Preceptor Issues-Long!

[New ICU Nurse]

Okay. What a mess this is. I am a new grad RN that was hired into the ICU. I am currently doing my 6 week preceptorship on the cardiac floor prior to going into the ICU. The hospital I am in is completely new to me-I never had clinicals there. I am going into my third week on the floor.

At first, my preceptor seemed okay. She wanted me to follow her-which is fine- and see how she does things before letting me do anything. The problem is that she does not take the tiem to explain what she is doing or why. When I ask a question she says that she really needs to finish what she is doing and to hold that thought and she will answer it later. I fully appreciate the fact that she is busy and that things need to be done. However, it is her job to teach me.

Another thing is that her nursing practice is questionable at times. I know that as a new grad things are different in the real world. I am very much a by-the-book kind of nurse. For example, she had me change a PICC dressing. I said okay, this is a sterile procedure. She said no- I don't know what they are teaching you in school nowadays- I said I really thought it was a sterile procedure. Anyway, I said can I check the policy really quick?- she said forget it, I don't have time for that, I need to pass my meds. So she changed it using clean gloves.

One day she called in and I was with another nurse. She had me take patients and do everything for them. It was great-I managed fine, except a little slow. That nurse was available to answer my questions and help if I needed it.

When I was back with my regular preceptor, on the last day of my 2nd week she gave me two pts. Everything was okay except that I had a question about something about the pts chest tube. It was a full two hours before she could answer my questions. Each time I tried to ask her, she said I need to do this, hold that thought. I approached her at least 6 times. Thank goodness it wasn't something critical. I figured ok she's really busy-I can respect that- I tried asking other nurses. They said you really need to ask your nurse. Ahh! I was so frustrated.

In the afternoon I took an admit from the ER. I am ok with the admission paperwork and assesment. I needed help with figuring out how to make sure the orders were entered and pharmacy sent the meds up, and which meds were to be given. The pt went to xray before I could see the chart to see the meds ordered. (20 minutes after arriving-Iwas in his room that whole time doing admit). I asked my nurse what to do about meds because I didn't have the chart to verify the orders. She kept telling me she was too busy to deal with that now.

The pt came back 30 minutes before change of shift. I was very concerned because he had not gotten his meds. i finally got the chart from the doc that was writing new orders. I verified all the meds. Now I had to see if they were up to the floor. All with no help from my nurse. Now I had to give report. the night nurse was mad and kind of yelling because he didn't have his meds. I tried to explain. My nurse comes over and says he really needs these meds.

So i get his PO meds and that's ok. Then he has an IV abx that was due in the afternoon. My nurse tells me to go get it. I say ok it is in the pyxis? she says yes. (I could tell she wasn't really listening, she usually doesn't). I went and got it out of the pyxis. She comes out and says not from there, I told you it was in this cabinet.

So I try to say that I asked you if it was in here, and you said yes, but I can't because I start crying like an idiot. I knew it was going to happen because all day I was so frustrated from not getting answers. So I try to pull myself together and we go do the meds. She says see, I told you that you were not ready for pts. I just wanted to scream. I am fine with pts if I have someone to answer my questions.

Now i have to back tomorrow, and I need to talk to her and apologize for my behavior (crying). I also need to address the fact that I feel like she does not answer my questions. Also, i need to talk to my manager because I don't want the nurse saying that I can't handle things. I don't know if I should ask for another preceptor. I kind of feel that I want to leave that hospital. There just seems to be a low standard of care- I have been told that it is better in the ICU. For example, I asked 4 different nurses what the policy was on changing IVs. Each one told me that they were good as long as they still flushed. My pt's had been in for 10 days. The policy clearly states that w/o a MD order it must be changed in 96 hrs.

I am sorry this is so long. I have just been so frustrated.

[delta32]

OK wow first things first. get a new preceptor...yours is incompetent. Any cath's such as PICC, TLC, Swans, etc need to be done with sterile procedure. as for her putting off your questions until later is because she does not know the answers. She is avoiding giving you answers so that her own issues do not show and used the issue about the patients medications to reflect her own issues onto you so that her own incompetence does show. I would not apologie to her, i would be meeting with whom ever your boss is and demanding a new preceptor. she is setting you up for failure. You need to be up front and honest with your manager that this situation is unacceptable.

Jamie.

[EmmaG, RN]

You need to have a sit-down discussion with your manager ASAP. This nurse isn't simply disregarding your questions and being generally unhelpful, she is teaching you (by her words and own actions) dangerous practice.

[GeminiTwinRN, BSN]

I agree with all the above. Please help yourself by requesting a meeting with your manager ASAP, before you lose the opportunity of going into the ICU at this hospital if that's what you want to do.

She is setting you up, and it's because she is (apparently) incompetent. She is doing things that could cause harm, and as we all know, first we do no harm! True, there are some questions that can be held off, but all of them? Come on. She doesn't know. And she's obviously a terrible preceptor.

Take the bull by the horns and make sure that you get the experience you NEED to become a competent RN. You earned it. Don't let this experience cause you to lose the license you worked so so hard for.

(((((((((hugs))))))))))

[rn-jane]

I'm a stepdown/icu preceptor. I've done this for about 8 years. Go talk with your manager the next time you see her. This nurse is doing a disservice to you. You deserve a better education to the floor. Even though you are new you deserve a little respect which you are not getting. She sounds rude and someone I would prefer not to work with let alone should be teaching new grads at a new facility. When you see your manager tell her how you are feeling and perhaps give it in writing these circumstances you have explained to us. I'm sorry you are going through a bad time, most preceptors don't mind taking the time to explain what they are doing when they are doing it and why. Let us know how it goes.

[Sabby_NC]

You need to have a sit-down discussion with your manager ASAP. This nurse isn't simply disregarding your questions and being generally unhelpful, she is teaching you (by her words and own actions) dangerous practice.

Agree with above comments.

You need to do something about this ASAP. For your own license sake.

Hang in there *hugs*

[New ICU Nurse]

Thank you all for your responses. I am going to talk to my manager first thing in the morning. I am really dreading it, hopefully I can get my concerns across clearly and reach a solution. I guess this is a great opportunity to practice being more assertive.

[EmmaG, RN]

Thank you all for your responses. I am going to talk to my manager first thing in the morning. I am really dreading it, hopefully I can get my concerns across clearly and reach a solution. I guess this is a great opportunity to practice being more assertive.

Be calm and objective. Clearly state what you want (a new preceptor) and why... and give her specific examples.

Good luck.

[nurseby07]

UUUGGGHHHH! As a new nurse, I can tell you that regardless of how crappy your preceptor is you are learning! Yes, that abx is now in the cupboard, drawer, or basin above the pixus forever in your mind. Yes! PICC dressing changes are always sterile procedure! This is the awful part of the nursing-learning-process. Hang on. the time will come when you orient the new grad and remember these tiny snippets of things and can say 'Go get the Flagyl...it's in the &*((&" and tell them the story of being new and all you had to learn. I am just a few months ahead of you and relish those small tid-bits that were so hard-learned!

[allthingsbright]

I agree--print out your entire post above, go over it and write down key points so you can discuss them with your preceptor first, then your manager needs to know what is going on.

I agree that you need a new preceptor, but you do need to speak with your current preceptor (you will be working w/ her in the future, right?). It is obvious you have a bad match w/ this person. I am so sorry-orientation is difficult enough w/out all that drama!!! And it is compromising the safety of your patients which is the key to everything--make sure you stress that in your meetings.

Best wishes! (((HUGS)))

[TigerGalLE, BSN, RN]

If you had two of her patients then what was she soo busy doing? She sounds like a very rude person. Reading this post just made me mad. If you have a question she needs to answer it right then and there! It may be something serious! Sometimes new nurses pick up on things that are very important!! Good for you to stick to your guns about the PICC Line dressing change. Continue to do that through out your career. It is your license on the line, not hers!

Tiger

[DudeNurseRN]

It's going to be tough asking for a new preceptor, but being a new grad myself I have to say, that, this person probably is a good nurse, but doesn't appear to be a good teacher. There are people who are great nurses but not great teachers, and that's okay, but only if they aren't training in new staff.

If you knew me you would know that I am a very understanding person who will always give people the benefit of the doubt, and give people multiple chances to redeem themselves, but. With regards to the "See I told you, you weren't ready for pt's." comment. That my friend is ABSOLUTELY INEXCUSEABLE. It is her job to train you, and it is her absolute FALIURE as a teacher/mentor IF you weren't ready for pt's.

Please by ALL MEANS tell your manager about that comment, and the situation verbatim. It is not her job to grump, and scold you, but rather to teach and mold you.

It won't be easy but it will be worth it, changing preceptors. I have had 2 wonderful preceptors, who taught me, one with 25+ years experience, and one with 30+ years experience, and I am thankful for, and am a product of, the wonderful job they did teaching me. AND I still am able to ask them questions, and they always make time for me.

That's the kind of preceptor you can have and should have.

Make sure to take time for yourself, and take a couple deep breaths.

Once you get over this issue, the payoff of being a confident well trained RN will be great. Believe me. You can do it.

I have to tell you, yeah, there is a difference between how things are done in the real world versus school with regards to sterile procedures, but central line dressing changes are not the exception to the rule.

I deal with a TON of these things on my unit, and I think it would be fair to say if you were trying to keep sterile and had an "oops" moment that the patient would probably be okay. But deliberately not using sterile technique puts peoples health (and in rare cases lives)at risk. I have had lines go bad, and it SUCKS. I have had people get septic from it, but more often they have to get the lines pulled and have another one put in. Can you imagine? "I'm sorry Mrs. Jones we are going to have to take out that surgically implanted IV and put in another." That's the reality/risk of not following sterile technique in this situation. Foleys we want to try to stay sterile as well, but if we don't the risk is giving a person a UTI, and we pull the foley. Obviously, we don't want to cause disease in anyone, but a systemic infection vs. a bladder infection, to me are two VERY different things. Central lines vs. foleys, I have to say central lines take priority in making very certain that you keep as sterile a technique as you can.