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!!!
And NEWSFLASH: It is exhausting and A LOT OF WORK to precept students & new grads especially in places like the ER & ICU where they have zero clue, and you have to explain everything.
Excellent point. Precepting a fresh new grad makes your workflow so slow since you have to stop and explain every little thing that you're doing. It can create a huge time crunch. Therefore, at the beginning, preceptors have to prioritize what is worth slowing down to explain and what they need to just do themselves.
If it's your first week, I'm going to take an extra hour to walk you through the basics like safety checks, assessments, rounds, etc. If we have a higher-level skill later on in the shift like stringing complex lines, starting a PIV, doing a dressing change, there may not be time to stop everything and let the orientee attempt it because we're probably already running a bit behind. I want my orientee to watch, but there simply may not be time for them to attempt everything during that first week. That's why orientation is several months: you're not going to get everything all at once.
But to the original poster, seriously, who cares? Lots of people take ADHD & other psychotropic medications, Judgy McJudgerson. to improve their quality of life.
While I agree with you on this I do think that there are things that do not need to be shared with what amounts to be perfect strangers (sorry Facebook fans). If I needed to take a medication (regardless of type) I think I would just take it and not advertise what it is. Also I don't think I'd be popping anything where a patient/visitor could possibly see me. That would have the potential to open me up to questioning.
While I agree with you on this I do think that there are things that do not need to be shared with what amounts to be perfect strangers (sorry Facebook fans). If I needed to take a medication (regardless of type) I think I would just take it and not advertise what it is. Also I don't think I'd be popping anything where a patient/visitor could possibly see me. That would have the potential to open me up to questioning.
Good point. Popping pills right out there on the unit is how rumors start. (And worse...)
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.
One of the best pieces of advice I got from my mom (retired from nursing after 40 years) : You are at work to help your preceptor, not the other way around.
I did central line care the other day, and I did not know where the sterile gloves were. So.. I had to get gloves from a new box and put them in a specimen cup instead. (Shh.. it is a "secret").
I used to take my antidepressant at night instead of during the day like it is prescribed. Technically that did make me a prescription pill abuser. (Thankfully, I have had the support to get through that habit and problem).
"I went into the profession because it is a helping profession. Customer service is dependant on team work. No one single person is responsible for the team." --thoughts/words of every single interviewee ever.
Congratulations on landing an ICU job straight from nursing school. I would have loved that opportunity, but ironically i was dealing with PTSD from an ICU internship.
Some work cultures are pretty disparaging, so please do not overanalyze this. No nurse has ever gone into the profession to try to hurt a patient or eat a new nurse alive. Remember the last time you had a bad day and remember who helped get you out of that slump and what is was specifically that they did or didn't do.
The OP says her preceptor took Adderall “around noon” in front of her. I take that to mean she took it at lunch. Which is usually somewhere private, not in front of pts and visitors.
Why should she hide taking her medication? I don't see a problem with that. I do have a problem with how much of the public is reliant on Adderall, caffeine, nicotine, etc. We shouldn't need all of that to function and without a doubt Adderall is over prescribed, but if she has a prescription, what do you care?
I notice that all the "my preceptor is terrible" posts seem to come from nurses new to the profession. I think the problem is more reality shock than bad preceptors. IMO more clinical time during school is needed, any procedure on paper is going to be different IRL, especially if it involves a confused patient and prioritizing five others.
I thought everyone was a fabulous nurse. My CI was unskillful RN who I didn't see perform nursing procedures, nada. In my nursing school with high acuity patients, I learned my skills from the floor nurses. On the other hand, my CI had so much negativity about RNs in general. For her, you're inferior if your RN is below MSN. I was listening like a wall to her complains and rants how mediocre nurses are. When I looked her up, I found out she had a few records. LOL! I can smell it when a person is insecure.
Sorry, but 3 shifts is not long enough to start criticizing your preceptor. I wouldn't be letting you do much by day 3 either. Sounds like her manners are a little rusty, but I would give her a break. Take this time to look around at the atmosphere, politics and such on the unit. There's so much more to learn than how to "titrate" drips.
Sorry, but 3 shifts is not long enough to start criticizing your preceptor. I wouldn't be letting you do much by day 3 either. Sounds like her manners are a little rusty, but I would give her a break. Take this time to look around at the atmosphere, politics and such on the unit. There's so much more to learn than how to "titrate" drips.
This is my favorite motto: "If I am walking with two other men, each of them will serve as my teacher. I will pick out the good points of the one and imitate them, and the bad points of the other and correct them in myself." --Confucius Since then, I'm fine with people unless they're that unethical and breaking laws then I would say something or stay away.
Girlfriend, I wouldn't complain about a preceptor taking their PRESCRIBED medications in front of you. For people that take prescription medication, 12 hour shifts generally necessitate that.
adventure_rn, MSN, NP
1,598 Posts
Excellent point. Precepting a fresh new grad makes your workflow so slow since you have to stop and explain every little thing that you're doing. It can create a huge time crunch. Therefore, at the beginning, preceptors have to prioritize what is worth slowing down to explain and what they need to just do themselves.
If it's your first week, I'm going to take an extra hour to walk you through the basics like safety checks, assessments, rounds, etc. If we have a higher-level skill later on in the shift like stringing complex lines, starting a PIV, doing a dressing change, there may not be time to stop everything and let the orientee attempt it because we're probably already running a bit behind. I want my orientee to watch, but there simply may not be time for them to attempt everything during that first week. That's why orientation is several months: you're not going to get everything all at once.