New NICU nurse, feeling very disheartened ;( Question to Preceptors

[NewNicuNurse1336]

I had a question for nurses who have been preceptors to new nurses, whether you liked it or not Did you spend all your time with the new nurse as she took care of her the patients or did you leave the new nurse alone most of the time (as in left the floor for 30 minutes to hours). If you did can you please tell me how far into the training of the new nurse you did this.

I ask because I am a brand new nurse in NICU and I find that my preceptor is leaving me alone for longer, and longer periods of times. She is very sweet, smart, and encouraging, but I recently found out from the shift that I gave report to that my pt. got an infiltration. I checked the IV site and I didn't see it blanching or swollen or red. I will learn from this even though I feel terrible right now, but I just want to know if it is the norm for me to be doing a 3 patient workload on my own and I havent even finished my 1st month of training.

I would appreciate any input or any comments, since right now I feel completely defeated by my mistake and how this will make me look to other nurses.

[NicuGal, MSN, RN]

I agree with the above...our new nurses do a modified internship....they really do not need the adult skills since we are pretty specialized. A lot of what we do needs to be hands on. We do show them how to set up our lines, how to change broviac dressings, but do they really need to spend the day going around hanging blood and such...not really since we don't do it the same as adults, our vitals are the same, but our process is different. Changing a trach on a baby is different than an adult, where else do you need 3 people...two to change and one to hold. Suctioning...you can't cause an adult to have a brain bleed just from suctioning, so that is something that can't be learned on the internship round. Most of our drips are not commercially available, we have pharmacy mix them and we have to check if the dilution is right according to baby size and type of access...we don't always have central lines. Neonates aren't little adults, or even little children! The basic concepts are similar but it is like apples and oranges. We only start them out on stable kids, sure one can go bad, but that is why the preceptor is there. When we get into the next 4 weeks we start taking stable vents, etc. Critical thinking skills are starting to come into play in that first 4 weeks...who gets done first, why that patient needs done first, why do I do this and that, how to prioritize the care.

We do 3:1 with vents, but we have a stable vent kid with two easy feeders. We do this a lot and it really isn't that bad. We are in pods and not separate rooms, so we can keep an eye on the kids. Better than the dim dark ages when we would have 2 horrible vents and a feeder, and that was norm.

[Bortaz, MSN, RN]

We only start them out on stable kids, sure one can go bad, but that is why the preceptor is there.

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AHA! There we have the crux of the situation from the OPs viewpoint. Her preceptor is NOT THERE, for hours at a time.

All of our discussion has politely avoided the main concept...missing preceptor...and led the discussion into different (ephemerally related) topics about patient loads and acuity.

Her problem is that her preceptor is not available to her, a new nurse in (to most new nurses) the scariest place in the hospital...for sometimes hours at a time.

We could train a monkey to do vitals, change a diaper and feed 3 feeder/growers q3. But that monkey can't respond when that kid crumps. Neither can a new nurse...even with four WHOLE WEEKS of orientation. 4 weeks of orientation might be as few as 8-10 shifts.

[Bortaz, MSN, RN]

On a lighter note, I sure have been enjoying the activity we've had lately in the NICU forum. Love being able to pick y'alls brains and try to expand my limited knowledge.

[NicuGal, MSN, RN]

I think I did say she needs to speak up. And hopefully this person's coworkers say something too...we had one preceptor like that and we were on her like ducks on junebugs. Sometimes you have to be your own advocate since no one else will. Our orientors have meetings with our CNS and UM on a weekly basis, so something like this would have been nipped in the bud if the person mentioned it. And if she disappeared for hours, then she needs to speak up.

[karnicurnc, MSN, APRN, CNS]

Bortaz hit the nail on the head. It is grossly inappropriate for the preceptor to be out of the room for hours at a time, period!! The amount of time the orientee has been working there is irrelevent. As long as he/she is on orientation that preceptor needs to be available at a moment's notice. All it takes is one incident and one savvy parent to find out that the person taking care of his baby is in training and her "teacher" was nowhere to be found. Shame on that preceptor. I have been training new hires (both with experience and new grads) for more than 10 years and I am horrified at this preceptor's actions. Her manager needs to know what is going on before something very bad happens, for everyone's sake.

[davery]

I am a new NICU nurse as well. I have finished my orientation and have been on my own for 5 months. Your preceptor should not be leaving you that long. This is a very specialized field with a huge learning curve. They don't teach you this in nursing school. Its very emotional and overwhelming. NICU nurses i have been told eat their young. I have had some rough times during orientation. I know how you feel I had a infiltration during orientation I felt horrible. My advice is if you dont feel comfortable with your preceptor than ask for a new one. I would straight up tell your preceptor that you are uncomfortable with her leaving (she shouldn't be leaving that long) if that doesn't solve it talk to the Charge Nurse. It does get better and infitration does happen. Learn from your mistake and apply it to be a better NICU nurse. I have had a lot of emotional days at the NICU and sometimes wonder why I choose this field, but it does get better. Always ask questions even if the nurses don't want to give answers always, always, ask questions. you will learn to like it. if you have questions let me know Its rough being the new nurse... GOOD LUCK