My preceptor is everything they taught us NOT to be... - page 8

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   ThePrincessBride
    When I was in DBT, I learned that when dealing with a conflict to always first asked myself: what is my end-goal? In your situation, is it to piss off and one-up your preceptor? Or is to get through orientation and start your first year of nursing? If it is the former, keep nit-picking and you will find yourself without a job. If it is the latter, however, you will need to change your approach.

    I work on a busy med/surg unit. I am in my eighth month. Let me tell you: when you have 6-7 patients, multiple sitter cases and lots of tasks to complete, you WILL have to find a way to become more efficient. I highly doubt that there is a nurse who hasn't had to cut corners at some point in his/her career. Is it right? No. But is it wrong? Not necessarily. Management keeps giving nurses more and more to do with less resources and ancillary staff to accomplish these things. Naturally, nurses have had to adapt to the heavier workloads.

    NCLEX hospital doesn't exist. Infinite resources and techs and 1:1 pt ratios (outside ICU) are a part of fairytales. That being said, I don't necessarily agree with the shortcuts that your preceptor is encouraging; I like to take a vitals cart with me prior to administered BP meds, I prefer my blood sugars to be checked within thirty to forty-five minutes of insulin administration, and I scan my IV meds as I give them.

    Unless it is dangerous/negligent, I would keep my mouth shut if I were you and stay under the radar.

    Best wishes!
  2. by   trshrn11
    I am sorry to hear you are having a bad time. Please request a change in preceptor! I have precepted a number of new nurses and always tell them to let me know if they feel we are not working well together and I do the same. Some examples you gave are smaller details that right now seem vitally important. When you are new, EVERYTHING seems important. You will learn with experience what to follow up on. Know the policies where you work and follow them. Your preceptor and the manager cannot fault you that. Stay true to yourself and develop your practice as you feel it should be.
    Good luck!!
  3. by   Jwin10
    I think the main issue is that the preceptor is not an experienced RN herself. Had OP been placed with a more seasoned nurse, she would have known how to handle, or even anticipate new grads questions and concerns.

    Sound changes are clean, not sterile unless specifically indicated.

    Yes, always check glucose prior to giving insulin and don't go based on an old result. That is one of my pet peeves. It irks my soul when I get report in the morning and the night nurse says "their 0600 accu check was 234." I ask if it was covered and I get "no, I figured you'd cover it when they eat breakfast". :-/ which is usually 2 hours later. I tell them either cover it when you check it or don't check it and I'll do so before they eat. Ugh!!

    Scanning meds. Most places have a window of an hour before and an hour after the med is actually schedule. If med is a 1000 then anywhere between 0900-1100 is acceptable. No need to prescan iv abx as many only run over an hour or even half hour. If it's a time issue then reschedule med. or ask pharmacy to do so if the RNs don't have that capability. Or ask the dr. There are work around a that are legit. Maybe the precepting RN didn't KNOW to ask to reschedule a med and thought she was doing it the right way.

    Which leads back to my point that the preceptor has no business being one with only a year experience.

    I'm a preceptor for my hospital and I had to get recommended by my nurse mgr and unit educator to take a class to learn how to precept and have intelligent and productive interpersonal communications.

    My style of nursing and teaching is laid back. Not saying I'm lazy, but I don't get excited by many things and especially when teaching a brand new RN!! It's scary enjoy it to be a new RN and to have an excitable or inexperienced preceptor is just making it worse.

    Also, I don't think I take short cuts per se, but I work smarter. I bundle many things into a task. If I'm ambulating a patient I'm also checking their skin, watching their gait, listening to their breathing and also checking their mentation. So short cuts, no. Making the most of my time. Absolutely.

    OP sounds intelligent enough but it's hard to make that switch from student to RN. I hope there are other experienced RNs who OP can go with to finish her program. Any preceptor who has the best interests of the new RN at heart would encourage such, as it takes more than one person, experience or job to shape ones nursing style.

    Good luck
  4. by   Jwin10
    So many typos! So sorry! :-/
  5. by   Loracs72
    I have an issue with the way the preceptor did the dressing change. An old dressing should never be put back in the wound bed. The purpose of a wet to dry dressing is to debride the wound enhancing new tissue to form. At one place where I worked we were expected to change gloves between removing the dressing and packing it. In Home Health we taught the family to only use one pair of gloves.

    The nurse at shift report wanted to notify the dr. about the urine output. It's the dr,s judgement whether the output is a problem. As a nurse we have to cover our butts and report it.

    The Preceptor in my opinion was unprofessional when she discussed the patient's information with other staff that were not involved in the patient's care.
  6. by   Loracs72
    Also as the new nurse I would not say anything to the Preceptor, but bring it to the attention of the Manager. It could cause friction between the Preceptor and the new nurse, but it's worth bringing it up. If nothing is resolved, I would practice nursing as I was taught after I am finished with orientation.
  7. by   sarose611
    I am appalled at the responses you are receiving, though not terribly surprised. It is often said that nurses eat their young, and you are a perfect example. As a new grad from a good program, you have the theory to be a good nurse. Your preceptors job is to.assist you in putting that theory into actual real life practice. As an RN, you.may not be as directly involved in some of your patients' less critical cate. Delegate some of that to the proper people, such as aides, the family or the patient themselves. You focus on what has to be done by an RN. Set priorities. Charting in some cases is more important than assisting with morning care,for instance. Check orders for things like sterile vs clean dressing changes. And in the case you described, the treatment has long since been proven ineffectiv, so perhaps one could speak to the provider about better, current treatments being used. Your preceptor sounds jealous and scared. You are better prepared than she, and she may see you as a threat to her job. No one should be precepting with only 1 year experience. She is still learning as well. Since you wil likely always work in a group setting, polish your collegial behaviour. How you present yourself and your views is as important as what you present. Have a little charity for you fellow nurses, and try to gently raise their levels of care, rather than decreasing your own. GOOD LUCK!
  8. by   Heartnurse24
    Quote from sarose611
    I am appalled at the responses you are receiving, though not terribly surprised. It is often said that nurses eat their young, and you are a perfect example. As a new grad from a good program, you have the theory to be a good nurse. Your preceptors job is to.assist you in putting that theory into actual real life practice. As an RN, you.may not be as directly involved in some of your patients' less critical cate. Delegate some of that to the proper people, such as aides, the family or the patient themselves. You focus on what has to be done by an RN. Set priorities. Charting in some cases is more important than assisting with morning care,for instance. Check orders for things like sterile vs clean dressing changes. And in the case you described, the treatment has long since been proven ineffectiv, so perhaps one could speak to the provider about better, current treatments being used. Your preceptor sounds jealous and scared. You are better prepared than she, and she may see you as a threat to her job. No one should be precepting with only 1 year experience. She is still learning as well. Since you wil likely always work in a group setting, polish your collegial behaviour. How you present yourself and your views is as important as what you present. Have a little charity for you fellow nurses, and try to gently raise their levels of care, rather than decreasing your own. GOOD LUCK!

    I agree with this also. What I find in my own practice is that some veteran nurses automatically go on the defense whenever a new grad nurse joins the ranks. They label them as know-it-alls or that they want to throw people under the bus, when in essence they just want to learn. They are taught so much theory that they just haven't acquired the skills yet to put it into practice. So what may appear as them being nitpicky is really just them trying to transition. They are nervous and overwhelmed and i'm sure having a preceptor being all offended and attitudy doesn't help. My opinion is, if you are a veteran nurse and are doing things the *right* way, and are practicing safe then you shouldn't have a problem mentoring new grad nurses. IF a new grad nurse is questioning your skills or bad habits, then maybe you need to take a step back and reevaluate how you are doing things. It's not always the new grad nurse's being difficult, they most likely want to make sure they are going to do things correctly.
  9. by   Sweecy
    Quote from susskykatherine
    No 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.
    Sometimes pre scanning can be dangerous. What if you forgot to go back and hang it. That happens all the time. I walk in a pt room and previous nurse left full bag hanging in room and didn't tell me anything, I don't know what to think. I scan, hang mine and discard theirs because I don't want to throw people under the bus. It's ok for med to be late oh please. Leave it red so u can remember to do it just make a note on why it was late to cover ur a$$.
    Pt don't check their bp at home, but a hospital is not home. It's acute for a reason, anything can happen. What if the nurse before u gave bp med later and 'pre scanned' now pt bp is on the low side. We wonder sometimes why pt crash early on during the shift? Bad judgment from previous shift mixing with bad judgment from current shift. Sometimes a few minutes extra and second guessing our act can save a life. Sometimes, I'm afraid when a family member is in the hospital. I learn to not trust hospital care because too many people worry so much about leaving on time, cutting corners. If management tells me to leave early I ask them if I can leave my charting undone right in their face. I let them know my care will be done and I will only document what was done. Sorry about the overtime that you want to keep as your bonus is what I really want to say.
  10. by   Sweecy
    Quote from Heartnurse24
    I agree with this also. What I find in my own practice is that some veteran nurses automatically go on the defense whenever a new grad nurse joins the ranks. They label them as know-it-alls or that they want to throw people under the bus, when in essence they just want to learn. They are taught so much theory that they just haven't acquired the skills yet to put it into practice. So what may appear as them being nitpicky is really just them trying to transition. They are nervous and overwhelmed and i'm sure having a preceptor being all offended and attitudy doesn't help. My opinion is, if you are a veteran nurse and are doing things the *right* way, and are practicing safe then you shouldn't have a problem mentoring new grad nurses. IF a new grad nurse is questioning your skills or bad habits, then maybe you need to take a step back and reevaluate how you are doing things. It's not always the new grad nurse's being difficult, they most likely want to make sure they are going to do things correctly.
    Thank you for that answer. I was that new grad. Always anxious and asking questions I already knew the answer just to make sure I was right and ready. Not because I know it all. I sure was labelled a know it all. My preceptor would have done things differently in different days or I would have observed someone else do it differently. I've always wanted to know why and wouldn't get rationales. I would be met with hostility and retaliation. Leaving that job was the best decision I made in my life.
  11. by   Heartnurse24
    I was that new grad also. I was met with so much attitude, not from everyone, but a select few. I wasn't pompous or a know it all but just wanted to soak everything in to learn. I don't know why some nurses feel threatened. We really do eat our young and then we wonder why there is such a nursing shortage in this country. We need new nurses, as there are many older ones that are at retiring age. New nurses get so discouraged not because they don't want to help and care for patients but because of the atmosphere they get hired into. We really need to do better.
  12. by   bethchpn
    Been a nurse for 40 years and my only advice is to learn quickly that the only thing we can change is ourselves. The sooner you learn it the better. You in general will always want, nurses,patients, loved ones etc to change but it is fruitless. Concentrate only on what you can do to change.
  13. by   Txldy
    Nursing school is VERY different from the real world. That said, nursing school gives you the ideal. You may be dealing with a preceptor who became bitter and angry over a staffing situation over which she had no control. You need a HECKOVA lot more nursing experience to be a mentor to a new graduate. I have been a mentor for a new RN grad. You have to care about your patients, and you MUST, legally, respect their privacy. You must wear clean gloves to remove a dressing to protect the patient AND yourself. You know to do these things. Perhaps you can ask for a different nurse on your floor, or even another floor, who will give you a different experience.

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