My preceptor is everything they taught us NOT to be... - page 9
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 15, '15I don't even know where to start. I had been an RN for 10 years in long term care before deciding I needed a change. At my interview for a med/Surg position at the hospital, I was honest with the managers that I did have good thinking skills, but lacked clinical experience as there were a lot of things I never did in long term care. As far as charting went, I knew I had that skill, but I told them if the hired me, I would need to be treated as if I was a new nurse, with a preceptor and an organized orientation period. Lucky for me, I was hired and basically treated as a new grad, because that was my experience level on med/Surg. I learned from wonderful nurses who were encouraging, and I was never disrespectful, but grateful even though most of these nurses were 15 years younger than me. Because I was respectful and willing to learn from all different types of nurses, when I was on my own I never ever had an issue of somebody helping me if I needed help, or me helping someone else. Fast forward one year later...manager wants me to start precepting new nurses and be charge nurse. I fought this for months, I was not nearly comfortable trying to teach a new grad how to be a nurse when I was trying to be a proficient nurse myself. I had a lot of anxiety at the time, worrying myself to death about making sure I did a good job. Finally manager said I had to precept and couldn't refuse. I was not happy about this, because I wasn't confident in myself. I got 3 great grads to whom I explained my methods and rationale, however I expected them to develop their own methods and critical thinking. Nobody treated me like a bad nurse, because I told them from the start that we are all RN's with the same credentials and we were going to be a team and figure things out together if I didn't have the answer. It was part of the learning process for all of us. I was always tools I did a good job, and was never critical of another, either as as preceptee or preceptor.
Dec 15, '15Please believe that this is not about nurses eating their young. Yes the OP's preceptor sounds like she is too inexperienced to be precepting. But this isn't the NCLEX world. Instead of making waves and demanding others to do their job a certain way set an example by doing it right yourself. You are going to see bad practice everywhere in nursing but trying to be super nurse is more likely going to get yourself in trouble rather than help the situation. I would never ever think about nit-picking like this. If it is this bad you should have asked for a preceptor with more experience instead of complianing about everything your preceptor did. And BTW most dressing changes are not sterile on adult units.
Dec 15, '15Good luck. No right answer hereLast edit by Renewed RN on Dec 15, '15 : Reason: change of heart
Dec 15, '15Quote from Been there,done thatOne thing that I am seeing is that the Dr's order and your policy and procedure manual are your best friend. Perhaps your "preceptor" knows that. You can quietly know that you would do it differently. That you would use gloves during the removal and clean gloves for the placement. You could quietly and pleasantly hand your preceptor clean gloves from your clean, gloved hands. I do not know that you will be getting fired. Knowing the policy and procedure set forth by your hospital (most hospitals. They are pretty standardized within the scope of nursing practice guidelines) and following them will keep you in good practice and out of court. Just because a patient is nonverbal doesn't mean he doesn't know what's going on.So.. what I hear you saying is... while one is orientation... one has no say in the delivery of care?
Any lawbreakers can sue your butt off for ignoring the privacy act and you will be be dragged in to court if the hospital doesn't settle.
Keep your head down and get through it. Then do it right when orientation is done. Work on your speed as your practice gets better. Be a conscientious an kind but all business team leader.
Dec 15, '15Alright. I have to say something. Because I was a preceptor a year in to my first job as a new nurse. I hope you see this comment out of the hundred or so you probably already have here, but you probably won't, so here it goes anyway.
You sound like a very good nurse. Yes, patient care always without a doubt comes first. There have been days (I'm almost 4 years in now) where I don't start charting until my shift has ended. On a med-surg floor especially, the first things you should be doing are assessing your patient and getting the patient up and out of bed/walking/into the bathroom so they can have breakfast and you can pass your AM meds. This is priority number 1. For your 5-7 patients on dayshift.
What you have to realize is that if you try to practice to the perfection that you are trying to aspire to, you will get fired or burn out within the first year. Because whether you like it or not (and trust me, no good nurse does like it), charts matter. The time you chart matters. If you don't give your meds in a timely fashion, that's a write up. If you don't have your charts at least started by a certain time, that's another write up. When that one patient gets sue happy about something that happened during their hospital stay and you're brought to court, charting times matter.
Hospitals don't like when their employees are a liability. So they expect the impossible. They expect you to be the perfect nurse, the perfect customer service robot, and an asset to their company. Nurses take shortcuts. Like many comments before me have said, there is real world and nursing school world. That ideal vision needs to be removed from your head, and instead planted with the smart nurse who has the skills but knows how to get **** done.
Dressing changes are never sterile on the floor, unless they are ordered as such. Change your gloves in between removing the old and applying the new. Make sure the patient isn't soiled.
Go by your CNAs vitals. That's what they're there for. Unless you know that they did them purposely at a wrong time to better suit their needs.
It's okay to scan 2 IVs at the same time. If something happens, you back chart and say not administered and this is why.
Stop striving for perfect. Go for ideal. Nobody wants the perfect nurse when you're taking too much time doing something that doesn't need to be done, and your 4 other patients are ringing their buzzers.
If you see something against policy or something unsafe that your preceptor is doing, you can report them. Otherwise, learn to adapt, but be comfortable and safe doing so, for your sake and your patients' sake.
Dec 15, '15Okay, I'm going to approach this from a different angle here to start.
As a new nurse with about 1.5 years of experience with the 1st year being on a med/surg floor, I can relate to the big picture of what you are saying here.
Based on the information I've been given here, I believe you have your heart in the right place, and you have a lot of passion for your patients and the drive to be a good nurse, and that is wonderful. That is something you should cherish and hold on to, and never let anyone change. Also, you are critically thinking. You have potential to be a wonderful nurse.
With that being said, another huge aspect of nursing is learning and growing. As a brand new nurse all the way until the day you retire you will be learning. Learning is not always receiving advice and wisdom. Just as often you are going to be learning based on making the decision that what you see is not something you want to be doing in your own practice.
I have now moved to a critical care, which is a better fit for me. Med/surg is not for everybody, but those who do it have a brave heart and handle very difficult patients and assignments in their own way. If med/surg is not for you, take the opportunity to still be learning and work on making a short term goal for yourself and go for it. During my time on my previous unit, I saw things daily I did not agree with, but only if I thought a patient's safety was being jeopardized did I decide I needed to intervene; I really can only think of this happening a couple times. You have to respect your fellow coworkers and learn from them, even if it is not the type of learning you were to expect. You are just a baby nurse (I am just a toddler nurse ) we have SO much to learn!
Trust your gut, critically think, ALWAYS be open for criticism, learn how to interpret that criticism (ex.- charting supposed to be done by 10- I need to focus on time management and work my way to charting being done by 10! Do NOT automatically assume this is not an issue and that your preceptor is at fault. Her approach at telling you may be poor, but find in yourself what you can learn from that!!), and finally find a place where you feel valued and happy.
Good luck. You are not in this alone (use your resources), but you ARE solely responsible for the kind of nurse and coworker you will be.
Dec 16, '15I agree with the other posters. There is such a thing as real life nursing. You are comparing things to the way you learned it in school and it's just not realistic all of the time. The dressing change for sure is not done sterile. There is no way to keep it sterile after. The I.V's get signed out together, you can always chart they weren't given. The reason for this is time management. This is a corner that is ok to cut. If you did things by nursing school standard, you would literally never finish a days work. In order to have time for other things you cut these corners. You really need to have time to look up labs, test results, talk to other team members, etc. The BP med situation, I wouldn't not go with the earlier BP unless it was lower and cutting it close. If the patient trended a higher BP, I would use it. It doesn't hurt to retake it tho. Part of your preceptors job is to determine if you will fit into the team they have. If you are constantly challenging her practice, you may not be a team player. You are going to see things you disagree with. You will see what really poor nursing care is someday. This isn't it. Sometimes you have to just say to yourself, "self, make note to not do this when I am off Orientation". Them you move on.
You most certainly wouldn't be the reason that patient ended up on dialysis bc of the decrease voiding. That doesn't happen overnight bc of a decrease in voiding. You have to trust in your preceptor that they have been doing this longer, have seen more and have a lot to teach you. I wouldn't take what your mentor friend said to heart. They may be just trying to sound good to a new grad. If you want to keep your job and reputation than just go with the flow and know that you can do what you want when you are on your own.
Lastly, the charting needs to be done asap. The doctors come in and look for your assessments. There are reasons for that to be done by a certain time. In fact, it is mandatory at most hospitals. Your cna or tech will do am care. You have to delegate some stuff. If the patient starts going south and you haven't even charted your baseline assessment, that could be a problem.
Good luck to you
Dec 16, '15You should have bladder scanned the patient with the voiding issues, this way you know if it is an issue with urine production or expelling the urine. Just a thought. You do not need a doctors order or instruction to bladder scan.
Dec 16, '15Resign before you get fired. You'll feel so much better after you remove yourself from that stress. You will get another RN position soon.
Dec 16, '15A little bit of both, honestly. She sounds like she needs to improve her practice, but what you need to learn about nursing is that everyone has their OWN license and their OWN accountability.
Sorry but you have to get through preceptorship, and unfortunately it won't be the last time you have to pacify and put up with bull. Was the BP 110s/60s? What's their trend? You'll learn to base your practice on life, not books and 30-min rules. If something you're asked to do is truly unsafe and reasoning isn't given, then: yes, absolutely refuse, collect your objective evidence, chart asap, and demand they do the task themselves if they insist.
You need to, for lack of a kinder what to state it, hop down from your high horse. You sound as though you have yet to understand the big picture of nursing. You can't improve something you don't understand. You'll learn the value of getting your charting in when you get 2 discharges with 2 readmits, and suddenly that person you've been watching codes and you have no head-to-toe BC you were doing ADL care.
Dec 16, '15I am a new RN but not a new nurse. I have worked in LTC for 10 years and am not transitioning to hospital care. It has been difficult for me to change the way I was used to nursing in LTC to acute care. All nursing is not the same. Every nurse does things differently. Book nursing is based on a perfect world and is not realistic. I understand that you just finished school and have learned to do everything perfectly but nursing is not perfect, it is realistic. Reading your post, you seem to know book nursing very well but clinical nursing is different. If someone has chronic HTN, they need their meds, they need to keep that medication in their system to maintain their bp at an acceptable level, even if its 110/70 right now, chronic HTN patients will jump up if not given their medication. Its not just about the numbers, its about the patient. You have to treat the patient not the machines. Maybe your preceptor knows this and maybe not, but trust me, they have chosen to allow her to precept you so they think she is competent even if you don't. Now you have the option to refuse to administer any medication if you have a medically based reason not to, but you will have to have a good reason not to give it and be ready to show how it would be a detriment to the patient to give it. I am not bashing you or calling you whiny, just being honest about nursing. The manager does not know your skills and does not trust you, they are relying on your preceptor to tell them how you are doing, you need to fix your relationship with her, never act like you are better or more knowledgeable than her, even if you think you are.
Nursing is not fair and you are new so you are not the one managers will listen to because to them you have no skills (even if you do), you have to prove yourself over time. Many thing will confuse you and frustrate you. You will be expected to be in ten places at once, do ten things at once, pass meds, assess, give care and chart all at the same time. You have to learn how to prioritize and delegate so you can get the more important things done within a reasonable amount of time, and you will still get those awesome notes about how you did something wrong or not on time.
Things to remember, take care of your patients, don't piss the doctor off, chart well enough to cover your own ass. Real nursing is nothing like nursing school, it is chaotic and never perfect scenarios. If you are not comfortable where you are, maybe you should look at a different kind of nursing, there are thousands of areas to work in.
Dec 16, '15I am a newish nurse, and I had the opportunity to precept a new grad this fall. I was not shy about admitting my shortcomings in front of my precectee and we both learn lots.
Op, your preceptor is not perfect. Nursing is tough. And if you are coming on to a floor saying you came from a good program instead of being willing to learn, I am imagining that you are a tad defensive when taking feedback.
Your preceptor was chosen because she is a good nurse and they thought you could learn from her. And you did not.
My preceptee is now flying own her own and I hope that she never forgets to ask questions.