Why are Newbies Such Whiners?

[Ruby Vee]

catchy title, eh? right up there with "why are nurses such backstabbers" (assuming that all nurses are backstabbers) and "nurses eat their young" and "why are nurses so mean?" i don't know about the rest of us "seasoned nurses", but i'm getting rather tired of all the threads busting on us for being "mean" to new nurses, students, etc. it seems to be an underlying assumption on most of the threads of the ilk that nurses are mean, evil backstabbers who live to humiliate someone with less experience.

i've had the opportunity lately to observe some newbies and their preceptors from the patient's perspective. granted, i've been a nurse for 29 years and have been both an orientee and a preceptor -- most recently an orientee. so i do have some experience from pretty much all sides now.

i was a patient, flat in bed after my spinal surgery. the orientee and preceptor introduced themselves, outlined the plan for the day, and then the preceptor left for a short while to sort out another patient who was screaming the screams of the totally demented, leaving the orientee to do my assessment and am care. the orientee was supposed to be almost ready to be on her own -- and she scared me to death! wanted to give my antihypertensives when my bp was 82/50, wanted to give my hctz when i was dehydrated from vomiting, npo, and my iv rate was only 50cc/hour and a few other things indicating (to me, anyway) poor judgment. when i refused to take the meds and outlined my rationale, she ordered me to take them anyway so she wouldn't get into trouble. i asked her how long she'd been in this job, and was it her first nursing job, or where had she worked before. the floodgates opened, and she started complaining about what a terrible place it was to work, the lousy pay, the horrible hours and how all the experienced staff were mean to her. (the preceptor came back into the room in time to hear that.) totally unprofessional! the preceptor didn't say anything in front of me, and calmly took her off to "plan the rest of our day."

later that day, i overheard the orientee telling someone (i'm assuming on her cellphone) how totally mean her preceptor was, and how the preceptor was "out to get her." she said "all i was doing was bonding with my patient who is a nurse, too, and the ***** (preceptor) just totally humiliated me. she told me i was unprofessional! i thought you were supposed to be nice to your patients."

nurse eating her young? or totally out of line and unprofessional newbie whining about being justifiably corrected?

another time, i heard a preceptor tell her orientee not to give my antihypertensives if my bp was less than 100/systolic. (it was.) newbie comes in to give my antihypertensives anyway. (different newbie.) i refuse. newbie goes to get preceptor. preceptor and i discuss my bp and agree not to give antihypertensives. later, i hear preceptor calmly explaining to newbie that giving an antihypertensive to a hypotensive patient can cause problems. (they're out in the hall, evidently close to my room, and i didn't hear anyone else around, so i'm assuming there was at least an illusion of privacy for this discussion.) newbie got defensive and started lying. preceptor remained calm and reiterated her position. newbie continued to be defensive, escalating the volume. later, i hear the two newbies commisserating about how mean their respective preceptors are.

i have to admit that when i hear a new nurse complaining about how "nurses eat their young", especially after those recent experiences, i always wonder what a preceptor could possibly do to try to correct some of these blatent mistakes without being accused of being "mean." and i wonder if that new nurse was as ridiculously in the wrong as those two were, and if she was, did she have any clue that her problems weren't all someone else's fault!

precepting is a tough enough job without being accused of being evil everytime you try to help someone to do better! being a new person is difficult, too -- but please try to look at what you contribute to the problem rather than just blaming the seasoned nurses you work with!

[ZASHAGALKA, RN]

i did mean the title to be a little tongue in cheek -- and to point out the silliness of assuming that all nurses are mean, backstabbing evildoers who eat their young. and i wasn't offended. although i do get really tired of reading thread after thread entitled "nurses eat their young" and "why are nurses such backstabbers," etc. i get really tired of people who blame all of their negative interactions on the other person!

there are two sides to every story. sometimes, one side is just that the person is a bitter, difficult person. but not every time and that goes both ways.

i like the phrase, 'in the trenches' to describe nursing. the war analogy is apt. just like war, the 'newbies' are sometime treated with some level of cynicism, a need to 'prove themselves'. when lives are at stake, the consequences are large and so is the need to get on your feet. the interactions in the trenches are just as high as the stakes involved.

perspective is everthing. chalk it up to being 'eaten', or chalk it up to the occupational hazard of the job you chose.

in any case, you can never affect the actions of others more than you can affect your own actions. the key action you can influence in any interpersonal exchange is your own.

~faith,

timothy.

[Marie_LPN, RN, LPN, RN]

Although I do get really tired of reading thread after thread entitled "Nurses Eat Their Young" and "Why Are Nurses Such BackStabbers," etc. I get really tired of people who blame all of their negative interactions on the other person!

It's easier to blame the other person for some, since the other person isn't here to tell their side of the story.

[Spidey's mom, ADN, BSN, RN]

It's easier to blame the other person for some, since the other person isn't here to tell their side of the story.

Very true . . . . .

Attitude is a choice . . .

No one can take advantage of you without your permission. At least after the first time . . . sometimes we are a bit naive.

steph

[anne74]

I was eaten alive by some really poor preceptors - and I've always been nothing but thankful and respectful them. I admire every nurse who has more experience than me, and I seek and appreciate chances to learn from them. I totally agree with the other poster who stated that there are many wonderfully experienced nurses who are poor educators.

I also think part of the problem is that nursing schools are terrible at preparing new grads these days. Most older nurses got much more clinical time in school, so when they graduated, they could hit the ground running (especially those diploma nurses!) So older nurses are comparing their experience as a new grad to the new grads of today.

Now we get hardly any clinical time, then are thrown into highly technical situations with very ill patients. Honestly, I feel like new grads of today get the vast majority of their nursing skills during their first year of nursing. So consider us learning from scratch and have some patience! (My mother is a diploma nurse, and she was flabbergasted with the pathetic amount of clinical time I got in my BSN program - even worse, she was shocked with the amount of technology and body of knowledge I was expected to handle, with such little training.)

The new grad examples the OP mentioned are unfortunate, but seem to be in the minority - at least from my experiences. There are always some bad apples who come out of nursing school with poor attitudes. But I think it's much more prevelant to see an eager new nurse being shredded by an experienced, yet jaded, impatient nurse.

Many times if you see a new nurse being defensive, it's because they've experinced a long history of being beat up, ridiculed and belittled. In fact, I had so much anxiety from poor preceptors, I started making stupid mistakes and became even worse! Most new grads try very hard and want to be good nurses, but when our confidence gets shot down, it's very hard to crawl out of that hole and improve.

By the way - I transferred to a new unit, had wonderful preceptors, and now I'm actually becoming a decent nurse! So that's my validation that good preceptors can make - or break - our new generations of nurses.

[tencat]

I agree that some people might know TONS about a subject, but might be HORRID teachers. Teaching someone requires skills that we don't necessarily get in nursing school or on the job. I had a fabulous preceptor, but because she is so good at it, she is constantly precepting people and not getting a rest or recognition for it. The powers that be are running her into the ground instead of trying to figure out how to help others learn how to be good preceptors.

I do not blame 'old' nurses for cringing at the thought of being preceptors. Usually it means they have their 5 patients that they are responsible for AND a new nurse they have to watch like a hawk, because technically the preceptor is responsible for the patients. I think incentives would go a long way toward improving preceptor/preceptee relationships. Extra pay or time off would be a good starting point.

[TinyNurse, RN]

I've been on the forum for a few years now. Is it me, or are there more and more threads popping up regarding "nurses eating their young", "my preceptor is mean", etc.?

Nursing is hard. Nursing school paints the picture too pretty. I was taught how to insert an IV, not how to deal with a waiting room full of patients that scream at me, nor deal with an overwhelming patient load because of staffing problems.

If I was your preceptor, and you wanted to give an antihypertensive to a hypotensive patient, I would definitely let you know that it's the wrong thing to do. Then we'd walk through it together.

Let me also say that I like new grads, and would never be mean to any of them. Afterall....in a year or so they will be the ones that have my back when I get the difficult patient, or the anterior Mi.

Like I said.......nursing school doesn't prepare you for the real world of nursing. Nursing really IS on the job training. The most important things a newbie can do is listen, absorb, watch, and ask questions when necessary.

[newbiern2006]

...no one expects the novice to have the knowledge level of the experienced preceptor

Ha! They do where I work - I was thrown to the wolves of night shift after just two short weeks on day shift orientation, and on my own after just three inadequate weeks of orienting on nights with a nurse who a) Never worked nights before and didn't know the night routines, and b) didn't want want to do it, neither did she want to precept anybody, she was just doing it for the money. I went to my supervisors to explain I just wasn't well-enough oriented to be on my own, but to no avail. If one more day nurse rolls her eyes and accuses me of not doing my job because I wasn't aware of something I needed to do or I ask for help with something I don't know yet, especially after I've just spent 13 straight hours without a break, nothing to eat or drink, trying to "do my job" while cleaning up the mess (literally, as many of them are horrible slobs, also in work left undone by the day shift, and scrambling for simple supplies like flushes and syringes because they can't be bothered restocking and leave everything empty) I swear, I will slap the crap out of her. Just yesterday morning, after working a 12 hour shift I was called in for because a nurse called out sick, and dealing with nine patients, half a dozen of whom were sundowners screaming all night and climbing over their rails all at the same time, the same nurse who did such a lousy job of precepting me had the gall to say "You night nurses don't know how easy you have it!" I replied that she didn't know anything about how difficult nights can be, and that everyone always thinks other shifts don't work as hard as they do. She said she'd worked them all and knew it all, and I, sick of her negative b.s. (she's always sour and nasty), promptly reminded her I'd worked nights with her, and she'd never stopped bitching. She shut right up - because she knew it was the truth. I will not put up with any more disrespect or abuse from ANYBODY - I don't care if they were a nurse before I was born (I'm 47). I work HARD - and I've had to learn eveything the hard way. I deserve respect, and a little help when I ask for it without all the attitude.

[NurseWhiteRN]

I am a seasoned nurse,I hear the remarks from the newbies. I sometimes bring to their attention the difference in our education/prepration. That being: old college nurse training and the present education/prepration are nothing alike. If it was, they would not be whining/complaining. I do try to help them understand that presently their career choice is ALL ABOUT THE PATIENT..stay focused.

[NurseWhiteRN]

NewbireRN2006, I am sorry to hear you are having such a difficult time.

I thought I was being treated horribly years ago, and actually I was treated horribly. But, it helped me become a most excellent nurse. I think it did. While I was orientating, we didn't have preceptors. At first. I tried to get help where ever you could. If I ever asked a question, they would tell me "go look it up", and it was in a book! a Big Book. Not on a computer like today. If I ever asked for help, they told me " let me show you how to do that by your self from now on", and they did show me how. If I made mistakes, It was mine, not a preceptor (I didn't have one). They told me my nursing education should have prepared me for the orientation and work field. Apparently it did. Tons of nurses have the new nurse nightmare. I focus very hard not to treat anybody the way I was treated. As you become a seasoned nurse, don't forget how you were treated.

Try to hang in there, maybe try a different area of nursing. I mostly work critical care, I perfer to have 1 or 2 patients, not 7 or more.

[rn/writer, RN]

Some thoughts:

Seasoned nurses are often not given a choice about precepting. Many are not compensated in any way (extra pay, decreased patient load, etc.). In fact, some are given a few additional patients because, "you have help." Never mind that working with a newbie creates extra work. They don't always have any warning either. Imagine showing up at work and finding out that you will have to do your job with a 50-pound back back that has stuff falling out of it. That can be what it's like to take on this extra responsibility. Some do amazingly well and are a blessing to their trainees and to all of their trainees' patients for years to come. Others stumble.

Preceptors have a tremendous amount of responsibility. They need the power to nudge the timid, the radar to stop the overly confident, and the wisdom to know the difference.

In an ideal world, nurses capable of doing the job would volunteer to precept, and they would know about it at least several days in advance. They would be given a premium for the shifts when they are precepting and, whenever possible, a break in patient load (at least during the first days of a new nurse's orientation when there is so much to cover). They might even be given some training in the fine art of precepting.

Some seasoned nurses, while they possess excellent clinical skills, are not apt teachers. They do not have the patience, the time management capabilities, or the communication skills to work with someone who has far less experience and knowledge. This isn't always apparent to the nurse manager who makes the assignment. Respectful feedback can be helpful here.

It can be good to have more than one preceptor. Within reason. This helps to determine what is hard-and-fast protocol and what is merely style. It can also add to your bag of tricks. And, in a pinch, it can get you away from someone with whom you clash without pointing fingers. You can simply say that you want to see a variety of approaches.

Newbies may still be functioning under the "totalitarian regime" thinking of nursing school where criticism of any sort conjured up fears of discipline and dismissal. This is a good time to do some monitoring of those inner voices to hear what they're telling you. If most of what is going through your head is based on fear, it might be time to do a brain flush. In school, it could be the kiss of death to admit you didn't know something. "What? Didn't you learn that in the 378 pages of reading from last night? For shame!"

During orientation, you should know basic A&P and nursing principles, but application might escape you. Now is the time for you to ask for clarification, rationale, and help. This is especially the case with site-specific matters. You can't be expected to "get" all of this when you haven't yet been exposed to it. Be willing to listen. If you disagree with something, respectfully ask the seasoned nurse to help you understand her thinking. If you still disagree, try it her way (if it isn't dangerous), then decide what you will do in your own practice.

In the working world, criticism is a means to an end--turning out a competent Clinical I level nurse at the conclusion of orientation. This is more of a challenge if your preceptor is difficult, but it still doesn't entail the "trapdoor instantly opening beneath you" kind of mentality that is common in nursing school.

Communication is key. If preceptor and orientee are both willing and able to meet before a shift, stay a few minutes after, and/or call or meet in person outside scheduled hours, this off-the-clock kind of contact can go a long way toward bringing about a successful precepting experience. Each can find out what to expect from the other and size each other up in general. This CAN be done on the fly, but it's nice to have it out of the way and reach some sort of comfort level ahead of time.

Ongoing communication is important as well. Have a rough shift? Touch base at the end to determine what went wrong and how to head it off the next time. Maybe the stressors were all circumstantial and you just have to endure. It might help to know that every nurse runs into problems now and then. Then again, maybe there are areas where you need to brush up, read, practice, etc.

Newbies need to know what they did well and where they are making good progress along with the criticisms. When you're feeling overwhelmed, inept, and rattled, a kind word can be all it takes to keep you going through the rest of the shift. It also helps restore perspective to hear that 98% of what you're doing is all right. Otherwise, it can feel just the opposite.

Newbies also need to understand that part of the orientation process includes turning them from baby ducks imprinted on the mama duck (and following her around as if their very life depended on her), into semi-independent fledglings who are starting to think for themselves most of the time. Somewhere between cowering hatchling and daredevil know-it-all is the proper state of mind.

Even when orientation is complete, learning never should be. There is always something to learn. Coworkers should have the freedom and the motivation to ask each other questions and seek out opinions. In this kind of atmosphere, knowledge grows and eventually becomes wisdom.

Nurses who remember the good and the bad about their own orientation experience can use these memories to tailor any precepting opportunities that come thier way.

Newbies sometimes have to learn that it isn't always about them. Preceptors can have sick kids, car troubles, cramps, bad hair days. Kind words can flow upwards, too. That's part of becoming a peer.

A little common sense and sensitivity can go a long way on either side of the precepting relationship.

[GrnHonu99, RN]

I agree that some people might know TONS about a subject, but might be HORRID teachers. Teaching someone requires skills that we don't necessarily get in nursing school or on the job. I had a fabulous preceptor, but because she is so good at it, she is constantly precepting people and not getting a rest or recognition for it. The powers that be are running her into the ground instead of trying to figure out how to help others learn how to be good preceptors.

I do not blame 'old' nurses for cringing at the thought of being preceptors. Usually it means they have their 5 patients that they are responsible for AND a new nurse they have to watch like a hawk, because technically the preceptor is responsible for the patients. I think incentives would go a long way toward improving preceptor/preceptee relationships. Extra pay or time off would be a good starting point.

My preceptor was paid to precept me, I thought that was standard.

The new grad program at my hospital is great. We have protocol in place to stop issues like those mentioned above. Our preceptors have to go through a training class to precept and its 100% voluntary. They are paid more (not sure how much though) and they know we are coming far in advance. We have paperwork that keeps us on track and makes sure I don't miss anything. I think I had somewhere in the ballpark of 10 pages of things I needed checked off on. I also had 2 binders full of papers telling me step by step what all the ICU protocol are and diff procedures. We also have 2 binders at every nurses desk that have similar information and research...info about titration..etc.

Then, and yes it goes on...we have to meet with a seperate educator a few times during our 12 weeks orientating and discuss how its going with our preceptor. Then we also have to fill out an evaluation about how we thought they did..etc. We are also assigned to 2 preceptors so that we get a diff. persepctive. There were some nights when I would work with other nurses and that was awesome bc I was able to observe many diff styles!

I think about what it would have been like if I didn't have an awesome preceptor...I cringe....

[Sheri257]

...no one expects the novice to have the knowledge level of the experienced preceptor

Well ... let's not forget that preceptors don't always know everything either. Some things I was told by one of my preceptors:

1) The heart is on the right side of the body so don't worry when a patient complains about left sided chest pain. Uh ... ok.

2) Give all meds before dialysis even though the dialysis nurse confirmed you're supposed to hold most of the meds because they would be dialyzed out.

3) Don't give the insulin as scheduled, wait until the trays come out which, inevitably meant some patients started eating before they got their insulin and their sugar skyrocketed because you couldn't cover all of them in time.

This was a six year veteran RN so ... experience is not always a guarantee either.

:typing