My preceptor is everything they taught us NOT to be... - page 6

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   Heartnurse24
    I am actually shocked at the responses to this new nurse. It sounds to me like she is being set up to fail. Nursing school vs work nursing is a whole different reality, however, it is OUR job as experienced nurses/preceptors to guide her and give FULL explanations as to why a corner may need to be cut. She has a right to question why IV meds are all being scanned in at once, or fingersticks/insulin coverages don't match. At the end of the day, it is HER license that they will come for, because we all know the preceptor will CYHA and not admit to any wrongdoing. I also fault her employer's orientation program. The nurse manager and educator should be giving her weekly meetings to assess what she may/may not be doing right and have discussions with her and her preceptor together to open up communication and find out if there are any personality clashes. There continues to be a lot of intimidation, incivility and workplace bullying in nursing and it sounds to me that this is what is occurring. Shame on you for thinking she's "nitpicking". She needs help and GUIDANCE as a brand new nurse so that she can better her skills and her practice. We have all been brand new nurses before. Dont act like we haven't. (sorry for the tone, but this post really upset me).
  2. by   brewski09
    There are serious issues here as well as some thug a that aren't an issue. First of all, scanning mess and then not giving them until later can be viewed as a reportable medication error as well as falsifying documentation to the hospital and the BON. I think that is a very big issue and absolutely do not practice this way nor do I find it okay. The vitals not being charged by the techs u till that far after can also be coo soldered falsifying documentation and is also unsafe when giving cardiac meds. I also agree with the insulin issue, meds within an hour of the finger stick is pretty standard practice.

    the dressing change I've seen go both ways. I prefer the sterile gloves because they are so much better protecting me for dressing changes that are involved like that. However, look up your hospital policy on the dressing change. Look it up for everything for that matter and print it out so you can tell your manager the policies you were following. If leave that unit if I were you because the managers and your preceptor don't seem very open.

    FYI, if you are a union hospital have your union rep there even though you aren't off probation yet, they may still be able to help.
  3. by   debdouc
    I can really appreciate your position here but would like to point out some possibilities for you. My comments come from my experience with Preceptor A , who was a 20 year fabulous nurse from a diploma program. She was also a horrible preceptor, going about her business and not giving me much attention unless she didn't like what I was doing. I was stressed because I wasn't getting what I needed and didn't know how to change that. When my externship was over and I had my license, I requested a change in preceptor, had had enough experience with all the nurses by that time to know who would provide me with the best learning experience, and requested the change, got it, and had a remarkable experience with Preceptor B. I learned, was able to question and interact with Preceptor B in a fulfilling way, and ended up doing well.
    1. Morning care is part of nursing school clinical process and is an important part of the learning process. Once you're a licensed nurse, though, it's important to think about your job and realize that, while providing basic care falls within your scope, so does timely charting. The CNA also has the scope of providing basic care but not timely nursing charting. Ultimately, if you are busy doing basic care rather than getting your charting done and something goes south with the patient, the clinical picture, represented by timely and accurate charting, is incomplete and you, your patient and the entire clinical team are disadvantaged by not having adequate information available on which to evaluate the patient's change in status.
    2. Many, if not most or all, hospitals and physicians set parameters for blood pressures and heart rates when giving blood pressure medications, indicating that these need to be done just prior to giving the medication. If you are not comfortable with the time lapse between v.s. and medication, get your own set to make sure it is safe to give the medication. Many charting systems request these be entered along with the medication administration. You haven't hurt anyone by getting a second set and are following the provider's orders in doing so. Patient safety is the ultimate goal.
    3. Many facilities require that premeal blood sugars and insulin be done when the meal trays are delivered to the floor so that the patient is less likely to experience a dangerous drop in blood sugar. You might want to check your facility's standard of care and act accordingly.
    4. When questioning your preceptor's practice, it's a good idea to ask in learning mode rather than in challenging mode. Just because your preceptor does things a certain way doesn't mean that that should be your model for practice. Ask and do the best you can, understanding that everyone is a teacher, whether by fair means or foul.
    5. Reread your dressing change orders to determine whether it is to be sterile or clean. In my experience, hospital dressing changes are sterile because we have the means to do so and it is about patient safety and wound care. If the order says clean rather than sterile, act accordingly.
    6. I've never heard that scanning medications in advance of hanging them or giving them was appropriate nursing practice. It gives an inaccurate picture of patient care and medication administration. It makes no sense on any level, especially when considering the opportunity for medication error. It doesn't even make sense from a time management perspective. Scan the medications when you are giving them and do your best to prevent medication errors that will ultimately be traced to you if you do otherwise. It's your practice and your license, no matter what your preceptor says. You don't have to challenge or argue about it. Just do the right thing.

    I've read many of the responses to your post and can really appreciate the wealth of experience represented. Ultimately, we each, individually, are responsible for our own practice and the consequences thereof. We are also responsible for our patients and their care in which we participate, and to the facilities for which we work. Sometimes it's a juggling act to keep all the plates in the air. Best wishes to you as you continue your journey.
  4. by   Dranger
    Some of your concerns are valid some are nitpicky.

    The insulin, BP med, pressure ulcer dressing and urine output situations come to mind.

    GFR is used often for CKD staging an the fact they gave contrast must have meant they REALLY needed to see something in that CT. Obviously it is an acute exacerbation of a chronic problem which has resulted in an acute kidney injury. This is something a doctor is going to see in I/Os and lab work. Is it something I am going to call about? Probably not. Docs aren't idiots, he/she is going to see it during rounding.

    If you ever work nights and only have a doc on call you are going to need to use critical thinking to determine what is worth calling about. Would I mention it in passing if the doc was there? Sure. Would I drop everything to call him/her? No.
  5. by   eieiyo
    I agree that nursing can be a popularity contest. Two identical nurses, one brown nosed one not: the big shots will choose the brown noser. I tend to not be a brown noser, and although I am a very good nurse, the other is chosen. I fight this every day
  6. by   eieiyo
    I agree that nursing can be a popularity contest. Two identical nurses, one brown nosed one not: the big shots will choose the brown noser. I tend to not be a brown noser, and although I am a very good nurse, the other is chosen. I fight this every day
  7. by   joanna73
    Playing the game is not unique to nursing. Is it fair? No. However, workplace politics exists everywhere, in every profession.

    There is a certain art to knowing how to filter your comments and how to stay under the radar, without sucking up. Some people never realize this, and they are the ones who are labeled the "problem employee". Again, is it fair? No. It is what it is.

    Unfortunately, during a probationary period you have to be vigilant about the filter. Once people know your work ethic, that filter becomes less important.

    If there were many options for employment, that filter may not be as important. However, finding new employment often takes months.
  8. by   Jaykalkyn, BSN, RN
    Are you her preceptor?
  9. by   Jaykalkyn, BSN, RN
    I don't understand why it is so difficult for people to offer useful information online instead of pulling out their anonymous claws and ripping people for asking a question.
    You seriously sound like her preceptor right now.
  10. by   kellils
    Look up as many policies as you can! Your concerns are valid, and at the end of the day you have to protect your license and your preceptor has to protect hers--if she thinks you are posing a threat to her license I have no doubt she will not only throw you under the bus..she will probably be the one driving it. I work in a pediatric facility and their is pretty much a policy for everything, don't be afraid to do the research.
    I know you said the hospital you are at is the closest one to you, is moving an option for a better market? I would desperately try to not get fired, however, if it happens it won't be the end of the world.
  11. by   joanna73
    No I'm not. I've learned A LOT about human behaviour and workplace politics during my 27 years of working full time.

    And BTW, I've read through many of the responses. I don't think anyone has come out with claws. We've been honest.
    Last edit by joanna73 on Dec 12, '15
  12. by   NavySRNA
    You may feel like your nursing program made you a "confident, competent" nurse, but your post reeks of arrogance. While I'm sure you attended a great program, and without a doubt learned alot, I assure you that you've only scratched the surface. I suspect the learning curve is just beginning to level out for your preceptor who graduated only a year ago. I began my nursing career in a civilian ICU at a busy level 1 trauma center, and it took at least a year or two just to start feeling comfortable in that environment. I couldn't imagine having to precept an extremely knowledgable nurse such as yourself after only a year of experience. If they don't fire you I recommend you request a new preceptor, since I'm sure the one you have now has had it with you. Then I recommend you have a large slice of humble pie before your next shift. As a new nurse I can remember being bailed out many times by my senior coworkers, whether it was being overwhelmed by my patient load or some idiotic mistake I made. I guarantee that you will find yourself in a similar situation no matter how good you think you are, and those nurses you were so eager to criticise will be more than happy to sit back and watch you drown.
  13. by   mtmt99
    An RN with 1 year of experience probably isn't the best choice to precept. I had to go to special preceptor classes after being recommended by my manager (who is one of the good ones). I work with some nurses whose skills are very poor. That being said, administration really doesn't care until the patient complains, or the Joint Commission is in the house. When I complain I am generally met with an attitude of "don't rock the boat" from higher ups. I was quite upset as a new grad by some of what I observed, but remember my instructors referring to "Ivory Tower Nursing" and "Real World Nursing".

    Also, someone mentioned time management and delegation. This is SO important. Feeding and bathing patients can be delegated, but your nursing tasks cannot. If you are doing the CNA tasks you will get behind in your charting and other nursing duties (and written up for it) and the CNA will not be able to help you catch up.