Hello, I could use your feedback and advice. Recently I resigned just short of the full term of my orientation in an ICU, though it was the last thing I ever thought I would do. My primary goal since I decided to pursue nursing was to become a good nurse.
Background: This is my second career. My first was successful, but it was time for a change. A former manager called me "the quiet professional." I am not an extrovert and was known to work hard and keep my nose clean. In every workplace I have formed very good friendships with others. Before nursing school, I achieved a lot due to some amount of intelligence and a LOT of hard work. I completed nursing school in one year (accelerated program), top of my class, with commendations from the dean. All of my clinical instructors wrote very good recommendations for me when I applied for jobs. I passed the state boards answering 75 questions. My success up to this point I attribute to a lot of hard work and a wonderful family. During my orientation I did not advertise any of this. I told no one except my preceptor about the number of questions I got on the state boards, and even with her, I made it a point to be modest. Personally, I don't like people who brag and boast, and doing well in school or on a test doesn't mean someone will do well in real life.
Several of us from the same class were hired by one ICU. We had the opportunity to complete our last semester with this unit, which we saw as a head start in orienting to the unit. We each had the same preceptor during this period and during orientation. I discovered during this last semester that many of my fellow-students were ahead of me in terms of responsibilities given. I was uneasy about this and asked my preceptor a couple of times for more responsibility. Her response was that I was a student still and that there was plenty of time to learn.
By the way, I was never late (always very early), never sick, and never rejected the opportunity to do anything. I loved the extra classes offered and did well in them. I looked forward to them.
During this time I also learned that the unit had had a bad reputation due to poor management. Nurses came and left within 6 months. There were a lot of agency nurses to fill the gaps in the schedule. The former manager had been fired because the work environment was so toxic. A new manager was hired shortly before I was hired.
In the last semester of school I noticed a few things about my preceptor:
1. She was very negative about other nurses, doctors, and even patients. She would treat patients she suspected abused drugs or alcohol badly - she would try to avoid giving them pain medicine, she would speak very negatively about them. She was not very compassionate with most patients in general. On three occasions the patients complained about her and requested me to be their nurse.
2. She was very condescending towards me. The longer we were together, the worse it got. I tolerated it because I realized that it was a temporary situation. As long as I was learning what I needed to know, I could put up with her bullying, I could put up with her behavior. She would have particularly bad days when she would disappear for long periods, then reappear in a patient's room, ordering me to do XYZ, as though I had done something wrong, when in fact I was in the process of doing those tasks. Several times patients and patient's families commented on her behavior once she left the room.
3. As time went on, I saw that other orientees were progressing, learning things I that I longed to learn, but wasn't taught. I was given tasks that a PCT would have, and on the rare occasion that my preceptor wanted to teach something to me, her lessons fell short. For example, when learning how to draw a blood sample from an arterial line she said: "turn the thingy up." That evening I went home and watched videos online to figure out how to do it. What she meant was: turn the stopcock off to the flush. On several occasions I asked her nursing questions that she couldn't answer. No harm, I thought. She can still teach me how to do the basics. But she didn't, or perhaps couldn't, do that either. As time went on, I felt more and more behind and that I wouldn't be prepared for 'real life' in the unit.
4. In the fourth week of orientation my preceptor was reprimanded. Her head was not in the preceptor game before this, and after the reprimand, it most definitely was not. For the first couple of shifts after the reprimand, she was almost nice to me. I thought it would be the turning point. Then she became even worse than before.
5. Right after she was reprimanded, she suddenly began to go through the preceptor's evaluations with me. I got good marks and her general remark was that I needed to learn more stuff. Well, yes, I thought. I DO.
6. In the seventh week of orientation, the manager saw a tense exchange between the two of us. I asked my preceptor a question in front of the manager, my preceptor snapped at me, and I replied that I hadn't been shown how to do X. It had gotten to the point that she was very critical with me all the time about everything. I could do nothing right. I was becoming more and more nervous at work. Sometimes I had trouble breathing. A few minutes later I asked the manager to talk to her, thinking I could talk to her alone. The manager called in my preceptor and then asked me how orientation was going. I was kind. I said that I didn't feel I was on the right track. My preceptor then totally torpedoed me. She said she didn't think I had what it takes to be a nurse in ICU. I replied by saying that in my heart I believed I did, but that I wasn't being taught how to do just that.
My preceptor left, I spoke with my manager who said she would find another preceptor. She also offered me the opportunity to transfer to another unit, saying that I could be a good nurse in another unit. I wanted to stay in ICU. Now I realize that was my moment to exit gracefully.
Within a few days I had another preceptor. She didn't seem enthused to have me. In fact, on our second day together she said she thought new grads shouldn't be hired in ICU. She was definitely not on my side. After a few shifts together, in which I learned a great deal - the learning curve was amazing - I discovered that I had been doing about 1/2 the charting I should have been doing. I quickly adapted. I was given full responsibility of two patients (normal load) and even though we had to stay late the first time, I did a good job,
I discovered in the following weeks that my first preceptor had a very bad reputation. She was seen as lazy (yes), a gossip (yes), gave very poor patient care (no Q2 turning or oral care, leaving patients who needed consultations in their rooms languishing - experienced this on several occasions), and unkind to patients (yes). I never participated in this talk, just listened. When asked about the change in preceptor, I said that we had decided to mix things up a bit. I made it a point to saying she had taught me a great deal.
I was steadily given more responsibility, feeling overwhelmed sometimes, but happy to finally have the opportunity to learn what I needed to learn. I thought I was making great progress. By the fourth or fifth shift together, preceptor 2 left the unit to make a phone call, leaving me in charge of two patients. One of those patients was on levophed. The levophed ran out shortly before preceptor number 2 came back from her phone call, and then it was my fault that the patient's BP dropped. Somehow I felt this was unfair, but I accepted responsibility for it, had bad dreams about it, and spoke with preceptor number 2 about it. Her reply was that I should have learned all about levophed in school.
Looking back, I see that there was no 'winning' from this point on. Even though I explained that I was behind others because I wasn't taught skills, she was not convinced. Preceptor #2 reported every mistake I made to the manager. I was docked for asking questions, I was docked for being behind the other orientees who started with me, etc.
For two shifts I worked with other nurses, who each said at the end of the shift that they would report what they observed back to the manager. One said she was very surprised at my performance - I had asked a lot of questions, and she thought I needed another 12 week orientation. I was very surprised since I completed all of the documentation and almost all of the tasks (save two) for THREE patients by the end of the shift - no staying late.
The second, and last nurse, I worked with was a true horror. She was a disorganized mess who arrived late and spent the shift talking to colleagues. Three people came up to me during that shift, giving me words of comfort. I realized that this nurse, who I rarely saw during that shift, was talking about me with other nurses. Near the end of the shift, I went to the charge nurse to ask her a question and found the nurse I was supposed to be working with talking to the charge nurse. It was obvious that the two of them, plus one more, were talking about me. A little while later I confronted her and she admitted to talking to the charge nurse about me. It was her duty, she said, to weigh in on my performance. In her opinion I should work in Med-Surg. During that shift I took care of two patients and did all the documentation for them as well, well before the end of the shift. I made one mistake with an infusion pump, which was reported back to the manager.
It was in the middle of the next shift that I asked to speak with my manager to discuss my progress. In my opinion, in three weeks I had picked up more than I had in all the time before. I had certainly made mistakes, they were beginner's mistakes, and no patient was ever hurt. In this conversation the manager said ICU wasn't a good fit. It was pointless to argue, so I decided to conduct myself as professionally as possible and to end on friendly terms. The feedback I was given was that I as a nurse I had excellent assessment skills, documentation skills, was detail oriented, was a good communicator with nurses, doctors, and patients, but I needed to work on prioritization skills and basic skills.
The good news is that physically I feel like a huge burden has been lifted from me. I have been sleeping well (whereas before I couldn't sleep through the night) and my stomach is no longer in knots. Maybe I dodged a bullet, but then again, maybe I simply failed.
If you have made it this far, Experienced Nurse, I would really appreciate YOUR feedback.
Where did I go wrong?
What should I have done differently? I don't want to make the same mistakes.
Now that this has ended, how do I talk about it in future job interviews?
Thank you for your input.
Last edit by Joe V on Jan 3, '17
Nov 15, '16
Sorry it did not work out. I once worked in the ICU and I feel that there are a many factors that determine if somebody is a good fit for the ICU. When you are new you definitely depend on the team "liking you" - ICU teams are tightly knit and sometimes it is hard to find out if somebody would fit into the team. But ICU nursing is different in that it is important to get your charting and things done but prioritization, safety, critical thinking, and prevention of disasters (running out of a pressor....) is essential. Not everybody is a good fit for ICU. It is important to see the bigger picture and provide safest care. It sounds that the team did not feel they can trust you and that you were not progressing to the level required.
By the way - there is no guarantee that prior med/surg makes a nurse a good fit either. But it helps to free the mind up for the ICU stuff because the person does not struggle with the basics of nursing at the same time.
I think that you realized you were not progressing as fast as others and that there were gaps but it seems that you did not pick up on the critical thinking piece.
So where to go from here? Apply to a setting where you can excel and gain some confidence. You are used to 2 patients but general med/surg has more, which means another transition. You wrote about that this is your second career and you were doing well in school. But there is a huge difference between school and reality. In nursing, nobody cares about your first career - you start at zero. I wonder if it would be good to reflect on how you come across. Depending on your age and attitude you may come across in a way that makes experienced nurses edgy. If you come across as overly confident or "know it all" it will be hard to fit in anywhere.
When you interview you should just say that you really wanted to work in the ICU but it was not a good fit. Don't blame it on the unit or the preceptor. Explain that your nursing skills all in all where not matching the ICU needs and that you are glad for what you have learned but you are looking forward to working in an environment that is a better fit.
Nov 15, '16
I could say that this sounds part and parcel like a common situation. No matter the details, you became the whipping girl, whether you deserved it or not. It sounded as if more than one person took their frustrations out on you. That happens. The only problem I could see, is that you said a group of you from the same program started at the same time. Who is to say that any of the others did not put a target on your back by talking about your achievements in a negative manner? It did not have to come from you. If that is the case, then the scenario was set without you being aware. You might have been blindsided.
You have to move on by putting as neutral a tone to the matter as possible. Telling a prospective employer anything you might suspect, or any truth that you encountered, is not going to do you any good. They don't want to hear that. You have to put the right spin on matters, in order to get things to work in your favor. Hoping your next position is not so negative.
Nov 15, '16
It sounds like you got the worst of preceptors available at the time. The unit sounds like it has some difficult personalities and difficulty retaining staff. You may have done much better with a skilled, dedicated preceptor.
From there you got behind, and engulfed by negative momentum. Politics wise, ICUs tend to have some pretty harsh characters, I've noticed. If you get a bad rep by an entrenched old bird, it's hard to shake it off, even if it's undeserved. It's like being thrown into a small chicken coop, if you're bottom of the pecking order they peck half your feathers out.
Cutting your losses is wise in this situation. Just dust yourself off and find your niche.
Nov 15, '16
It looks like we were at the same unit at different times
Give yourself a week or two to recover. Think of what you liked and not in terms of nursing process and what you felt like struggle. Think HARD about it, then think in which area of nursing your talents and gifts will shine, and go there. Paint broadly: if you like pathophys and pharm, acute dialysis with its management of fluids and lytes in very sick people can be your niche. I came from ICU as well, did not even know about LTACH existence and fell in love with it pretty quickly. Read this forum - there are plenty of very experienced people here in "specialities" part, they will be happy to describe you all the good, bad and ugly things (which are everywhere, just different).
Only try to figure out beforehand the atmosphere and situation in the hospital/unit you are going to apply, however you can. Network hard, go through Linkedin, ask in your school's alumni office. Nothing is worse than just walking from one can with spiders into another.
Nov 15, '16
You documented your situation here very thoroughly with details in logical order. I would venture that you likely gained that skill from you previous career. Which made me think how long you were employed BEFORE nursing? Nursing & healthcare seem to be a completely different direction for you.
I may be VERY VERY wrong about this, but are you older than the young'uns graduating these days? And who are populating your ICU?
Could there have been an 'age clique' in your ICU that existed even unintentionally?
It's difficult to think that AGE may be a determininng factor, but that is a reality (altho some may think not).
Time to move on and if age is a factor, keep it in mind for your next move. Good luck!
Nov 16, '16
Moved to the Critical Care Nursing forum for more feedback.
Nov 16, '16
Oh, dear. I am about to write a post that is probably going to be highly criticized. But as you asked for good feedback from someone with experience in these matters, I am going to give it to you -- from someone who spent many years coordinating orientations in a few Neonatal ICU's. I have been the person who has had to tell orientees that "this is not working out."
For you to succeed next time, you need to acknowledge that you made some mistakes in how you approached the situation.
You seem to have ignored a lot of "red flags" prior to taking the job. You knew the unit was troubled, but somehow you thought none of the that would affect you. You were extremely passive as things went badly from the beginning. Even while you were a student, you saw that the other students were progressing faster than you were. You knew your preceptor was bad, but "tolerated it." You saw other new grads progressing more quickly, but didn't seem to do anything to fix that. You knew by the 3rd week of orientation that you were continuing to fall behind the others. And yet, you remained passive. You seem to have thought that that since you are a good person and did OK in school, then everything was guaranteed to turn out OK in the end if you just "went along." Simply "going along" doesn't fix things -- and in a viper pit like the one you knew that it was before you took the job, it is not realistic to expect that strategy to work.
I'm not saying you should have become mean yourself, or overly demanding ... but you should have been monitoring your progress, comparing your performance with the ideal standard (or at least with the other students/new grads), and speaking up when you noticed yourself fall behind. You probably shouldn't have taken the job in the first place, knowing how troubled the unit was and knowing that you were already performing at a level lower than the other students. You ignored a lot of serious red flags and took the job anyway.
So while you maintained a pretty high opinion of yourself (based on your first few paragraphs) ... you took a job in a troubled unit where you already had a reputation for not be as advanced as the other students. Did that ever occur to you? - that you walked in there with a not-so-good reputation? Once orientation started, you should have sought help from very early on -- particularly knowing that you had not progressed as far during your student experience as the other students had. Was there a unit educator, assistant manager, etc. that you could talk to and ask for some honest feedback and suggestions? You should have sought someone from day #1, if not before.
If you were one of my orientees, I'd be thinking ... "Weak hire from the beginning ... then once she was here, she was passive -- just going with the flow rather than trying extra hard to catch up to her classmates. I'll try another preceptor or two for a couple of weeks, keep a close eye on her and seek a lot of input from her preceptors and other witnesses (e.g. Charge Nurses) about her performance. If she is still making beginner-level mistakes after 2 months here & a student preceptorhip ... I'll cut my losses. She got the student experience and now several weeks of orientation as an employee. We can't keep investing scarce resources in someone who isn't progressing appropriately."
To avoid a similar outcome next time:
1. Choose a unit that will be a little less demanding -- and one that has had stable management for at least a year. Don't choose a unit that you know is troubled.
2. Choose a unit where you can build on the skills you already have.
3. Make sure you know what the expectations are and how much progress you are supposed to making each week of orientation. Discuss them openly with your preceptor, unit educator, etc. to make sure you are on track. The minute you seem to be off track, ask for help in getting back on track.
4. Invest a little time in making friends on the job. Ask people about their off-duty activities, etc. Friends will help you through. If you don't seem interested in making friends, people won't want to work with you. So "read" the culture and adapt to it so that they see you as "like them" as much as possible.
5. To talk about this first job, just say that the ICU was not a good fit. Don't go into details. Don't make yourself look bad by talking about your failure to progress at an appropriate pace or mistakes that you made -- but don't blame the preceptors or staff of the ICU. Rehearse a few things you can say -- the types of things other posters have suggested.
I wish you the best of luck in recovering from this first job that didn't go well. Learn from it and find a better environment to work in.
Nov 17, '16
This may also be a result of the changes in nursing education. I see a lot of book smart BSN prepared nurses who do not have a grasp of basic time management and patient care. I worked my way up and without my in hospital LPN foundation I would be struggling in my latest acute care job. This is not a dig at the students just the result of the-student-is-now-a-customer nursing education. Hang in there.
Nov 17, '16
I've read your comment three times and you have some very useful advice. I particularly like your advice to be more active and the paragraph in which you give me insight on how a manager might see my performance.
A couple of points of clarification.
I was hired before my last semester as a student, so I was as weak a hire from the beginning as any of the other students. I did not realize what sort of unit I was hired into until I was working there as a student (employment contract already signed). Another clue that all was not well in the unit was that so many students were hired at the same time. However, much was made of the new manager who had been hired around the same time the group of us were hired. The feeling was that things would change. There were definitely red flags and it is good that you make me think about investigating the reputation of a unit before accepting a job offer.
During my student period I did indeed ask my first preceptor many times to be given more responsibilities, to be allowed to operate more independently, to be shown how to do this or that, but her reply was usually that I was still a student, or if she would demonstrate something, it was often not very well done. On many occasions I would go home and look it up myself or watch videos, then go back to practice. I believe that I was not being taught skills from the beginning (student period) because my preceptor simply didn't want to make the effort to teach or to even perform certain tasks. The second preceptor told me that she herself had spent one week with my first preceptor and she noticed her that patients did not get proper care. The second preceptor did an excellent job of explaining and demonstrating these tasks, so at least these were properly modeled for me then.
Many times during the student period and after I wanted to switch preceptors, but the unit was small and there were not many nurses who weren't already preceptors. HOWEVER, looking back, I should have talked very straightforwardly with my first preceptor and the manager about my concerns. You are right.
I did feel that I was in a bind: I was assigned to a nurse who quite simply should not have been a preceptor. She was reprimanded four weeks into my orientation. This implies that her behavior at work and her work performance were not adequate, so why would management allow this sort of employee to precept? Why would you allow this employee to continue to precept AFTER being reprimanded?
That being said, I agree that in my next position I must be much more pro-active and a more active participant in my training.
As for me having a high opinion of myself, I wrote what I did about my achievements to let the reader know that I am a hard worker by nature. I come from humble beginnings and have achieved a fair amount because I work hard. It is good to know, however, that I will have to be careful to "pitch myself" differently to avoid the kind of reaction I got from you.
Nov 17, '16
I am sorry that all of this happened to you. It sounds like an awful experience. I hope that you are able to dust off and find your niche!
I am a second career RN was in my 40's when I graduated. There do seem to be some issues with older mostly second career and/or degree nurses. I experienced it and witnessed it with others in school yet not on my own unit but know of situations at my hospital where it has and it's on here to an extent as well. I don't understand it and don't think others do either.
Secondly, since you clearly haven't done much reading of past posts and replies on AN so I feel that I must tell you that ALL of the above posters gave you empathetic, non-judgemental and very helpful responses. You appear to have taken umbrage at llg's response as evidenced by your last sentence in responding to their advice.
By some fluke, you've experienced none of the all-too-frequent posters who slam, offer little truly helpful advice and have zero empathy to those who come here with these types of situations.
If you really were offended by kind of response you got from llg, then hold on to your hat, scarf and gloves since a snowflake-calling storm may be headed your way so it's likely downhill from here especially
since you used the b word. There are are a few strident b word deniers here or that the b word happens very, very, very rarely in it's truest form but mostly these deniers contend that it's the fault of the alleged victim.
Nov 17, '16
GraduateNurse14, the responses I have gotten to my original post have been very helpful, each in its own way. People have responded differently to my story and their responses, as well as how they have responded, are very helpful. I have 'liked' every post that I haven't directly responded to. Hopefully this is proper etiquette to say "thank you." I have also corresponded with one of the posters above, going into more depth, and of course thanked that person as well.
I found LLG's response very helpful too. I has made me think about my past actions and think about how I could act differently in the future. I do believe, however, that management was wrong in keeping the preceptor I refer to in the position of preceptor. That was my point. Another point was that I have had nothing handed to me in my life, I have worked hard in life, and will continue to do so. I don't expect orientation to be easy. But in expressing this, somehow I seem to have come across differently than I intended. Perhaps it is the nature of posting, or perhaps I need to work on my pitch. From your response I am thinking that this is the case.
I'm scratching my head in reading your reference to a 'b word.' Not sure what this means.
Nov 17, '16
I agree that the management should not have kept an ineffective preceptor but it seems to happen a lot. I ran into when I was more involved in my union and what is posted on here. Hopefully she isn't one now.
The b word is bully. Claiming that you were bullied on here can really set some nurses off as they have very strong opinions about its frequency and whether it even really exists in the classic form in nursing. Some have said that nurses who claim that they've been bullied see themselves as special snowflakes and say nothing that is helpful.
Your post is really good. There is nothing wrong with how you expressed yourself. It is very well written, detailed and not bragging in the slightest. You were clear that your successes came from hard work which is commendable. My point was that too many times nurses come here with real issues, complex painful situations and feeling terrible about themselves and their future but do not get much empathy or kindness from fellow nurses but a pile on that can be hard to read as you are picturing the OP reading knowing that he/she is being made to feel worse. I was very heartened that you received really nice responses from so many nurses but preparing you for what could be coming.