What do you think??

[AnnieOaklyRN, BSN, RN, EMT-P]

Hi all,

this is both a vent and a question about how I should deal with, well what I think is a major issue. So here goes:

I am a new grad working in a hospital in Idaho in med/surg for 4 weeks, I am 3 weeks into it, and then I will be hitting the ER. Anywho, the hospital thought it would be a grand idea to hire a nursing instructor from a local school to deal with the new grads, ALL 9 of us, yes I said one preceptor for all 9 of us on the same floor. We are all lisenced. We each started with one patient and no meds and for the past two weeks have had one patient with meds ( oh yeah, wonderful, just like nursing school) and last week I was given the green light to do all routes of meds on my own. (she has to sign a competency and then we are able to go on our own), which worked out great, no more waiting in line with 8 other people waiting for meds... Last week went well, I was doing pretty much everything on my own, only had two patients friday, planned the day etc, I was happy and all and then.... I come on today, shift starts at 0700 and she tells everyone well I know I told some of you you could give meds, but I want to take a look at them today and make sure its ok, mind you this means she is going to have to take the time to look up meds for all 18 patients before giving us the go ahead AGAIN after she already had last week. So 7:30 arrives and still no word on whether I can give meds or not, and both patients have them due at 8a and 9a. so i come find her and say I would like to be able to get Ms H's meds out and then take them in with me and get my assessment done and then if appropriate (BP med etc) I will give them to her (all PO meds), I vebalize that one is a BP med and I will assess that before deciding whether to give it to her, so then she says well i still havent had time to look at the meds yet, I will get back to you. So I go and do my assessments on both patient and put it in the computer charting, because, yes I am still waiting for her. So I find her again and she says, I want to do the meds with you today, cause i feel like i rushed approval last week :angryfire. So it is now about 9:30 since she was busy with the 8 other people waiting in line and I say ok so can I get Ms. H's 8am meds and give them to her. She says no, Mr. S has an 8am antibiotic that needs to be hung, and I say ok, he also has topical meds due at 9am with dressing changes along with an IV antibiotic and some PO's, so I say ok can I just get them all out and do it all at once. She says no we will just hang the antibiotic for now becuase i have to do other meds with soemone else. So i do as she says and we get the antibiotic up adn running and then she says ok you go get Ms. H's meds and then show them to me. So I go get the 4-5 PO meds for her, and after waiting a half hour for her to be free I show them to her, and finnaly give them, it is now about 10:30. Now mind you Mr. S still has meds that were due at 9am that she wouldnt let me get earlier when we were in the freakin room, so now I go get those out, and I also add that we still have topical meds and dressings to do. She checks the meds i had taken out, watches me push lasix (yes, for all 6 minutes, mind you I am a paramedic and have pushed lasix more times than i care to count), and then leaves while i give all the POs. She says that she has to go do a large dressing and give insulin with someone else, so i say ok. So i get the stuff for the dressing, its now about 1200 (they were due at 9am), and she now says oh I am still tied up, just start doing the dressings and I will be in. GRRRR I COULD HAVE DONE THEM HOURS AGO if she would have just let me. If she woul dhave just let me stick to the original plan I would have had the first patients meds done on time, hell the meds ALL were at least an 1 hour- 1/2 late!!! This nurse is a nursing instructor and I think she is afraid to cut the umbilical line, forgetting that we are RN's and not students. To make matters worse I have already developed my own way of doing things with dressing etc, and she insists that you do it her way which is really annoying!! I can honestly say i spent THREE HOURS of my 8 hour day waiting in line to get things done! The whole idea of having this preceptor was to take some strain off the nurses and us, but it is having teh complete opposite effect.

So anyway I have strong feelings. after leaving the hospital today VERY ANGRY and aggitated, that I really need to talk to somene about it. I am wondering if I should talk to her or the clinical educator in charge of the new grad program, especially since I am not the only one that leaves fuming mad, and the nurses on the floor are confused about what their role is and are also not happy with the whole situation, because well, we are new grads and things are getting missed because she is just to busy to really check in with charting and new orders, and labs. A critical lab value was missed last week just to give and example. I am concerned that she is going to do this everytime we have a new patient, as far as not letting us be independent. I always come to her with questions, so it is not like I am being a know it all and making her nervous in that sense.

Any oppinions? I am afraid to talk to her because I really do not think it would do any good, other than to make things worse.

Sweetooth

Thanks all for any oppinions and sorry about the length.

Sweetooth:angryfire

[Altra, BSN, RN]

The situation you describe does not seem to be appropriate for new nurses - it sounds like an instructor overseeing students. However, if this is truly just for 1 more week before you move on to your (permanent?) ER position, I would probably just let it ride.

When you fill out your evaluation of your orientation, however, I hope you'll comment at length about this so that orientation for the next group of new grads will be better.

[santhony44, MSN, RN, NP]

I agree. As frustrating as it is, it might not be worth fighting at this point. If you were continuing in this area, that would be another story.

However, I would be prepared to give a detailed critique of how it actually went. Try to keep it as factual and unemotional as possible.

Whatever they were trying to accomplish here, this obviously didn't work. I would not be surprised if the clinical educator and the instructor involved had very different ideas of what was supposed to happen. I can't imagine the clinical educator expecting new grads to be treated like students.

Hopefully things will go much better when you get into the ER.

[TheCommuter, BSN, RN]

You are a new grad, correct? If I am correct, you have already displacyed competency by completing nursing school. Excuse my French, but what the heck are you still doing with a nursing instructor? Your workplace needs to be more progressive and proactive by placing you with a preceptor who is only focused on you, and nobody else.

This situation would irritate me, too, because it is inappropriate and uncalled for. You completed school, and you do not need to be taken by the hand in order to pass meds, do treatments, and other nursing skills.

[CRNI-ICU20]

Being PRECEPTED is different than being INSTRUCTED....this facility seems to have confused the two. OR the nursing instructor does not know HOW to precept nurses. You are not practicing on HER license anymore, therefore you do not need constant monitoring, you only need directional help according to what ever the policy and procedure is in the hospital you are working in.....this facility is paying her an awful lot of money to "teach" you what you already know! Is there a nurse manager you can talk with? Or, are you uncomfortable with that?

I could see her reluctance turning you loose if you were not a full fledged nurse, but this is helicopter instruction at it's worst....(always hovering over you).....

In most institutions I have ever worked, the seasoned nurses, or the ones who work there that take a preceptor class are the ones who mentor the graduate level nurse or first year nurses....they are on their own licenses, but just need someone to show them the ropes until they are able to handle a full load on their own....they shadow the same schedule as the mentor for 6 weeks or more, and then are turned loose....they are lucky....I had a one week"orientation" and then was thrown to the wolves....fortunately, administration and others have opened their eyes a little and understand the importance of improving their orientation for new nurses.....

I am sorry for you.....how much longer before you are on your own???

Maybe you can just "endure" it if it isn't a long time....just humor the instructor....it is a bit over the top, though...

[herecomestrouble]

How often do they hire new grads?Do you think that she's afraid if she let's you all go on your own she will be out of a job?It sounds like she wants everybody to be dependent on her/

[loricatus]

What would have happened if you gave the meds and did the dressing change on time? If the patients are yours and you are an RN, I think that you have the right to manage them as you see fit, within your scope of practice and abilities as a new nurse. You certainly have a right to advocate for them and keep them safe from this disasterous way of training new nurses. Also, who is being held accountable for the meds being given so late? Think about filing incident reports for all those late meds and the institution may think twice about this insane situation they created.

[4XNURSE]

..... If the patients are yours and you are an RN, I think that you have the right to manage them as you see fit, within your scope of practice and abilities as a new nurse. ..... Also, who is being held accountable for the meds being given so late? Think about filing incident reports for all those late meds and the institution may think twice about this insane situation they created.

First let me admit to being old and retired. (or is it retarded?) Let me pose a couple questions.

What are the "standard of care" protocols?

When I was working, meds were supposed to given within a framework of "one hour before to one hour after" the times they are due.

Who's name/license is on the record?

I doubt your "preceptor" is going to step up to the plate if the state comes in and starts reviewing those records.

If I was you, (I'm not) and knowing what I know now, (you have no idea) I'd be flooding the risk management department with incident reports. Making sure somebody knows I tried to get my work done on time, but was told not to by this "preceptor".

Just my $0.02

4XNURSE

retired, with lots of time and no money.

[Dolce, RN]

Well, she caused you and a bunch of other new nurses to have med errors because the meds weren't given at the RIGHT TIME! Maybe someone should review the 5 rights with her so that she remembers that drugs need to be given on time. I'm afraid she is so concerned about all of the nurses that she is precepting that she is not thinking about the patient. I'll tell you what I would do...I would fill out an incident report or medication error report each time that happens. Technically that is a med error. It needs to have a med error report filled out. Ask the charge nurse where to find one. You would be amazed at the power that an incident report has.

[RN1263]

E.R. probably won't be too happy that you weren't given any autonomy while on the med/surg floor? They probably wanted you to get your nursing "legs" a bit before coming down?.....

I would discuss this situation w/ someone before moving on to E.R. This way at least the nurse manager of the E.R. won't be wondering what the heck you were doing for the past month if problems arise and so forth.

good luck!

[bluwavyhat]

I think sound points are made in all the prior post, yet I remember surveys at the end of my preceptor program. This questionnaire will be another avenue to enlighten the preceptor program in your facility.

[miko014]

Wow, I don't know what they are thinking at all! A preceptor should be a one-on-one mentor who works with you on the same group of pts. My orientation was I think 4 (maybe 5, I can't remember) weeks, and I'll admit, I had about 9 different preceptors as I flipped shifts, but after that first week and a half, I was with the same fantastic RN for the rest of it. I started off taking one pt, doing complete care, ad picking up another as my preceptor saw fit. At first, she would go over every med with me, ask me a lot of critical thinking questions, help me look up policies, check orders I was writing, etc. Then after awhile I had to chase her away from my pts cause she wanted to be doing something...I made her sit at the station or help the other nurses because I was able to handle it on my own, and really just needed her for the occasional questions (and believe me, I still ask a TON of questions!). A preceptor is not someone to check off your meds for you, and like it has been said several times, you are an RN with your own license! How can they still be doing this to you after 3 weeks?? I'm not sure what I would do in this situation. I think I would talk to the manager of the floor you are on and tell her your concerns - and that you have only had 2 pts so far and have had no autonomy whatsoever and are concerned that you're not going to be ready for the ER and that you would like to take a larger pt group and be more independent about it. Good luck and let us know what happens! I have never heard of anything like this before.