orientation prob. bring it up with my boss or not

caliotter3 · Dec 24, 2017

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 · Dec 24, 2017

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!

purplegal · Dec 24, 2017

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** · Dec 25, 2017

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?"

Been there,done that, ASN, RN · Dec 25, 2017

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?

singleye · Dec 25, 2017

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?

MunoRN, RN · Dec 25, 2017

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 · Dec 25, 2017

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.

Been there,done that, ASN, RN · Dec 25, 2017

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 · Dec 25, 2017

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.

singleye · Dec 25, 2017

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.