Preceptor is SO BAD!

Nunya, BSN · Oct 31, 2019

I would give it one more shift and then if it doesn't improve go to the boss and ask for a new one. Be aware this will possibly (likely) put you on the **** list with many of your coworkers, including her of course.

Serhilda, ADN, RN · Oct 31, 2019

In before COBs eat the OP alive.

But seriously, I'd just try to take the initiative more often. Switching will almost certainly come back to bite you.

SteelGrey · Oct 31, 2019

Iv’e been the lost puppy!

I’d maybe give it a little more time- you may have to develop more of a relationship with her in-order for her to relax and start letting you do things and be more open. I’ve been with some control oriented people who were amazing at their specialty, and it took time. However, if you are in a new grad program or have any other mentors, people to talk, its okay to reach out.

I hope things get better for you, sounds like you have an amazing opportunity!

adventure_rn, MSN, NP · Oct 31, 2019

Take a breath.

Yes, it sounds like you and your preceptor got off on the wrong foot, and that her teaching style isn't fitting your learning style. However, instead of just going over her head and requesting a new preceptor, I think you'll do yourself a favor by sitting down with her and expressing your needs. It takes way more courage than simply telling your manager 'my preceptor sucks,' but it's so much more helpful in the long run. If you can express your needs and explain specific ways in which she's not meeting them or could meet them better, then she can adapt to your learning style.

In addition, I'd caution you against labeling your preceptor as a lunatic just because she's going off book. She can still be a great nurse even if she's not a great preceptor (and she may actually be a solid preceptor). The fact that she's well-regarded on the unit speaks volumes, and suggests to me that there's something important that you can learn from her (even if it's unclear to you right now what exactly that is).

As a new grad in your first week of ICU, I'm kind of unsurprised that you weren't actually doing a lot yet. When you're first learning in an ICU setting, you are going to be doing a lot of observing (i.e. see one, do one, teach one). Your preceptor should be explaining to you what she's doing as she's doing it; since it sounds like she's not, maybe your feedback to her should be that you need more explanation as to why things are happening. In the moment, you can prompt her by asking questions, which it sounds like you're already doing--keep doing that. However, it's entirely appropriate if you're still in the 'observation' phase (whether that's giving report, doing dressing changes, etc.); after you've watched her do things a few times, you'll get to have more of an active participation role as you go along.

A note on policy: there are some nurses who don't follow every policy by the book but are still strong nurses. You'll probably find that there are certain policies on the unit that nobody follows. In theory, the policy should be the best way to do something; however, if your preceptor has been around long enough, they may realize that in certain scenarios there are better ways to go about things, and that you have to pick your battles. Ideally your preceptor should at least show/tell/teach you the 'right' way of doing things by the books, but they may then inform you that things are never actually done that way. I've seen this on every unit I've worked on, and the people who have been around long enough know what actually works even when the policy doesn't. It's not 'right,' but that's the reality.

If you do end up with a new preceptor, I'd be very cautious about how your frame your narrative when you're talking to your coworkers. You are not going to win yourself any friends by taking a role model on the unit and calling them incompetent then reciting a laundry list of all of the things you think they did wrong. Honestly, the majority of the things you brought up are not that big of a deal in my opinion. Even for the ones that made me raise an eyebrow, I feel like I'd forgive them under certain circumstances if I otherwise trusted that nurses' judgment.

Sidebar: it sucks, but most preceptors don't do a great job of introducing new people to the other people you encounter (providers, people you're giving report to, other people in the room, etc.). To most preceptor it's honestly an afterthought (like they don't even think to do it), and they forget how awkward it is to be the random person standing there, waiting to be introduced. Don't take it personally; a small minority of preceptors are very deliberate about introducing their orientees, but most aren't. It stinks, but it is what it is.

Cowboyardee · Oct 31, 2019

2 hours ago, Citygirl606 said:
Hi All,
I'm a new graduate nurse who just started in the ICU and on my third shift tomorrow with my preceptor. She's been there for 7 years and everyone was telling me how lucky I am to be precepted by her before I even met her so I was excited.

The quote above is a pretty good indication that it might be a bad idea to go to war with her on her own unit.

Look, she's surely precepted before, and it's pretty unlikely that all of her orientees never get to participate in patient care. So probably there's something going on as to why she's taking it slow right now - either she sees something about you that you're not seeing, or maybe she just likes to take it slow at the outset in general.

So my advice would be to acknowledge to her that you are feeling like she is dragging her feet in getting you involved, and also that it makes you wonder if there is something you're doing wrong or that is concerning to her. Then take her response seriously.

If that doesn't work, find someone she's precepted in the past and ask them for insight.

Also, nurses are allowed to take prescription medications, and sometimes the best answer to certain clinical questions is actually, "because the government told us so." It's not unlikely that she notices your hostility. Palpable hostility is not very conducive to your preceptor speaking freely about clinical matters or giving you more freedom and responsibility. Your preceptor has to trust you.

Katie82, RN · Oct 31, 2019

Not every "good nurse" is a good teacher. Mentoring is a skill that goes above and beyond clinical skills. Not every mentor/student is a good match. I would ask for another mentor, but do it in such a way as to not cast a negative light on your mentor. You will have to work with her, so don't slam her for something that may not be her fault. As for your description of her skills, some of that may be attributed to the fact that you have not yet learned that the "real world" is really nothing like you learned in nursing school. I fondly remember some of the new grads I mentored during my years in med/surg, and that's the first lesson you have to learn.

JKL33 · Oct 31, 2019

2 hours ago, adventure_rn said:
A note on policy: there are some nurses who don't follow every policy by the book but are still strong nurses. You'll probably find that there are certain policies on the unit that nobody follows. In theory, the policy should be the best way to do something; however, if your preceptor has been around long enough, they may realize that in certain scenarios there are better ways to go about things, and that you have to pick your battles.

I would not apply this idea to something as important as IC policies and principles r/t working with central lines. Part of being a strong nurse is picking your battles, as you say, and that involves using appropriate discretion in deciding "more important" vs. "less important."

**

Also not impressed with anyone's unit rep given the particulars described. People highly endorse great people, and they also sometimes endorse people out of politeness, propriety, fear, ignorance and just being easily impressed.

I will go ahead and guess that this is a wreck based on...stuff. The question is how to deal with it.

I would try the tack of forging a careful rapport and increasing communication and initiative. If there are many other signs of problems (with the individual or the unit practices and culture) I would strongly consider rethinking the whole thing. People who are highly respected despite demonstrating poor judgment say something about themselves and about those around them and the situation that harbors them. We are discussing a case elsewhere which I suspect involves principles similar to what I am saying.

ruby_jane, BSN, RN · Oct 31, 2019

Document the everloving pants off of everything. Everything.

I did not; I just asked to change preceptors and ultimately left the unit. Had I documented half the shenanigans my excellent nurse/crappy preceptor did I might have been better off.

Cowboyardee · Oct 31, 2019

1 hour ago, JKL33 said:
I would not apply this idea to something as important as IC policies and principles r/t working with central lines. Part of being a strong nurse is picking your battles, as you say, and that involves using appropriate discretion in deciding "more important" vs. "less important."
**
Also not impressed with anyone's unit rep given the particulars described. People highly endorse great people, and they also sometimes endorse people out of politeness, propriety, fear, ignorance and just being easily impressed.
I will go ahead and guess that this is a wreck based on...stuff. The question is how to deal with it.
I would try the tack of forging a careful rapport and increasing communication and initiative. If there are many other signs of problems (with the individual or the unit practices and culture) I would strongly consider rethinking the whole thing. People who are highly respected despite demonstrating poor judgment say something about themselves and about those around them and the situation that harbors them. We are discussing a case elsewhere which I suspect involves principles similar to what I am saying.

It is very possible that the whole unit is a wreck, based on some of the practices described and the preceptor's reputation. However, for a new grad on the unit 3 days so far, that's a much harder problem to either diagnose or fix than simple preceptor difficulties. Especially if the OP is on contract, as many new grads in ICUs are nowadays.

I think either way, the OP would be well advised to build bridges wherever she can, learn everything she can abput both critical care and her unit, and report back here or to a trusted and more experienced advisor in a couple weeks. Ruby's suggestion to document everything isn't a bad idea either, though it's no guaranty of a good outcome.

adventure_rn, MSN, NP · Oct 31, 2019

2 hours ago, JKL33 said:
I would not apply this idea to something as important as IC policies and principles r/t working with central lines. Part of being a strong nurse is picking your battles, as you say, and that involves using appropriate discretion in deciding "more important" vs. "less important."
**
Also not impressed with anyone's unit rep given the particulars described. People highly endorse great people, and they also sometimes endorse people out of politeness, propriety, fear, ignorance and just being easily impressed.

I do agree, especially with regards to central line dressing. My thought is that it's hard to make a judgment based on the OP's description alone without actually being there and seeing what was done (i.e. which precise part was unsterile). Yes, a blatant disregard for central line sterility is never ok, but the nature of the OP's description (and the fact that this person does have a reputation as a strong nurse/preceptor) makes me wonder if there is more to the story. The OP's main complaint on the whole is that her preceptor doesn't do a great job of explaining what she's doing as she's doing it; I'm wondering if there's a chance that the preceptor was following policy (or at least had a reasonable justification for doing whatever she did in the moment) and that the OP just didn't realize it...

It reminds me of a practice I sometimes see in NICU. When we've got a really, really tough IV or art-stick, some of the most old-school, skilled nurses on the unit will stick for IVs/art-sticks without gloves on (or with one glove on) because if gives them a better feel for the vein/artery. When I first saw it, nursing school me wanted to say "You can't stick/poke/draw blood without gloves on!!! That's nursing 101!!!" Even though I would never personally do it that way (I fall firmly into the 'policy abiding' category myself), I get their justification for why they do it, and sometimes they get the IV/poke when literally nobody else can. I still have a lot of respect for those nurses, and I don't think it undermines their overall credibility as a nurse.

I know that the latter example is a little different because it puts the nurse at risk instead of the patient, but it's an example of what I'm trying to say.

beekee · Nov 1, 2019

You’ve had two shifts on orientation as a new grad in an ICU? Yeah, she may not be the best preceptor but this sounds pretty normal to me. You aren’t to the point where you can do much yet. You need to show initiative and confidence, and definitely less disdain.