Orientation...blechhh

DixieRedHead, ASN, RN · Nov 24, 2011

Intense? Sounds to me like she took orienting you seriously, and tried to find out what you knew? There's no way to do that except ask. Perhaps she was too "intense" while telling you to speed it up, but she was keeping you on track.

I doubt that you will get a reputation. If you do, it's ok. Those who matter don't mind,and those who mind don't matter.

She sounds like a wonderful resource for you, keep up the good work.

netglow, ASN, RN · Nov 24, 2011

She could be from the U of K (University of Know it all) AEB the quizing. Quizing is kinda a waste of everybody's time and tolerance IMHO.

Good you laid it out for her. I think you did exactly what you should have and none to soon. She needs to respect you, if she wants your respect.

Christy1019, ASN, RN · Nov 24, 2011

An ass? No.. a confident, professional that is smart enough to know her limitations and will put patient safety first, instead of rushing to appease her b/c you're the new kid? Yes! I commend you, I can't honestly say I would've had the guts to do that when i was orienting, but i was also a new grad at that time.

I think you handled it very professionally, she was wrong to tell you to hurry, especially since a lot of this is new to you. However, i do agree with her quizzing you w/scenarios and why you're doing certain treatments. Even though you are new to this area, i think she's trying to get you to use critical thinking skills which is definately important in dealing w/critical patients. If you can give some examples of questions you asked I'd be more than happy to help you understand what i mean and show you that you already have the skills, just need to understand how to apply them.

Just curious, what kind of unit did you come from, and what kind of unit are you in now?

just remember: always always always put the patient's safety and needs first. Never let anyone bully you into doing something if you dont understand or are concerned about doing. And never be afraid to ask questions, the nurses who dont b/c their afraid of looking dumb or think they know it all, are the most dangerous nurses out there. We are always learning and nobody knows everything!

maelstrom143 · Nov 24, 2011

I think she takes orienting you seriously and likes what she does. Maybe she was so excited about being able to precept you that she may have been a little pushy, but it sounds like it is just her way of trying to do a good job. You did fine, though. You set boundaries and allowed her to see that you prioritize safety above speed and that is paramount in any setting you may encounter.

She sounds like an awesome resource to have, though. Good luck in your new unit.

Christy1019, ASN, RN · Nov 24, 2011

She could be from the U of K (University of Know it all) AEB the quizing. Quizing is kinda a waste of everybody's time and tolerance IMHO.
Good you laid it out for her. I think you did exactly what you should have and none to soon. She needs to respect you, if she wants your respect.

I totally disagree w/you about quizzing during orientation. There's no way an orient will get the opportunity to encounter every situation/treatment/disease process during their orientation, so giving scenarios to show how they would deal with those situations and to further show how they can apply their critical thinking skills to any situation. Plus we dont remember every thing learned in nsg school, and if we havent used certain info in previous care settings, we forget it. Quizzing can trigger our memory of what we did learn in school and then say "oh yeah, i DO remember that"

Maybe a preceptor's questions/quizzes isnt as important in gpu or LTC settings b/c its more continued care, but in any critical care setting i.e. ER, ICU, the majority of what you will be dealing w/is acute care issues where you are doing a more focused assessment and may need to respond immediately to situations. Having that refresher in the back of your mind will help you respond appropriately and not stress out under pressure b/c youre unsure.

OCNRN63, RN · Nov 24, 2011

Good grief. Now you can't even ask a preceptee questions. I we're just supposed to assume people who are new come to the unit fully knowledgeable. It's a lose/lose proposition for a preceptor: ask questions, and you're a bully. Don't ask questions or give guidance and you're not being supportive enough.

Psychtrish39, BSN, RN · Nov 24, 2011

Well it is a difficult thing orienting and being the orientator as well. I have done both over my career. I was just recently starting a job in assisted living at LPN wages for one thing because I needed the income, and the nurse orientating me was just out of school and would not allow me to do anything on my own and I have been a nurse 8 years and have much more experience I ended up showing her correct way to do things and teaching her some too. I didnt end up staying because the orientation sucked and the caregivers didnt do adequate care i.e. keeping the clients clean and we as nurses werent allowed to question them and delegate the client's care as ILAs are not CNAs as this was assisted living with MR/DD clients so I booked I am not going to work at a place like that but in your case it could be constructive help she is giving you or just a know it all but you did the right thing sitting boundaries and good luck in your new position. Nothing wrong with doing that as a nurse and a person. Something I myself am still learning as a nurse and a person.

whereslilly · Nov 24, 2011

The OP stated this unit is a "more critical unit". Not clear if this means a Critical Care Unit. Anyway, what you are describing is a Preceptor who is on her game! As far as asking you to speed up, perhaps your preceptor was thinking of the needs of the Pt? Perhaps as an experienced nurse she knew the blood could go up faster. Was the Pt decompensating and in dire need of the transfusion. If so, your "orientation needs" are secondary. I would take advantage and glean as much knowledge from her as I could.

Babs0512 · Nov 24, 2011

Okay, my preceptor story. While in nursing school we were on the surgical unit - there was this one nurse - I'll call her "Attitude" - who was so nasty to the students and showed such contempt for us, that I never forgot her, she even reduced me to tears one day because I got nauseated taking care of a woman with peritonitis who's abdomen was left open to close by secondary intention. I had to do wet to dry dressing and cover the wound properly. My instructor stood by, as I was unpacking her abdomen - the smell was indescribable! I was a 1st year nursing student at the time, and I had to reach in to all the cavities, where my gloved hand would literally disappear, to get all the wet dressing out. I remember at the time, my "spirit" left my body and it was like I was watching from above. I got through it, never wrinkled my nose or anything. Apparently I chatted with the patient, but have no memory of this. After we were through, I went out into the hall, and felt like I was going to faint - so I slid down the wall to a sitting position. My instructor apologized to me, she said "this was NOT a 1st year patient, I didn't know - I'm so sorry - if you want to go home for the day, you can." When the feeling faint past, I went into the dirty utility room to wash up, and I was teary eyed thinking "What ever was I thinking becoming a nurse - I can't do this!" In walks "Attitude" and says, "Your pathetic, grow up and get a grip" in her most disdainful voice.

I stuck it out, didn't go home, but I was ashamed that I had such a hard time with the sights and smells of that patient. I decided then to get a PT job as an NA at the same hospital - I figured that would cure me of my squeamishness.

Fast forward. now I'm am RN, just past the boards, and same hospital hires me for their float staff. They send me to med surge to work with my preceptor for two weeks. I get to the floor, eager to start my day, who walks up to me but "Attitude" and with a sly smile says, "I'm your preceptor for the next two weeks!" I almost pooped my scrubs - my worst nightmare was in my face and I had to "prove myself" to her.

She pretty much left me alone - except during med passes, and I would come to her with questions. This is how the question and answers would go: Me: "What do I do about blah, blah, blah..." Attitude would look at me with her most bored expression and say "What do you think you should do?" I'd stammer and say, "if I knew that, I wouldn't be coming to you!" Attitude: "yeah, well, what do you think you should do?" So I'd stammer and try to think of an answer, and I would give her an answer - Attitude would then say "yeah, and then..." I would answer some more. Attitude "yeah, so....?" So I would complete my answer and usually answer my question. Attitude "so go do it!" That's how it went for two weeks. I NEVER got her to answer one question. I hated her for that. During my last med pass needing Attitude to follow me around, I got to the last room, Attitude said "Your doing fine, just finish up this last room" and walked away. I got "A" beds meds ready, and as I walked into the room, "B" bed calls me over to ask me some questions. So, I'm talking with "B" bed and as I'm doing so, I give him the meds in my hand. He said "What's this one for?" I told him "It's a stool softener" "B" bed says "but I'm not having trouble going to the bathroom." and on it went, he questioned everyone of the pills, and I answered, and he took them. As I was walking out of the room, I realized what I had done, and I started to panic - I just knew I had flubbed up royally. I went to Attitude and told her what happened, I said "I'm going to be fired, aren't I" She said in her usual bored voice "No, it's my error, I should have been with you." She went ahead and took care of everything. She came to me afterward and said "Well, your dammed good at educating, you convinced "B" bed to take all those meds". Then she said "What have you learned from this experience?" I said "Well, if a patient questions a med, I should go back and double check the MAR" she said "And?" "I should have told "B" bed that I would be right with him, and finished giving the meds to "A" bed first." She said "Barb, you know more than you think you do, TRUST in yourself and what you know, problem solve step by step, eventually everything will fall into place."

Well, she "passed" me, and I moved onto the next unit. It wasn't until YEARS later - that I said to her one day "Thank you for all you taught me when you precepted me." She said "You taught yourself, I was just your sounding board." I said, "No, you taught me a lot, and I wanted to say Thank you" she smiled and said "Well then, you're welcome." She looked at me and said "Barb, your one of the best nurses we have, next to me of course, I developed much respect for you over the years." I said "Attitude, why do you always come off like such a *****" She said "It's my reputation, so don't tarnish it by telling anyone about this discussion!" and yes, she continued to act like a *****, even to me. I knew better though.

She had developed faith in me, and she taught me that I did indeed know more than I thought I did - and I learned to think things through step by step - and over the years, I noticed I didn't have to go step by step, I could get from A-Z without thinking about the steps in between. I never made the same med error again - Oh, I found new ways to make them, but never gave an entire cup of meds meant for one bed to another bed. But every error I made, I learned from. And, I can proudly say, that in 20 years of nursing, I've made only 10 med errors.

Sometimes, things aren't always what they seem. It took me a while to figure that out. She was the best preceptor I'd ever had - and when I began precepting, I used some of her techniques, but I did it with a smile and patience. Nuff said.

canesdukegirl, BSN, RN · Nov 24, 2011

Hmmm...I understand your preceptor wanting to remind you of s/s, quizzing you gently, etc. But you aren't exactly a new grad. You have been nursing for 5 years.

You did the right thing when you responded that by speeding up, you would be apt to make an error. You are so right. When you are learning the lay of the land, the processes of a new unit and the expectations of your preceptor, you have to do it slowly but surely. Time, repetition and confidence will then segue into efficiency.

She sounds like an awesome preceptor, but perhaps a bit overbearing. I am guilty of that myself sometimes. I actually overheard my NM tell one of my nurse residents that I can be quite controlling, so she needs to 'take ownership' of her learning. My NM was partially correct...I DO suffer from OCD and I DO like to maintain a controlled environment. She was wrong in assuming that my controlling mindset extended to PEOPLE. I don't control people; I guide them. I would never dream of telling someone to 'speed it up'. We all learn in different capacities and at different speeds. Orienting a new employee with a stop watch in your hand only leads to anxiety for the orientee. That's almost never effective.

As you get comfortable with your preceptor, and you can start using humor to dissipate tension. I have found this to be the most effective way to find common ground with a new co-worker.

Elvish, BSN, DNP, RN, NP · Nov 24, 2011

Being an ass: "Shut the **** up, I can't go any faster."

Being assertive: "I can't speed it up. I don't want to make mistakes."