Preceptor has 1 and half year of work experience

[nurselambda]

Hello all,

I am a new graduate and after lots of looking I finally managed to land my first hospital job. The hospital who hired me has 6-week preceptorship program for new grads, which I was more than happy about. The unit I was assigned to has a few other new hires. The preceptor I was assigned to is a young lady with a friendly enough yet assertive (hear loud and cocky) personality. Talking to her I found out she has 1.5 years of hospital experience, and I was her first preceptee. I didn't think anything about that first. I have been working with her for 2 weeks now, and I can say she overall knows what she is doing, I have been developing some second thoughts and mixed feelings. She can be blunt. I witnessed her yelling at a patient who underwent a BKA 3 days prior for no real reason. To me also, making feel like I should already know and act with the most confidence. Not only that but I started questioning her skills. It's been several times that she induces in error but refuses to admit she was wrong. The biggest question mark occured the other day. One of her patient needed an NG tube to be inserted, and she told me she had never done it before. For the record, I inserted 2 NGT while in nursing school. She got the charge nurse involved to guide her through the process. Long story short, it costed the poor patient a few bouts of vomit to have the tube inserted. The X ray confirmed that the tube was inside the right lung... The medical team had to be called and the tube placement had to be fixed.

After the incident, I noticed her picking at me in an semi aggressive way. Back at home, I was giving the day and the 2 weeks a re-run. I feel like I really starting to hate the job already. I'm the type of person that's quiet at first. I starting thinking that precpeting is not for everyone, and certainly not for the "hyper" personality type. Not only that but someone with 1.5 years of experience shouldn't probably be teaching either.

What do you think?

[popopopo]

I've been through this. I would keep my head down and play along, finish your preceptorship and practice how you'd like. Don't fight it, it'll only turn out badly for you if you do.

[kaylee.]

I have 6 years experience and one day I was getting report from a new grad on orientation with a night nurse that has only a year of experience.

What really irked me was the fact she left the new grad to report and was sitting at the desk not there to chime in or back up the info being given.

When she did pop in she was a little defensive, and it just left me feeling off about the interaction.

I have since then been questioning why they are making new grads precept new grads! I think they feel the pressure of seeming competent to their orientee while balancing the fact that there is much they dont know.

In your situation I am thinking her attitude was probably stemming from her own insecurity with the error.

Heck, just the other day was the first time I saw an ng tube actually inserted in the lung. And this was done by the gastroenterologist!

[JKL33]

I don’t think a discussion about whether a nurse with this level of experience should be precepting is going to get us very far. There are some newer nurses who can do a great job and some who can’t. Same for more experienced nurses, actually.

Generally speaking a nurse who has a handle on the required knowledge and skills and can operate with some measure of calm confidence would be best IMO. But that’s not the situation so...

What are you going to do about it? There are a number of ways you could try to handle it, but they’re pretty dependent on specifics. Is the overall culture supportive? How is staffing? How many experienced nurses are around? Your own personality comes into play, too, insofar as it affects your tolerance, perseverance, communication skills, the way you portray yourself to others and much more.

What are you inclined to think about it all?

[Nurse Beth, MSN]

With 1.5 yrs experience, she is most likely at the advanced beginner stage of development while you are at the novice stage, so she is qualified to orient you.

Not every nurse should be a preceptor, and we don't know what training she's had to prepare her for the role. So many hospitals run short-staffed and don't have a large pool of preceptors to choose from.

Don't let this ruin your new job. Right now you are disappointed and focused on her shortcomings. Instead focus on your development and what you need to accomplish over the next 4 weeks remaining of your orientation.

[Cowboyardee]

People more experienced than your preceptor have put NG tubes into the lung. That's one reason why we get an xray.

Look around your new unit: does your preceptor seem like the only one in over her head? Or are the other new hires being oriented by confused newbies too?

My advice to you is not to dwell too much on your preceptor. Chances are she got voluntold to start precepting. If you just got unlucky and were assigned the one new preceptor struggling with her new role, then you can also probably rest assured that her evaluation of you is unlikely to be the final word on whether you make it or not. Her boss (your boss) knows she's new. Politely ask others for advice, build relations with your new coworkers, learn as much as you can on your own without going out of your way to make her look bad.

If on the other hand everyone seems new and confused, I have good news and bad news. The good news is that your unit probably can't afford to flunk you from orientation anyway. The bad news is that this may not be the best place to work, and you may find yourself in your preceptor's shoes a few short months from now.

Best wishes.

[RNNPICU, BSN, RN]

Just to put some things into perspective.

You now have two weeks of being a new nurse on your unit. It is often easier to find fault and nitpick on others if you are also being corrected.

As for your preceptors experience, I think it is a good match for your skill set. As for her "yelling" at the patient, what was the full story, was the patient violent and yelling at her, was she "yelling" at the patient because the patient was inappropriate and she was trying to get some help or to let the patient know the behavior was inappropriate.

Although it is difficult in text to interpret tone, it sounds like you are being overly critical that the preceptor did not know how to insert an NG tube. You are making it sound like she should have known... perhaps the floor she works on does not use them frequently. Your preceptor sounds like she was smart enough to know to get resources - Charge RN, and she did not proceed in an unsafe manner. The Xray is always done for placement.

You are on an orientation journey and will be learning and observing new things. This preceptor may have been told ways to precept and she is also learning, just like you.

[TheLastUnicorn]

Most hospitals have preceptor programs one has to take before they can precept. The requirements at mine is 12 months experience on the unit before precepting. My preceptor had only 2 years of experience. She was amazing.

Also, you mentioned she has 1.5 years of specifically hospital nursing experience. You don't say how much experience she has outside of hospital. If she spent 5 years in SAR or LTC, that's still nursing experience she should be credited for. Nursing doesn't revolve around the hospital. The hospital isn't some golden palace of nursing.

Lastly... You kinda sound like one of those nursing students who runs to her clinical instructor because the floor nurse didn't do something by the text book. There's no ivory tower anymore. Welcome to the real world. Not everyone gets the same exclusive in nursing school. I never got to put on an ng tube in school. In fact I've put one in once in my five years of nursing. There are plenty of skills that years from now you will not have performed, or performed in months, years, or even since school.

And sometimes, you need to lay it down with your patients. Not everyone resounds to the soft, therapeutic hand holding kiddy speech we are trained it. Eventually some pt will cross a line and you'll set your first boundary. They'll cross it. Then you'll lay it down. As a note. In my perspective, my husband yells all the time. In his. He doesn't. Is he really yelling? Not really. He's a loud talker.

[JKL33]

22 hours ago, RNNPICU said:

Although it is difficult in text to interpret tone, it sounds like you are being overly critical that the preceptor did not know how to insert an NG tube.

7 hours ago, TheLastUnicorn said:

Lastly... You kinda sound like one of those nursing students who runs to her clinical instructor because the floor nurse didn't do something by the text book.

Meh, I think the OP is probably neither impressed nor reassured by the loud and cocky behavior. And yes, that may be coloring his/her conclusions about the preceptor.

For the OP's own sake I think it is wise to not focus on the preceptor and to focus on the goals instead. But I can't say I would be any more impressed than the OP is, generally-speaking.

[Megarline, CNA]

Do you want the job? If yes, don't focus too much on her. You'll be by yourself later. Always have your theory textbook with you.

[Snatchedwig, BSN, CNA, LPN, RN]

Ask for a new preceptor. Simple

[RNNPICU, BSN, RN]

2 minutes ago, Snatchedwig said:

Ask for a new preceptor. Simple

Not that simple. The OP has had 6 shifts on the unit and her ideas and perceptions of her OP could easily be clouded by her newness. OP stated her preceptor was loud and cocky personality. What I am also wondering is what is the OPs personality? She very well likely will be getting a new preceptor but I think asking for one when she has only had 6 days on the unit will not bode well for the OP.