Preceptor Made Me Feel Like I Should Leave Nursing

[Nurse12390, BSN]

Thank you for the feed back. I have now been training in the nicu now for a little over two months and it hasn’t gotten any better. I was really hopeful that it was going to be a better environment for me to work in.

My preceptor is really nice but she can be very controlling. She never lets me go into rooms by myself and she will critique everything I do. Yesterday I was changing out an infant’s nasal cannula and redressing it and she was criticizing the way I cut my tegaderm because it was 1cm shorter than it needed to be. I always listen to her input and will redo things if she is unhappy with how I am preforming tasks.  I am always open to feedback and constructive criticism but it’s gotten to the point where it feels like she critiques everything I do and that everything I’m doing is wrong.

A lot of times she will take over things I’m doing or take medication out of my hand to do it. It’s very discouraging and I feel like I’m having a hard time accomplishing anything because she is always upsets about something I am doing. I’m new to the nicu but I was a nurse on a renal transplant floor for 2 years prior so I do have some skills that translate over.

Last night we had a kid that was very sick and vented and she told me that she would be doing everything and that I could watch her. I was very discouraged and disappointed because I wanted to be apart of this kids care and it felt like she was indicating that she didn’t think I was competent enough to do so. The kid ended up coding and I tried to get involved in the code as much as I could by getting supplied/suctioning/decompressing the stomach. I was pretty upset after the code because it was my first one and it’s horrible to see your patient that way and she never debriefed with me.

We were able to get the kid back and started a blood transfusion. I pointed out to her that it looks like the IV is infiltrated and she told me it looked fine. I was concerned so I was checking the site every 30 minutes. The IV ended up infiltrating pretty badly and when we went in together to asses she asked me if it looked like this 30 minutes ago which I responded no. She then asked me if I was sure which I was very insulted by and told her I would never keep something infusing through an infiltrated IV. 

My patients are everything to me and I work really hard to learn as much as I can to be the best nurse I can be for my patients. When I was in the nursery training I received very positive feedback and was told that they could tell I was a good nurse on my other unit and that I was doing really well. I even got thank you cards from families I had while over there. I was with a different preceptor the other week and she told me that I did an amazing job and gave a very detailed report. My other preceptor often talks over me while I’m giving report and makes me practice with her before giving report.

I’m more than happy for any opportunity to learn but other preceptors have never had a problem with how I give report on this unit and when I’ve ask for feedback they always tell me that my reports are good. 

I decided to talk to my preceptor about why she wouldn’t let me help with the sicker kid because it was really bothering me. This week she has been especially critical of everything I have been doing and won’t let me do anything on my own so I wanted to clear the air. I was hoping to get feedback on how I can improve and if I am where I should be at this point in my orientation. She basically told me I’m lacking critical thinking skills and time management/prioritization. She told me that if she had let me have more control in the assignment last night that the kid wouldn’t have been recovered. Which really made me sad when she said that. I really want to improve and do better but it seems like my preceptor has no faith in me and thinks I’m a bad nurse who shouldn’t be there.

Her response broke my heart and it made me feel like I’m a terrible nurse. It even made me consider transferring to a different floor. The nicu  has always been my dream job and I’ve worked really hard to get a job on this unit. I’m devastated that this has been my experience on this floor so far. I know the turn over rate on the floor is very high due to bullying and the senior nurses make it very clear that newer nurses are not welcome there. I’m looking for advise of any kind. I’m just completely devastated and questioning if I should even be a nurse at this point. Thank you for reading and sorry this post is so long!

[Emergent, RN]

If I were in your shoes I would leave. You say it has a reputation for doing this so it's not you it's the unit. Don't waste your time anymore and go to a healthier place.

[caffeinatednurse, BSN, RN]

I've been on both sides of this situation.

Obviously, I was a new grad at one point. I had a preceptor who was nothing short of a bully. I ended up leaving that floor not long after I started and took a break from hospital nursing altogether for almost 2 years. When I went back, I was lucky enough to have a *fantastic* preceptor who helped me get up to speed, trained me to become a charge nurse, and is still one of my best friends to this day. 

I have also been a preceptor for 5 years. Although we want our experiences with preceptors to all be the same, the orientation and training that a nurse gets really depend on what type of nurse they are and how they approach their orientation to a unit. I've had experienced nurses who thought they knew everything almost kill a patient under my watch. I've had nurses try to neglect a patients' basic needs under my watch. I've had new grads fake knowing what they're doing, only to miss a major issue and let it escalate, under my watch. As a preceptor, you become aware of what the nurse you're training is doing and more importantly, what they're not doing. And what they're not thinking about. It can be scary when you have an orientee who doesn't pay close attention to the patients, and you as the preceptor become very protective over your patients and the quality of care that is being delivered. 

Have I taken over the care of a very sick patient, instead of letting my orientee care for that patient? Have I told my orientee that I don't think she's ready to care for someone this sick on our unit yet? Absolutely. Because at the end of the day, I am responsible for what happens to that patient. You are in training, and my manager knows this. They would hold me responsible for what happened to a patient that was under the care of an orientee. 

I'm not suggesting that your preceptor is completely correct because it sounds like there is a lack of tact involved on her part for the way she is communicating this to you. It also sounds like she is under considerable stress, and that she may not trust you yet. But you are completely new to NICU, and she is responsible for you while you're in training. Perhaps more importantly, her main responsibility is to protect the patient. As a preceptor, she absolutely has the right to tell you that you're not ready to take care of that very sick patient. She has the right to change your assignment based on her assessment of your capabilities. It doesn't mean that you're a bad nurse, it just means that you're not ready. You're new, and that's to be expected. 

I've also worked with nurses who had a similar crunchy demeanor. Sometimes it's really important to have a thick skin and to not take things personally. I would, however, listen to the feedback that she's already given you. I have said similar things in the past to orientees, not because I wanted to hurt their feelings, but because I wanted them to realize where their weaknesses were and what areas they needed to work on. I would try to look at things from her perspective first. Look at your actions and behavior as well. Some things to ask yourself...are you doing things in the clinical environment that make her feel uncomfortable? Have you asked her what her expectations of you are, at this point? Have you proactively asked her how you can improve as a nurse on that unit? Have you asked her why she does things a certain way? Chances are, if she's jumping in there and interfering with what you're doing, you might be doing something incorrectly or it might not be how they do things on that unit.

Again, her main priority is keeping that patient safe. Your learning/orientation comes second, so that's something to keep in mind. If you still feel like her behavior/demeanor is interfering with your learning, then I would ask the manager for a different preceptor first, before giving up a specialty altogether. 

[JKL33]

There are 3 basic options: Leave, confront, ignore. What you do depends on your assessment of the situation and your personal preferences.

If I were the one facing this I would probably take the tack of visibly ignoring direct hits. So ignoring isn't the right word because it's actually more an act of standing your ground. It's a good approach for people who are capable of buckling down inside (emotionally) and refusing to be shaken. If you know that you are making progress and thus know that this is just someone being a bully, it's what I would do. It's a less confrontational confrontation. ?  You refuse to react when they attempt to provoke. Then slowly build rapport. The rapport building is possible because they get thrown off when you don't immediately react.

Direct confrontations I suppose can be successful; they aren't my personal preference. Some people are good at having success with direct verbal confrontation.

Talking to the manager could be successful but that involves a second person you can't control and really alters the dynamic so can become a can of worms.

It's up to you. If in your position I would strengthen my resolve and take on the bully with the approach I described first. People who are seen as bullies are much, much weaker than they appear. If they weren't weak they wouldn't need to be bullies.  ?? It costs nothing to stand unaffected and look them in the eye when they try to provoke a reaction.

$.02

[JKL33]

Just read @caffeinatednurse's replay and agree with much of it.

This does sound a nurse who is a bit particular and I'm one of those myself. The underlying motivation is taking good care of patients.

 

[Nurse12390, BSN]

I 100% agree that patient safety come first and I would never do anything to put their safety at risk or pretend that I know more than I do. I always make sure to ask question or for help if I don’t know how to do something. I always ask her for feedback at the end of the shift on what I can improve on for the next shift. I have taken her feedback very seriously and always look for ways to improve. 

It is a bit awkward because she’s younger than me (not that it matters) but knows so much and is a very good teacher/nurse. Everyone on this unit does things differently so I’ve learned different ways to do things. I always make sure to do it her way once she shows me her preferred method. She has admitted to me that she has a control problem and has apologized to me about it before. I’ve caught mistakes that providers have made before and she has completely dismissed my concerns but she ends up blaming me for and taking credit for catching them during rounds. A lot of times our only interactions is her criticizing me about something . She spends a lot of time with her friends on the unit gossiping about the other nurses or complaining about how they have to precept or how they think a new nurse is stupid. I’m usually able to make friends and have become friends with previous preceptors in the past but I haven’t been able to on this unit. 

I really want this to work out but now I  feel really discouraged and like I am not cut out for it anymore. 

[subee, MSN, CRNA]

16 hours ago, Ashywlms1290 said:

Thank you for the feed back. I have now been training in the nicu now for a little over two months and it hasn’t gotten any better. I was really hopeful that it was going to be a better environment for me to work in.

My preceptor is really nice but she can be very controlling. She never lets me go into rooms by myself and she will critique everything I do. Yesterday I was changing out an infant’s nasal cannula and redressing it and she was criticizing the way I cut my tegaderm because it was 1cm shorter than it needed to be. I always listen to her input and will redo things if she is unhappy with how I am preforming tasks.  I am always open to feedback and constructive criticism but it’s gotten to the point where it feels like she critiques everything I do and that everything I’m doing is wrong.

A lot of times she will take over things I’m doing or take medication out of my hand to do it. It’s very discouraging and I feel like I’m having a hard time accomplishing anything because she is always upsets about something I am doing. I’m new to the nicu but I was a nurse on a renal transplant floor for 2 years prior so I do have some skills that translate over.

Last night we had a kid that was very sick and vented and she told me that she would be doing everything and that I could watch her. I was very discouraged and disappointed because I wanted to be apart of this kids care and it felt like she was indicating that she didn’t think I was competent enough to do so. The kid ended up coding and I tried to get involved in the code as much as I could by getting supplied/suctioning/decompressing the stomach. I was pretty upset after the code because it was my first one and it’s horrible to see your patient that way and she never debriefed with me.

We were able to get the kid back and started a blood transfusion. I pointed out to her that it looks like the IV is infiltrated and she told me it looked fine. I was concerned so I was checking the site every 30 minutes. The IV ended up infiltrating pretty badly and when we went in together to asses she asked me if it looked like this 30 minutes ago which I responded no. She then asked me if I was sure which I was very insulted by and told her I would never keep something infusing through an infiltrated IV. 

My patients are everything to me and I work really hard to learn as much as I can to be the best nurse I can be for my patients. When I was in the nursery training I received very positive feedback and was told that they could tell I was a good nurse on my other unit and that I was doing really well. I even got thank you cards from families I had while over there. I was with a different preceptor the other week and she told me that I did an amazing job and gave a very detailed report. My other preceptor often talks over me while I’m giving report and makes me practice with her before giving report.

I’m more than happy for any opportunity to learn but other preceptors have never had a problem with how I give report on this unit and when I’ve ask for feedback they always tell me that my reports are good. 

I decided to talk to my preceptor about why she wouldn’t let me help with the sicker kid because it was really bothering me. This week she has been especially critical of everything I have been doing and won’t let me do anything on my own so I wanted to clear the air. I was hoping to get feedback on how I can improve and if I am where I should be at this point in my orientation. She basically told me I’m lacking critical thinking skills and time management/prioritization. She told me that if she had let me have more control in the assignment last night that the kid wouldn’t have been recovered. Which really made me sad when she said that. I really want to improve and do better but it seems like my preceptor has no faith in me and thinks I’m a bad nurse who shouldn’t be there.

Her response broke my heart and it made me feel like I’m a terrible nurse. It even made me consider transferring to a different floor. The nicu  has always been my dream job and I’ve worked really hard to get a job on this unit. I’m devastated that this has been my experience on this floor so far. I know the turn over rate on the floor is very high due to bullying and the senior nurses make it very clear that newer nurses are not welcome there. I’m looking for advise of any kind. I’m just completely devastated and questioning if I should even be a nurse at this point. Thank you for reading and sorry this post is so long!

IMHO, NICU is a terrible place to put a new grad.  When the patient is someone else's kid, the anxiety stakes are much higher and that puts most people on edge taking care of the tiny people.  This probably has nothing to do with you.  You are the one more mistake the hospital made by putting a new grad in that unit.  If the turnover is so high, they haven't learned from their mistakes and you know what that diagnosis it:)  Why start out on ice when you can start out on snow?

[JBMmom, MSN, NP]

Do you have anyone else in the unit that you can speak with about things? Have you gotten feedback from anyone else about how things are going? I have no doubt that your preceptor could be going about things in a more tactful way and to make the statement that a patient wouldn't have recovered if under your care is completely inappropriate. However, there may be some level of accuracy in her assessment under her poor delivery. I do not precept often, and my manager has warned new coworkers that I can be a bit overbearing and harsh with new employees. I don't see my approach in that description, but I do have high expectations and I'm often direct in my communication style which can sometimes be interpreted as rude. It's unfortunate that the older nurses on the unit are not more welcoming, perhaps that also will improve with time. 

As others have mentioned, you're at a decision point. It would not be unreasonable for you to step out of this unit at this time. You're still very young, you will not be closing the door on that area of nursing permanently, it sounds like truly not the best fit. Or, if you feel that once you're on your own you will be able to fit your niche in this unit, then you just have to power through the orientation with the end goal in mind. There's a very good chance that despite the harsh treatment during orientation, your preceptor may think you're ready to come off orientation in the end. 

Critical thinking and time management are both things that, to some extent, come with time. No one should expect an orientee to act like an experienced nurse, because they're not.  I've had a couple new grads get very frustrated that they didn't "know everything" at the end of orientation. I had to tell them that no matter how much they wanted it, they couldn't get five years of experience in a three month orientation, perhaps your preceptor has lost site of this.

Good luck with whatever you decide. I'm glad you directly confronted her when you had questions about that particular situation. Maybe now that she knows you're open to feedback and learning she will hopefully improve her communication with you.  

 

[Nurse12390, BSN]

Thank you for response. I completely agree with everything you said. Unfortunately I have no other resources on the unit. The other nurses have made it very clear that the newer nurses are not welcome here. I do ask questions or for help if I don’t know how to do something. I make sure that I look something up or try to figure it out on my own first before going to someone else. I don’t mind having a preceptor who is direct or hard on me. I want to learn and I am very open to feedback. I make sure to ask her while I’m doing new skills or after our shift together how I can improve. She usually tells me that my reports could be more organized or that I just need more practice with a new skill so the response I got from her the other day really shocked me. I have gotten feedback from other nurses who have precepted me who told me I was doing a great job or that they could tell I was a good nurse on my other unit so not all my feedback has been negative. I even got a thank you card from a family for my care. 

My issue is that she micromanages me to a point where she isn’t letting me do any tasks independently. Nicu is so specialized so I definitely have skills to learn that I’ve never done before but there are skills that I’ve learned from my other floor that I am comfortable completing independently (e.g., hanging blood, bed changes, assessments, giving antibiotic/medications).
 

I had to take a kid down for an MRI and I got everything set up to take them down and she was telling me not to use a drager and to take them down in an open crib. I had asked other nurses and they had told me that they always take kids down in a drager and I’ve seen other kids get transported down this way on the unit. She didn’t believe me and ended up verifying with someone else and when they told her that the drager was correct she said that’s what She thought and completely dismissed me. It’s just little thing like that where she questions my competency on things that I am doing right. There are alot of times I definitely need her to intervene or her feedback and I am very appreciative of that. I clearly don’t know a lot of things and I own that and am open to changing that. 
 

I was devastated when she told me that she would be the primary nurse for the patient that was unstable and I could observe. She completely dismissed me that night and kept making comments that came across like she was questioning my intelligence. 
 

At the end of the shift I decided to address why she didn’t want me to have the assignment and was completely taken back by what she said. I really want to learn and grow as a nurse but there was nothing constructive about her feedback. Her telling me that I would not have been able to resuscitate the kid broke my heart and made me feel like she thinks I’m too incompetent to do anything right and would cause a patient harm. 
 

Moving forward I’m not sure what to do. I love the  patients/families in the nicu but my coworkers are not supportive and make it clear that they don’t want anyone new there. It’s hard to be in a stressful environment with no support. I don’t know if I should bring my concern to my nurse educator and ask if she could follow me for a day to make sure that my preceptors assessment of my progression during orientation is correct. I feel very hurt and embarrassed to go back to my floor. My preceptor tends to gossip a lot with her friends on the unit and I’m sure she has told them all about how she thinks I’m dumb. I here the other nurses talk about how they are not impressed with a certain new nurse or how they think she stupid all the time during my shift. It’s also awkward because my preceptor is younger than me. Not that it matters to me but I don’t know if that is something that is making her feel uncomfortable. I’m feeling very lost and find myself questioning if I’m even a good nurse or if I should just leave all together. Thanks for taking the time to read and for all your feedback. It means a lot to me. 

[Closed Account 12345]

I can't speak to your performance to give feedback, but I can say this as a parent.  If I were ever in the horrible situation of my newborn child being critically ill and heading towards a code, I would choose for the experienced NICU nurse to step in and take over care every single time. The best orientee is still an orientee, and from a parental standpoint, I wouldn't care what an orientee learned during that shift. I'd care that my baby had the best nurse possible and survived.  Maybe try to think of it from that perspective.

Your preceptor might have realized how dire the situation was and realized what was coming. While operating at that stress level, her communication and teaching skills probably weren't ideal. She may not have mentally been in a place to debrief you appropriately or discuss your performance after she'd just had a newborn baby die on her and gone through the adrenaline rush and trauma of trying to reverse that death. Could she voice her concerns in a more kind, clear, and tactful manner? Of course!  But I'd give her grace for that night because she had just experienced the same trauma you had.

Hang in there. Remind yourself of the positive feedback you've received along the way, and remind yourself that a micromanaging preceptor isn't necessarily a reflection of your performance or abilities. It might just be her style. If you have down time on your next shift, ask her to walk you through her thought processes and actions from the critically ill/coding baby so that you'll be better prepared for similar situations in the future.

[CalicoKitty, BSN, MSN, RN]

4 hours ago, subee said:

IMHO, NICU is a terrible place to put a new grad.  When the patient is someone else's kid, the anxiety stakes are much higher and that puts most people on edge taking care of the tiny people.  This probably has nothing to do with you.  You are the one more mistake the hospital made by putting a new grad in that unit.  If the turnover is so high, they haven't learned from their mistakes and you know what that diagnosis it:)  Why start out on ice when you can start out on snow?

The poster is not a new grad. She said she has 2 years experience in renal transplant.

[Olivelove20]

Talk w/your manager, ask for another preceptor so you will get a fresh/different view of where you are/how you are doing. Make this about YOU wanting to get better/need someone else for a different experience in orientation..if you make it about your current preceptor it will come off as though you are placing blame on her (whether it's warranted or not)

Yes, speak to the Nurse Educator. You have to advocate for yourself - no one else will. This is a good lesson really for you to learn early. Speak up, don't just roll over and  take whatever is handed to you. Maybe the preceptor is correct in her assessment of you, maybe not or maybe it's somewhere in the middle. But if you let one nurse ruin what you want from your career, well that is just foolish w/o trying to ask for assistance outside of her.

If you are met w/the same resistant/critical feedback w/o the offer of support, etc. then go elsewhere because you for sure will know then that while some of it may be you, the majority of it is the unit and the people who work there.