My preceptor is everything they taught us NOT to be... - page 12
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
Dec 27, '15Joined: Mar '14; Posts: 27; Likes: 11Quote from ArtClassRNLol at everyday I hope she retires.My primary preceptor, a 30-year nurse, was clueless. Almost no clinical skills, no computer skills, no time management skills (other than taking her breaks), zero ability to plan, react, or adjust to situations. No interest in taking initiative. Completely clueless on the use of the EMR system. Not able to use any electronic tools or resources. Not able to and no interest in figuring out multiple IVs or compatibility. No interest in patient progress or planning. Never tried to figure out a thing for herself, always called and blamed the doctor or pharmacist and even refused verbal orders when she got responses (she didn't know how to use Epic to implement the orders). The only thing she ever did was double-check my medications.
Every time. Even on our last day. That's all she did. "I'm making sure we keep our licenses."
I pretended to pay rapt attention to everything she said or did, got through preceptorship with glowing reviews and began doing nothing the way she did when I got on my own. (I did have other very good preceptors and some other excellent mentors.)
I worked on that unit four years, gained excellent experience, and moved on. She is still there giving nurses a really bad name. Every day I hope she retires.
Dec 28, '15Occupation: Medical Sub-Acute-->Mother Baby Joined: Oct '09; Posts: 20; Likes: 27I would rather someone incorrectly change my dressing in a sterile fashion than in the manner this poster's preceptor performed the dressing change. My point was that there are many comments here that stated this poster is "nitpicking" her preceptor when the practice she is seeing is wrong. Not "real life nursing", but actual unsafe practice that can cause an infection. No, it didn't need to be sterile. But the preceptor has some issues with her nursing practice and if nurses are advising "go along to get along", well I'm sorry, but I hope no one who thinks that way ever cares for my loved ones.
Dec 28, '15Occupation: Medical Sub-Acute-->Mother Baby Joined: Oct '09; Posts: 20; Likes: 27That was my point exactly. Whether the OP was incorrect on thinking the dressing change should be sterile is irrelevant. The practice witnessed was wrong and unsafe.
Dec 28, '15Joined: Feb '09; Posts: 7,635; Likes: 26,317Quote from TxldyWith what?I couldn't agree more.
Please use the quote feature so that your posts make sense to the rest of us.
Dec 30, '15Joined: Nov '15; Posts: 15; Likes: 16This is a game in the nursing world. If you question your preceptor more than the smallest amt., you will get on their shite list and that is not a good place to be. Your manager will go with the preceptor over you every time. The preceptor is a proven employee. It doesn't matter who is right.
Dec 30, '15Occupation: CRRN, now a case management RN Specialty: Case mgmt., rehab, (CRRN), LTC & psych ; From: US ; Joined: Feb '05; Posts: 38,032; Likes: 69,288Quote from GreatNurse04Your point is salient. Management typically will not ask someone to precept unless he/she is valued for the knowledge and skill brought to the table.The preceptor is a proven employee.
Dec 30, '15Occupation: ED nurse, graduate student in AGACNP Specialty: 9 year(s) of experience in Emergency Medicine ; From: US ; Joined: Dec '15; Posts: 373; Likes: 1,406Quote from Live..&..LearnSo I guess OP is not coming back. Why do people post things and then not respond to any advice or suggestions others have taken the time to write?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.
Dec 30, '15Occupation: Critical Care Nurse Specialty: 20 year(s) of experience in ICU ; From: US ; Joined: Aug '11; Posts: 1,078; Likes: 2,652She did reply to three posts. It went downhill from there. Some of the responses were, in my opinion, unnecessarily insulting and harsh and did not merit a response.
Jan 1, '16Joined: Jan '16; Posts: 1; Likes: 2I have been an RN for almost thirty years. I am currently a Family Nurse Practitioner working in a Primary Care setting. My previous experience as a bedside RN has helped me greatly in my medical decision-making. I advise any RN who wants to go into Advanced Practice as an NP to work for years as an RN first, then seek the NP after getting the past experience. An RN with only two years of experience would cause me to question how soundly the decision was made. Not being judgmental, just passing along advice.
Jan 1, '16Joined: Jul '09; Posts: 19; Likes: 5I am a new grad also and I just loose my first job opportunity because my preceptor. She was a really bad nurse and was always yelling at me in front of my pts.. So after 6 weeks with her I couldn't hold anymore... I asked to finish my training with another preceptor, after that I don't "know" why they failed me and I loose my job..
Jan 2, '16Joined: Dec '15; Posts: 587; Likes: 1,528Quote from RFFNPI personally believe two years is enough. I've spoken with several of my coworkers that happen to be in NP school. They admit that the first year or two have helped them, beyond that all of them say that NP mentality is different than RN mentality. Most say that most their learning occurs during clinical. They reiterate that finding a strong preceptor is imperative. My other friend that is an NP with 3 years experience states that most of her true learning began after NP graduation.I have been an RN for almost thirty years. I am currently a Family Nurse Practitioner working in a Primary Care setting. My previous experience as a bedside RN has helped me greatly in my medical decision-making. I advise any RN who wants to go into Advanced Practice as an NP to work for years as an RN first, then seek the NP after getting the past experience. An RN with only two years of experience would cause me to question how soundly the decision was made. Not being judgmental, just passing along advice.
Some hospitals offer NP residencies that rotate with the PA and medical students.
Jan 5, '16From: TX, US ; Joined: May '14; Posts: 19; Likes: 20There is ALOT of wisdom here and a HOT topic with 12 pages (and counting) of comments. Some of it might hurt your feelings and I can see why...but it is a GREAT opportunity to restart for a great career. After 20+ years in numerous settings, I can say that getting along with others is extremely important (unless you are Dr. House). Co-worker navigation cannot be underestimated and you can learn how with some of the great suggestions on the replies. Much of my career has been floating to multiple units so staying on the good side is essential. Do I know a co-worker is lazy? sure I do! if I have some free moments I will offer to check their patients glucose or grab a vital sign. Trust me they will sing your praises. Are they difficult to get along with? absolutely! I keep my cheerful smile and ignore them unless they need to talk to me first. If YOU have a tough time working with them you better believe you are not alone..so others will really admire how you handle yourself. My work speaks for itself and I dont waste time trying to change other nurses. That is going to backfire on me as well but this is also the MANGAERS job IMO. Precepting is short...managers do NOT want to deal with spats between nurses and trust me you will be labeled. Now, I KNOW you are smart enough to realize patient safety (TRUE safety) demands getting involved but I find those incidents pretty rare. Try not to be discouraged and most importantly think about how you will handle stuff like this in the future... with your passion for excellence you have alot to give
May 15, '16Joined: May '16; Posts: 1To the author...you are NOT a nit picker or tattiltail...you are conscientious and smart...never let the bullies that live within nursing bury you in their own unhappiness...policies and procedures exist for reasons... if you always cut corners and do work around then the only thing management sees is that you got the job done and that means your staffing and process they have in place are working...if you form a collegial group to demonstrate things don't work and your staffing levels are to low you speak louder than those who just cheat the system and then complain on deaf ears...preceptor ingredients when does right is a gift...not only do you build a strong nurse but you keep your skills ontop...nursing is notorious for destroying our young and this is a perfect example ...instead of being supportive and providing positive assistance people attacked you...
If you can ask for a new preceptor if they ask why tell them you feel it is to overwhelming for her as a new nurse and you think it would be better for everyone...give it a try...if you can't just keep being strong, speak up when you are 100% sure you are right, show the evidence , it, p&p manual and don't waiver...someone's life depends on your strength...good luck and remember there are are still some out here who understand and believe in what we do.
Nurse for 30 years!!!!! Preceptor all the time!