I am a new nurse into the PICU one month into my internship. I have gone between 3 preceptors in this time and have just met my "main" preceptor after about 10 shifts, while everyone else has been with their "main" since the get go. After taking report, she said that she did not like how I jotted the body systems and began making remarks that she did not know that I would be so "unadvanced" at this point in time and that she would have to start me from the beginning. That's fine, because I want to learn and do the way that works for her. By the end of the shift I felt I was getting the hang of things and ended the shift on a positive note. In the morning I jotted the way that she wanted and while charting on the same stable pair from the day prior, I was getting behind and had not finished charting on the first patient. She told me that this is the most stable patients that we have and if I was getting overwhelmed with this that I don't belong in the ICU. When I went to flush the IV, I did not see that it was clamped and she sarcastically asked me where I went to school and if I have ever worked with IVs. I feel that at this point in time I felt overwhelmed because she was breathing down my neck. When I administered the meds through NG tube, it backed up and some of it spilled on the sheets. I re-sent for another from pharmacy, but she made a big deal out that because the sheets had just been changed and I was scared of her seeing it before coming in the room because of the fit she had made over the IV a few minutes prior that I was literally shaking. I understand the ICU is a no-nonsense kind of place, but 1 shift into meeting her I am beginning to believe that I am incompetent. When I went home that night, I cried, because I feel that I made a mistake going into the ICU as a new grad, that I'm not going to ever get better, not last and that they will fire me and wind up homeless. I don't really know what to do. I had never felt like this with my other preceptors. I feel like I am giving 100% and that I will never be able to live up to her standards. I am not trying to put her down, she is an amazing nurse loved by everyone on the unit, which is why I feel so poorly about myself at this point in time. I feel as if I am dreading going back to work and even worse.. this hospital comes with a 2 year contract.
Girl, cheer up. You're not incompetent. We all sometimes forget about the stoopit clampy-do and try to push a med through it and then have a duh moment. I've had NGs not just spill on the sheets, but explode all over myself and the room....and sometimes visitors. And you're a new grad. These are the times when you can be, "Hey, I'm new. I kinda get a pass for things like the stupid clamp." I milked that excuse (within reason) for as long as I could.
I've been a nurse for two and a half years now and I still occasionally forget to unclamp the IV and to hook the BP machine to the BP cuff before starting to inflate it. On Saturday I tried to help a coworker out by flushing a possibly clogged NG tube. Turns out it was clogged, enough that when I flushed the tip of the syringe popped out just enough to spray the water back all over my face. The family member was horrified and asking if I was ok, my first reaction was to burst out laughing. It happens, you laugh it off because none of these things hurt the patient. NGs and the like leak, you'll learn fast to put a washcloth or something under it to prevent things from getting too messy. These are nice little tips for your preceptor to be helping you out with.
Which brings me to your preceptor problem. I agree that you should try another shift with her. Realize that if you go in with high anxiety your performance will not be as strong. If you can, ask before the shift if you two can go over goals for you to work on that day and what suggestions she has. This should all be constructive. If she is still behaving inappropriately I would tell whoever is in charge of preceptor assignments that you just don't think her style of precepting coincides with your learning style. It's not a lie, and that way you stand less chance of stepping on toes (if that's a concern). Anyone who has precepted knows that some people respond better to others. I wonder if she has behaved like this with other preceptees?
I'm going to go against the grain and state that the PICU is a very challenging environment; you have to learn to chart on the fly and get a routine down, which can be challenging when you've had so many preceptors, or preceptors that have, dare I say, an "ICU personality"-not that there's anything wrong with that... I kid, but in the CC environment there is an atmosphere for "no room for error" and rightfully so, which can be stressful for a new grad.
I've been in your shoes before-I tried everything that you have done, and I didn't succeed in my first RN job in the PICU; in hindsight, this position would be better suited for me 5 years into my career, not the first position, I realized it when I was about 3 weeks in; but I wasn't a quitter and tried to advocate for myself, along with other personal issues that I decided to divulge because they preach being "supportive", but Attempting to exercise the "needing support", I ended up with a target on my back-biggest mistake ever that I learned and grew from.
I didn't become homeless; I ended up taking positions and ended up in a Level I Pedi ED where I am thriving and have been tapped to become a superuser and mentor new hires-I've only been there a year.
I say this to say, do your best, advocate for yourself and try your best; if it doesn't go well, ask to transfer and get what you need; you can always return later to a Critical Care Specialty later- the most important thing is to gain your footing as a beginner nurse in a supporting environment.
I'm sure some nurses thrive on making the new nurse feel incompetent. Always remain professional in front of her, look and feel confident and try to get to know her. Tell her you respect her knowledge and would love to have her show you how to be a good nurse. Chances are once she sees your confidence and even starts to like your personality, she will then start to teach you in a more professional manner.
After taking report, she said that she did not like how I jotted the body systems and began making remarks that she did not know that I would be so "unadvanced" at this point in time and that she would have to start me from the beginning.
That's fine, because I want to learn and do the way that works for her. By the end of the shift I felt I was getting the hang of things and ended the shift on a positive note. In the morning I jotted the way that she wanted...
I feel like working with someone like this would automatically bump your performance down several notches just from the negative micromanaging! I agree with what everyone has said so far. I will just comment on another part of your post that really got to me...
I don't understand why she doesn't like they way you are "jotting things down"...Huh? This is so constricting and inhibits any shred of autonomy you are trying to have with the way you learn about and track your patients.
YOUR jotting on YOUR sheet is not for anyone but YOU! I personally jot more than most because it helps me learn and understand my patients better! This is how I absorb information.
If her notetaking works for her great! she has years of practice and probably has more stuff stored in her memory. You don't have that yet. So if she makes you write the way she writes then you are severely disadvantaged, since you don't have the stuff she has in her own head.
To me it suggests that she has no understanding of how people learn. Or she is just that controlling...either way, you are disadvantaged in this sense if this goes on...
Tell her she "must jot in cursive with her nondominant hand" because that is the hand YOU write with...and of course...the cursive...jk...
I'm an Older Dude who has only been a nurse for 3 years, but let me say that in many things, not just nursing, there are quite a few people who are good at something but aren't necessarily good at ALL in teaching it, and/or have a crappy/snarky/? attitude like this preceptor. You deserve better. And no, you're not incompetent, you're just NEW. Hang in there.
I do not agree with the statement that there is no room for mistakes and a critical care personality "thing". I worked critical care for almost 10 years before branching out. Of course people also make mistakes in critical care - but the consequences could be severe. Having said that - making a little mess or forgetting a clamp is not a big deal.
I want to say that a preceptor with a bad personality can turn any new nurse into a failure no matter how gifted. It can create such an anxiety and cycle of anxiety that the person will fail no matter what. On the other hand - you can have a new nurse that is just a bit slow and not a "shark" and with the right support help her to become a confident nurse. It really depends a lot on your preceptor! If your preceptor is supportive and helps you to integrate into the team I want to say that most nurses can be successful in many settings. In my 20+ years as a nurse I have only seen few nurses who were not a fit for a specific setting - and that mostly applied to acute dialysis...
A) Relax and tone down the drama. You aren't going to be homeless because of one bad shift. This is a simple personality conflict, not the end of all things good in the world.
B) Talk to your nurse manager and tell her what your preceptor said. Be professional, not whiny, and you will probably get a different preceptor, or your preceptor will get a talking to and will adjust her attitude. Either way, it's a win for you.
C) Be confident in yourself and your abilities. You're freaking yourself out and making things worse. She is not a cat, you are not a mouse, she is not going to eat you. You are both professional nurses. If she doesn't act like she should in her role, that is a problem for management to sort out. They can't sort it out if they don't know, so you need to tell them.
D) Take a few deep breaths when you feel your anxiety spiraling out of control. If this level of melodrama keeps happening to you, you may need to see a professional to get your coping skills on track.
Specializes in Psych, Addictions, SOL (Student of Life).
When I went home that night, I cried, because I feel that I made a mistake going into the ICU as a new grad, that I'm not going to ever get better, not last and that they will fire me and wind up homeless.
Drama Much? I am going to say something to you and want you hear it. Maybe ICU is not the right place for you but is too early to tell. Sometimes people push you to see what you are made of. Some preceptors are nice and some are nasty. I am one of the nicer ones but still I pecept new grads into LTC where orientations are short and brutal and I have a lot to teach in a very limited time. Instead of shaking, crying and feeling hopeless try to figure out where she may be right about your performance If you think she's mean wait until you get backed into a corner by an angry Doctor. I once had a preceptor like this and I stood my ground and said "I know I have a lot learn and I respect your expertise so perhaps you can show me some tips on how to perform better?" In other words use flattery and self-confidence. There are bullies out there for sure and such people thrive on any weakness so don't be weak. Come in early check on your patients prepare for the shift just as you did when you were in school. If ICU is not right for you there are many other nursing specialties to consider before you become homeless. Keep your chin up and keep trying push back a little.
Specializes in Psych, Addictions, SOL (Student of Life).
In a probably extremely unrelated note: I have dealt with difficult preceptors in the past (in nursing school) and you mentioned yoga/gym before work. HOW DO PEOPLE DO THIS PLEASE TELL ME. Like I've tried the gym thing before class/after class and I'm exhausted and miserable. And that's without 12 hour shifts. Please enlighten me.
I don't go to the gym right now but I do start my day with some focused stretching and breathing, eat a clean diet and usually have a cup of herbal tea before bedtime.
Oh, Boy! This sounds like my preceptorships to a T!! I wish I had some solid hind-sight advice for you. This is something I am working through myself. One thing I have noticed for myself, is that every nurse has their own way of doing things and to them, it is the best way. You get tripped up when you try to do things someone else's way when it is not natural for you. The old saying, "Nurses eat their young" is so true! Just remember this: the longer someone has been in their profession, the harder it is for them to remember what they didn't know from the beginning. Also, if you let someone else walk on you, they undoubtedly WILL walk on you. I think you need to take some time to decide what is important and not so important and do what works for you. I understand completely that it is hard to learn to work things your own way by trial and error with someone breathing down your back. Pray as hard as you ever have. I just finished orientation at a new facility after I had been a critical care nurse for 10 months at a much larger, higher acuity hospital, and I have been treated like a brand new young college kid who is straight out of nursing school and knows nothing. I took care of patients on heparin and insulin drips, Amiodarone, stable vent patients...yet I get assigned the easy nursing home med-surg overflow patients because I don't have experience in THEIR hospital. All I can say is, toughen up your skin, and plow through. One day you will be experienced and can speak up about why you do things a certain way. Remember this time when it is your turn to take someone under your wing.
You are not incompetent. You are learning. And even experienced nurses have tried to flush an IV that is closed. Many experienced nurses have also had some medication spill on the sheets when administering them via an NG tube. You will get better with time... You will learn tricks to prevent issues.
Some preceptors seem to hoard knowledge and just criticize rather than really teach. I just don't get it.
Maybe some others are right that she will act better if you respond in a assertive fashion.
I've seen these kind of preceptors too. This is one of the main reasons new nurses quit. Hopefully you be able to provide feedback about your preceptor at the end of your orientation. I would recommend you don't give up, try to just get through. When I was a new grad I saw another new graduate just terrorized by his preceptor. He kept his mouth shut and just kept surviving ( 6 month orientation). I don't know how he did it but he survived. He then quickly moved off our unit (less than a year) to a fab job in the OR and never looked back. This will seem like impossible advice but .....Don't get down on yourself. Make sure that one day when you are a preceptor you don't make the same mistakes. Do you have good support from the hospital nurse educators? If so maybe you can request a new preceptor. Sometimes it is difficult to determine what kind of support/backing you will get. My workplace has changed since I was a new nurse. We now have a nurse residency program and believe me new nurses are treated amazing (its the preceptors who better watch themselves). Please keep us up to date!
I kid, but in the CC environment there is an atmosphere for "no room for error" and rightfully so, which can be stressful for a new grad. 
Nurse Jen, RN
9 Posts
I've been a nurse for two and a half years now and I still occasionally forget to unclamp the IV and to hook the BP machine to the BP cuff before starting to inflate it. On Saturday I tried to help a coworker out by flushing a possibly clogged NG tube. Turns out it was clogged, enough that when I flushed the tip of the syringe popped out just enough to spray the water back all over my face. The family member was horrified and asking if I was ok, my first reaction was to burst out laughing. It happens, you laugh it off because none of these things hurt the patient. NGs and the like leak, you'll learn fast to put a washcloth or something under it to prevent things from getting too messy. These are nice little tips for your preceptor to be helping you out with.
Which brings me to your preceptor problem. I agree that you should try another shift with her. Realize that if you go in with high anxiety your performance will not be as strong. If you can, ask before the shift if you two can go over goals for you to work on that day and what suggestions she has. This should all be constructive. If she is still behaving inappropriately I would tell whoever is in charge of preceptor assignments that you just don't think her style of precepting coincides with your learning style. It's not a lie, and that way you stand less chance of stepping on toes (if that's a concern). Anyone who has precepted knows that some people respond better to others. I wonder if she has behaved like this with other preceptees?