Preceptor telling me to cover things up....

[KayceeLeeRN]

So I think it is safe to say that the honeymoon is offically OVER and I have stepped into REALITY :uhoh21: ...........

I have quickly realized that nursing school is pretty far from the truth when it comes to what really goes on. I am seeing a lot of "covering up" to protect yourself type of stuff. I actually feel terribly guilty about something. Here goes.....

So other day I got an order to give K-Dur 20mEq x 3 now. I gave the first dose....then I went about my busy day, and completely FORGOT to administer the rest. The next morning in report the night nurse mentions that I need to sign for the K, my heart jumped into my throat. Once she left I called my preceptor over and I told her that I had made a big mistake, and asked her what should I do, she said "The K is still going to be low, and the md will order more, so just give that." I asked her what would happen if I just came clean and told the md that it was never given, she told me that he's one of the "nasty" ones so just give it when he orders more, because the patient needs it anyway. She then proceeded to tell me that one of the most important things I have to remember is to "NEVER ADMITT TO ANYTIHNG."

Then yesterday I had to give Dilaudid (sp?) IVP, I went to go do it but the patients IV was clotted and no good. We called the IV nurse to come and put a new one in (she wouldn't be there for an hour or so). So I'm standing there with a syringe filled with a narcotic in my hand and I ask my preceptor what should I do with this? She tells me to put it in my pocket. I ask her again, "in my pocket? are you sure we shouldnt waste it?" She told me again to put it in my pocket, and if the IV nurse can't get a new lock in we will waste it. I felt very uncomfortable walking around with a narcotic in my pocket. But I wasn't sure if this was the right/wrong thing to do. The way she told me to "put it in my pocket" just sounded very shady to me.

I just feel so guilty. Covering up like that. Is this the norm? Does this go on everywhere?? I'm not sure if this is common, or if my preceptor is showing me bad habits. I feel so naive to all of this. Can someone explain this to me???

[Tweety, BSN, RN]

I agree with Tweety and Stevielynne.

Always be honest.

That physician could send the patient home on a dose of K+ that could be dangerous on the assumption that the med was given.

NEVER chart something that is untrue.

I was thinking the same, but didn't mention it. The MD presumes her/his orders were followed and now is ordering on the presumption it was given. She may indeed decide to supplement more frequently based on the presumption that three doesn't weren't effective.

Give me the dictator by-the-book preceptor over one who advocates covering up mistakes any day.

[fultzymom]

I disagree with not telling the MD that the potassium did not get given. You always have to tell when something like that was omitted et deal with the consequences. What's done is done but I would advise not to do that again. As for putting the Dilaudid in your pocket, I have done that. If I start to give something then have to go do something else first, I have put a med in my pocket. There was no real reason to waste the medication when you needed to get the IV in et then give it. But I am with the others: why could you or another nurse not put in the IV? A hour is a long time to make someone wait if it is time a pain med could be given.

[KayceeLeeRN, BSN, RN]

But I am with the others: why could you or another nurse not put in the IV? A hour is a long time to make someone wait if it is time a pain med could be given.

I think our policy is that the RN has to have 2 attempts before we can call the IV nurse to put it in. What I have noticed is that my preceptor does not try, she looks at their arms and then calls the IV nurse. As for having this poor patient wait for pain meds, my preceptor was HUNGRY and I actually had to stop her from going to lunch so she could get me the pain med (I can't get into the narc closet myself yet). Then when I couldn't push it, she just said "we'll call the IV nurse, put the narc in your pocket, lets go to lunch." You are all right, and I am sad to admitt that I didn't think of this patient's pain because I was so distracted by having a narcotic in my pocket.

I don't know what to do. Do I continue like this? I am so afraid to say anything to my manager because I don't want to get my preceptor into trouble, I actually like her a lot. But I know this is NOT a very good learning experience for me.

[sissiesmama, ASN, RN]

Helo -- congrats on finishing nursing school!! I am an RNC with 16 years of nursing experience. I have my certification in med-surg, but I have worked in varied areas, ER, ICU, tele. Wherever you choose to work, you will meet people with different values, I know I have. I try to take care of my patients like I would like myself or my family to be cared for.

One thing that I noticed from your last posting is that your preceptor told you to put the narc in your pocket while you guys were going to eat lunch. I understand that the patient may not have had anything to stick, but as a patient or a family member I would be highly upset that my nurses went to lunch and I had to wait an hour fo pain meds when she didn't attempt a stick and my nurses went to lunch.

My point of this posting is that you may want to rethink the idea of leaving the unit, even just going to the cafeteria, ect. with a narcotic injectable in your pocket. Sooner or later that may come back to bite you in the rear, and a fellow staff member accusing you of attempting to divert the drug, even though your intention was innocent. Try to keep in mind the endless nights of sturdying for exams, getting up for clinicals, ect. You worked so hard to finish school and you DO NOT want to get your license in trouble for leaving the unit with narcotics!! I have seen this type of thing with other nurses and it did not end well.

Anne, RNC:)

[SuesquatchRN, BSN, RN]

My point of this posting is that you may want to rethink the idea of leaving the unit, even just going to the cafeteria, ect. with a narcotic injectable in your pocket.

Bad idea, that. Never leave your unit with a controlled substance on your person, including 0.25 mg of Ativan.

[Tweety, BSN, RN]

I don't know what to do. Do I continue like this? I am so afraid to say anything to my manager because I don't want to get my preceptor into trouble, I actually like her a lot. But I know this is NOT a very good learning experience for me.

You do not continue like this. But you don't have to run to your manager requesting a new preceptor either. Have a heart to heart with your preceptor expressing your concerns in a nonconfrontational manner and let her know you weren't comfortable with these two outcomes and in the future you're going to be a little more insistent in doing things by the book.

The next time something comes up that doesn't seem quite right, stop and talk about it. If the preceptor asks you do something you are not comfortable with, do not it and ask assertively to do it the right way. If you're not happy still, then use the chain of command, asking your charge nurse what to do.

Preceptors are not Gods that you have to obey every single command.

Good luck. Hang in there, you can get through this. :)

[KayceeLeeRN, BSN, RN]

You do not continue like this. But you don't have to run to your manager requesting a new preceptor either. Have a heart to heart with your preceptor expressing your concerns in a nonconfrontational manner and let her know you weren't comfortable with these two outcomes and in the future you're going to be a little more insistent in doing things by the book.

The next time something comes up that doesn't seem quite right, stop and talk about it. If the preceptor asks you do something you are not comfortable with, do not it and ask assertively to do it the right way. If you're not happy still, then use the chain of command, asking your charge nurse what to do.

Preceptors are not Gods that you have to obey every single command.

Good luck. Hang in there, you can get through this. :)

Thank you so much Tweety. I am still thinking about what I am going to do/say and I think I may go straight to the manger. I just don't feel that I am being guided in the right direction, and that is not safe for me or my patients.

[Tweety, BSN, RN]

Thank you so much Tweety. I am still thinking about what I am going to do/say and I think I may go straight to the manger. I just don't feel that I am being guided in the right direction, and that is not safe for me or my patients.

And it certainly is not the right direction for your hard-earned license. I tell you the truth the BON isn't going buy for one minute "but my preceptor told me to lie" as an excuse.

I tell my students and preceptees "don't ever ever do anything your are not comfortable doing, even if I say it's o.k. If you're not comfortable because it's new, I'll guide you. If your not comfortable for any reason we'll talk." A good preceptor is open to this idea, in my opinion. I'd tell you to come down with me but I'm taking a new position and won't precept anymore, much to my disappointment.

Whenever something "just doesn't feel right". Stop immediately and take stock of the situation.

Good luck.

[LadyNASDAQ]

DON'T YOU DARE DO THAT AGAIN!!!! You go to the Charge Nurse and get that wasted immediately. This is how to walk into lots of problems. Waste the drug. Never leave any narc in your pocket because it shows that you will give it to you or someone else.

As for the K Dur, you learned a lesson but what you should have done was do what we experienced gals do and that is a post it where you will see it. It was wrong not to report your mistake but the narc was a really bigger deal you don't ever want to do. I never listen to people who tell me to put the med in my pocket. You could have the CNO just walk in with no notice and ask that every Nurse empty their pockets for no reason. They can do it and they do it in many hospitals. You having a narc in your pocket is automatic dismissal and a severe write up to the State Boards. Just trust me.

[KayceeLeeRN, BSN, RN]

You go to the Charge Nurse and get that wasted immediately.

You are not the only person who told me to do this. The funny thing is that MY PRECEPTOR WAS the charge nurse that day. Figures.

[cybernurse81]

thats sounds wrong to me, i work as a nurse in england and pretty much everything is checked and stuff like that is picked up, u never know what may return to haunt u in the future, its always best to be honest and document what u have done or not done, it happens to all of us at some point, it's easy to forget stuff when ur under pressure all the time. at the end of the day no harm was done to the patient, but where do we cross the line when covering stuff up? we are all different and work differently, so honesty is the best policy for us all.

[cybernurse81]

by the way as for the narcotic in your pocket. its a definate no no. if u forgot to administer the k, then u may forget the narcotic too, its way too risky and in england u would be called before the matron to explain ur actions and then put on probabtion when administering drugs, its really not worth it, just waste it and always document what u have done and why, hope it hepls x