shouldnt precepting be teaching , not working?

NeosynephRN · Dec 1, 2008

I hope you find something that you like better....however if it were me I would stick it out with the new preceptor, and see what happens. When I started as a new grad in the ICU I only had 3 months orientation..and I learned a ton more when my preceptor started to leave me alone. At nine weeks in I do not think it is totally unreasonable to be "on your own" with a person to bounce things off of? Have you addressed these issues with anyone, besides when you "quit"? I mean if they do not know you are having a problem they cannot really fix it!

As for the ratio's I am not sure what you expect...we are always 2:1 in the ICU...at times 3:1. Very rarely will you get a 1:1 espically when you are a new grad, the 1:1 patients are that way for a reason they are more work than 3 patients...I wish you the best of luck finding what you desire!!

marilynmom, LPN, NP · Dec 1, 2008

I am in my 9th week of being a new grad working in the ICU. I was being taught for the first 2 weeks but then they put me out there working and helping me if I have a questions, now Im not being taught at all and my preceptor is telling me Im not catching on fast enough.
Shouldnt my 12 week oriantation be me working next to her learning?
There is none of this, its me working and then she reviews my work and critisizes me that Im missing things.
Im very discouraged.
P.S. my ICU oriantation is only 3 months while most ICU oriantation 6 months, doesnt this sound fishy to you?

Sorry your having a hard time. I graduated in May and went into ICU as well--ICU is a hard place to work, especially as a new grad. Are the nurses you work with supportive of new grads?? When you do ask questions do they answer them?

No, orientation is not working 'right with' someone. You NEED to be out there doing most of it on your own! My preceptor, after a week or two, was around but not right by my side at all. She wanted to me figure stuff out, know when to call the doc, use my critical thinking skills, etc. In and ICU you have to be able to learn fast.

My ICU orientation was 10 weeks and most places I know is 10-12 weeks.

At the end of the 10-12 weeks you need to be able to take on 2 patients on your own. That is what they should be preparing you to do.

marilynmom, LPN, NP · Dec 1, 2008

Yes, in reality, Ive gotten a 2 week oriantation. We have three open positions on days that no one is applying for, the ratio is always 2 patients and sometimes three, which I think is dangerous.
My boss has assigned me to a new preceptor because I broke down and quit, she convinced me to come back and train with a different preceptor. To be honest, Im looking for a new job tommarow, I now have ACLS and three months under my belt, so Im not experianced but maybe someone will take me in?

2:1 in ICU is normal. I sometime I have 3:1 if they are basically going to the floor the next day. 1:1 is for the super duper sick and that isn't what you want as a new grad! LOL! 2:1 sound about right, I ALWAYS have 2 patients.

Also realize as a new nurse your GOING to feel like breaking down and quitting....check out the New GRad forum here! Its' very normal and common to feel that way. Your going to be overwhelmed and feel like you don't know what your doing, etc.

Every single day at work I have stuff that I don't know about, have never seen, etc. My job is to know who to call and who to ask questions to.

beachbum3 · Dec 1, 2008

I don't know. I think you ought to try to talk to your preceptor and let her/him know you need more direction. I personally was taking patients on my own with my preceptor checking charting etc after a couple of weeks. I tend to ask alot of questions anyway and I preferred being more hands on and kind of left alone, because if there was something new I hadn't seen before, I'd always ask what the best way to handle it was. Also, my preceptor would kind of meet with me once we got our patients and fill me in on any "extras" beyond the usual routine that needed to be done. I think that it just depends on the person whether or not the type of orientation you've had would be effective. I'd prefer it the way you are getting it, but then you would prefer it to be different... everyone has a different learning style.

MB37 · Dec 1, 2008

My orientation is 16 weeks, and I'm about 6 weeks in. I basically take care of my two patients (we never have three, thankfully), while my preceptor is available to answer questions and to demonstrate things I don't have any/much experience with. She goes in and assesses them in the morning and periodically to make sure I'm not missing anything, and she'll notice if I'm really behind and pitch in, but she's really just supposed to be a resource for me. If your preceptor isn't available to you, or has her own patient load on top of yours, then there's definitely a problem. What does she do while you're taking 2 pts? At least for me, this system works well, but my preceptor is always there if I do need her for something.

Creamsoda, ASN, RN · Dec 1, 2008

To a certain degree, yes they should actively be teaching, but, by the end of the 3 months, will you be on your own? If so, then these last few weeks you need to take patients on your own to make sure you can actually handle the load with a resource person to answer your questions and to help you when you really need it. Where im from, we go through a 6 week critical care course, and 5 weeks of orientation/clinical, then thats it. If we think we need more, they will give us more. Talk to your educator and ask what the expectations are, and just make sure you are always asking questions, and approach your preceptor with scenarios to discuss to keep the teaching going. You also need to be an active participant. Make sure you are always offering to do things, do the hands on things over and over while you have someone there so you know your doing it right.

Batman24 · Dec 1, 2008

I would see how things go with the new preceptor. It sounds like they are trying to get you the help you need. Tell your new perceptor exactly how you feel and ask questions when you are unsure. I would also ask for feedback on what you are doing right and wrong because that is how you will learn and grow. I'd give them a chance to right the ship as it sounds like they might be worth.

Also, you won't be standing by watching your preceptor nor will they be standing watching you the entire orientation. If someone told you that they gave you wrong information. Two weeks was too soon but at about six weeks you should be on your own with them supervising you and available for any and all questions you may have. They do this so at the end of orientation you will be able to handle your patients alone and have built up some confidence in doing so as well.

As a new nurse you will always feel a little insecure and unsure of yourself. That doesn't go away for some time. The 2:1 ratio is normal in ICU and if it goes 3:1 it should go to a more experienced nurse.

Candycornrocks · Dec 1, 2008

Ideally, your preceptor should remain with you the entire time you are orienting. I think 2 weeks is too short! Do you have an education liasion that you could go to about this? I would start there. It is better to give you adequate/safe training up front so that you will learn and STAY!! Good Luck!

Aneroo, LPN · Dec 1, 2008

I wanted to add- she might be a wonderul preceptor under the right circumstances. If you're short staffed, she might be trying to help others as well, and taking on a load bigger than what she should.

PiPhi2004 · Dec 1, 2008

The ICU is a tough place to hang for a new grad, but my question is, how is the acuity of this ICU? In some places, having a 3:1 isnt a big deal because the patients aren't so sick.

I would personally sit down and talk to you preceptor and make some goals of where you want to be at the end of your orientation. What are you nervous about? What are you not getting? What are you not doing fast enough? Make a list and talk about how you can accomplish those goals. You will be lost sometimes and you will want to feel like quitting, but I think quitting is a bad idea unless the conditions are completely horrendous and people are asking you do unethical things or giving you assignments no one can handle. I'm sure they want you to succeed at what you are doing but you do have to take some initiative into making it known, specifically, what you need experience with.

I am sorry about the experience you are having. Being a new grad in the ICU is extremely difficult and it's a rough transition no matter who you are/where you work. I hope all works out for you one way or another. :heartbeat

jjjoy, LPN · Dec 2, 2008

Isn't part of the problem here expectations? Students are often reassured by instructors that they will have plenty of time & support to learn what they need to know during their orientation/preceptorship. Why wouldn't they assume that would mean more than 3-6 weeks of quickly ramping up to the full gamet of responsibilities that every nurse is expected to take? Is it unreasonable for the student to expect more from their orientation/preceptorship than "Here's your assignment - let me know if you have any problems and I'll help out where I can" ?

And how reasonable are the expectations & time frames new grads face? Given how little most nursing clinicals resemble real world nursing, it is asking an awful lot to expect newbies, within just a few short months, to take responsibility for the full load that experienced nurses are expected to take. Is there any accounting for the fact that the newbie will most certainly be slower in order to be safe and to effectively learn?

Just how far can we expect newbies to get in a few short months when starting out involves so many aspects to cover: practice a slew of brand new, practiced-on-dummy-once skills; figure out how to more quickly perform all these not-yet-mastered skills; work with diagnoses and treatment regimens that are unfamiliar - perhaps seen one or twice total in school; just begin to develop clinical judgement - with lots of feedback from more experienced colleagues; figure out how to quickly & adequately assess patients (the newbie might overlook something important if they try to mimic the speed of an experienced nurse too soon); practice real world prioritization; learn facility policies, admit and discharge procedures, charting methods & computer programs - and then become faster at it (keeping in mind that this isn't just a new workplace, it'a whole new job role tossed in with utterly novice skill sets);interact with physicians, nurse managers, nurse colleagues, ancillary personnel for what's likely the first time in the nurse's role; taking time to review one's work, correct the inevitable mistakes, access resources and references - etc.

When experienced nurses, with their fine-tuned assessment and clinical skills and with facility policy and procedures engrained in their day to day practice, are hustling their whole shift to get everything done, how in the world can we expect an inexperienced newbie, in just a few months, to get anywhere close to adequately meeting the many demands placed upon them?

pagandeva2000, LPN · Dec 2, 2008

If I sounded unempathetic, I sincerely apologize. I don't believe that people are responding with a lack of compassion, but are saying that at least, your supervisor is giving you more than most gave us...another preceptor. This person may, in fact, be what the doctor ordered, so to speak. In addition, in spite of what you may believe, you may have already learned, even under the strained circumstances, and if this person can sort of tie the loose ends, it may end up a bit more positive.

I am not placing blame on you. I just received my license in the middle of 2006 and there are some situations that I am still not clear with. Of course, there is a clear difference in the way that LPNs and RNs have to function, but it is still scary. This supervisor may silently agree that this system sucks, therefore, is trying to at least give you a chance to work with someone else that may be more agreeable with your learning style. If you find, that even with a new face to work with, that it is still a negative situation, then, of course, leave. It is not worth your license that you worked so hard to obtain. But, I really believe that the supervisor is at least trying. And, giving it your best shot will leave no question in your mind that you tried to be flexible, IMHO. Good luck...I really wish you the best!