My preceptor is everything they taught us NOT to be...

  1. 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.
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    About Live..&..Learn

    Joined: Dec '15; Posts: 3; Likes: 29

    157 Comments

  3. by   remotefuse
    Sounds to me that you are nit-picking. Some of these things may need attention, but I think it's important to realize there is the nursing school world and the real world. Like the dressing change on the ulcer. It's not a sterile dressing change, it's a clean dressing change. And I see the scanning multiple bags all the time. Especially if they are hung within 30 min or so within each other. And if they are not actually given for whatever reason, then they can be documented against. Sometimes on my emars, I will have 3 different IV drugs due at the same time so yeah. Some of your preceptors actions, described by you, may need some attention, but overall I think you are over reacting.
    Last edit by remotefuse on Dec 10, '15
  4. by   caliotter3
    Always easier to nod and go along with the program with a preceptor, then when cut loose on one's own, do it the way one wants to do it. Don't go out of your way to make enemies. Showing the preceptor up got you on her bad side. As soon as you sensed that she was annoyed, you should have changed your behavior.
  5. by   ProgressiveActivist
    She is throwing shade because you are giving off the vibe that you are looking down at her. That relationship is broken.
    Ask to come off orientation or request another preceptor.

    The manager sounds rather dense as well. You ought to be applying to other better hospitals.
  6. by   Live..&..Learn
    Thank you...I feel like a "nit picker", but when I confided in a mentor with many years of experience in emergency and critical care medicine, the response was much different, talking about "patient safety" and "positive patient outcomes", and do I want to be responsible if something happens, like a sick elderly woman ends up on dialysis because I didn't address my concerns to avoid "rocking the boat" so to say, or someone is transferred to another department and doesn't receive their q24h abx because it was charted that it was already given. I'm new to this, brand new, so I don't really know if these things are acceptable practice or not. Obviously there's a lot more going on than what I listed here, but I can walk away with some lessons learned regardless.
  7. by   flyersfan88
    Why don't you ask her why she does things the way she does instead of nit picking and tattle tailing? I'm sure you graduated from like, a totally awesome program, but you still don't know anything. Maybe you should act that way instead of acting like you know everything. Regardless of the things she isn't doing right, this isn't a good look for you.
  8. by   Been there,done that
    Quote from 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.
    Did you receive weekly reports on your progress? THAT is what matters here. Weekly reports are the standard.

    Newbie preceptor has picked up your vibes.. that you do not agree with their care.

    If you were offered the (correct) opportunity to discuss your progress.. newbie nurse would not have been enabled to slam you with negative feedback.

    Nursing education needs to know what is happening here.

    Good luck.
  9. by   Live..&..Learn
    Quote from flyersfan88
    Why don't you ask her why she does things the way she does instead of nit picking and tattle tailing? I'm sure you graduated from like, a totally awesome program, but you still don't know anything. Maybe you should act that way instead of acting like you know everything. Regardless of the things she isn't doing right, this isn't a good look for you.
    Sorry, I was not trying to be sarcastic in my comment, not at all. I'm brand new to nursing, and really don't know anything. I put my head down and didn't say a word for several weeks until she started hammering me with bad feedback, even then I only asked her a couple of times why she does things the way she does. I'm lacking in nursing experience, but have plenty of life experience, and am not out to be an arrogant b####. I didn't "tattle" on her, I didn't talk to anyone else in that department or the manager about any of this. Seriously, 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? I really did not try to come off that way, maybe I did, who knows, and apparently I'm coming off that way here.
  10. by   caliotter3
    Reread the second paragraph of your initial post.
  11. by   Nonyvole
    So, I have a couple other thoughts.

    One, what are you saying non-verbally? One of my former preceptees was from a different style of program than I attended, and although there wasn't anything said out loud, their attitude of "my program was better than Nonyvole's" was loud and clear. As a preceptor, I simply gritted my teeth and tried to ignore it.

    Two, you're saying that you are heavily involved in all of your patients' AM cares, often to the detriment of your charting. This is something that should be said...do you need to be that involved? Are these things that require a nurse to be there? By 10 AM, doctors are in-house and are looking for things like morning vitals, labs, and nursing assessments. It truly is a matter of delegation, prioritization, and time management. You are not the tech/CNA. You are the nurse. You have more responsibilities than making sure that everything is done, when a good portion of that everything can be delegated.
  12. by   MunoRN
    I think there's a lot of opportunity to learn for a new nurse from the possibly questionable habits of other nurses, most importantly how you are going to evaluate the big picture of patient care going forward. I commend your high standards and don't want to discourage that, but I also think maybe you've come to believe that your own understandings of things are what the universe revolves around.

    For instance, sterile dressing changes for chronic wounds, even deep wounds, are not the standard of care. The main position papers come from APIC and WOCN which don't actually recommend sterile technique for these dressing changes, only in very specific situations.

    As for the BP med, I think you need to actually think about the purpose and reasoning behind BP monitoring in a patient on antihypertensive medications. Part of the transition from nursing school to nursing practice is going from rigid "do-this" rationales for practice to actual reason based and patient specific rationales and practices. A BP within 30 minutes of when a dose is due is actually not very useful in evaluating for whether or not the medication is making the patient's BP too low, by that point the previous dose is far less active then at it's peak and later in the morning the BP will typically rise based on circadian rhythms, so really a BP earlier in the AM is much more useful in determining if it is safe to give the patient the next dose.
  13. by   OCNRN63
    A new nurse should not be precasting a new grad. I also think there's more to this story.
  14. by   VANurse2010
    I don't have time to give a full reply now, but... there are a couple practice issues with your preceptor, however, *you* were in the wrong on several of those examples above and you really need to let the small stuff slide or you are going to drive your self crazy and more importantly not be successful as a nurse. I have multiple issues with some of your examples, but the biggest one - that dressing change did not need to be sterile unless the facility policy required it. I have never done a truly sterile dressing change in 5 years - nor have I been required to. You're not in a BICU.

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