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.

[Jaykalkyn, BSN, RN]

Are you her preceptor?

[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.

[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.

[joanna73, BSN, RN]

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.

[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.

[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.

[junelle1]

I have a different opinion than those posted. I work as a clinical instructor and bedside nurse. A person scanning all medications then hanging them at a different time, it's considered fraudulent documentation. Had a friend fired for that. Start a new IV line or get the medications retimed if possible . The one thing I see at the bedside is the inability of nurses to critically think. She is aware of what's being done wrong by her preceptor. What happens to the next person she trains who adopts her bad habits? These habits can cost you professionally. I've seen joint commission come in and people practice their bad habits. It's not pretty! Plus, who lets a nurse of a year experience train a new grad. She is still a novice nurse herself. I would have given my manger feedback on her and requested a new nurse . Delegation is important I agree but charting can be done later. On a good day, I may not sit down until 10 am to start charting. Please note: I see a lot of nurses copy- charting and they are done earlier.

[tch1920, BSN, RN]

Take this as an opportunity to learn. Preceptors usually have more than one year of experience, but that is beside the point. New nurses are an investment so unless you have really messed up they will not fire you. Normally, you will be assigned a different preceptor and if that preceptor has issues with you then they will let you go.

I have some questions for you to consider....

Before or after the dressing change did you ask why the procedure wasn't sterile? That was an opportunity for you to understand why a sterile procedure wasn't done. As far as the BP and glucose go, did you ask the reasoning behind her decisions? The IV med timing, another opportunity to find out why she does things the way she does. The timely charting issue, did she tell you why charting needs to be completed by that time? Did you explain to her why you were having trouble getting it completed by 10:00? This was an opportunity for you to understand why delegation is so important.

Orientation is very different than nursing school clinicals. In clinicals, you learn skills and it is important that you learn the correct way to do these skills but when you start working as a nurse, the skills are a small part of the overall picture. There are so many tasks that need to be completed and prioritization is key.

Be open and honest with your preceptor. Ask questions. You don't know everything and a nurse that does not ask questions, is a dangerous nurse (new grad and experienced nurses included). Negative feedback is not a bad thing. It is an opportunity to become better and stronger in your nursing practice. Listen, really listen to the feedback you are given and don't be so defensive.

Don't take it personally, it isn't meant to make you feel inferior but to increase your proficiency.

Take a step back, and look at it from an outsiders view. Go into the meeting with the manager and be humbled not defensive.

Hang in there, I hope everything works out for you.

[rasingirl7]

Don't quit. Did you end up getting fired? She should have changed her gloves after removing the old dressing. It may not require sterile gloves, but clean gloves are always nice... and if you felt like checking the bp again that's your call, you're the nurse. it shouldn't have been a big deal and she should have appreciated your concern for patient safety. Even if she KNEW you would still get a high enough reading for the meds and that you were wasting your time. I mean really, who cares if you wanted to take it again. That's how you get a feel for things and learn your own lessons.

Don't feel bad, she didn't sound like a good preceptor because the moment she sensed you didn't like or understand her way she should have communicated with you why and let you share your thoughts and questions. This is no biggie, just keep working and doing what you think is best. Quitting is the worst thing but if you already did then, you'll get another job and things will be ok too. Either way, you'll be fine.

[raulnihno]

First you need a new preceptor, i work in california so we had ratios. I practice nursing as if the patients where my family members, you cannot make bad habits common practices. I know you are new, but nursing school is the foundation of what nursing should be. do the right thing when no one is watching, do it once do it right, and advocate for your patients needs. All nurses do their job different, just get a new preceptor, get experience and get a job where you feel more comfortable. med

[daisydoodle123]

I would hate to be this person's preceptor.

[KY.RNBSN]

If you would use critical thinking skills I don't think you would be nit picking as much. As for using a blood glucose from 2 hours prior...was that BG 150? If so the patient is receiving cont tube feed and 2 little units of insulin will not cause the pt to bottom out. It may cause the next BG to be higher but you can give additional units per SS if indicated. On my computer system I can scan the med and change the time (up to an hour) in advance. As long as you give the med within an hour it should be fine. If the med was given outside that range you can modify your charting. Remember, you can always change anything you've charted. As for administering BP meds, I agree with you. I personally like to know what a BP is before I gave 3+ BP/diuretics. Again, use critical thinking. If pt has been hypertensive throughout hospitalization a small dose of one BP med will more than likely not cause them to became hypotensive. USE CRITICAL THINKING SKILLS!