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.
Come to find out, I feel more disoriented with her than actually oriented. She took her ADDERALL right in the middle of my first shift around noon in front of me, doesn't follow policy or procedures and does things the way she wants, leaves me out of almost everything and doesn't explain anything unless I ask and even when I do ask she just says and I *** you not "this is what the government says to do", tells me I can do whatever I want, didn't introduce me to anyone on the unit, dumped urine down the sink instead of the toilet, didn't sterile glove when changing a central line dressing, doesn't tell me why or what she's doing and is doing everything HERSELF instead of having me lift a finger. When I asked her when I can do medications, assessments, or anything she just said "Yeah I guess you can do this" I just looked at her in disbelief and just went to the bathroom and cried. She is very OCD and needs things done her way and I did notice she is very thorough and does go above and beyond for the patients we had but she's a lunatic! When SHE was giving report to the night nurse during the end of our shift, I just stood there. The night nurse coming on even said "who is this" because I was just standing there like a lost puppy. She gave report, she could tell I was hypertensive and angry with her for leaving me out once again and apologized and promised we will go through everything.
I told my peers/previous classmates about this and they thought I was joking. They said to stick it out since it'll only be the third day and she has a good reputation for a reason. My thought process is I only get one orientation and I'm eager to learn and be the best nurse so I don't want to waste another second with this joke of a preceptor. I'm not amused. I'm not impressed. Should I ask the manager for a new preceptor? Good grief all I wanted was structure, to be included, more focus, just anything at this point!!!
As a Nurse Manager, I disagree about not providing details. If you don't let the Manager know what's going on, how can he or she fix it? What about the next new grad they stick her with? I really hope you have a good Manager that can help make the transition smoother for you but it's worth whatever you have to go through to get a really good foundation with a Nurse that is competent in both Pt care and in precepting. You're right- you only get one orientation.
Her preceptor has been there for 7 years. If her unit manager doesn't already have a pretty good idea of how she practices and her M.O. as a preceptor (and she isn't brand new to the unit herself), the unit must have bigger problems.
If, on the other hand, the manager is new to the unit and legitimately doesn't know these things, the OP would be wise to exercise caution before inserting herself further into unit politics than she needs to be at this point. She has no allies yet and any manager happy to use a new grad as ammo against established staff isn't necessarily looking out for the long-term interests of the new grad anyway. Even if the OP ultimately asks for a new preceptor, she really shouldn't blindly launch a crusade against established staff.
Have you asked her how she is doing? She sounds very overwhelmed by it all. Some new grad nurses come in brimming with self-confidence, other don't. IF she is going in the bathroom and crying, you need to find out the reason. Ever person has a different learning style. You as the preceptor needs to find out this new grads learning style. Maybe she is overwhelmed, maybe she is scared of you. Maybe her education was not as she had hoped, talk with her, ask her what she needs, have her tell you what she needs, build her confidence. The nursing profession needs to nurture new grads not scare them away. ICU is a tough place to learn as new grad.
I am pretty sure that "Devil's advocate" post was fiction written from the OP's preceptor's point of view.
Either way, OP, I hope that hypothetical viewpoint might have given you a possible point of view from her perspective. And start introducing yourself to people! ? Your preceptor should not have to do that, IMO.
OP- I'm so sorry that you came here for help and instead found Nurses that are making excuses for a Nurse that is clearly not doing the right things and made it YOUR problem- IT IS NOT!!! I agree with the Educator above that you have a couple options. As a Nurse Manager, I disagree about not providing details. If you don't let the Manager know what's going on, how can he or she fix it? What about the next new grad they stick her with? I really hope you have a good Manager that can help make the transition smoother for you but it's worth whatever you have to go through to get a really good foundation with a Nurse that is competent in both Pt care and in precepting. You're right- you only get one orientation.
Hang in there- it does get better! You worked hard to get here and YOU MADE IT so you can get through this too. The first year it the hardest for so many reasons, but it will be worth it once you get through this hard part.
Please keep us updated.
Don't you feel though that only two shifts is a little bit of a knee jerk reaction to having a different preceptor than the new grad anticipated? My preceptor had a very different nursing style than what mine ultimately is (or what I thought a nurse "should" be like), did some things slightly off-book, but was a respected nurse who cared for her patients safely and efficiently. Ultimately I took the lessons that worked for me and left the habits that didn't appeal to me behind. I had another preceptor for night shift who had some IMO awful habits, was not particularly friendly, but WAS very skilled when it came to meds, IV tricks -- and you know what? Some of our patients like her better b/c she's no bulls***. So, I learned everything I could from her, looked for mentors elsewhere, and came back to her whenever I needed help with an IV. No matter who OPs preceptor is, the floor is going to be filled with personalities and nursing styles she will like and dislike. It doesn't MATTER if you like like or dislike them, or if she finds taking Adderall in front of someone rude or not, because after orientation you're on your own, and it's the pt who matters, not your feelings.
And this is coming from a sensitive millennial here (although elder millennial- hard to consider myself in the same group as those that don't remember not having cell phones), so I'm generally not in the tough love crowd, but two shifts in and wanting out? I do have empathy (my first reaction to my unfriendly night shift preceptor was shock... then, OK, so this person isn't my BFF, cool) but I think OP needs to be patient. If it's been 5 or 6 shifts and nothing at all has improved, or worsened? OK, make a plan. It's been two!
Don't you feel though that only two shifts is a little bit of a knee jerk reaction to having a different preceptor than the new grad anticipated? My preceptor had a very different nursing style than what mine ultimately is (or what I thought a nurse "should" be like), did some things slightly off-book, but was a respected nurse who cared for her patients safely and efficiently. Ultimately I took the lessons that worked for me and left the habits that didn't appeal to me behind. I had another preceptor for night shift who had some IMO awful habits, was not particularly friendly, but WAS very skilled when it came to meds, IV tricks -- and you know what? Some of our patients like her better b/c she's no bulls***. So, I learned everything I could from her, looked for mentors elsewhere, and came back to her whenever I needed help with an IV. No matter who OPs preceptor is, the floor is going to be filled with personalities and nursing styles she will like and dislike. It doesn't MATTER if you like like or dislike them, or if she finds taking Adderall in front of someone rude or not, because after orientation you're on your own, and it's the pt who matters, not your feelings.
And this is coming from a sensitive millennial here (although elder millennial- hard to consider myself in the same group as those that don't remember not having cell phones), so I'm generally not in the tough love crowd, but two shifts in and wanting out? I do have empathy (my first reaction to my unfriendly night shift preceptor was shock... then, OK, so this person isn't my BFF, cool) but I think OP needs to be patient. If it's been 5 or 6 shifts and nothing at all has improved, or worsened? OK, make a plan. It's been two!
I guess I count as a millennial, although I do recall not having cell phones (born in the early 90's haha!) My night shift preceptor was also a "cut the S***" kind of nurse, held my hand for one shift and promptly dropped me on my butt for all the rest of the shifts I worked with her. She would sit at the nurse's station and when I came for help or sat down to chart would pepper me with questions that made me feel incredibly stupid. She also always seemed to know what was going on with my patient before it even happened. This made me feel slow, frustrated, and angry that I always seemed so behind. It also made me learn. Because of that preceptor I have no doubt that I am not just a better nurse, but a better ICU nurse. I hated being with her for the first week (until I figured out her style and saw the point of what she was doing). Now, I have a lot of respect for her and appreciate what she did for me, and we are actually good friends now that our preceptor/preceptee relationship has come to an end. Definitely agree that OP needs to have some patience and figure things out.
Specializes in OR, Nursing Professional Development.
My thoughts:
2 shifts in is far too soon to be questioning the ability of your preceptor to precept (separate issue from unsafe practice issues- not addressing those here especially as ICU is not my own specialty)
How much of this could be the reality shock of moving from nursing school where everything is by the book and you're very protected vs. now the new reality of "I am the nurse"?
Not everyone has the best social awareness. Your preceptor is comfortable with those on the unit and may simply not even think about introducing you. In that case, speak up and introduce yourself- it's not a requirement that your preceptor has to and you aren't allowed.
You need to open your mind. Deciding that someone is a lunatic after 24 hours together is a bit extreme. Wipe the slate and start fresh with the next shift. Remember, you are the new person and need to acclimate to the environment you are entering- the environment is not going to change for you.
You are a brand spanking new nurse- in my ICU the first couple shifts are for the orientee to observe, see the flow of the unit, see our charting system, etc. It is the same for all orientees- experienced ICU nurses and experienced non-icu nurses (we don’t take new grads).
”because the government says so” is probably in reference to the joint commission. Having had the honor (please note sarcasm here) of sitting down with a surveyor for TJC, I absolutely can tell you that half of the stuff that came out of my mouth was not what I wanted to say and that they live in delusional bubble. I don’t always go by the book, same with all the other experienced nurses in my unit because when a patient is crumping you do what you have to to keep them alive and from coding. I can tell you I’m not by the book and government approved with titration of vasopressors and sedation at times- but I’m experienced enough to be able to tell what the situation requires. I certainly am not going to let a patient potentially code because the order states “start at 2mcg and titrate by 2 every 5 minutes for a MAP of 65-70” when the pt’s SBP is in the 40’s-50’s with MAPs in the 30’s. That’s just one easy example off the top of my head.
It is WAY too soon for you to even be worried about giving report. You need to listen and take note of how report is given. My preceptor in the ICU had me practice and give report to her to get everything down before I started to give report to the next shift.
You could have introduced yourself to the night shift nurse. They could have introduced themself and asked who you are. I’ve gone up to new people in my unit and said “hi, are you new to the unit? I’m Ace and welcome”. Introductions aren’t just your preceptors responsibility. We also try to introduce/highlight new staff or visiting staff at our daily huddles.
Two shifts in is really way to early to be so judgmental of your preceptor, especially when you have zero real world nursing experience under your belt. I hope you go back with a more open mind and give it some more time. I also hope you sit down with your preceptor and educator to discuss what you need before making any changes.
When I asked her when I can do medications, assessments, or anything she just said "Yeah I guess you can do this" I just looked at her in disbelief and just went to the bathroom and cried.
Two shifts in and already hitting snowflake-crying mode? In reaction to the statement "Yeah, I guess you can do this."??
Agree that two shifts is too soon to make a call about this. Your preceptor is not a mind-reader, so you probably just need to communicate some of this to her. No, you will probably not get to do everything you want right away even after you talk, but you will gain a better understanding of her rationale for taking it slow. When she does things not strictly by the book, ask why! Not accusingly, just, "In school we learned it this way; is this a better strategy? Why?" (Obviously if it's something blatantly unsafe, you will not emulate this behavior.)
I feel like these scenarios are why it's kind of helpful to have a few preceptors instead of one dedicated one. As a newer nurse, I found it very helpful to see how different people organized themselves, completed tasks, and explained things to patients and doctors; plus, when one preceptor was stressing me out, I knew that maybe next shift I'd be with someone else and we'd get a break from each other. Now that I've precepted a few times myself, I don't feel as much pressure to be everything and teach everything to the new employee, because I know they're getting to learn from the entire team. That way I can concentrate on that shift and the learning opportunities presented that day.
Both sides of this equation are tough! Have a little patience with your preceptor, communicate openly, and assume the best about her! If you can do that, I think in a few weeks things will be a lot smoother for you two.
Cowboyardee
472 Posts
Her preceptor has been there for 7 years. If her unit manager doesn't already have a pretty good idea of how she practices and her M.O. as a preceptor (and she isn't brand new to the unit herself), the unit must have bigger problems.
If, on the other hand, the manager is new to the unit and legitimately doesn't know these things, the OP would be wise to exercise caution before inserting herself further into unit politics than she needs to be at this point. She has no allies yet and any manager happy to use a new grad as ammo against established staff isn't necessarily looking out for the long-term interests of the new grad anyway. Even if the OP ultimately asks for a new preceptor, she really shouldn't blindly launch a crusade against established staff.