Preceptor nightmare(vent but advice sought

HouTx, BSN, MSN, EdD · Apr 17, 2012

Are you saying that you want her to stand next to you and watch/comment each time you push a med? Forever? Doesn't that strike you as a tad needy? Once you have been observed performing a skill correctly, you do not need to be observed/supervised again. Make sure you are familiar with policies and procedures - and take the initiative to use these references rather than expecting your preceptor to do it for you.

There's nothing wrong with wanting to leave work on time. If they have to go into overtime due to the need to follow up or provide you with extra assistance, this will surely trigger the (negative) attention of your manager - and this would not be a good thing for them or you. Review your orientation checklist and focus your energies on meeting each one of those requirements. When you ask for help, it should be triggered by a specific issue - not generalized anxiety. If you are experiencing difficulty with software, ask your manager or educator for additional training.

Having multiple preceptors is never ideal - for exactly the reasons you have stated. However, you can lessen the problem by keeping up with your orientation checklist/documentation and referring to this as needed..."I already got checked off on _____, so I don't need to be supervised on this, but I do need you to check me off on ____. Can we do it this afternoon?"

Bottom line? Try not to be a burden to your preceptors. They will have input into your performance evaluation.

JustBeachyNurse, LPN · Apr 17, 2012

I'm confused! you need supervision to administer medication every single time as a licensed registered nurse?

I will agree that multiple preceptorship could be an issue. But I think you are being a bit unrealistic wanting someone to walk you through each nursing skill each time...they don't even do that in nursing school (and if your instructor has to walk you through each skill each time that is not a good sign)

Generally the purpose of orientation is to orient you to how a unit runs, the policies and procedures, perhaps a class on how their facility specific EMR system runs, unit specific skills, procedurs and equipment etc. Before you meet with your unit manager perhaps come up with a learning plan as suggested by the previous poster. List your strengths and perhaps request assistance with skills that you are weaker at or are unfamiliar with (for example in nursing school the pediatric facility used Kangaroo feeding pumps exclusively but where I work now most patients utilize Moog pumps. So I asked for additional help in set up and trouble shooting these pumps as while they are similar they are not the same. My preceptor was happy to demonstrate the tips & tricks she knew from experience)Good luck.

tespinoza · Apr 17, 2012

I agree and disagree with HouTx. Remember, you are an RN now. You shouldn't need babysitting to take care of patients. Be confident in your abilities and knowledge. The orientation should be to help you learn the specifics of the hospital and unit in which you are now working not teach you how to be a nurse.

However, There is nothing more scary that a new grad that doesn't ask questions. If there is something you don't know or don't feel comfortable with, you need to speak up. Always have the patient's well being in mind. Pay attention when you get things explained to you. Take notes if you need to and refer to them instead of having the same thing explained several times.

Communicate with you preceptors. Look inside yourself and decide what your real fears are. We all remember that anxiety of being "responsible" for the patients now, but when you have a task to do, think about it first. Remind yourself how you preformed the task in school. Then take the initiative to get it done. If you truly don't know how to do it or what an assessment is telling you, then by all means ask for a second opinion. When you are asking for a second opinion start with 1. This is what I need to do or this is what I have done. 2. This is what I think it means or what I think I should do next. and 3. What do you think? or Do you think I should do something different. You will begin to see that you know more than you thought and start to trust your instincts. Be confident, hang in there, and Good Luck.

dhusc1228 · Apr 18, 2012

Let me clarify. Of course I am not saying that anyone needs to hover over me. Each time just meant for each check off skill I have to be observed doing it. When I cannot get someone to watch me check off then that is my problem. Then the check off has to be the way it wanted in the facility which I can understand. However, if one does it one way and the other does it another, see where I am going?

The computer system is part of the check off, skills yes I learned those and can modify to the way they do them, but the computer software, did not get taught that in school. I ask questions all the time, but when the answer is just do it where do you see a problem.

dudette10, MSN, RN · Apr 18, 2012

You mentioned multiple ways of doing things. That is nursing. I know as a new grad (only half a year on the job myself), that can be frustrating early on. Isn't there a "right" way to do things?

Well, with some things, yes, and some things, no. As in school with NCLEX-type questions, there are multiple ways, but there is one way that might be the best way.

Regardless of what many people think, you were taught the up-to-date basics in nursing school. I had one experienced nurse tell me to put a sugar packet in the juice I was getting for a hypoglycemic patient. I didn't tell her "that's wrong and no longer done"; I just didn't do it.

Think about the methods the nurses are using and determine if their methods fit the basic safety guidelines for the skill. Skills have multiple steps, but one step is usually very important to do right, and it often involves sterility. Think about if the way the preceptors complete the task make sense? Do research on your own to determine the "most right" way. You'll find that when a new protocol or device is introduced in a facility, you are all--regardless of experience--on an even playing field when it comes to knowledge about it.

Becoming a competent nurse isn't just about what your preceptors tell you. You must research. I do it almost every day, everything from meds, to skills, to pathophys, to widely established protocols. You must observe. I listen with one ear every time a nurse makes a call or talks to a doc.

After you get past the panic phase of your orientation--been there, and it's baaaaad--your real learning can take flight. Right now, you're just trying to survive.

Good luck.

beeker · Apr 24, 2012

Wow guys really? Do you remember your FIRST DAY as a new grad? Yes I wanted my preceptor to supervise me pushing meds on DAY 1!! I do not think that is unreasonable, you are a huge bundle of nerves and I wanted them to watch me do everything. Once you have done it and feel ok with it, then it is ok to do on your own. I have been out of school for months and while I passed the NCLEX it had been awhile since my last clinical. Of course not forever, but day 1 I think it is pretty standard to want someone with you.

OP- I have had a different preceptor almost every shift and it has made me batty! There are some I love and some I did not love. I learned a little something from each one, but it seems that a lot of them confused policy with their personal preference. One of them is like a super charter, charts 90% of the shift. Another one charts basically nothing. It was very difficult to sort out what had to be charted vs what each one did since they all did it toally different. Some were more laid back some were very high strung, It was hard to go back and forth between them.

Each time I did a new skill or something I had little practice in during school, I wanted another pair of eyes with me. Like starting ivs, putting in an NG tube, etc etc. I wanted to be babysat the first few times and I am grateful to my preceptors for being supportive.

Merlyn · Apr 24, 2012

Just tell the nurses to check you off. If they don't do it go to the supervisor get her to check you off. No check go to the supervisor. But why would an RN want an LPN's name on RN stuff. Doesn't it have to be another RN?

dhusc1228 · Apr 28, 2012

Well I guess it won't matter after Tuesday. Looks like I may be let go.

noyesno, MSN, APRN, NP · Apr 28, 2012

Oh, no.

What happened?

dhusc1228 · Apr 28, 2012

Something I hadn't planned on. I have a disability and said something to a charge nurse and today all of a sudden it is nothing working out. Meeting with admin to see if I can stay.

Gold_SJ · Apr 28, 2012

I truly hope this isn't the case, considering you only just started out. To be released when you haven't even settled in yet seems foolish on their part. All grads have struggles in the beginning as I see it and most are all resolvable with education and support in most situations.

A disability shouldn't come into it, not if you've passed nursing school and the NCLEX

Hope everything works out. Sending good thoughts your way.

Gold