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.

[mrclark0000]

Really? So don't be a good nurse, don't rock the boat? Are you a nurse or a politician? What I gathered from the post was:

1. A Bad Preceptor.

2. A Manager that doesn't listen to the genuine concerns that a new nurse has brought forth.

Either one of these is a cause for concern. Togeather they spell disaster.

Either the manager is close friends with the preceptor, and doesn't want to "rock the boat" with the friend by avoiding enforcement of good nursing practice standards, or the manager is incompetent and can't discipline the preceptor.

I agree that a year is way too short for a nurse to be a preceptor.

[NanikRN]

---NM

[LucyRNPRI]

First of all commend you for taking responsibility for being a nit picker. I agree you are nitpicking because you really do have to start realizing you are in the real world, not nursing school and not the nclex world. That world only exists in the professors mind. As far as preceptors go, I know them oh so well, and yes she sounds like a Oh I am cool, I have been doing this a year now, I am a pro, let me eat the young. I hate that mentality with a passion, and trust me she will get you fired before you get started because trust me the manager is on her side. You are the newbie on the block and they will see you only as a trouble maker and non compliance. Welcome to the doggy dog world of Nursing. You find out why I have formed my independent Nursing business. I am sick of the disrespect from fellow nurses and upper management and corporate America. You will find everyone thinks they are the perfect nurse and follow all the rules. Don't be that nurse. because in the real world there is no such thing as being the perfect nurse. You are overworked, they put so many demands on you, it Impossible to do things exactly correct and on time. The only way that can be done is when you don't go above and beyond. Think outside the box and yes I agree with you patient first, charting can wait. I truly don't envy you being a new nurse. I put in my time on a med/surg floor. Just keep your nose clean, listen to your preceptor because God knows she is perfect and knows it all. Let her think so. Once you are on your own you can establish who you are and your own way., not her way. I get so sick of these self righteous know it all people. Anyway that I my issue..LOL. you can tell I have been burned by them in my past. I have precepted and New grads or student nurses would ask to be with me, You know why because I provide a learning environment and don't roll my eyes, and allow for mistakes, and know that I was a new grad once and a student nurse once. I never forget my routes. I dislike people who get all caught up in their status and forget where they came from. And that is all I have to say about that. I do agree with the reply from remotfuse .

[LucyRNPRI]

Great Advice and spot on!

[Cnrundle]

I have been a progressive cardiac care nurse for 4 years, in a leading cardiac hospital, and was a Tech for 6 years prior to that. I frequently precept new grads and expierenced nurses to my unit, although I think I'm still a "new" nurse. I also serve in a relief charge position and sit as chair of our shared governance committee, so I feel I have a little to say about this. First, I agree with a previous post that you should be receiving weekly feedback on your progress, discussing your weaknesses, and plan of action moving forward; this should also be a time where you can discuss concerns openly with all parties involved present, and not feel persecuted. Second, if you feel your learning style is extremely different from your preceptors teaching style, you should also be allowed to request a different preceptor. Third, you should feel comfortable questioning your preceptor and asking for clarity in how/why he or she completes a task a particular way; however, do so privately, not in a patient's room and be polite. For example say something like "I'm not exactly sure why you didn't use sterile technique during that dressing change. Could you help me understand?" In our facility each employee has access to all policies and procedures online. If this is so for you, maybe pull and review policies before raising questions. One thing I ALWAYS teach my preceptees is to ALWAYS trust your instinct, your gut feeling. Learn your organization's chain of command and use it, create a binder of policies and frequently used order sets for reference, and know there will never be a day as a nurse that you're not learning something. I know, personally, one of the hardest things to learn was delegation of task. Of course you will help a patient to the restroom, or get set up for a meal but if they need some new socks or want to get washed up, ask an aide to assist them or work out a schedule with the patient that will better work for the both of you, so you may assist. I feel everyone eventually finds their own method to the madness, as I'm sure you will. I wish you the best of luck in your future endeavors!

[jimmyalvin]

I don't have time to give a full reply now, but... there are a couple practice issues with your preceptor, however, *you* were in the wrong on several of those examples above and you really need to let the small stuff slide or you are going to drive your self crazy and more importantly not be successful as a nurse. I have multiple issues with some of your examples, but the biggest one - that dressing change did not need to be sterile unless the facility policy required it. I have never done a truly sterile dressing change in 5 years - nor have I been required to. You're not in a BICU.

[Txldy]

Being a preceptor is teaching a person who will eventually be working with you as part of the team on your shift. You are responsible for the competency of that person, building a good colleague and possibly a friend. Hostility and condescension will do you absolutely no good.

[Txldy]

I couldn't agree more.

[StudentAmie]

I admit I haven't read all the comments, but I find it disturbing how many people have dismissed the dressing change as "it's not a sterile procedure". Maybe not, but you absolutely need to wash hands and change gloves between dirty/clean dressing. Ew. I also think the fact that many posters closed rank and said it was this new nurse's attitude vs. poor practice was the real issue at hand speaks volumes about the reason it is said we eat our young.

[MunoRN, RN]

I admit I haven't read all the comments, but I find it disturbing how many people have dismissed the dressing change as "it's not a sterile procedure". Maybe not, but you absolutely need to wash hands and change gloves between dirty/clean dressing. Ew. I also think the fact that many posters closed rank and said it was this new nurse's attitude vs. poor practice was the real issue at hand speaks volumes about the reason it is said we eat our young.

Washing hands and changing gloves is part of "clean technique", not "sterile technique" which is why the claim that dressing changes are always sterile procures was correctly dismissed.

"Eating our young" does not refer to legitimate criticism. Correcting incorrect beliefs is a normal and expected part of what we do, lateral hostility is a very different thing.

[Txldy]

Ok, I will say it. It might "just" be c clean dressing, but take your nasty dirty gloves off and wash your hands before you replace it.

[jemerald]

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.

Lol at everyday I hope she retires.