we often see threads with the title "fired for no reason," or "new grad harassed and fired" or something to that effect. and i always feel at least a little sympathy for the individual involved, if only because i can clearly see by reading between the lines of their self-justifying post that there was a reason for their termination, even if they just don't get it. (there are always a few posts every year from a new grad who is convinced that the reason she's not getting along with her co-workers is that she's just so beautiful they're all jealous, that crowds of mean people are following her around, that she's so wonderful she's going to rock the er or icu or nicu or or and no one sees her wonderfulness clearly, or that some mean, tired, old nurse who ought to retire and get out of the way is targeting her for no good reason.)
i worked with a new grad who was recently terminated for, as she puts it, totally bogus reasons. evidently seeing mine as a sympathetic ear, she went on and on and on about how unfair it was that management expected her to get her act together and actually understand what was going on with her patients. "i've got the time management thing down pat," she said. "i don't know what else they want. they're just picking on me for no good reason." i liked sal, i really did. she was interesting and entertaining and really, really nice. she was also smart, hard-working (when she was at work) and well-educated. but she didn't study outside of work, and really didn't understand what was going on with her patients. i participated in several meetings with her in which it was pointed out that it's not enough to do the tasks, you have to understand why you're doing them. it's not enough to draw the labs. you have to understand what the results mean and then address them. for instance, if the inr is 9, it might explain the nosebleed, the cherry red urine and the fact that the hemoglobin is now 6. giving the coumadin at 6pm as scheduled is not a good thing, even if you gave it right on time and were able to explain to the patient that "it's a blood thinner." i could go on and on.
i got a call from sal today, complaining that she knows she's blackballed for no good reason because she just can't get another job. she wanted me to give her a reference. did she just not get it?
all you new grads out there who are convinced that you're being picked on for no reason, that your more experienced colleagues are just out to get you, and that you're being unfairly targeting, harassed, or picked on, hear this: it may be something you're doing (or not doing) and all those "mean people" are trying to explain it to you so you catch on, learn your job and succeed. we all tried over and over with sal, and she still doesn't get it. are you guilty of the same thing? if your preceptor says you lack critical thinking skills, do you take it to heart, think about it and learn from it? or are you convinced that the entire issue is that she's jealous of your extreme good looks? if your charge nurse charges you with a deficit in your time management skills do you spend time figuring out where you could speed things up a bit? or do you dismiss her as a tired old dog who can't learn a new trick and ought to retire anyway? are you taking to heart and benefitting from any negative feedback you're getting, however poorly given it is? or are you obsessing about how "mean" that nurse was to you and totally overlooking the message?
i wish sal would have "gotten it." she would have been delightful to work with if she had. but right now she's focused on badmouthing her preceptors and the charge nurse, and she still doesn't understand what she did wrong. don't make the same mistakes.
That may be true but there a few things to consider, that IMHO, many that take on the not-so-easy role of precepting DO NOT UNDERSTAND. (And carollady, I totally get what you are saying as well.) As I was saying, the way you instruct adults IS MUCH DIFFERENT then how you instruct children. Seriously, so many don't get this. They may not mean to be unhelpful and condenscending, but the results are the same for the person on the other end.
Also, with most helpful instruction, the process is a combination of both show and tell or tell and show. It's like say one, see one, do one. It can be very frustrating to someone new to a place to have them figure out things pretty much for themselves. Why? Even the process of locating materials is altogether too time consuming, and no one really cares why you are five or more minutes past the deadline for a med--particularly when you have a bunch of other IV meds to run on a pump--or you have another line, but you have to triple check you approach as you stop one med in a concurrent line due to the need to flush and run and incompatible drug. You can get behind real fast, especially in a critical care unit or on a busy tele floor. It isn't wise to often take that, go and figure it out approach. You have to use your head and be as supportive and helpful as possible. Trust me, if you and the orientee are careful and dedicated nurses, you won't be making her too dependent. More than likely she or he wishes to be independent, but if wise, knows that that has to be deferred until the familiarity and comfort level comes.
Furthermore different people have different styles and needs for learning. This is why they shouldn't allow just anyone to precept even with one of those fly-by-night precepting courses, and neither should they allow any person with CNS or advanced practice or the like to be the nurse educator. Well-educated nurse educators will learn and understand the different styles of learning--much like most teachers must learn this.
Some folks are more auditory, some are more visual, some more kinesthetic, many are some combination of these with varying dominances.
Hospitals are doing themselves huge injustices when they don't have a sound program of education--the right tools, and right teachers, and the right attitudes, and the right, objective measureable processes in place. More nurses are lost through this and the lame personality type of weeding out processes. Hospitals waste sooo much money b/c they don't get this. They think, "Hey, we hired the wrong person." More times than not, it isn't about that in nursing. Those few that shouldn't be nurses or that are not meant to work perhaps right away if ever in the particular area ARE MUCH MUCH LESS THAN THE EDUCATORS, MANAGERS, and administrators want to admit. They need to learn how to do the job well, with real insight, patience, perserverance, and commitment. They they would have more loyal, effective, and dedicated nurses then they would know what to do with. But perhaps in some cases that is the point. Sometimes I wonder if it is just a matter of playing shell games with the budget and approach and appearing to be committed to Magnet requirements, etc. Those hospitals and "leaders" know who they are. . .and it WILL catch up with them eventually.
I have found this thread great to read! It reminded me of my initial preceptorship experience.
When I was first preceptoring as a new grad onto a peds unit, I was paired with an older, very experienced nurse. She refused to answer any of my questions! AND SHE WAS FABULOUS. She wouldn't answer my questions, but went about showing me how to find the answers I needed. How to look things up in the policy and procedure manual, in text books, in journals (all pre internet access) and how to phone pharmacy or get the resources I needed. Whenever I asked a question, she would send me in the direction of the answer, and take the time to look things up with me. I remember thinking how generous she was with her time, and how valuable these lessons were. It would have taken her way less time to just answer my questions, but I learned so much more through her teaching.
What was really interesting was a nurse who had preceptored onto the unit about 6 months prior to me with the same nurse and described the nurse preceptor as unhelpful and not knowing anything! This other new grad nurse's interpretation of the acts of "making her" look things up and phoning pharmacy etc was a sign that the preceptor didn't know her stuff.
Interesting isn't how we see things! By the way, this preceptor "knew" her stuff, and her lessons of looking things up for myself and verifying information are things i have used through out my nursing career.
Bravo. "The mark of a well educated person is not necessarily in knowing all the answers, but in knowing where to find them" ~Douglas Everett. This is my favorite quote related to education. Knowing that you can look it up, that you know where to look, this gives you power and independence. Whenever a staff mem ber asks me a question I try to either tell them where to look, or show them where it is and we look it up together. I think your preceptor was wise.
i don't ever want to compromise patient care for the sake of ego.
I love this sentence. You could say the same thing to some preceptors who worry about whether the orientee will be "loyal" to the unit, or leave within a few months. Even if that orientee only worked one day, as a preceptor you owe it to the patients to tell the orientee everything they need to hear and know. It's still about the patient, right?
We had a new grad on one of our tele floors quit recently "Before this place makes me lose my license." Okay, there are some places that are that bad. But our facility is not one of them.
In ONE WEEK, she managed to:
Give meds to the wrong patient on at least three different ocassions
Leave blood transfusing as the patient spiked a temp from 97.8 to 102.2
Attempt to start an IV into a dialysis fistula (and then insist that "once they don't work anymore, they need to take them out somehow so we can use those veins")
Not recognize sustained V-tach; then, when it was pointed out to her, had no idea what to do about it, didn't even go to check on the patient
Left a femoral sheath open so that the patient bled all over the freaking place
Draw a PTT on a pt on a heparin gtt from the IV access that the heparin was infusing into, thus destroying the access on an impossible stick and getting a PTT result of >200, so she shut off the gtt (this was on a patient with new positive Troponin I's)
Push undiluted Lopressor over about five seconds on the above patient, without checking the BP/HR first, resulting in a drastic and sudden bradycardia into the 20's
Sure, it's our facility's fault that you got your license out of a Cracker Jack box. Seriously, I have little patience for nurses who fall into this category...she knew it all, and would yell at you if you tried to help her, then disappear as you fixed the screw ups she caused.
So I know exactly what Ruby is talking about. There are many sad points to this... One, she should have been let go. I'm sorry, I may get flamed for this, but the learning curve in nursing is steep for a reason; people's lives are in our hands. If you can't hack it after a reasonable amount of time, you should be out. Two, her lack of skills and knowledge placed an unfair burden on the rest of us. Three, she'll probably never figure out just why she didn't succeed, since nothing is ever her fault, and she'll be dealing with traipsing from job to job until she does lose her license...that can't be a fun life. And most importantly, how many people will she seriously harm or even kill before it gets to that point?
I can look back and see some pretty stupid stuff that I've done over the years, but never anything of that caliber.
It is hard when you're faced with criticism, I'll allow that. I had a HORRIBLE yearly eval a few years ago. Prior to that one, I had always gotten "exceeds expectations". That year, I barely scored high enough to get my raise. I went home, fumed, cursed, cried, and yelled about it. The next shift I worked, I pulled a few of the people whose opinions I trust aside, told them that I had some questions that I wanted honest answers to, and showed them my eval. Mostly, the response that I got was "What did you do to tick her off so much?". But there were a few areas that I thought I was doing fine in that my co-workers told me I was doing adequately, but could do better. At first I was a little hurt, but after a few days of reflection I realized that maybe I could improve. It took a level of maturity that I don't think I had when I was 22 and a new grad.
We had a new grad on one of our tele floors quit recently "Before this place makes me lose my license." Okay, there are some places that are that bad. But our facility is not one of them.
In ONE WEEK, she managed to:
Give meds to the wrong patient on at least three different ocassions
Leave blood transfusing as the patient spiked a temp from 97.8 to 102.2
Attempt to start an IV into a dialysis fistula (and then insist that "once they don't work anymore, they need to take them out somehow so we can use those veins")
Not recognize sustained V-tach; then, when it was pointed out to her, had no idea what to do about it, didn't even go to check on the patient
Left a femoral sheath open so that the patient bled all over the freaking place
Draw a PTT on a pt on a heparin gtt from the IV access that the heparin was infusing into, thus destroying the access on an impossible stick and getting a PTT result of >200, so she shut off the gtt (this was on a patient with new positive Troponin I's)
Push undiluted Lopressor over about five seconds on the above patient, without checking the BP/HR first, resulting in a drastic and sudden bradycardia into the 20's
Sure, it's our facility's fault that you got your license out of a Cracker Jack box. Seriously, I have little patience for nurses who fall into this category...she knew it all, and would yell at you if you tried to help her, then disappear as you fixed the screw ups she caused.
So I know exactly what Ruby is talking about. There are many sad points to this... One, she should have been let go. I'm sorry, I may get flamed for this, but the learning curve in nursing is steep for a reason; people's lives are in our hands. If you can't hack it after a reasonable amount of time, you should be out. Two, her lack of skills and knowledge placed an unfair burden on the rest of us. Three, she'll probably never figure out just why she didn't succeed, since nothing is ever her fault, and she'll be dealing with traipsing from job to job until she does lose her license...that can't be a fun life. And most importantly, how many people will she seriously harm or even kill before it gets to that point?
I can look back and see some pretty stupid stuff that I've done over the years, but never anything of that caliber.
It is hard when you're faced with criticism, I'll allow that. I had a HORRIBLE yearly eval a few years ago. Prior to that one, I had always gotten "exceeds expectations". That year, I barely scored high enough to get my raise. I went home, fumed, cursed, cried, and yelled about it. The next shift I worked, I pulled a few of the people whose opinions I trust aside, told them that I had some questions that I wanted honest answers to, and showed them my eval. Mostly, the response that I got was "What did you do to tick her off so much?". But there were a few areas that I thought I was doing fine in that my co-workers told me I was doing adequately, but could do better. At first I was a little hurt, but after a few days of reflection I realized that maybe I could improve. It took a level of maturity that I don't think I had when I was 22 and a new grad.
I totally see what you are saying here--absolutely. But trust me. You have to know by now that there are a significant number of nurses that are very safe and intelligent and caring practitioners that get weeded out b/c of the ridiculously subjective mentalities of others nurses and nurse managers based PRIMARILY ON PERSONALITY. I been a nurse for more than one decade. I have seen it over and over and over and over ad nauseaum.
You are talking about someone who needs complete remediation and very close mentoring to get her to be safe--and even then, who knows. This person needed a more controlled and regularly measured precepting/orientation. Sounds like someone let her off of it WAY TOO SOON. And I might guess that regular measures and meetings for progress were not gone over every week. Apparently this person was smart enough to quit before she was fired.
OTOH, there are very intelligent and competent practitioners as myself and a number of others mind you that have been let go for simply being a tad bit outspoken. And by that, I don't mean not willing to accept constructive direction as to how said particular unit does thus and such--or being disrespectful or insubordinate--even I agree or not, unless it is unsafe,unethical, or immoral, I follow direction, period. I stated to the preceptor, while adjusting to nights again and coming down with the most horrendous flu symptoms over something so ridiculously simple, "Fine, we'll do it you way." I said it again with regard to paperwork, which was secondary to the higher priorities needs of a patient with a thrombus that could not be anticoaguated for a couple of reasons. When he was upset that the paper work, which was required for a send-out and was not critical for that moment or even two hours thereafter (which by the way I had started), I responded, "Fine, we'll do it your way." There are a few other instances very, very similar and relatively benign in interactions, and for that, admiting that clinically I was on the ball, they let me go. Said, lol, I wouldn't fit with the team. Hmmm, well, I have busted my butt to help any team I've been on. Something just wasn't right about the whole thing, and I kept ignoring the little voice in my head and the feeling in my gut. I believe in a team that truly commits to being collegial with each other--not covert games that are rationalized as "good team formation." That's not the way to get a team of excellence anyway. I am beginning to think that they found someone that they could bring in for $15,000 less per year--and in this economic nightmare that hospitals are even having to contend with, that's what they did. I suspect something like that may indeed be part of it.
At this point, I will learn what Ican about myself and how to be Oh so very careful with every miniscule thing I say or show on my face. And I will learn to be more observant about the dynamics and listen to that voice in my head and the feeling in my gut--and if it's telling me to move on, I am going to move on.
This is the problem when you get let go. People assume it is for the kinds of incompetencies that you have described mama. The next potential employer or others in the field do not necessarily know that you are let go for reasons that have to do with personalities and games that have nothing to do with you being a very effective, competent clinician or have nothing to do with you being a collegial, cooperative, loyal employee.
They have to start developing objective systems of evaluation with regular and full documentation. Why should a good nurse's reputation be put on the line for nonsense? And it happens a lot more than you may think.
I would like to know who makes the rules in regards to what is the Right way to handle something and what is the wrong way to handle it. I have read alot of posts at direct ends of the spectrum. What makes one right amd the other one wrong? So many times a single bit of information can change the whole story. How many people have missed that one unseemingly important piece of info in their story telling?
Remember this.....There is no one who is harder on the self than the self. Sometimes people are looking for someone to help them sort through all the self doubt and find guidance as experienced nurses do we look the other way or help our babies?
Guest343211
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That may be true but there a few things to consider, that IMHO, many that take on the not-so-easy role of precepting DO NOT UNDERSTAND. (And carollady, I totally get what you are saying as well.) As I was saying, the way you instruct adults IS MUCH DIFFERENT then how you instruct children. Seriously, so many don't get this. They may not mean to be unhelpful and condenscending, but the results are the same for the person on the other end.
Also, with most helpful instruction, the process is a combination of both show and tell or tell and show. It's like say one, see one, do one. It can be very frustrating to someone new to a place to have them figure out things pretty much for themselves. Why? Even the process of locating materials is altogether too time consuming, and no one really cares why you are five or more minutes past the deadline for a med--particularly when you have a bunch of other IV meds to run on a pump--or you have another line, but you have to triple check you approach as you stop one med in a concurrent line due to the need to flush and run and incompatible drug. You can get behind real fast, especially in a critical care unit or on a busy tele floor. It isn't wise to often take that, go and figure it out approach. You have to use your head and be as supportive and helpful as possible. Trust me, if you and the orientee are careful and dedicated nurses, you won't be making her too dependent. More than likely she or he wishes to be independent, but if wise, knows that that has to be deferred until the familiarity and comfort level comes.
Furthermore different people have different styles and needs for learning. This is why they shouldn't allow just anyone to precept even with one of those fly-by-night precepting courses, and neither should they allow any person with CNS or advanced practice or the like to be the nurse educator. Well-educated nurse educators will learn and understand the different styles of learning--much like most teachers must learn this.
Some folks are more auditory, some are more visual, some more kinesthetic, many are some combination of these with varying dominances.
Hospitals are doing themselves huge injustices when they don't have a sound program of education--the right tools, and right teachers, and the right attitudes, and the right, objective measureable processes in place. More nurses are lost through this and the lame personality type of weeding out processes. Hospitals waste sooo much money b/c they don't get this. They think, "Hey, we hired the wrong person." More times than not, it isn't about that in nursing. Those few that shouldn't be nurses or that are not meant to work perhaps right away if ever in the particular area ARE MUCH MUCH LESS THAN THE EDUCATORS, MANAGERS, and administrators want to admit. They need to learn how to do the job well, with real insight, patience, perserverance, and commitment. They they would have more loyal, effective, and dedicated nurses then they would know what to do with. But perhaps in some cases that is the point. Sometimes I wonder if it is just a matter of playing shell games with the budget and approach and appearing to be committed to Magnet requirements, etc. Those hospitals and "leaders" know who they are. . .and it WILL catch up with them eventually.