Preceptor Problems - Advice needed

[dragonfire123]

I know having problems with one's nursing preceptor is common, but I just thought I'd fish for some advice here. I graduated from nursing school a few years ago with a BSN, at the top of my class and fairly confident. Alas, it took me a while to find my first nursing job, in semi-acute care at a rehab facility. I worked there for over a year, and now I just started a new job at an acute care facility. The entire situation is very different from my first job -- patients are sicker (so some of the interventions are very new to me), the charting system is different, the nurse/patient ratio is different -- essentially, it is starting over for me.

I was assigned a preceptor who is well-respected, well-liked, and very experienced. Alas, she is very impatient with me, even though I have only been on the floor for a few days. She feels I am too slow, gets annoyed if I do not understand how to use the equipment or know how to do some of the skills (some of which I haven't done since nursing school), tells me I talk too much to the patients (I talk while working to keep myself calm and centered, as well as to get to know the patients better), and gets irritated if the computer system isn't very intuitive to me (my previous facility had NO computers).

I have been very respectful to my preceptor and openly admitted that I feel a bit new and lacking in confidence. I feel I 'am' progressing slowly (I have half an assignment after only a week, even though the intention was to give me one patient a week -- I now have 4, and a full assignment is 6). But my preceptor is only focusing on what I'm doing wrong. Adding to this, she always takes breaks with me but will not talk to me at all (my attempts to make small talk fall flat). When asked if she was upset with me or something, she harped that I was 'half-baked' and 'not ready' (and will not be in the allotted 4 week orientation) and that 'new nurses have it easy today and not like when she became a nurse years ago.' She gets particularly irritated if I 'don't write things down' like where supplies are (though I have indicated that I remember by doing and seeing, not by writing things down -- I am a very visual person).

Bear in mind that I am in my 40s and though I am new as a nurse, I am not a child and have done many other things in my life. I never asked to be treated as an experienced nurse, but I just don't feel she sees me as a human being or is very compassionate. Very weird when she is nice to everyone. Even when I mentioned I had a migraine at work the other day (I get them bad), she was unsympathetic and just asked if I had finished my charting.

I apologize for sounding dramatic, but my orientation experience is really turning me off to the facility -- a very nice facility, and one that could afford me a great learning experience. Not sure what to do -- I just can't afford to come home and go to work feeling so low about myself when I feel I am trying so hard (and feel I am progressing, though not to my preceptor's expectations). I hate feeling so stupid and being made to feel so. I would appreciate your candid advice and feedback (please be kind).

[Libby1987]

Before going into a meeting to discuss how the preceptorship was going I would consider that I was still on probation and make sure that my end was completely buttoned up.

My director and admin are pretty open to such discussions but we have a hard time finding good candidates and tend to try to accommodate our new nurses' orientation as much as possible. I'm not sure how the reception would be in a flooded market, nor do I even know the job climate in OP's area, but I would filter out the ruffled stuff and stick to safety issues if this was a job that I really wanted and/or was hard to come by.

[ArrowRN, BSN, RN]

Sometimes the "best" preceptor can be the wrong choice. I know in nursing school for my final practicum my initial preceptor was..not that she was a bad nurse...just her personality clashed with mine. I told my instructor and I got a new preceptor.

Point is, talk to your manager and just be honest. Let him/her know that this preceptor is just not working out for you and asked to be assigned someone else. Manager know sometimes personalities just do not go well sometimes even if your preceptors might be the best nurse in the world. Its best to take interventions early before you end up with a horrible experience and leaving a good hospital based on just your experience with 1 person.

I'm more introverted, seems like so is your preceptor but I do not see why you have to change your personality and force yourself to be quiet or less chatty for your preceptor. If you had the right person they would notice this and maybe explain things in more detail so you get it and get on with your learning. Don't try to drag it out for your orientation sake..it may feel uncomfortable bringing this up with a manager but it will definitely clear the air and get you on the right track. Maybe do it one on one first then let the manager decide if to involve the preceptor...

[dragonfire123]

Thanks, everyone -- I really appreciate all the feedback.

[ORNurseCOS]

Hello, 1st off I'm sorry this is going on b/c it just sucks.

Stand up for yourself and call her out. Don't beat around the bush or she will NEVER respect you. You have to give as good as your getting it, plain and simple. You'd be amazed at how quick things can change when you call people out on their attitude. Tell her point blank you appreciate the opportunity to learn but you are not learning and the environment she is creating is not conducive to your success. List the reasons why etc.

When she's done picking her jaw up off floor ask her if you can move forward in a more positive manner or not? Get a response. If she doesn't shape up then go to the manager direct and discuss it with her.

Don't get pushed around, don't take her crap, call her out, discuss, move forward.

P.S.

One last thing (people like this really piss me off) she needs to understand that your success reflects on her and your failure reflects on her. Help her to remember what her damn job is, people like this sometimes need to be reminded just who they work for....maybe she'll realize it is time to move on.

[PacoUSA, BSN, RN]

A GOOD preceptor will encourage you and make sure you are positively reinforced. A good preceptor will also offer constructive criticism without tearing down what little dignity and confidence you have as an orientee.

This preceptor of yours is NOT a good one, I can tell you than having been a preceptor myself!

My first reaction would be to change preceptors, but at this point that move might likely be futile. PPs here have already offered some good advice. If you have a meeting with the nurse mgr and your preceptor, BE UPFRONT and express your concerns about the comments being made about your performance. Seriously, there is nothing wrong with questioning in front of the nurse mgr what the preceptor meant by you being half baked. Put her on the spot and call her out on it. And attempt to find out what GOOD you are doing as opposed to what you are doing badly. You need to know where you stand if you are to succeed on this unit. Dont let that woman have the upper hand on you.

[jadelpn, LPN, EMT-B]

Thanks, NurseQT. I appreciate all your advice, folks. I suppose my main concern is that this person will eventually be my charge nurse, so the relationship is only beginning. I am hoping she ease up a bit as I acquire more experience, become more efficient and effective, and feel more comfortable and confident in my role. As it is, I will heed your advice and suggestions, as well as building my skills and confidence and buttressing myself with the necessary emotional armor to endure.

I would listen to the feedback you are getting. A "thank you" and go about your day. You may want to have a paper brain (and AN has many examples of this--use the search function) to keep up with your patients. You may want to have a clipboard with notes on where items are located, and computer cues. As you are a visual person, you can and should employ the use of a couple of highlighters, and a pen that has more than one color ink on it. That can be helpful in cueing you visually on things that you need to know.

If you can go eat or break outside, do it. If you can distance yourself and be able to read or just relax over your breaks, do it. There is no need to take your unpaid time hanging and attempting to make small talk with someone who doesn't seem interested in that. And that is ok, work and personal separate.

You will get your own groove once you are on your own. Yes, you do have to explain to the patient exactly what is going on, what you are doing, and the like. This is part of education of the patient, and should be documented as such. When you head to toe assess at the beginning of the shift, you can discuss at that time plan of care, what will be happening in the time you are caring for them, that type of thing.

Everyone has their own practice. Yours and mine and that person's can be and are all different, but equally as effective.

Do what you can to learn what you need to. When this person becomes your charge nurse, if you are doing your job and documenting same, it will be a non-issue.

And I would think about a meeting with your preceptor and manager, just regarding feedback, where you are in competency skills (if you have a checklist) and a plan moving forward to make sure that you are touching upon everything you need to if your orientation is limited.

Best wishes.

[klone, MSN, RN]

I'm only about halfway through the thread, but I wanted to comment on something that resonated with me in the OP. You mentioned that you take breaks together but your attempts at chit-chat have fallen flat. I can relate to the preceptor in this situation - I'm an introvert, am on the autism spectrum, and a bit socially retarded (using this word correctly!). I don't "do" chit-chat or small talk - I don't understand how to do it, I don't see value in it, and am really bad at the back-and-forth that is involved with it. Don't get me wrong - I'm friendly and can hold a conversation if I'm sharing information, sharing a story, or interested in eliciting info from someone else about something. But if someone tries to engage in smalltalk with me, I don't know what to do with that, and I will answer their question. For example, and this happens often at my work, someone will ask me "So, what did you do this weekend?" I might respond "I painted the bathroom walls and had a barbecue on Sunday." and then I will go back to whatever it was I was doing, because it doesn't occur to me until after the fact when I'm analyzing it that I'm supposed to reciprocate, but I didn't because frankly I don't really have interest in knowing what you did this weekend.

Anyway, this was my very long, self-absorbed way of illustrating that even if she doesn't seem overtly friendly or interested in getting to know you, does not necessarily mean that she dislikes you. A lot of it is just different personality styles - I see a lot of myself in her, honestly.

[ArrowRN, BSN, RN]

Hello, 1st off I'm sorry this is going on b/c it just sucks.

Stand up for yourself and call her out. Don't beat around the bush or she will NEVER respect you. You have to give as good as your getting it, plain and simple. You'd be amazed at how quick things can change when you call people out on their attitude. Tell her point blank you appreciate the opportunity to learn but you are not learning and the environment she is creating is not conducive to your success. List the reasons why etc.

When she's done picking her jaw up off floor ask her if you can move forward in a more positive manner or not? Get a response. If she doesn't shape up then go to the manager direct and discuss it with her.

Don't get pushed around, don't take her crap, call her out, discuss, move forward.

P.S.

One last thing (people like this really piss me off) she needs to understand that your success reflects on her and your failure reflects on her. Help her to remember what her damn job is, people like this sometimes need to be reminded just who they work for....maybe she'll realize it is time to move on

I agree partly with this but the only issue is the OP is the outsider here and if she "calls her out" it may seem as confrontational then we all know the preceptor will immediately go to the manager with this and could skew things the wrong way. I'd be hesitant that why I'd go to the manager first who would hopefully have some objectivity.

But these are really the only two choices I see. Good luck.

[SHGR, MSN, RN, CNS]

It will be hard cutting down on the talking -- explaining my interventions and why I'm doing what I'm doing in the patient's room was a habit I picked up (encouraged by my mentors) in nursing school to help me focus, as well as to make my patients feel more comfortable and informed. But I will continue to try cutting it down . . . sigh.

I just viewed a webinar on why talking to pts and explaining what you are doing cuts down on patient distress and increases satisfaction with care received. This link explains what I am talking about http://www.beckershospitalreview.com/quality/4-strategies-to-boost-hospitals-hcahps-scores.html

(I know we harp on "patient satisfaction" focused interventions here at AN but I see more positive here than negative). It sounds to me like you are doing what you should be doing, just keep it more clinically focused and less chatty.

As far as the charting issues, can you meet with the hospital educators? Review the templates and process? Going from one EHR to another is fairly easy, but going from paper to computer is a difficult transition. Some hospital systems here have full week to two weeks of computer-only orientation before people even hit the floor orientation.

[PacoUSA, BSN, RN]

Some hospital systems here have full week to two weeks of computer-only orientation before people even hit the floor orientation.

Say what? I've only had one or maybe two days MAX training on any hospital's EPR.

[dragonfire123]

I only had a day of computer orientation, and only for an hour or so. Considering my previous charting experience (with no computers), I think I'm doing pretty well -- certain things, like charting admissions from beginning to end, will require further orientation and hand-holding, which I don't think is unfair to ask for (or expect). I realize I do need to dial my sensitivity down, but I just wish my preceptor were more patient and encouraging -- I'm not a child and hate being treated so. Alas, I have to own my orientation experience, as some of you have suggested. Thanks again, everyone.

[joe007]

Dragon. I was in a similar boat only a little over a year ago. I started as a brand spanking new RN out of school with no prior healthcare experience in the ER. My initial preceptor thought she was GOD with 2.5 yrs experience. I put up with her ******** for about 3 weeks before I decided there is no way it was going to work. I went to the manager and explained that she was belittling me and talking to people behind my back and that I needed a new preceptor. The manager switched me to a more experienced 7 yr vet preceptor male and I didn't have problems. If I were you, I'd go to the manager and pretty much lay out your issues. A lot of times the nurses they put you with feel ill prepared to precept or aren't experienced enough to precept or are stressed out. They don't know how to control their stress and lack of teaching ability and freak out. Also, there's an aggressive attitude many nurses have to attack and be hyper critical of new nurses because it's a power trip and they feel powerless with everyone else in the medical system except you. Bide your time, and ask the manager for a different shift if you are forced to be under that nurses supervision in the future. I find that a lot of preceptees have more power than they think. Just don't say anything insulting. Keep it framed in a positive way.