Preceptor Issues

[hiimnewhere]

ETA: I was two months into my nursing program when COVID happened. My skills lab was mostly virtual (basically getting checked off my watching videos and not doing the skill). Clinicals were cut short and very restrictive. Most of my experience was with tasks normally performed by patient care techs or CNAs. 

Hi. I’m a new grad nurse and working my first job as an RN. I passed boards over the Summer. I started my first job a month ago. The first week and a half was online orientation and then two and a half weeks (8 shifts) on day shift and now I have had my first 2 nights on night shift (my desired shift). 

My preceptor for day shift was great! I learned a ton. By the end of the two and a half weeks I was taking on 3 patients, with mild assistance. 

Now I have an all new preceptor for night shift. She’s very thorough and has a totally different work style than my day shift preceptor. She has precepted many nurses on the floor, she was on different meds and is now TTC, so off of them and the preceptor that at one time was always up and moving and teaching seems to just want to sit and talk with the other nurses. I spent my first night off in a corner with a list of things she expected me to chart that I was not ever shown before. If I do something the way my day shift preceptor showed me in the charting system she says that’s not the best way and expects me to do it her way. 

Anyways, my first night I took on three patients, she followed me in their rooms the first few times just to check out how I do things. Fine by me. The night rolls on and then there’s an admission, so naturally we get the admission, and without ever doing so before she made me get report without even listening in. I have never done one solo, so she came in the room. She was basically rushing me through it and doing most of it by herself. She had me leave the room to grab something and did a head to toe assessment, then I wanted to do one also but all I got in was lung sounds and bowel sounds before I was rushed back to the computer to do the admission busy work. After leaving the room she was like okay go chart the head to toe, knowing that I didn’t get a complete one done, she did. She sat down at the other side of the nurses station, eventually she came over and assisted. The rest of that night went on. 

On my second night shift I came in and she said here all four of these patients are yours. Basically do what I need to do. She walks around and quickly does shift assessments on them. Two patients had q4hr assessments to be done. One was a neuro assessment and one was a neuro vascular assessment. We hardly touched on these in school. She gave me a paper and a quick verbal list. I reported to her different things I seen and she was basically like okay if that’s what you saw chart it. As I’m running around trying to get antibiotics and all meds on time, she’s just sitting at the station chit chatting, I get to take an admission. This one the expectation is I do it alone, she stood in the room and watched in. Orders start rolling in and it gets busy again. I finally get to sit down and chart and the phone rings, it’s a doctor. She puts me on the phone and he’s calling because he has noticed a low MAP on a pt have been off and wants me to hang a bolus. I have never done this before, so I go in and set it up how I think it should be. She comes in and basically says I did it wrong and that’s not how she would do it (it wasn’t wrong, but maybe a little more work). Things get busy again around shift change, and she jumps in a helps a little to help with the pt getting sent to surgery. 

I’m just upset that she would see others struggling and jump in to help, but me the new nurse she basically threw me to the wolves. I understand that I need to learn, but being overwhelmed isn’t what I like. I feel like she thinks my questions are stupid and I feel judged. And the pt with abnormal MAP, I feel that since she spent so much time at that station with charts pulled up she could have caught that easier than I (these patients are still partially hers too). She was very annoyed the doctor called and was basically mocking him. Orders like when to call the doctor haven’t been shown to me or where to find them until I talked to him. 

I’m just really overwhelmed, I loved this unit and people on day shift. I just don’t feel the same connection with night shift (there are day shift positions open). I wanted to like night shift so bad, but I feel this preceptor not really teaching me and just expecting me to do all the work is putting a damper on my first ever RN job. 

What would be your expectations as a preceptor to a new grad that’s only had 10 days on the floor? Is it normal to be expected to handle a full load of patients? Maybe I’m just being difficult.

[JKL33]

Hello,

I doubt you are being difficult; nothing you said sounds like that.

But you do need to be pleasantly assertive. In the course of a shift there are numerous opportunities to be interactive and to say what you need and prefer. Example:

8 hours ago, hiimnewhere said:

Two patients had q4hr assessments to be done. One was a neuro assessment and one was a neuro vascular assessment. We hardly touched on these in school. She gave me a paper and a quick verbal list.

"I'd like to observe you the first time around, or have you observe me if you prefer. Or both." Lots of choices there; 3 of them. Abdicating all responsibility and putting everything on a trainee is not one of them.

That statement is also succinct. Since "I didn't get to do this at all in school" is going to be a recurring theme during orientation, leave that out. It may be true but it's one of those things that is frustrating to hear repeatedly. Just be very straightforward. Make good eye contact, use pleasant tone and non-verbals.

You need to do this throughout the day as appropriate.

What happens is that people don't speak up and then there is a snowball effect: The orientee begins to feel significantly more stress than is necessary, they become resentful, the preceptor tends to think the orientee can't handle this--oh an now they're showing signs of a bad attitude, too...

I think you need to backtrack a little. Have a conversation with her wherein you tell her that you were spending some time reviewing your performance on your day off and would like to try another tack; you'd like to work a little more closely for a week or two since there is so much that you really don't have direct experience with. Tell her that observing and working alongside her and having her observe you would be a very valuable experience for you.

Good luck. Hang in there; put significant effort toward staying positive.

[hiimnewhere]

13 hours ago, JKL33 said:

Hello,

I doubt you are being difficult; nothing you said sounds like that.

But you do need to be pleasantly assertive. In the course of a shift there are numerous opportunities to be interactive and to say what you need and prefer. Example:

"I'd like to observe you the first time around, or have you observe me if you prefer. Or both." Lots of choices there; 3 of them. Abdicating all responsibility and putting everything on a trainee is not one of them.

That statement is also succinct. Since "I didn't get to do this at all in school" is going to be a recurring theme during orientation, leave that out. It may be true but it's one of those things that is frustrating to hear repeatedly. Just be very straightforward. Make good eye contact, use pleasant tone and non-verbals.

You need to do this throughout the day as appropriate.

What happens is that people don't speak up and then there is a snowball effect: The orientee begins to feel significantly more stress than is necessary, they become resentful, the preceptor tends to think the orientee can't handle this--oh an now they're showing signs of a bad attitude, too...

I think you need to backtrack a little. Have a conversation with her wherein you tell her that you were spending some time reviewing your performance on your day off and would like to try another tack; you'd like to work a little more closely for a week or two since there is so much that you really don't have direct experience with. Tell her that observing and working alongside her and having her observe you would be a very valuable experience for you.

Good luck. Hang in there; put significant effort toward staying positive.

It was just super stressful watching her just sit and talk, helping out other nurses on the floor, but not me. She will go through what I chart and add things in columns (under her name obviously), but not tell me what I missed. I even had to give report for the first time and she literally ran off a verbal list very quickly and then was no where around when it came time to give report.  A Tech would say so and so needs pain meds and she would wait for me to come back around to tell me. On day shift everyone was always helping out others, they would run it by the primary nurse first, and if they seemed busy they would offer help. 
I’m new to everything, and I don’t feel that I should be expected to be able to care for a full load of patients without assistance with only 10 days on the floor. I feel I know a decent amount already, but I feel she’s just taking advantage of me not knowing what the expectations are at this point. Like I have no idea where I should be at at this time in orientation. And I don’t really feel the connection I have had during day shift to really reach out to anyone for help. I looked forward to my shifts, but now I don’t know… 

I appreciate the advice given and I will do my best to give it a shot! Im just pretty down at this point. Everyone raves on about how great she is and that they have learned a lot from her; but I’m not feeling like I have gotten the same experience so far. ? 

[JKL33]

Understandable. Try the suggestions and see where it takes you.

While you are thinking this over, remember that there are so many explanations for a situation like this. Maybe she is sort of taking a little break instead of being more involved with training you, but there are also other possibilities, such as: She perceives her actions as being less overbearing, she is trying not to over-instruct, she doesn't have a routine/plan for conducting the day-to-day training, etc. The employer bears some responsibility as well--they should have expectations for orientation, they should provide toos/resources/training to preceptors, and they should staff for success.

You really don't control any of that. What you have to work with is your own effort, attitude and communication.

I hope things will turn around for you. Getting started is rough; just being new is rough. It'll be okay.

[kkbb, BSN, RN]

We have a resource nurse on our unit, and their entire job that shift is to support the other nurses and do whatever is needed to help push the shift forward.  One night as a new grad I asked our resource with help doing something for me in one room while I finished with something in another.  She asked what all I had going on, and then after I told her, she said no to helping me.  I remember being so frustrated at the time.  I now understand that she was forcing me to learn how to handle what was happening.  I should add, there wasn't anything drastic going on, and was well within my ability to handle,  I just didn't believe I could. 

Perhaps your preceptor is doing something similar.  Maybe that is why you see her helping others.  

But, I do see issue with her not providing feedback.  I would ask for feedback, maybe focusing on charting one shift, then something else another shift.  I am a big fan of feedback, in real time.  I always point out things when I look over others charting when I precept.  

Hang in there.   

[TippyTappyMeow, MSN]

I remember feeling this way when I transitioned to nights. Two out of the three preceptors were polar opposites from my day shift team, and each other. The first would interrupt me and do her own thing. Blunt, harsh and giving 150% all the time. Would do things for everyone and at some point decided I needed to learn how to manage without them. The problem was it wasn't realistic because they'd be off helping everyone else and normally we wouldn't be staffed with an extra nurse. 

My second preceptor would sit at the nurses station and watch movies. Wouldn't check my charting or help me unless I had a urgent/emergent situation. 

In the end I had to accept the fact that my preceptor giving 150% truly wanted me to be able to handle the workflow of the unit. Most often than not I ended up working short. I was able to appreciate it afterwards but I also recognized I am human. I may need help and that's OK. We have to be able to prioritize the situations.

I will add my clinicals were cut short by covid as well. I lost out on a lot of skills. I still have to notify co-workers of this in my new role like hey sorry this wasn't typical on my unit, and wasn't complete in-person for school.

[YouCanCallMeFrank, RN]

I had a similar-ish experience -- my daytime preceptor was extremely patient and helpful and always provided opportunities for me to ask questions or offer feedback. When I started on nights, my preceptor was much more nonchalant, and essentially fulfilled the role of the CNA (my unit doesn't assign CNAs with orientees) and that was it. Unless I asked for help. I think a lot of it has to do with how challenging it is to know what each orientee has learned prior to starting night shift, as each shift is so different--day shift is easier because everyone starts at the bottom. Rather than wasting a bunch of time to go over concepts I may have already understood, my preceptor chose to only cover those I reported to her as unfamiliar. It also doesn't help that night-shifters tend to be the less bubbly of the bunch and now masks make interpreting body language and expressions more difficult -- our present situation makes it much easier to misinterpret being laid back as being uninterested or uncaring. I agree with the above posters that you should express any unfamiliarity or concerns you have in the moment, and ask for a demonstration or instruction. You can then utilize your next opportunity to demonstrate your understanding. I would also like to add that asking questions or seeking out assistance is something you should learn to feel comfortable with now, because you're never going to know everything.