Preceptor is SO BAD!

40 minutes ago, TitaniumPlates said:

i agree jed. she does have an attitude of entitlement.  not attack, because she is frustrated and frightened.  she needs GUIDANCE and LEADERSHIP.  not attacks and the "i am the attitude adjustment police".

give her decent, relevant advice or like my momma taught me...keep it to yourself. its not helping the new nurses cope or integrate.

she is scared. i was where she is. i got the craptacular preceptor who told me to "get in there!!" in my first trauma...no guidance, no help, only attack and criticism afterwards.and he was a 10 year veteran who was just SO LOVED and respected.

help her. that is what she has reached out for. there is a way to redirect her without calling her names and being demeaning.

Part of the problem for this kind of topic is that it really lends itself to projection. People who've had genuinely useless or malicious preceptors can easily imagine the OP as themselves and cast the nightmare preceptor from their own past as the OP's foil. Meanwhile all of us who've had the displeasure of precepting a new grad who has no idea how little she actually knows but nonetheless runs to administration every time she sees anything different than what she learned in school and cries about being bullied anytime someone tells her she's wrong... well, we can easily imagine the OP to be that particular new grad. 

The truth is probably that neither one quite fits, but ALSO that two shifts is definitely too early to tell. All I can say with any certainly at this point are the following 3 bits of advice:

- Be patient. 2 or 3 shifts is too soon to know the lay of the land.

- OP does need an attitude adjustment. Not because the preceptor is necessarily in the right but because the OP's attitude surely isn't helping things in either case. 

- The OP should quietly and carefully cover her own butt. 

 

35 minutes ago, TitaniumPlates said:

i agree jed. she does have an attitude of entitlement.  not attack, because she is frustrated and frightened.  she needs GUIDANCE and LEADERSHIP.  not attacks and the "i am the attitude adjustment police".

give her decent, relevant advice or like my momma taught me...keep it to yourself. its not helping the new nurses cope or integrate.

she is scared. i was where she is. i got the craptacular preceptor who told me to "get in there!!" in my first trauma...no guidance, no help, only attack and criticism afterwards.and he was a 10 year veteran who was just SO LOVED and respected.

help her. that is what she has reached out for. there is a way to redirect her without calling her names and being demeaning.

I will think about what you said.

I am curious about something though, and not in an attacking kind of way. Why do you all-caps GUIDANCE and LEADERSHIP but not begin any of your sentences with a capital letter? (I tutor English as a second language and this is one of the things we have to focus on with folks getting used to writing.) Is it a 'writing-from-my-phone' kind of thing or a non-conventional stylistic choice?

I had a crappy preceptor like that and desperately wanted to change, I did not.  What’s more I think they knew I was struggling because my boss asked me three times how I was doing.  She signed absolutely nothing off in my whole orientation  (another more experienced nurse had a fit when she found out my preceptor hadn’t checked off my list).  She kept saying “oh yea we need to go through your list, huh”.   Frequently she would say “I do it this way but don’t if x, y or z is around”.   Same thing with report.  Either she’d do it and ignore me or she’d interrupt me like I was some idiot. It made me insane.

My advice, get with your policies.  Read them and know them.  Make a file and keep it in your locker.  Ask other nurses questions too. Do some self study at home.  I had to go way above and beyond.

Sometimes we have negative learning experiences and sometimes we have positive experiences.  I’ve learned how I don’t want to be and I identified nurses I would like to emulate on my unit.  We had some gems who were strong nurses, organized, respectful and good teachers.  I wanted to be them when I grew up.

And yes I cried a couple of times on the way home, in frustration.  I’m not saying it’s ok but I’m darn sure I don’t want anyone else having that experience.  Certainly not from me.   

 

21 hours ago, Jedrnurse said:

Some people get skeeved out when you then start to do the dishes immediately afterwards. 

This was exactly my thought! 

Oh yes, I do think it’s important for you to stop calling her names. Even in your head. Find something good about her and concentrate on it.  Whether she stays your preceptor or not you’re on the same unit.  I would give serious consideration to a moment of quiet time in your car before shift. During that consider how you can be of service to your patients, colleagues (Include her) and employer. I do this every day.

Be classy with her no matter what and I’d suggest thanking her when orientation With her is over.

 

OP:

As many others have said. You were two shifts into your orientation, that is 24 hours! Just think about that.  What were your expectiations on your first two days on a new unit? How can you jumo into assessments and meds if you have no idea about the patient history, medication, approrpiate doses.. etc. 

If after 6 shifts things haven't changed and you are not doing any patient contact, then I think you would have some issue. But first... You should talk to your preceptor.  What was her rationale for having you observe the first two nights? I agree with others, stop with the name calling as you will automatically taint a picture for yourself. 

Starting in the ICU is tough. There is a lot to learn and you will get there. I had one preceptee that really wanted to do a specific task to feel like in her words "a real nurse". I asked her why she felt this specific tasks was one of a real nurse and she was able to tell me. After discussion, I had her look up everything that was needed and why it was important for this patient. I gave her a few hours heads up. She was able to do it talking out everything. Had she not spoken up that night, it would have been a few more shifts before this nurse was able to do it.

 

OP. I know you want to be all fast forward in the ICU, but it takes considerable time and effort to precept someone. Just take your time and you will get there. Not everything needs to be done in the first 24 hours.

She didn't sterile glove for a central line?  What the...???

 

21 hours ago, Pixie.RN said:

Seriously, though, patients have died from infections that have been traced back to nurses dumping patient waste down a sink. There have been outbreaks of Elizabethkingia meningoseptica and also Shigella from improper disposal into sinks. The things you learn in hospital epidemiology! Yuck. 

How could this happen?  Not saying it didn't, just wondering how.

As someone who recently completed an orientation in a critical care area I think I can shed some light on some things. Firstly, you got hired there, these will be your coworkers,it is important for you to bring a positive, learner attitude to the table. Take initiative and introduce yourself to all the nurses on the unit when you see them; the ownance is on you! You should also make things clear with your preceptor, I'm sure she will appreciate it; tell her what you feel comfortable with, what your goals are for the shift, week, orientation, ect. Ask her for feedback ex. "how do you feel I did this shift? How can I improve?". Take initiative, ask her if you can do things, if you can give report. Ask her how she structures her reports. Ect. ect. You need to take ownership of your learning, she will appreciate that. It's worth noting that there are many different styles of nursing and you likely did not get paired with a nursing style that is similar to your own, this is fine and happens more often then not. Take notes, learn, and encorporate what you can into your practice and leave out and change what you wish. You are an independent nurse now. There are other good comments on here regarding practice vs. theory and other concerns you had. To me it sounds like you are being very judgemental after only 2 shifts and without actually picking her brain and attempting to take initiative. If that doesn't work then get back to us. I'm sure her reputation is there for a reason.

1 hour ago, Kooky Korky said:

How could this happen?  Not saying it didn't, just wondering how.

I have the same question. I'm picturing someone having to take their hands, wipe them on the sink, then put their hands over their nose/mouth/open skin. And in that case, wouldn't the infection technically be from THAT bizarre behavior and not so much the dumping of material down the drain? I just don't understand. 

Not that pouring urine down a sink isn't gross. My private duty patient has some very strong smelling urine, and the thought of the smell lingering just grosses me out. 

Edited Nov 3 by Orion81RN

It can happen from bacteria colonizing in the sink and contaminating the sink and potentially the water supply, and contamination also occurs when liquids aerosolize when poured. Ewww. But if you pour water in bright sunlight, you'll get a good look at aerosolization. Or read this, and think about Legionella:  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277565/

A couple of other references for you:

Using the Health Care Physical Environment to Prevent and Control Infection:

http://www.ashe.org/resources/pdfs/cdc/CDCfullbookDIGITAL.pdf

Balm, M. N., Salmon, S., Jureen, R., Teo, C., Mahdi, R., Seetoh, T., … Fisher, D. A. (2013). Bad design, bad practices, bad bugs: Frustrations in controlling an outbreak of Elizabethkingia meningoseptica in intensive care units. Jounal of Hospital Infection, 85(2), 134-140:

https://www.ncbi.nlm.nih.gov/m/pubmed/23958153/
 

Interesting responses.

It doesn't matter if we like it or not, we do not impress anyone by meeting a brand new member of our team (whose training we have been asked to assist with) and fail to welcome them, fail to lay any groundwork for a relationship, fail to state any kind of very basic plan, and fail to help introduce them into this group of which we are already an established member. Generally speaking, if someone has even an inkling of concern/thought about someone who can reasonably be understood to be in the more uncomfortable position,  then these are just basic things that follow.

We work in chaotic and busy environments, but that's no excuse either. At the very least it is not impossible to say, "Looks like we're going to hit the ground running as usual. Just follow me/stick with me for now - we'll find a time later to come up with a plan." In other words, this doesn't need to be hand-holding and sharing our deepest thoughts and forging a lifelong commitment, but rather simply very briefly considering the person in an obviously less-comfortable situation.

To be fair, the unit should allow some small amount of time for the two who will be working together to get to know a tiny bit about each other and to discuss a basic plan. And it should be encouraged as an expectation that it will be undertaken seriously.