My preceptor is everything they taught us NOT to be...

[Live..&..Learn]

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 termination over complaints made to my manager "per preceptor".

I a new grad from an excellent, small hospital based program where the instructors have tons of professional and life experience, and we leave feeling like confident, competent New Grads. I was assigned to a preceptor who has just over a year experience, and was impressed by my clinical skills, stating she didn't learn anything in school. I've noticed the following things that have caused me to question her practice and ability to precept. I would like some opinions on whether I'm over reacting, or valid in my concerns...

Pt has a stage 4 pressure ulcer on her coccyx, wet to dry dsg changes ordered q day. I observed while she changed the dressing. No sterile field, no sterile gloves, out clean gloves on, removed the dsg and packing, never changed the gloves, soaked the packing with her gloves hands, repacked and dressed the wound.

If my pt has multiple IV meds ordered for the same time she told me to scan them all, hang one, and leave the rest to be hung when it finishes. I don't sign for meds that haven't been given.

Non verbal pt has orders for blood glucose monitoring and insulin sliding scale. 0630 fingersick done, pt does not score for coverage. 0800 the tech who came on did another finger stick and pt needs 2 units. At 1000 preceptor says that pt needs coverage, I never signed off on the task (he didn't score when it was ordered). 1030 administering meds, recheck fingerstick and pt needs 2 units. I signed off on the 0700 order (outside of parameters), charted the new reading, gave the insulin at 1030 for the 1100 order. That's wrong, I should have covered him for 0700 and rechecked at 1100. I told her I don't think I should give insulin 2.5 hours after a fingerstick without a recheck. Or cannot even tell us if he's feeling off, and is npo with tube feeds.

New admission two days post discharge. Dementia, not a good historian of her medical hx. Form asks "has pt had a flu shot". Preceptor states "I don't know for sure, but they must have given it on d/c. Charts that she had it and pneumonia vax on date of last d/c.

We were told that no blood pressure meds are to be given without a. BP within 30 minutes. She was not there that day. It is 0920, pt has a bp charted for 0811, but the techs do vs at 0700, it was charted at 0811. "Give it, it's fine". Next pt is on a beta blocker, calcium channel blocker, and 80mg lasix. I rechecked the BP and she seemed quite annoyed.

I heard her giving report in the hall outside a pt room. Openly discussing hx of drug abuse, etc. Another pt is a registered sex offender, I overheard her telling a tech from another dept. His reason for being a sex offender.

I had a pt who was on two iv and, including vancomyicin. The day before she had IV contrast. Her BUN and Creatinine were elevated, GFR was around 40 the day before. She told me in the am that she is usually up four times a night to void but hasn't been up once. I report this to preceptor. After a little bit, I got her up to the commode where she voids 40mls. At lunch I got her up again and she voids 60. I went to preceptor who tells me that she went for her. I asked if I should call the doc just to be safe, she says she will take care of it. End of shift I asked, she said pt is fine, no need. RN I am reporting to ask about output, I explained it to him and he called provider.

I could keep going, but I feel like a vindictive crazy person. I know these are bad habits, and refuse to adopt them into my own practice. She wants all of my tasks and charting to be done by 10am. I often do not reach that because I choose to assist pts with am care, breakfast, ect. The charting can wait in my opinion, as long as everything is done on time. I have one foot out the door anyway, and will likely be fired today. I can deal with that, I definitely can, but I was advices by a mentor to approach her, I tried, and yo go to the manager, I asked him to meet with me, and he told me that he has continued to receive negative feedback from my preceptor and will discuss it with me. I know I'm being fired, and there's not much to do to change that, unfortunately being fired means I will not be eligible for 're-hire at the one hospital near me. But, what do I do about this preceptor? Let it go so the next new nurse can learn these poor habits, or try to bring it to someone else's attention?

Thanks for listening, sorry about the extremely long post...I refuse to adapt bad habits just yet, or sit back while patient safety is compromised, unless of course I'm being an over reactive cry baby.

[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 .

[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.

[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.

[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!

[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

[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.

[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.

[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.

[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.

[RNinDM]

Not all hospitals have techs to handle things like getting the patients fed and other aspects of am care.

[MarkStallbaumer]

Suck it up, don't rock the boat and go along with your preceptor. When you are free to practice on your own, do what you know is the correct way to do it. You will get into your own groove and know that you are doing things correctly. Not sure why you have a preceptor that is less than a year out of nursing school. That is almost like the blind leading the blind.

[mrclark0000]

First of all you have a preceptor with only One years experience??!! I had to wait until I had 4 years experience. The management is very poor at your hospital.

You have had an unfortunate experience to have had such a bad preceptor.

I'd quit before I was fired. Heck I'd run out of that hospital so fast I would break the sound barrier!

The actions you've described are Wrong. Of you follow the preceptors instructions you'll have a lawsuit or loss of your license.

I've 26 years experience and let me tell you, run and find somewhere else to work. Don't " sick it up" and stay. It won't be worth the trouble.