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orientation prob. bring it up with my boss or not

i've worked in med-surg/ step down for 3 years, just got my new dream job in ICU. my preceptor has 2 years' experiences in the ICU. She is very passionate about teaching and has gone out of her way to show me things many times but she micromanages everything. 4 weeks into my orientation, I still assumes a supportive role and we were told by our boss to let me step up and take at least one pt on my own.

I was given one pt (almost step-down) status on my own for a week and I did fairly well. I felt bored so I asked her to give me her pt too (stable, on vents and pressor). I told her I'm not going to touch the pressor since she has been working on it. My preceptor agrees but I can tell she was bothered by my request to take two. I'm not sure whether she doesn't trust my ability or wants perfect control. Anyway, everything went well for 4 hours then I failed to pay attention to pt's MAP (dropped to 50s from 60s) and I was lectured in front of everyone if I want to take two pts I should not have done that. I didn't say anything but I want to say that you are titrating drips, you should have overseen me instead of spending the time chatting in the breakroom. She wants me to only take one pts from now on.

Luckily I'm switching to another shift after two more days with her. My question is should I bring this up to the boss (not in a negative way?) My only concern is I felt that I can take two (with supervision and help) and I don't want to waste 2 days (a week)of my orientation with one step down pt and feel bored. Also with my future preceptor, should I step out of my comfort zone and take a little bit more? I am not sure why my preceptor is so ticked off by me doing that.

Thanks so much.

I don't see any reason why you shouldn't discuss your concerns, however, in some situations when a person brings up concerns, those concerns are then used as the basis to get rid of the person down the road. That sort of situation gives me reason to always question my first reaction to ask certain types of questions at certain times. Just suggesting that you be cautious.

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

With only 2 years of experience, your preceptor is still not seasoned. She was probably feeling a bit more anxious than she was letting on. It wasn't that she didn't trust you. When you agitated for a second patient, she miscalculated and used the opportunity to slack off. She went from micromanaging to letting you work unsupported. Oops. Now she's letting you have it when she's really mad at herself, or should be.

This was a learning experience for both of you and I wouldn't necessarily bother the manager with it. You'll just know with your next preceptor to be more assertive about what you feel comfortable doing and what you need support with. Good luck!

My thought is, since you only have a couple more shifts with this preceptor, to not mention it to the manager unless the situation gets brought up. When you are new, you want as little negativity expressed about you as possible; if your preceptor doesn't mention it, I would keep quiet about it. Seems likely she wouldn't, as you would both be at fault. Yes, you missed a critical change in a patient, but you're right that she should have been supervising you and your patient. If not right with you, at least where she could see what was happening. She would likely get dinged for this herself, so she will probably be quiet, if only to keep negative attention off of herself.

As for your next preceptor, that is great that you want to jump out of your comfort zone. I think a lot of preceptors appreciate that. However, make sure you have a good discussion with him or her as to what you feel comfortable with and what you do not. These patients are critical so it's important to keep patient safety in mind and not take on too much before you are ready in the midst of gaining learning experience. State exactly what skills/procedures you are comfortable doing and how you feel your assessment skills are, but also request that your preceptor be nearby in case your patients start declining.

canoehead, BSN, RN

Specializes in ER.

When you have an issue with your preceptor, talk to them first, not your boss or your coworkers. You will look mature and its more likely to resolve the issues with warm feelings on both sides.

"Yesterday, when we had that problem with x's pressures, I was under the impression that you were adjusting the pressors. Did I get that wrong?"

You asked for it, you got it. You also failed. Nobody should miss a MAP. Your preceptor knows you are not ready for 2 patients. How can you feel "bored", when you have so much to learn?

Thanks for the comments! I appreciate it. My prob. is that I think I can take on more than one step down pt but my preceptor does not allow the increased responsibility and learning opportunity. I did voiced my concern with her first and it didn't solve my problem. Another problem is that she always lecture and criticize me in front of everyone. I have felt stupid and incompetent since day 1 with her.

Like purplegal suggested,I think I may not say anything to my boss because there are only 2 days left with this preceptor. The only reason I am considering it is that I hate to waste another week of orientation with 1 step down pt. In the next two days with her, should I even at least suggest a sicker pt assignment with my preceptor or just take whatever pt she suggests in order to keep a happy ending? Another new grad started the same time with me is taking 2 pts, taking and giving reports, calling dr. and putting notes in because of a more lenient preceptor. This make me feel behind even more. Anyone knows what is expected for a new icu nurse six weeks into orientation?

Edited by singleye

MunoRN, RN

Specializes in Critical Care.

At 2 years, and sometimes even 20 years, it's certainly possibly for an 'established' ICU to not feel comfortable enough in general with ICU level care to stand back while you jump out of the nest.

If the patient's MAP momentarily dropped to the 50's then that's usually not something to freak out about, there are more assessment variable to take into account than just MAP, and it's certainly not unusual for a patient's BP variability to occasionally put them below 65, and to titrate their pressors so that they never, ever fall below 65 as a general rule is bad practice.

As a new ICU nurse it's important to let you learn which is going to involve some instances that may not have occurred had the precepting nurse had total control, but that's how you learn.

Personally, this is why I don't believe in assigning a single preceptor, you should be rotated through at least 2 or 3 different nurses during your orientation.

BSN16

Specializes in ICU, trauma.

personally i dont agree with the "You take one patient, i take the other" form of preceptoring. Even back when i was a new grad preceptoring, and as an experienced ICU nurse going to a new ICU, in the ICU we both would "have" the patient. Both go in and assess the patient...gradually giving more and more responsibility and less supervision.

Thanks for the comments! I appreciate it. My prob. is that I think I can take on more than one step down pt but my preceptor does not allow the increased responsibility and learning opportunity. I did voiced my concern with her first and it didn't solve my problem. Another problem is that she always lecture and criticize me in front of everyone. I have felt stupid and incompetent since day 1 with her.

Like purplegal suggested,I think I may not say anything to my boss because there are only 2 days left with this preceptor. The only reason I am considering it is that I hate to waste another week of orientation with 1 step down pt. In the next two days with her, should I even at least suggest a sicker pt assignment with my preceptor or just take whatever pt she suggests in order to keep a happy ending? Another new grad started the same time with me is taking 2 pts, taking and giving reports, calling dr. and putting notes in because of a more lenient preceptor. This make me feel behind even more. Anyone knows what is expected for a new icu nurse six weeks into orientation?

You should be getting weekly reviews, during a highly structured orientation, where you give and receive feedback tailored to your training and the specific learning goals. If that is not happening, make it so. Make your needs known. Feel free to compare yourself with any other nurse on orientation, during YOUR review. Sounds like you need to take control.

Best wishes, it's a jungle out here.

OCNRN63, RN

Specializes in Oncology; medical specialty website.

You asked for it, you got it. You also failed. Nobody should miss a MAP. Your preceptor knows you are not ready for 2 patients. How can you feel "bored", when you have so much to learn?

Indeed.

Indeed.

because I have one stable near step down pt. I caught up with everything including charting, read MD notes a couple of times and truly has nothing else to do for my pt till next VS. I even walked around helping my coworkers a few times.

Often when I get valuable critical feedback, I thank the person giving it. Also, I often share with others when I have made a mistake...I do this as I want to help others, and I find that others often will share tips with me, etc. Nursing is a field where I am constantly aware of how I can do things better. I think it is because we are constantly checking ourselves.

I agree with a number of prior posters...think you have gotten some great advice...take it and move forward. Often I will try to give critical feedback privately. I try to be constructive, and even give positives on either side of the critical feedback. One time, I had someone upset that I gave critical feedback (the person didn't seem to notice the positives)...also, I had done it in private. Anyway, I think the person was too sensitive, and should have listened to the feedback. I was trying to help...

Sometimes folks won't bother giving critical feedback....as such, I usually thank folks for it.

On the other hand, if it's not constructive, that's another thing.... As others posted, sounds like your preceptor is new, and relaxed too much and was probably regretting it. Hopefully both of you learned from this. Keep going!

I know it can't be helped sometimes, but I think 2 years experience is too little to precept in ICU.

What is the rush?, eventually you will be doing it all on your own. Most preceptors know when you are ready to take on more patients. Sounds like you have more to prove than learn, learning never stops with nursing and even the best of the best nurses make mistakes. Slow down and talk to your preceptors about your concerns instead of going to the boss first. It doesn't matter how great you are, if people don't like or trust you, they will get rid of you.

Yeah. You missed a MAP. You dropped the ball. Do not go whining to the boss about this or a crybaby reputation is gonna follow you for years. So your preceptor is an over-functioning, micro-managing, hyper-critical ICU nurse. Welcome home & get used to it. The one thing I would do is to take her aside and tell her one on one that berating you in public is unprofessional and unacceptable. Tell you that she's getting the respect that she (in turn) didn't have the class to give to you.

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