I never get a response, i am not sure how she interprets it. I know she was having health issues within her family but we never really elaborated on it because i think it made her upset. My nurse educator is going to try to find a new preceptor for me but there arent any guarantees. I am supposed to be on the floor by myself in a month. I just want to get through this without any more stories being falsified to the people who hired me. And here I thought nursing school they broke you down mentally really good, oh my was I wrong. I guess I am just used to working with people who know how to openly communicate and can provide constructive criticism when needed.

[sommer0515]

I can totally understand where you coming from on this type of situation. I started in a critical care unit 3 months ago and have been on days orienting with a preceptor who doesn't like to teach and rarely even goes into the pt rooms with me unless I ask her and most of the time, my questions are used to make a mockery of how new and dumb I am. The only words of encouragement I can offer is that eventually (hopefully) the other nurses will see this behavior and vouch for you. Case in point...

We had a trauma victim who had surgery to right wrist and had an arterial line and 3 IVs to the left arm. I had noticed by the second day I had them, their left arm was edematous and since they were extubated and last ABGs were good and all pressors were off.. Perhaps it should be considered to remove A-line and all but one IV and see if this would help the edema. Of course, I would need to get order from physician but she was trying to shrug me off about it all. I proceeded to find another nurse who gave me direction and the outcome was venous Doppler showing 2 blood clots being discovered all bc I pushed my gut instincts and didn't allow someone else's bad attitude toward me hinder me from good pt care. Hope things get better for you!

[Kaytayxx]

I can totally understand where you coming from on this type of situation. I started in a critical care unit 3 months ago and have been on days orienting with a preceptor who doesn't like to teach and rarely even goes into the pt rooms with me unless I ask her and most of the time, my questions are used to make a mockery of how new and dumb I am. The only words of encouragement I can offer is that eventually (hopefully) the other nurses will see this behavior and vouch for you. Case in point...

We had a trauma victim who had surgery to right wrist and had an arterial line and 3 IVs to the left arm. I had noticed by the second day I had them, their left arm was edematous and since they were extubated and last ABGs were good and all pressors were off.. Perhaps it should be considered to remove A-line and all but one IV and see if this would help the edema. Of course, I would need to get order from physician but she was trying to shrug me off about it all. I proceeded to find another nurse who gave me direction and the outcome was venous Doppler showing 2 blood clots being discovered all bc I pushed my gut instincts and didn't allow someone else's bad attitude toward me hinder me from good pt care. Hope things get better for you!

It makes me feel better that this happens to a lot of people where some preceptors just don't have a good matching personality fit I suppose. I just wish I could go off my gut instincts in some cases but that would then turn into me being insubordinate somehow. She is very fast paced and I like that aspect but there are times when I need her to slow down and utilize some patience as I am new and do not know everything she does.

I'm just worried now because the way it was worded to my educator makes me 5 weeks in look bad, especially since my previous evaluations were great. I just don't want her to jeopardize my job and learning opportunities. This is the time I need to absorb knowledge and know how the most.

[icuRNmaggie, BSN, RN]

When you have a private moment say " tell me what I am doing wrong." You say: "ok it won't happen again." You are the rookie. She is the teacher. She says jump, you say how high. Don't lollygag (her perception) with charting or orders, if she says draw the stat labs. That and not giving that Tylenol was perceived as being resistant and unable to accept direction. If you're trying to multitask, ask her, should I do this first or this first?

It sounds like you became comfortable working on your own and stopped including her in all of the minutiae and that ticked her off.

This woman may be an ocd control freak but you are going to meet a lot of those in this business. Charting a Neuro check one minute late is not a crime. But don't poke the bear. Be glad that she is competent and conscientious. Many preceptors would goof off and let you sink or swim. Buck up and do it her way for a month, show an interest to learn everything that you can, and then you can go on your merry way and get on with your life.

[Kaytayxx]

I appreciate your insight. I do my best to seek out what I am doing wrong or what I can do better. Like i said, this woman is brilliant and I know I can and HAVE learned so much from her already. That is why I do not want to get a new preceptor necessarily, I would like to work beyond our communicating differences and continue to work together.

One thing I did not realize till now is the idea that I am getting more comfortable on my own, I do not consciously see that I do not include her in my daily details, I feel that I keep her informed very well. But this could potentially be the underlying issue. I will be sure to ask her about that when I see her next. I want to get through this last month, but I also want to gain a mentor in the end. I do not want to have this orientation end on a bad note because she is the kind of person who would be an amazing resource and friend to have after I am done training.

Thank you very much for your thoughts, they have helped tremendously.

[TheNGTKingRN]

Those are big paragraphs.

[TheNGTKingRN]

OP,

:Hugs: I know this is tough. I want to tell you that I am here for yah. Nursing is TOUGH. You are an intelligent, brave, and caring person for taking this up as your profession.

You sound like you're down to earth as a new grad. It sounds as if you care and that is GOOD news to me. Music to my ears.

Keep your head up. Sounds like your preceptor cares and she may be stressed at getting you over the hump. I'm not excusing her behavior but it may not be ill intent. You know ... most people aren't out to get us. She may actually care and she may be absolutely horrible at expressing her concern.

[decembergrad2011, BSN, RN]

I just want to give you a big hug!

I'm on vacation while my orientee is left to fend for herself with a sub this week and I've heard horror stories. Some nurses were not meant to be preceptors!

It sounds like you need to back off in texting her after work if she's not responsive to it. If she's already stressed, she may want to leave the work issues at work and not deal with it in the off hours. I would attempt to complete things in the fashion she would like, and clarify if she seems to give you contradictory information. In the case of the Tylenol, I would definitely speak up for yourself and mention that you were attempting to chart in a timely fashion, then were getting the Tylenol, but you can understand why the pain might come first and in the future will do it. Let her know that you want to be better, but that because you are a brand new nurse, you are very task oriented and are attempting to get everything she says done efficiently, so it may help if she explains her reasoning for doing one thing before another. This is something I try to do with new grads. If that doesn't work, I do hope that you are able to get a new preceptor.

Hang in there! Your nurse educator wants you to pass orientation and feel good on the floor - extending orientation or having you feel bad coming off of it isn't good for anyone. Don't be afraid to share your side of the story with her as well, especially if another situation like this occurs and you feel like you are being misrepresented.

[Guest838984]

I also am a new grad about 10 months out in the ER. And I just want to say my preceptor was absolutely nothing like your preceptor you described. She sounds very uncooperative, moody and pretty ridiculous. I mean I like how she emphasizes timeliness but still, there is a logical way of doing things which it sounds like what you're doing. I feel like you should've backed yourself up more when you talked to the educator. Don't let just one side of the story be heard! Let them know how you perceive the situation!! Don't let the "he said she said" make you look like someone you're completely not. I would just suggest that if you can't even get her to give you guidance when prompted then she shouldn't be your preceptor and you shouldn't feel bad or guilty about it or feel like you should have to deal with that. They hired you because they NEEDED you. And only YOU are in charge of your career. If you feel you are not getting a preceptor that will help guide you and improve your abilities then change that because no one else will. You don't have to deal with this so don't :) and good luck to you I hope you find a better preceptor

[Kaytayxx]

OP,

:Hugs: I know this is tough. I want to tell you that I am here for yah. Nursing is TOUGH. You are an intelligent, brave, and caring person for taking this up as your profession.

You sound like you're down to earth as a new grad. It sounds as if you care and that is GOOD news to me. Music to my ears.

Keep your head up. Sounds like your preceptor cares and she may be stressed at getting you over the hump. I'm not excusing her behavior but it may not be ill intent. You know ... most people aren't out to get us. She may actually care and she may be absolutely horrible at expressing her concern.

I have read some stories where the new nurse puts so much blame on the preceptor. Granted, in some cases, not all preceptors are a good fit. But I believe it should be a joint effort where the preceptor and preceptee are working together efficiently to overcome any obstacles . I am not going to be like others and play a blame game because there is so much my preceptor has to offer me, I just have to figure out how to get past what we see as the problem and our differences.

Thank you for your advice. And yes, I apologize for the huge paragraphs lol