Precepted. But.

Everyone knows what makes or breaks an internship depends a great deal on how well an orientee and preceptor fit together. Some people need that warm fuzzy super supportive hand holder. Some people need the hard ass whip cracker to keep them on the straight and narrow. Some need constant supervision, while others are best left alone until questions arise.

Now admittedly, I'm a difficult case to match with the proper preceptor. I have a great deal of knowledge because of my background, and I've run across preceptor type people that get intimidated--they get hung up on that and fail to see my willingness to learn.

I want to know why we do things, so I tend to ask numerous questions. "Because the doctor wrote an order," and "We just always do it that way," are the bane of my existence. But I also want to learn how you do things, although I may quickly find my own way. I am a very kinesthetic learner, so to really own skills I need to actually do them, although I can reason my way through tasks intellectually. I'm capable of being quite flexible, but that can mean while I appear to be holding my own, I may not be getting what I need to learn or function best.

I'm not sure what the perfect preceptor for me would look like, but I'm pretty sure it's not the one that I've been assigned.

Unfortunately.

The hospital has set criteria for us to meet that count towards our yearly merit raises. The idea is that nurses who contribute back to the workplace take ownership of their workplace, and make it an all-around better place to work. These criteria include teaching projects, community service, leadership roles, and...precepting.

My preceptor has been banned from precepting females, apparently because he has a habit of making them cry. Although I suspect there was some chauvinistic behavior that didn't impress the ladies too much either, particularly since he's married. He's not much of a teacher, or a community service kind of guy. It pretty much leaves precepting for him to get his chance at the full 5% merit raise.

But.

That doesn't seem to take into account whether or not he really should be precepting.

He has all the tools. He's one of the most senior people on the unit, and at 8 years of service that gives you the idea of the turnover we experience. (We have 6 people leaving for CRNA school in August.) He is very knowledgeable. He is in a leadership position on the unit, working as a charge nurse.

But.

He has no people skills. He is sexist, and he constantly makes suggestive comments to and about the female staff members. He takes shortcuts--all the time. He laughs in the face of paperwork, often saying that if an issue can be resolved in the course of the shift, then the paperwork doesn't need to be filled out.

But.

Everyone puts up with it, and nothing gets done or said.

Fine, not my problem, right?

But.

Example #1: Second day on the floor, I'm given a new admit from the OR--a lung decortication secondary to aspergillus infection. Never taken care of a patient with that procedure done before, but she was vented and sedated with propofol, on a few pressors, on an insulin drip, and a fentanyl drip for analgesia--no big deal. My preceptor helped me get her settled, and then I went about managing her care--I was only supposed to have the one patient being my second day and all. About an hour later, he gets a patient from another floor--a trachea erosion secondary to radiation for esophageal cancer waiting for a tracheal stent. Pretty unstable patient actually. We get him settled in the bed next to my patient, and the two have our four bed pod to themselves. Things were clicking along just dandy.

But.

Then he disappeared, leaving me by myself with the two patients for the remaining half of shift.

When the oncoming shift comes in for report, come to find out the way my preceptor had told me to run the fentanyl drips (mcg/hr) is very much NOT acceptable on our unit--unbeknownst to me. It turns out we have a weight-based analgesia protocol in place (1-3/mcg/kg/hr for fentanyl). On the patient I was originally taking, what I was giving was actually less than the weight based formula minimum.

But.

On the tracheal stent dude I was running at 400 mcg/hr to keep him pain free. He weighed 110 kg, and simple math tells you that our weight based max dose of fentanyl is 330 mcg/hr...I was running 70 mcg/hr above our protocol max thanks to my preceptor's cowboy shenanigans.

If the patient had crashed, or become say, hypotensive, (like patients receiving fentanyl are prone to doing,) it would have been my ass hanging in the wind. My hospital has made it very, very clear that as long as we stay within the confines of the policies and procedures, they will back us 100%. Step outside the shadow of those protocols, and we've been told, in no uncertain terms, we're on our own.

I'm sure he'd have been in trouble too, his license in jeopardy, but frankly I don't give a shit what happens to him. He put MY license in jeopardy, and I've had the damn thing for less than a month.