My preceptor is everything they taught us NOT to be... - page 10

I was hired on a med-surge floor, and have been working with a preceptor for several weeks. After questioning some of the things she is "teaching" me, I've been given a "final warning" and am facing... Read More

  1. by   Kssable
    I think you're in the right. Don't listen to these other posters. Practice what they taught you in school and patient safety comes first, not short cuts. Lots of nurses nowadays do shortcuts and risk patient lives, be a smart, responsible nurse but realize there are a lot of bad nurses out there that do not follow safe good guidelines
  2. by   CardiacDork
    Quote from Kssable
    I think you're in the right. Don't listen to these other posters. Practice what they taught you in school and patient safety comes first, not short cuts. Lots of nurses nowadays do shortcuts and risk patient lives, be a smart, responsible nurse but realize there are a lot of bad nurses out there that do not follow safe good guidelines
    Honestly, most nurses do try to practice as close as possible to nursing as it was taught by the books, but sometimes shortcuts happen, or you actually can delay care. Sometimes following the nursing school mindset is totally contradictory to the real world mindset. The blood pressure medication is a great example. I have patients whose blood pressure is 108/62 BECAUSE of their antihypertensives. Stop them? And they'll rebound.

    Another example is perhaps you have a patient with regular insulin odered at 0730AM, but perhaps the patient doesn't eat until about 0900, if you're in by the books thinking would you hesitate to put the insulin off an hour or two to accommodate the preprandial times?

    I mean, there are so many examples.

    Sometimes you have to use that noggin and not rely exclusively on what a book says, because let me tell you...patients are all individuals with individual physiology and pathophysiology.

    If you're a nurse, you ought to know better.

    If you're a pre-nursing student - realize this now and don't you forget it! = )
  3. by   allyl
    I definitely agree with the majority. While you are definitely knowledgeable about best practice, the world is not "best". If you were working with one patient at a time of course you could do everything right but you're not, multiple people will be needing multiple things at once and patients are humans who have their own quirks.

    I think everyone else has covered the clinical aspect so I'll just echo about time management. I am still horrible about this but documentation should be done AS SOON AS POSSIBLE. As for feeding patients and AM care, why are you doing AM care?! The only time that is acceptable is if you are down a CNA or a patient asks for something you can do quickly while you are in the room doing YOUR job. Ex.- Pt just finished urinating in urinal and your there to give meds, of course you'll empty it for them and give them hand sanitizer! Wound care scheduled for the day but wants a shower first, they can wait for the CNA to give a shower who can then notify you when they're back in bed. Just have supplies ready to go so they don't have to wait around with a wet dressing. Also fully brief your CNAs, they are a super help if they know what you want and explain why. She can't have food today vs. She can't have food until after her scan at 10am but clear liquids are fine, I've ordered her an alternative tray if. This saves time as you don't have to discuss with the Pt why the tray is different and if the tray is normal they can alert you.

    Last thing, personally I love to orientate new people. Teaching is fun for me and I get to learn what they would do in certain situations while perfecting my own practice. While we all development tricks of the trade and shortcuts, having someone around watching what I do and questioning makes me aware of my own complacency at times. I always pretend that they are a State auditor so I try to do the 'right' techniques. That can make me realize, "Hey, I've been taking a shortcut and it really doesn't waste that much time to do it the correct way" or "This is a really useful trick I need to teach this person." Sometimes it's just newer practice that I've learned since the school way isn't always up to date (especially in wound care) or things that certain doctors like. One doctor who I didn't like personally was great to work with as he knew I would do the dressing change his way and I knew what supplies he would want for chest tube removals.
  4. by   knurse8
    Honey your going to see i mixed bag of nursing practice where ever you go. Count your luck stars and soak it up if you get a great preceptor, but don't discount the value of poor role models. You can learn alot from the them about what 'not to do' and help better define the nurse you want to be. Never fun or easy but I promise the transition from new grad to experienced nurse will go a lot smoother if your less judgmental and more curious .
  5. by   dpeterson63
    While is is preferable to have a preceptor who is perfect and like able, it is not essential. My biggest concern is your indifference to being fired. In many states, being fired from a job is an automatic report to the Board of Nursing. And NOT disclosing this information on an application for another job is deceptive and often another fire able offense. Think long and hard about your situation... While I always loved the "CNA" part of the job, I also understood what I was being paid to do - to be the doctor's eyes, ears and to record the chronology of the patient's healthcare experience.
  6. by   EdRnhere
    I am appalled at the attitude coming off from the nurses on your question! Young nurses have questions and do need to learn the balance of "must do" and "nice to do" actions, but most of these comments sound like condescending bullying.
    I recommend having a conversation with your preceptor when you aren't at work asking her what she thinks of your progress and what her recommendations for improvement are- just to make peace. Follow the sandwich rule-- one positive comment, one question or negative comment, followed by a positive comment.
    I think your preceptor may actually be overwhelmed because a year isn't enough to become proficient and you are questioning her making her wonder about her own competence. I think you are on track with safety but need to start looking at the big picture to prioritize care so you have time to document, coordinate care, and teach your patients.
    Nursing isn't easy and we have to support each other. Support your preceptor. Then, support the new nurses hired when you are a preceptor.
  7. by   Sweetie80526
    Reading the comments from the other nurses about her nit picking and being a tattle tale is sad. She needs to go to management and explain the situation pronto. New RN herself as a preceptor, she shouldn't be precepting but the unit sounds like they don't keep staff long and for good reason. But also hear the RN out and ask why she does things and help to educate her as well. If a nurse is so pompus that she cannot learn or hear out the new grad, there is something that needs to be addressed. I'm not going to make any friends with my post probably, but things need to be addressed. Definitely needs to have gloves changed after taking off drsg, but not sterile. And not a good idea to hang multiple meds and scanning at same time. Management needs to see what is unreasonable and why they can't get to those meds on time, maybe too many/too heavy patients. That other nurse isnt helping show they need more help. As far as bp meds, VS every 4 hrs and PRN on most med surg floors, so unless symptomatic, can wait to check and still give, and continue to monitor pt. Do not give less than 100 systolic. Think of the onset times. But bld sugar definitely not a good thing. Check within an hr esp uf below 150. Hospitals have protocols for a reason. And if management doesn't do anything about it, maybe resign now and use your previous preceptor in nursing school to help you get that other position or mentor. Sad but true. And on charting, Chart what you're doing as best as you can in the room and finish after you get major assessment in the room completed time wise. As nurses we need to help one another, learn from one another no matter what experience and speak up for ourselves to ensure pt safety and healing. Good luck!
  8. by   mordap15
    Your reaction is normal for your circumstances. Textbook and real life are quite different. You can save yourself by using these examples as "learning moments" and assure your supervisor that you have learned better time management and the need to delegate non RN functions in order to document in a timely manner. Even if you are terminated, it will not be a negative on your record because either you or your employer may decide to terminate the employment for the first three months which is considered "orientation." I have been an RN for more than forty years and you will discover that not all nurses are what you would consider the "ideal." With more experience, the charting will take less time-logging on, documenting an activity will take less than five minutes, even though initially this may seem like an impossible accomplishment
    Last edit by mordap15 on Dec 20, '15 : Reason: spelling error
  9. by   Nurse Leigh
    I think one of the best pieces of advice I received came from my nursing program - Just because another nurse does something differently than you were taught does not mean it her way is incorrect.

    There are many things where we can take different paths and safely end up in the same place. I enjoyed learning tips and tricks from other nurses, aides, and RT that I could safely incorporate into my practice.
  10. by   Nurse from Canada
    Yes, as nurse students or new grads, we all observed some practices not to follow. I am not able to comment on all practice concerns except the wound care. I was in charge for the Wound Care Program in LTC for over 12 years. The research doesn't support wet-to-dry dressing practice. You may be able to suggest to the manager to review and apply the newest Wound Care Research in the facility. In LTC, nurses mostlyprovide clean technique dressing change.
  11. by   Wolfe24
    I've skimmed through a lot of the responses here and I just want to say one thing:

    To the OP - You are right, it is NOT ok to scan meds that you are not giving at that time. I'm completely shocked that so many nurses with experience are advocating for this practice. Never ever ever say you've given a med if you haven't actually given it or started the drip. It is NOT ok. Its the same as charting ahead of time. You never chart your assessment before you do it, right? What if something changes? Its the opposite of "if you don't chart it, it didn't happen." What if you do chart it and it doesn't happen? HUGE liability. DON'T DO IT. EVER.

    I won't address the rest of it as it seems that you've gotten adequate responses there Good luck on your new adventure, you seem to have the foundation to become a great nurse - make sure you soak up what you're learning and seeing, but *always* question what you're seeing if you don't think its right. If you don't question something, you may develop habits from someone that aren't right. I've been at this for 7 years now, and I still ask questions if I see something new or something I'm unfamiliar with.
  12. by   ED Nurse, RN
    I would not, at this time, speak to the nurse manager about changing policy or how they do things. Unfortunately I think it is the OP's attitude that has her in hot water and further instigating that with having her again suggest changes, before she is even off orientation with some real works experience, would more than likely lead to a termination.
  13. by   RNinDM
    Not all hospitals have techs to handle things like getting the patients fed and other aspects of am care.

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