Preceptor issues

Specialties Critical

Published

So my preceptor and I have butted heads a few times. 
I always try to explain my thought process, when I’m wrong, with the intention of letting her know where my thought was based so she can redirect my thought process. I’m really looking for her to say instead of doing that, you would do x, y, x because ….” 
but she perceives it as arguing. We have had this discussion plenty of times. But it doesn’t seem to be working and it makes me super anxious. 
I have been trying to not cause any problems because I hate drama, I really do. But yesterday, my patient was super hypertensive, partially bc he was not adequately sedated. So she decided we probably needed to get him a bolus of fentanyl and titrate his drip up. 
 

here’s the issue. whenever I pull a narcotic, I NEVER waste it in the moment. NEVER. mainly because I always check my pockets by the end of the shift and I would forget to throw the vial away, the vial is my reminder to go back and waste it. It would horrify me if I accidentally brought a narcotic home with me because I wasted it when I pulled it and forgot to toss it. 
but anyways, I asked her to waste it with me later and when we went to do it, it said I had already wasted it. It says I pulled it at 14:36 and it was wasted at 14:37. I’m like 80% sure I was with her when I pulled it and she was like let’s go ahead and waste it because I would NEVER do that on my own. She got mad at me over it basically and I told her I don’t recall exactly who I was with but I thought it was her. 
we checked the Omnicell history and It wouldn’t tell us who I wasted it with. 
is this a big deal or am I making it a bigger deal than it really is

Specializes in Intensive Care.

I totally see what you’re saying. 

Specializes in Intensive Care.

I really appreciate all of your comments and bringing different perspectives to my attention. 
I guess I never thought to bring a syringe into the med room with me, draw up what needs to be wasted, waste it and have another nurse watch me do it. Maybe it’s because I’m a new nurse but I’m not sure why I never thought of that til now. I feel like that’s actually a better idea to be honest. I really appreciate all of your perspectives and plan on taking this info into consideration moving forward and wasting meds! 
thank you all very much. I hope I can be a better nurse with the help of strangers like y’all 

Specializes in oncology.
2 hours ago, atlnurse7 said:

I guess I never thought to bring a syringe into the med room with me

Aren't there syringes in the med room?

Specializes in Intensive Care.

Nope. We get ours from the supply room. Med room is strictly the omnicell 

On 4/25/2022 at 6:33 AM, atlnurse7 said:

..... I asked her to waste it with me later and when we went to do it, it said I had already wasted it. It says I pulled it at 14:36 and it was wasted at 14:37. I’m like 80% sure I was with her when I pulled it and she was like let’s go ahead and waste it because I would NEVER do that on my own. She got mad at me over it basically and I told her I don’t recall exactly who I was with but I thought it was her. 
we checked the Omnicell history and It wouldn’t tell us who I wasted it with. 
is this a big deal or am I making it a bigger deal than it really is

You're 80% sure you were with her when you pulled the fentanyl. How sure is she that she was there? It is an unusual thing to not remember what you were doing and with whom, especially if the event were very recent. Not saying that you're not sincere, but this is exactly the kind of thing that the pharmacy cops zero in on and make a big deal over if the something comes back off. If your preceptor wasn't the one that was there (why would another nurse that is not your preceptor be there?) she's looking for this stuff now.

 It's a simple enough thing to have the Omnicell tech in the pharmacy pull the waste record to see who you wasted the drug with. Be more mindful of this stuff because they will make a big deal out of it if you don't.

Specializes in Critical Care.

I'm failing to see the issue here. One way or another the med was wasted. There's a lot more critical things to worry about than keeping a diary of who wastes with who. Waiting until the end of the shift to do all of your wastes is a horrible idea, though.

Quote

Not saying that you're not sincere, but this is exactly the kind of thing that the pharmacy cops zero in on and make a big deal over if the something comes back off. If your preceptor wasn't the one that was there (why would another nurse that is not your preceptor be there?)

This is the only reason why I can see anyone making a big deal about this but I can almost guarantee that the vast majority of pharmacies don't care and don't have the time to pull who was precepting who and match it with who wasted what with which witness. Anyways, a preceptor isn't chained to their preceptee for an entire 12 hour shift. Especially at the end of training where the goal is independence.

From my experience there has been a more noticeable shift to making sure nurses are wasting now vs wasting later (and especially making sure we don’t carry around vials or other drugs in our pockets to return/waste later). In theory a nurse determines the dose they need based off pt condition/eMAR/parameters, then pulls the med and wastes with a second nurse at that very moment. Sometimes I just prepare the drug/waste while they are signing off in the Pyxis, then we both waste together. Just get it done straight off the bat and then you also save yourself the headache of hunting people down, remembering who did what, etc. Huge point here too-you should never be carrying vials or meds on you at any time. If you need to use the empty vial to scan, you can tape the vial to the syringe with the pulled up amount to give- and then you can bring the exact amount to the bedside. I would try to get into the strict habit of wasting now. The only time I don’t waste now is if I have an emergency; In those situations the second nurse overriding is often the witness throughout the whole process of administering and wasting with me as well. As soon as the patient is stable we witness and record wastes asap. 
I’m not quite sure what happened with the fentanyl being wasted a minute later after you pulled it but you don’t “waste now”, and so weren’t quite sure what happened to it. You have to be extremely careful with handling or witnessing controlled substances in your career. Unfortunately, one small narcotic error or discrepancy can sometimes snowball into a big deal.  I would also recommend making mental notes of who you waste things like that with, in case that issue pops up again. Mistakes can happen and unfortunately there a few people out there who also divert, so you have to protect your license at all costs. And the responsibility will fall on you, your preceptor (probably will fall heaviest on your preceptor), and the second nurse who witnessed for you. Your preceptor can be inadvertently nailed by a big narcotic error like that so I would just waste In the moment and keep her in the loop with big stuff life that (and really she’s held liable for whatever happens that shift between the two of you, which can be a lot to have on her plate. 

Specializes in Pediatric Critical Care.
On 4/25/2022 at 12:32 PM, atlnurse7 said:

we don’t have an area like that at my hospital. We are supposed to draw up the medication at the bedside. I only draw up what is needed from the vial. In our little med room that has our omnicell, there is a blue bucket for the drugs that we are supposed to waste. Rooms also have similar buckets for our IV drips, etc for us to put them in when they are done. But we are supposed to draw them up at the bedside. 

I am confused.  You say there is a med room with an Omnicell and a blue bucket for wasting drugs.  Why are you not allowed to prepare your medication there?  Draw up your dose, label, waste the rest, and take the empty vial with you to scan.  Is that against policy?*

*If you haven't read the policy, it might be a good idea.

Specializes in Pediatric Critical Care.
23 hours ago, MaxAttack said:

I can almost guarantee that the vast majority of pharmacies don't care and don't have the time to pull who was precepting who and match it with who wasted what with which witness.

They don't.  Until something happens that raises the tiniest of red flags.

And then they do.

Specializes in Community health.

I agree with the others that wasting at the end of your shift is a bad idea. I’m a worse case thinker— what if you got an emergency phone call in the middle of your shift, a loved one in an ambulance or something, and you had to leave quickly? The chance that you’d remember to stop by and waste on your way out is low. You’d be more likely to arrive home with half filled vials of fentanyl in your pockets. 

Specializes in I've worked most every part of Psychiatry;.

This sounds like more than a waste issue!   Nurses eat their young and old,    if anything this preceptor is not helping you getting off with the right foot!   From what I've seen?  Best advise is to get out of there!  True story my last location I had a preceptor that told me "Sxxxx" ( nurse manager) "told me not to help you".  Well I was Mon that unit for two days and one hour,     In her office she bashed my work history, bashed my education, impossible to communicate with, tried every style I knew! Open ended direct, developmental.  I was warned this manager " holds things over her staff". Yup she did/does!    She is still there and her and her boss are best friends!   I submitted a code ofconduct, disruptive behavioral report.  Her boss investigated and called it "hearsay"  but she never spoke to my witness or debrief ED me!  Don't let that happen to you!   Maybe ask for a different preceptor?  But that could back fire,  No one should have to come to work with fear!  That not only affects you, but the patients also.   I get the vibe you are in a toxic workplace!

Specializes in Critical Care/Vascular Access.

Honestly, if you're still training, it sounds like you're developing some bad habits early on that are going to catch up to you sooner or later. Habitually carrying unwasted controlled meds around in your pockets until you conveniently get around to it? It's just a bad situation waiting to happen.......

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