My preceptor is everything they taught us NOT to be... - page 5
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 12, '15Quote from LM NYNothing sucks more than having someone talking to you like a kid. Some people don't have the art of teaching adults. They are too strong and most of the time forget that they are not molding kids, perhaps instructing adults new set of skills. You have to use a friendlier voice when instructing adults, let them ask questions, speak their minds and share their little tricks. It's not like your are trying to keep them in line because they are already in line (assuming a new nurse is a responsible adult). I can not learn from people with strong personality or those who like to show offs. Just get your done, let's have a good day while treating each other like adults and hopefully friends.I was only able to read some of the responses, but I am in the opposite situation. My preceptor is wonderful and takes every opportunity to teach me and still manages to care for her patients. I have had 2-3 patients and have been working mostly independently, but always keeping my preceptor in the loop. However, the new educator on the floor who has over two decades of experience, most of it being in critical care has been on my back about not filling in every line of the assessment on our EMR. We were in the documentation room and she was making comments and I know for a fact every single person was listening. I appreciate every thing she is trying to do for me and the organization, but I am basically her guinea pig for now. We both started orientation on the same day and she is overseeing me and two other new nurses on the other med-surg floors. I may be a new nurse, but I don't want to be talked to like an elementary school teacher telling her student to make sure to cross every "t". I know I can learn a lot from her and she is extremely knowledgeable. I guess I just had a moment where I felt like a little kid in the principal's office being scolded at. God bless all the nurses that have so many patients plus have to precept orientees or nursing students. If I didn't love nursing so much, I can totally see how people leave the profession.
Dec 12, '15Quote from Live..&..LearnSeriously, if an orientee asks why you do things a certain way, especially when all of your clinical experience was at a different hospital, than why take offense?
One of life's little lessons is that the guiltier one feels, the more defensive one becomes. The preceptor cuts corners (hell, I did too) but the work load pretty much demands that you do. I don't agree with everything your preceptor did but I certainly understand the reasons why he or she did it that way. Understanding your preceptor's behavior may show you the answer the next time. In this case, the preceptor became defensive because you questioned his or her actions. It may not even be what you asked as much as the way you asked. For example, asking "What happened that made you decide to do it that way?" is less threatening than asking "Why did you do it that way?"
When you want or need to manipulate another person's behavior, the secret to success is understanding what motivates them, then approach it from that angle.
Dec 12, '15Consider this.........a hospital that has such a sloppy nurse precepting maybe isn't the right hospital for you.
I would have advised you from the onset to report some of the practices directly to the educator or manager, now it will appear as if you are covering yourself. I also read some of the other posted comments, I especially take issue with the one "I haven't done a true sterile dressing in 5 years nor have I been required to do one". Sterile is sterile......clean is clean, in the case you sight, was there any exudate in the wound? if so then I agree change your gloves, better to be on the safe side. Scanning all your IV meds at one time, stand firm because you are absolutely correct! The vaccinations = falsifying the record, better to document unable to assess and write a note unless you can go into the old medical record and abstract the info and chart that you did so. Urinary output = 10-20ml/hr at a minimum, IV contrast the previous day with rising labs, you ARE CORRECT.
I think the issues you bring up are valid and applaud you for not turning into one of those "sloppy" nurses. Hold your ground and be proud that you are trying to do right for your patient. Let us know how it turns out
Dec 12, '15I've had one more thought about if you get fired. It's my understanding you recently graduated and have only been working in this hospital for a matter of weeks. Consider this:
In this economy, it's not unusual for people to have gaps in their employment, particularly new grads. If you do get canned, is there any law that you have to report your employment at this hospital to your new employer? How will they know you were fired if they don't know you worked there at all? Claim the new job as your first job.
Some people will say that's dishonest but all I will say is, they have their agenda; I have mine. It's not like you were separated from your job for being the Angel of Death™. Discretion is the better part of valor, as my father always said.
Dec 12, '15You can never go wrong by following the hospital policy. Yes, nurses cut corners. I don't believe they do it out of laziness. They need to get the work done. I bumped into the VP of nursing at my hospital and I told her how I was feeling overwhelmed. She told me to not be so hard on myself and to actually give myself credit. She said I will have good days and bad days and I felt like a burden was lifted off my shoulders. Nothing prepares you for real world nursing and I commend every nurse for putting up with what they do. I loved nursing before I entered the profession, but I have a newly found respect and admiration for the profession.
P.S. the nurse educator I mentioned in my earlier post likes to name drop. She mentioned all these top hospitals she has worked at. That was another reason I was turned off.
Dec 12, '15I am giving you a strict WARNING. If you want to start your nursing career do what she says...UNLESS you will be held accountable. Like giving a medication without following protocol. Take the BP before giving med you will never be fired for that. Take glucose before giving insulin you will never be fired for that. However you will be fired if you call the doctor without your preceptors permission, you will be fired if you can't keep up on a med surf floor which,means getting your charting done. Doctors look at the charting so get it in there they make decisions based on your charting. Do not feed anybody or do anything extra that a tech can do, unless you have Your charting done. Please heed my warning. what you are expering over 1/2 the new nurses experience I including me. Remember you will be fired from this job before you finish orientation of you don't listen to NURSE Ratchet. Suck it up. You have to be smart enough to get out of orientation. The boss will listen to the preceptor. Once out of orientation do not do something a tech can do unless all of your work is done. I got in trouble for giving a bed bath to an obese stinking woman. I was gonna throw up on her if I did not get that stincth off of her. She is wrong on most accounts but stroke her ego. Always I mean ALWAYS ask at the end of your shift with a notebook in hand what Did you do well today and what can I work on next shift. They like that you want there opinion. Plus if she makes up stuff u can pull your notes about your progress with the dates .
Dec 12, '15Maybe there is no experienced staff to precept its very common unfortunately. Experienced nurses are tired of dealing with management and their unrealistic expectations and are leaving bedside nursing for the inexperienced to figure it out.
Dec 12, '15Couple things people have gotten wrong: sterile technique is not required (that is so) but the 5 moments of hand hygiene per WHO standards do require a glove change between exposure to body fluid and placement of clean dressing. That is problem endemic to many practices, unfortunately.
The largest issue was the disclose of private data regarding a patient to a person not involved in their care. While sex offenders provide special problems in hospitals, our current patient protection laws still apply to them. As well, her intent in sharing that info is dubious. To be sure, there are likely corporate compliance rules that require you to report that indiscretion.
Lastly, taking multiple meds in a room, pre scanning them, and leaving them at the bedside is a 7 rights violation, an infection control concern (they cannot be returned to pharmacy after being in the room), and would be cited by any credentialing body that visited. Don't do it.Last edit by DavidLovejoy on Dec 12, '15 : Reason: Spelling
Dec 12, '15It was a poor choice to put you with a novice preceptor. It's like the blind leading the blind. However, I think your mentor put you in a bad situation by telling you to report every little thing. By doing this, all you were telling your new employer and coworkers is that you thought you were above them. Pointing out practice issues is a fine balance of what is a critical issue and what is not critical. And as a new nurse you think you know...but you really don't. Until you are on your own, your preceptor is your mom and dad, and you need to follow their lead. Consider this issue a lesson learned and change your thought process until you are on your own...then it's all yours.
Dec 12, '15If you haven't charted, you haven't done it. I get that. But I personally think it's a two way street: if you haven't done it, don't chart it! I totally agree with the OP that if you aren't going to give meds at that point in time, then don't prescan them and sign off that you have. And OP had a totally valid concern with the patient's reduced urine output, it's clear she was suspecting patient may be having contrast-induced nephropathy (and it didn't help patient was on vancomycin which also has potential for nephrotoxicity) based off increasing SCr, BUN levels and decreasing GFR + patient's self-reported assessments of urine frequency 24-hours post IV contrast.
OP, only thing I can say is that there was nothing wrong with the contents of your thought processes or complaints with your preceptor's shortcuts. Maybe there was a different way you could have gone about getting those heard (soft-skills like rephrasing questions another way, etc), but honestly I don't see anything you've done that merits you being fired!
Dec 12, '15I a new grad from an excellent, small hospital based program...Not because your school prepared their students well, and your preceptor stated that she didn't learn anything in school means that it's the end of it. Nursing school is preparatory. You continually learn in your nursing practice and build your skills as your progress. So your school may have given you a good foundation, but your preceptor has much more critical thinking and real world experience that should be taken into consideration rather than denouncing her ability to do her job. However you do have some good observations.
Dressing change: Unless otherwise stated, dressing changes don't need to follow sterile procedures. However, I would have changed gloves after removing the dressing. On the other hand, what was the quality of the dressing? Was it very soiled? bloody? was the wound infested with maggots or poop? etc
Multiple IVs ordered at the same time: Err, no. I personally wouldn't scan a medication and hold off on administering it to the patient. One might forget. Can the med be retimed? Are they compatible, perhaps they can be y-sited? Can you start a new IV for meds that are not compatible for IV ABX that will be given frequently?
Insulin: errrrr, why was the fsbs(finger stick blood sugar) done at 0630 for an 1100 order??? Did you ask your preceptor this? This suspicious. Ideally, the fsbs should be checked about 30 minutes before meal trays arrive.
vaccination: assume nothing.
Blood pressure and meds: Also, how have the patient's BP been trending? Do they consistently have a high or low BP? Were you going to give all of these meds for a charted BP of 100/75 HR55 or was the BP 185/101? If you're concerned , you can also tell your preceptor that you are checking because you'd feel more comfortable rechecking the BP since the aids began to check vitals 2hrs prior. I check the blood pressure before giving meds, unless I have a BP that's within the past hour.
Report: Hmmmm, why was she in the hall and not in the room? Discussing as in gossiping the Hx of drug abuse or passing on the pt. Hx.
One should consider your patient's dignity and not speak about them so candidly with others. However, as you progress in this profession you see that it happens quite often. Keep it to yourself and when you are giving report, you won't do what she's doing. This will be your standard. Move along.
Charting: When does your shift begin?? "The charting can wait in my opinion, as long as everything is done on time.", said no nurse ever!! Well I am certainly excited that you have the time for am care, and feed your patients (not being a smarty pants here). What's your patient ratio? the acuity? are you reviewing your labs? charts for new or change in orders? reviewing physican's notes? How much/how many tasks do you suppose that you preceptor is noticing not being addressed and she is completing because you are not making a priority to check? I don't know about your hospital, but at my facility we have computer charting. Docs have modified orders based on assessments, notes, and current vitals. You have an aide so that you may focus on your RN job. Utilize them.
Feedback: "continued to receive negative feedback from my preceptor and will discuss it with 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?" At some point you have to ask yourself "what about me? Am I missing something?" have you spoken to other new grads about their precepting experience? Do you talk to your preceptor about why she is doing x,y, z?(i,e,; the dressing change without glove change in between?). I'd like to get your preceptor's perspective. Do you bring to the attention of your manage every little thing that you don't agree with. I support that there are behaviours that you may not agree with, but how much of what she does warrants a complaint?Last edit by FunnyPants on Dec 12, '15
Dec 12, '15I noted that most of the responses to this thread were demeaning to this nurse. I applaud her for wanting to maintain her standards. One thing that bothered me was wanting to pass off morning cares because she is the RN. This is a good time to talk with our patients, maybe complete an assessment. When I was in med surg years ago on evening shift, I took the time every shift to change everybody's draw sheet and give a back rub. I wouldn't have passed on that task to anybody else. It didn't sound like she had time management issues. When someone is a preceptor, they should be at the top of their game. And be able to explain rationales. Starting out by pre scanning meds and cutting corners is not a good idea. While the dressing change may not have been a sterile technique, gloves should have been changed between Taking off the old dressing and putting on a clEan dressing Belittling new nurses for their standards is why many nurses leave nursing or get burned out. Rather than doing that, we should be encouraging this nurse. Props to you new nurse! Yes real life nursing is different than school but don't give up your standards.
Dec 12, '15No need for sterile dsg on chronic wound, ok to scan all meds,check recent creatinine and fluid intake on oliguric pt before calling provider,pts will not be checking their own bp prior to meds at home,more important to check 1 hr after esp if new med, ok to remind preceptor of hippa rules in a nice way like what if that was your family member etc, transitioning to the real work is hard, all nurses practice differently to some degree.its a balance between taking reasonable shortcuts so you can get done what needs to be done and following best practice based on evidence.