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 4th 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 4th 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 3rd 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 24hrsâ€. 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.
