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.
I hope you went to the manager regarding this situation. You could have requested the other nurse that you worked with the one day as your new preceptor.
The one thing I would have recommended was not to be critical of your preceptor and be simple and factual about why you want to change. Nursing is a small world and you don't want to alienate your coworkers despite the fact that you won't be in the same department. I'm sure you'll eventually give or take report from this person in the future. Unfortunately, an experienced nurse could feel slighted by being "dumped" by the orientee.
In any case, this sort of situation can be delicate and you want to handle it as such. I hope you resolved the issue without too much difficulty or stress. :)
Now i have to back tomorrow, and I need to talk to her and apologize for my behavior (crying)
Why do you need to apologize for crying? You weren't screaming at her and demeaning her. Generally, you apologize if you did something wrong. Sounds like you didn't.
Crying is a natural response in stressful, frustrating situations. Heck, do you apologize for crying at funerals?
I'm not a nurse so I can't speak for dressing changes, meds, etc. But I would bring your concerns to your manager. Can she change your preceptor to the other nurse that you seemed to mesh well with?
And I wouldn't worry about stepping on her toes. It's your job, your license.
I want to thank everybody for their responses. When I got to work that next day my preceptor was like a new person. I don't know if she felt bad or if someone said something to her. She said that she could see that she had not been giving me the time that I needed. I told her that my issue was that she was not answering my questions and that I needed her to do that. As the day went on, it was much better. She took the time to explain things and answer questions. It is still not a perfect situation. I still question some of the things she does.
I did talk to my manager and told her some of the concerns that I had been having. I told her that I would see how that day and the next went and I would talk to her again next week about what I wanted to do. She was very concerned and helpful to me. I did not mention the concerns that I had about my nurse's practice, or the standard of care that I see on the floor. I really don't want to talk bad about the floor or another nurse. I did tell her that it was very important to me to be taught the right way to do things. I am trying to figure out how to tactfully voice some of my concerns without being negative.
I am also contacting another hospital to see if I can get in there. I just don't feel good about the care that I see at this hospital. When pts complain to me or voice their concerns, it is hard because I see the same things too and have the same concerns.
Wow it sounds like you and your preceptor need to have a talk! I would suggest asking for a meeting with her away from work. There are to many issues to resolve during a busy shift.
It sounds like your needs are not being met. Maybe it is a simple case of different communication styles. Where I work the orientee and the preceptor meet before the shift to set goals. Then again after the shift to discuss how things went. Throughout the process the orientee is encouraged to provide feedback to the preceptor.
If your preceptor is not available to help you with new experiences like central line dressing changes and chest tubes that is a cause for concern! Are you being given a larger pt load because there are two of you? I would hope not. Or is your preceptor expected to serve as a resource to other nurses on the unit? Again, I would hope not!
My experience has been that central line dressing changes are definately a sterile proceedure. Looking up your hospital policy was exactly the right thing to do!
The bottom line is this orientation is for YOU. Make sure you get the most out of it. I would suggest having a talk with your preceptor away from work ASAP. These conversations are always difficult. However, I think you did a good job in your post of stating the problem objectively. When you talk to your preceptor I would state some things that she has done that you appreciated, and then state what has been lacking in non threatening, objective terms. Use examples and be specific. If she is not receptive to your concerns AND willing to work with you to improve your orientation, I would definately talk to your manager. Good luck with your nursing career. It sounds to me like you are motivated and conscientious- two very good qualities in a new RN!
Medic01
3 Posts
Well, how did you make out?