Worried after first day... moral dillema?

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I'm going to try not to rant/vent but no guarantees... 

I just had my first day on the floor with a preceptor with my first job and am already concerned. Not about how I cried in the bathroom, the car or at home (because I didn't). And not because it all seemed overwhelming, etc. (because really I was mostly shadowing). But because I felt like the standards of at least the person I was with were atrocious and potentially unsafe (yes, I'm being judgy and tell me if I'm being too much).  I'm not sure what to do here without alienating the people I may be working with for the next few years. 

First, except for about 2 times (being generous) I never noticed my preceptor wash their hands or use hand sanitizer upon entering and exiting the room (did use gloves each time). They also never did a head to toe assessment, though encouraged me to do it. They said they forgot their stethoscope. Their reason was that they had those patients yesterday. (um.... shouldn't each nurse do a head to toe, even if only a 5 minute one each shift, maybe comparing to yesterday works for some neuro things, but it's not going to tell you if lung sounds have worsened or that a pressure injury is forming). 

There were other minor things that are true with some nurses anywhere (like always talking loud and what I consider condescending (yes I know, pot, kettle, black...) but those are personality and whatever... 

But, for the things I consider not minor, what should I do? I first tell myself, well, I will be the kind of nurse I want to be. But I also know how easy it is to adapt to the culture and standards of the group you work with. Maybe it's not the whole group, maybe just this nurse. I haven't been there long enough to tell. I could speak to her directly, but when I say first day on the floor I mean FIRST day. How would you take some upstart punk telling you how to do your job LOL. Going higher has potential consequences but for who. Perhaps there is a suggestion box (I doubt it) where I can be anonymous. 

I was so worried about finding a job and did but still really didn't get any interviews or offers anywhere else. I just don't want to fall into bad habits, and of course want patients, even when not mine, to be safe. I don't want to quit because I think the place isn't up to "my standards" (sounds so pretentious). To be fair I mostly did clinical in magnet hospitals and this is not. Maybe after a time I can get involved in quality improvement committees, etc. But for now, as a total noob, what would you do?

 

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Specializes in NICU.

My advice is to keep your head down and focus on learning your job. You do not want to put a target on your back during orientation. I am not there to observe your preceptor, so I can not pass judgement on their nursing skills. They may be burned out and rolling the dice that the patient doesn't develop any new medical issues from their lack of assessment. There is also the Nursing School/ Real World factor.

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13 hours ago, Vicki17 said:

But, for the things I consider not minor, what should I do? I first tell myself, well, I will be the kind of nurse I want to be.

Yes. This.

13 hours ago, Vicki17 said:

But I also know how easy it is to adapt to the culture and standards of the group you work with.

There are plenty of people who never feel compelled to adapt to a standard of providing poor care. I wouldn't say it is a natural progression of things. There are those who strive to provide the best care they possibly can, and there are those who don't. You can just as well be one of the former instead of one of the latter.

13 hours ago, Vicki17 said:

I could speak to her directly, but when I say first day on the floor I mean FIRST day.

That is not necessary.

 

13 hours ago, Vicki17 said:

How would you take some upstart punk telling you how to do your job LOL. Going higher has potential consequences but for who. Perhaps there is a suggestion box (I doubt it) where I can be anonymous. 

All of this is not necessary.

13 hours ago, Vicki17 said:

I just don't want to fall into bad habits, and of course want patients, even when not mine, to be safe.

Here's where I will get into the meat of my comment.

Yes, many of us (I would venture to say the vast majority) want all patients to be safe--and well cared for.

The question is, what things can we fix and what things can't we fix? Follow me here: Just today, this very day, you have showed up on this floor and happened to be introduced to a nurse that (we will stipulate) is not providing the best care possible. But...the fact is, she was there yesterday and many other days before you got there. And what about the nurse who works on a different floor (who you haven't yet met or may never meet) who is also not providing the best care? And the one or two or five in the hospital across town? What about in the next county, the next state, all across the world?

I hope to illustrate that for right now, today, these are not your problems to fix. You are not in a position to effectively work on them in the way you are imagining. The best thing that you can do right now, today and tomorrow and the next day and for the foreseeable future, is to work hard to become the best nurse that you possibly can. And that is a very important task, for your own good and for the ethical care of all of your future patients.

It may sound like I'm making excuses and advising you not to speak up because there are also starving children in the world and lots of other problems that you can't fix. That isn't exactly what I'm saying; what I mean is that yes, this world isn't perfect, there are lots of problems. But you have encountered a sort of small/medium problem on your first day and are kind of alarmed about your first real-world exposure as an employed RN. This is natural as you acclimate to the real world of nursing.

1. Your primary task is learning to put into practice all that you have learned, to continue learning, and to bring all of it together so that you are shaped into the kind of nurse you can respect who provides the best possible care to patients

2. Both now and in the future you will, unfortunately, have to pick your battles as far as what to do about the things you see around you

3. Your sense of right and wrong may even change a little. You will learn to think through ethical dilemmas and some of your thinking may change over time as you can a larger perspective

4. You really, truly do not need to do something about this right now, today

5. Unfortunately you will find out, probably sooner rather than later, that even just within nursing there will be too many less-than-perfect scenarios for you to feel like there is a true ethical dilemma about all of them. That's just the way it is. I predict that you will eventually understand what many other nurses live with every day, which is that you can't solve everything and you don't need to make everything your personal problem.

Many new nurses have experiences very similar to what you are experiencing right now; it's almost a rite of passage. Sometimes it is disturbing to realize that things actually are not perfect, nurses actually are not perfect angelic beings, and being ethical doesn't involve going to battle every time we witness some of this less than perfect reality. This is a lot to think through. Will look forward to hearing your reaction(s).

??

Oh...PS:

13 hours ago, Vicki17 said:

I don't want to quit because I think the place isn't up to "my standards" (sounds so pretentious).

It isn't pretentious, just maybe a little naïve and idealistic. ?

13 hours ago, Vicki17 said:

To be fair I mostly did clinical in magnet hospitals and this is not.

I hope this isn't too much disappointment for one day, but I will break it to you now that Magnet is just a designation that some hospitals choose to spend a lot of money and effort on achieving. Whether they sustain the spirit of Magnet and are doing it for genuine reasons is an ENTIRELY different matter. Don't make the mistake of getting too caught up in it. Make your judgments based on the values and principles that you see in action from the nursing service line structure from day to day.

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Thank you! You've made a lot of good points. I know things aren't always perfect and in fact I have a ton to learn. As a few mentioned, I will just keep trying to learn everything I can and not make too many judgments or conclusions at the start, while trying to be the best I can personally be (which won't be perfect either). I  realize this seemed pretty silly now... after one day. 

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21 hours ago, Vicki17 said:

I  realize this seemed pretty silly now... after one day. 

It isn't silly. Your reaction means that you took your training to heart and have the internal desire to do your best. That's a good thing.

Good luck to you~

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

Be the change you want to see in the world. One day you will be a preceptor, and then the people you orient will learn better, and they’ll teach people better, and that’s how unit cultures change over time. 

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Specializes in Nursing Student Retention.
On 6/22/2021 at 11:22 PM, Vicki17 said:

I  realize this seemed pretty silly now... after one day. 

Not”silly” just evidence of culture shock.
Yes, make note of what you see that you want to include in your practice…and what you do not. When I was a new RN my Mum told me “Never give anyone a stick to beat you with”.  I think you know what she meant by that. Other commenters have said it well: please, change what you can when time and experience give you the chance and until then stay strong in your truth. ‘Best wishes for a year that gets better!

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Specializes in Dialysis.

I don't know how many times in my career that I've had a patient tell me "nurse x didn't do that (pick an assessment)". To this day, I still tell them that if nurse x signs off on said assessment and didn't do it, it will bite nurse x on the butt! Hoosier, on the other hand, does exactly what she signs off on, even if it means up and running all shift. To me, it's not worth the effort to lie about what I do

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Specializes in Emergency / Disaster.

1. I hated my preceptor.  She was horrible to me.  I tried to stick it out and eventually I was given a new one. You learn good and bad from preceptors.  It doesn't mean you have to be like them - but you do learn from them.

2. I carry my stethoscope and rarely use it - but I'm not a floor nurse. I do focused assessments because I'm in the ER.  If someone gets admitted then I do head to toe.

3. Just keep moving forward.  Don't say anything and when you are on your own, be the kind of nurse you want to be.  Real life isn't nursing school and sadly we have to cut corners sometimes in order to get things done.  This doesn't mean being unsafe, but it might mean you do look for changes in the assessments that you did yesterday and if you have time do a full assessment later.  

You will be surprised at how different being a nurse is from what you were taught to think it was in nursing school.  Just keep showing up and you will get there.  Its OK to be judgy - just keep it to yourself and remember who to go to when you need help.

We have a tech that is good but really rough.  If I have a frail patient, I will not ask that tech to help no matter what.  You learn to utilize your observations.  It will all be OK!  And besides, changing jobs wouldn't get you a different experience.  That exact same thing would happen elsewhere too - just different people.

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