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SICU New Grad Preceptor Problems

MICU   (5,490 Views 13 Comments)
by kimpatrtan kimpatrtan (New Member) New Member

1,542 Visitors; 29 Posts

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Hi all.

I just got a post on SICU as a new grad. I have a preceptor for the next two months. I've only been with her two days but I'm already afraid I'll have problems with her.

I graduated with a BSN from a nursing program that's locally known for putting out good nurses and did well. I got 75 questions on the NCLEX. Since I found out I was interviewing for the job, I've been reviewing my advanced med surg notes and reviewing material online. I'm a very visual learner. I learn by looking and watching and writing things down. So far I haven't had been stumped by too many things on the floor so haven't felt the need to ask a lot of questions of my preceptor. However, after asking her how she thought I was doing, she said that I don't ask enough questions and that I seem disinterested which I felt was completely off base especially after two days not only as a SICU nurse but as a registered nurse in the first place.

I'm not saying I know everything or that it's easy. It's not easy at all. I love what I'm doing but I'm exhausted after the day. I honestly don't know what to do next though because I feel like if she's already made this opinion about me, I won't learn as much from her as I could.

As preceptors, what do you expect your new grads not know? Should I ask questions to clarify things even though I know the purpose of some medications or arterial lines?

If there are any new grads out there, how are you going about things? I feel like I'm jumping into things when I can, doing hourly checks, zero-ing pressure monitoring lines and playing with vents but my preceptor doesn't think I'm doing enough apparently.

Any advice would be great.

Thanks all.

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PMFB-RN has 16 years experience and works as a Rapid Response, Trauma/CV ICU. ER/Transport.

68,884 Visitors; 5,143 Posts

Ask, even if you all ready know what the answer is. First you preceptor may have unique information she has learned first hand that isn

t availabel in a book, second it will make you seem interested, third preceptors like to feel that they are teaching, at least I do when I precept. Lot's of things are different in an ICU than in your med-surg books.

You preceptor has made it clear she would prefer you ask more questions so do so.

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16,406 Visitors; 2,438 Posts

Like the previous poster mentioned, ASK ASK ASK. A lot of things that you learn in school and read in a book might not necessarily be applicable in the ICU.

We do things different than non-critical care areas. We think different. We act different. We interact with the team different. Just because your drug book says Drug X is used for X doesn't mean we don't use it to treat Y but it might not be listed in your drug book.

Things to keep you busy: Monitoring trends of vital signs and labs. You've been a RN for two days. Learn to how focus in on what's wrong with your patient and do a really GOOD focused physical assessment for that body system. Your physical assessment skills will be weak for a while. That's always something you can work on. Verbalize your assessment to your preceptor and ask her what her assessment was compared to what you collected.

Stay on top of pain meds, turning, mouth care, bathing, serial labs. Talk to RT and your preceptor and ask them to teach you about the current ventilator settings your patient is on. Ask them why A/C is beneficial for your patient where say SIMV might not have been the best choice.

You've been in the unit two days. Don't worry, it will get busier. You likely won't be getting extremely critical and unstable patients for a few weeks yet. When you do have downtime ask you preceptor "Is there anything I'm missing or forgetting to do that I could be doing right now?" Seek out other learning opportunities from other nurses and their patients.

I don't expect a new grad to know anything until I am done with them. I expect my preceptee to take initiative, to ask questions, to see out things to keep them occupied, I expect my new person to interact with other staff rather than just focus on their two patients. I love precepting and I expect a LOT out of my orientee from day one.

You mentioned that you know the purpose of an a-line....but do you know how to properly trouble shoot an a-line? Do you know how to prime a transducer? Do you know how to change the flush and transducer? Do you know when you should trust your waveform or trust the cuff pressure?

Just a few thoughts for you!

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GoldenFire5 has 5 years experience.

6,299 Visitors; 225 Posts

You can always discuss the worst case scenario for each patient and what your action plan would be.

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4,960 Visitors; 261 Posts

Just play stupid for awhile. Nothing is more awkward than knowing more than your preceptor about a topic. I've had similar experiences in the past. It's like you know that they are a 10x better nurse than you will be for the next 5 years but when it comes to knowledge of physio/pharm/pathophysiolgy you may be ahead of them. Just play stupid because you don't want them to not teach you something because they are afraid to look dumb. You want to soak in all the pearls of wisdom you can while you're with them.

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713 Visitors; 3 Posts

I resent the fact that the above user is advising this new graduate nurse to play stupid. A new grad nurse in an ICU environment for 2 days is trying to absorb all that is happening around them. This is a very fast paced environment and it is not unusual if you don't ask any questions initially. I would encourage you to write things down as they come to mind and that will help you formulate your questions. There is nothing wrong with a new graduate nurse knowing more than their preceptor. New graduate nurses knowledge base at times tends to be more updated than some of the more seasoned nurses. Nurses who do not update their knowledge base regularly tend to lag behind. We are all life long learners and we learn from each other on a daily basis. I definitely would ask lots of questions, however, know that you might not know what questions to ask at that moment. Think about the WHY, WHAT, and HOW questions; why is the patient in the ICU, why is the patient receiving these meds, what is causing the patient's s/s, etc. Look at the overall patient presentation and you will be able to come up with questions to ask even if you have to revisit the patient scenario when you get a break or go home.

Do your preceptor use a competency based orientation checklist to help keep track of your patient experiences, do you have weekly or biweekly meetings with the preceptor, educator, and manager to see how your orientation is progressing and set goals for the following week? You and your preceptor should provide weekly feedback on each other at these meetings utilizing some sort of feedback tool. This ensures everyone is on the same page regarding your orientation, learning opportunities, and goals to help you progress from week to week. Never play stupid regarding your knowledge or skills, be proud of what you know and keep striving to be the best that you can be. Just know that years of nursing experience doesn't equate to being a good nurse or preceptor.

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5,181 Visitors; 170 Posts

DO NOT PLAY STUPID. It will get you nowhere, except maybe OUT of the ICU.

Right now, you probably don't know what questions to ask, and that's ok. I'm sure your program was wonderful and I'm sure you did well....but please, from one "I have a BSN had a 4.0 passed the NCLEX in 75 questions" new grad (well, a couple of years new) to another...what you don't know far outweighs what you do know, and the questions will come sooner or later. And when they do, you'll ask them.

Don't give up on your preceptor, after all, you don't want her to give up on you right? The relationship between new grad and preceptor is a two way street. Reasssure her that you are VERY interested and that you know the questions will come in time, that right now you're trying to absorb everything and fit the pieces together.

Keep jumping in but make sure you're safe. If you are even the tiniest bit unsure ask your preceptor for help, especially when working with lines and drips. I've heard it said that the scariest new nurse is the one who thinks she knows what she'd doing, and I swear it IS the truth. Zeroing lines, recording vitals, memorizing meds, etc...of course that's all important. It's also not all that difficult. It's MORE important that you see the big picture and understand WHY you're doing whatever it is you're doing, how will it affect the patient's outcome, and so on. That's the hard part. When you're ready, I would start formulating questions there.

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4,960 Visitors; 261 Posts

Obviously I don't mean play stupid to the point where they think you ARE stupid. But if your preceptor tells you something that you know is wrong or based on a misunderstanding then take a second before correcting them. Maybe you can tactfully pull it off without offending them or making them feel afraid to teach you, or maybe you can just smile and nod. In my orientation I would ask questions that the preceptor wouldnt know but then would try to come up with an answer that I knew was way wrong, so eventually I quit asking questions that I thought would push his/her knowledge base. You can play it however you want I'm just saying what worked for me, I didn't really want people to think that I was some super smart newbie that thought he knew it all already. I kept my head down a little bit at first.

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713 Visitors; 3 Posts

This new grad shouldn't have to play stupid or play like she don't know. The preceptor's responsibility is to teach and provide the preceptee with the correct information. Therefore, if the preceptor do not know the answer to the question(s) the preceptee is asking, he/she has a duty to research it and ensure the correct information is provided. Too many nurses try to BS their way through answering questions that they don't have the answer to. They have a problem saying I DON'T KNOW THE ANSWER, BUT LET ME LOOK IT UP AND GET BACK TO YOU.

If you as a nurse know that you are being given incorrect information and do not address it with the preceptor because you are afraid the preceptor will not want to teach you, then I say it's time to ask for a different preceptor. Continue to push the preceptor's knowledge base, do not quit asking questions like this CRNAhopeful suggests, and keep your head up. The physician's expect you to have the knowledge and skills when caring for their patient's, they do not like incompetence, and they will push your knowledge base.

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7,139 Visitors; 460 Posts

Precepting and or teaching in general is a skill which does not come natural to most. Many times, depending on the institution, it is in fact a rotating obligation. My advise is as follows.

* Avoid confrontation, if the situation is untenable, approach the nurse manager.

* Avoid showmanship, be the best you can be by letting your actions speak for themselves.

* Be courteous and professional to all in the face of anything less, lead by example

* Ask questions when you feel the need, independently confirm answers.

Good luck

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5,181 Visitors; 170 Posts

Also, maybe someone else has already noted this and I missed it...but...2 months orientation for a new grad in SICU? Seems way too short.

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JoyfulRN14 works as a Registered Nurse.

4,272 Visitors; 86 Posts

I like the point that someone else made earlier -

just because you know that answer to a question, doesn't mean you shouldn't ask it. (obviously not on very simple things though)

Your preceptor and other nurses you work with may have a different way of doing things/looking at things that you'll like better or remember better.

Even simple things like doing a pressure set-up for an ART line, maybe your preceptor has some little trick that makes it easier that you haven't thought of or seen someone do before.

I'm in my 5th week as a new grad in the ICU and have learned a lot by following that advice. I have a different preceptor every time I work, and I have learned LOADS just seeing different ways that people do things.

Someone else mentioned to go over worse-case scenarios that could happen with your patient, and I think that is a brilliant idea that I'll be putting into practice whenever I have the extra time.

I feel that I'm getting better at time management and more comfortable with my physical assessment, but when s**t hits the fan, I need to be told what to do. Part of this is that we're not doing ACLS til next month, but part of it is that I just haven't been in these situations yet, so I haven't practiced reacting.

I love the idea of going over what I would do in my head before bad stuff happens, that way when it does (and you know it will!), I'll feel more prepared and know what to do.

Good luck! Ask questions!! :)

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