Novice ER Nurse needs help please

Specialties Emergency

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I would really appreciate some input. This is the first time I'm posting so please forgive me if I'm doing it wrong. I'm a novice nurse, graduated last year and entered a 10 month orientation program at a local hospital. Novices started rotations through med-surg, tele, and then end up in home unit. My home unit is the ER and I have been there about 5 months. I was set to come off orientation and had been put on May's staffing schedule. My last week of orientation I ended up in the hosp so I was told that my orientation would be extended another week to make up for the week I missed. The last shift of that week I ran into the nurse manager and asked if I was good to go to start my own schedule the following week. She informed me that they were extending my orientation (but was not sure for how long) because they were concerned my critical thinking skills were not ready. This conversation happened in the middle of my 12 hour shift AND it was the first it had ever been mentioned to me and it had never been noted in my clinical folder. I put my big girl panties on and finished my shift. Honestly I did have a little cry in private but regained my composure and think that think I did a pretty good job. I called her back on my day off to pick up the conversation and let her know that I loved the ER, felt I had grown tremendously since I had been there, wanted to be a nurse there and would do whatever it takes. She countered with: she needed a timeframe from me on how long I thought it would take to develop my critical thinking skills and I had to write a plan and goals which are due Fri at 0700. I know I need to improve and grow but honestly feel that will come with experience. I am not making excuses for myself but have had issues with the preceptor I have had since getting on days and had been told months ago by the nurse running the orientation program that other novices had issues with this preceptor. I'm a new grad at 47 and my preceptor graduated three years ago and is 23. I hate to talk badly about her, I think she is a great nurse, but honestly don't feel she has what it takes to be a preceptor. That is not the issue I am facing now I am just extremely frustrating. What I am asking for at this point is any guidance with writing this plan. She did not give me anything to go on other than critical thinking skills. I do want to improve upon them but not quite sure how you write a plan for that. Other areas I know I need help on is delegation and confidence. I do believe part of the problem that this is stemming from is that I am the kind of person that wears her heart on her sleeve. I told my preceptor that I was going to be nervous when I came off orientation and started on my own (but I feel that is a normal fear). I just shouldn't have expressed it to her I suppose. And on one occassion last month I had my first BAT and when it was all said and done I complemented my preceptor telling her what a great learning experience it was for me that I don't know I would have known exactly what to do had I been on my own. UGH! Boy did that come back to bite me. Any suggestions for a plan?? I have a 4 week extension. Thanks for any help given. : )

Specializes in Med-Surg, , Home health, Education.

Familiarize yourself with typical lab values and correlation with diseases. Most novice nurses need to develop these skills and it comes with experience. She obviously knew you were relatively new to nursing when she hired you for the ER. I'm confident you'll do fine....a 47 year old new grad still has a leg up on the critical thinking factor and I'm sure you'll be a success...don't second guess yourself but don't be afraid to ask questions. Chin up!

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Specializes in CAPA RN, ED RN.

Good luck Lunar! Critical thinking involves your ability to make decisions about complex problems. Basically it is the nursing process and knowledge along with the experience that you need. If you need to address a knowledge base include that in your plan.

Ask your self "What is going on with my patient? How do I know? What do I need to do? What happened?" If you are continually looking for your outcomes and how you effected them you will greatly speed up the critical thinking development process. It takes a minute to take a breath with each patient and develop a plan but it really pays off. Watch where you are going with your plan as you take care of your patient. Change what you need as you go along. Also take that minute when you get done, check to see what your outcomes were and see if there was anything else you would have done differently.

You are still very new. Go easy on yourself but give yourself the tools to grow. There are many resources. Judith Wilkinson also has a book called "Nursing Process and Critical Thinking" with multiple concrete examples to develop critical thinking.

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Thanks again for all the input and support. You all have no idea how much this has helped me. I know I have a long long way to go. In answer to some of the earlier posts, no I've not made a med error (knock on wood); I am now up to the 4 rooms (5 when you get the psych block), which is the norm unless we are understaffed. Initially my assessments took too long but I have streamlined those (was used to doing a full head to toe from school and time on floor). And yes I have requested to have my original preceptor, who was absolutely fantastic and a great teacher. The sacrifice is she works 7p-7a which my body had a hard time with but now it seems worth the sacrifice The specific incident that was brough to my attention happened about a month ago. It was during my first BAT. A gentlemen came in completely asymptomatic other then "worst HA of life". He went downhill in about 15 minutes. On the way to CT he began gagging and my preceptor said we needed to turn around and go back to room as he was loosing his airway. Doc had to do immediate intubation and it was not an easy one. He went from htn to becomming extremely hypotensive and had to hang a levophed drip. He ended up being flown out. It all happened extremely fast. Once we got him stablized my preceptor told me to leave the room and find a computer to document everything because the flight crew would be arriving shortly and we had to print out a summary for them. That is exactly what I did. While I was out documenting, manager came by and pointed out to me that if I were a primary nurse without a preceptor I would not be able to leave the room and come out to doc. I would have to stay in the room and oversee pt and document. I acknowledged that fact and kept on documenting. When it was all said and done I complemented my preceptor and told her what a good learning exp it was for me and that I was in awe of her quick response. I told her I had never had that experience before that I didn't know that I would have known to turn around at that point. I was being honest. Those are the two incidents that have been brought up. I left the room to document and I didn't know that he was loosing his airway. Like I said it all happened so fast and I don't know that I definitely would not have known. I was in the back of the bed and she was in front of bed. I could not see the patient, she could. I made a statement that I probably should not have made. So that is what the manager is basing her decision on.

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Specializes in Emergency, Critical Care (CEN, CCRN).

So let me understand this... you're brand new to EC, straight out of school, everyone knew this going in, and you're being put on a remediation plan (which, at least in my hospital, is the step immediately before a termination for cause) because you complimented your preceptor on a quick response to an emergent situation?

Either you're being railroaded by your manager and/or your preceptor, or your performance has been a lot more lackluster than you've let on. In any case, something doesn't add up here. Has there been any indication prior to this point that anyone up the "chain of command" has been unhappy with your performance?

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Specializes in student; help!.

If your preceptor TOLD you to go doc, and you'd said, "No, I need to stay with my pt," would she be on you for that, too?

PS, BAT?

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Specializes in Peds Homecare.

I don't know if any of these videos will help or not, but I thought I'd post the link just in case. Good luck and hugs.www.youtube.com/watch?v=xrVF8D8axGI -

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Specializes in ER, pedsER, SICU, Trauma.

RN-cardiac thanks so much for that post! I've been in my ED for almost 6 years (first 5 as a tech now as a RN). I am just now feeling more confident in my assessments. I wish I had heard that earlier.

Thanks.

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On my way out door to turn in plan only have a sec. BAT = Brain Attack Team. He was having a stroke. As far as possibly not letting on about a lackluster performance... if I was giving one there was never a word said to me, never a word prior to finding out they were extending my orientation. Never a notation in my clinical folder, no one ever talked with me. I was put on the May and June Staffing Calendar. I was set to go. Then... the week before I was set to be on own... when I verified w/ manager... this is the first I heard. I had gotten feed back that I just needed to speed up but that would come with time; that I needed to stop second guessing myself cause I was doing a good job; that I was doing better than I thought; that I was right where I was supposed to be. (these all were comments made from different nurses I worked with). Got to run... wish me luck...giving her my "plan". I'll keep you posted. Thanks for all your support. : ) Say a prayer for me at 0700 please!!! : )

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Hope it went well ... keep us posted!!

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Specializes in Cardiac, ER.

Hope it went well.....I'm off to work myself,....sending prayers and happy thoughts your way!

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Thanks for all the good wishes. I feel it went very well. They loved the "plan" I proposed and I had a great day. Looking forward to next week starting with the other preceptor. Found out today that the other novice that had been with my preceptor is going through the same thing. I'm really thinking the preceptor was on a power trip. The other novice and I are going will both be with different preceptors. Yea! I'm off to bed to start reading ER manuals. lol Thanks again everyone! : )

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Way to go! It is so important to ask for help and for to grow in new ways. I hope you gain excellent knowledge & experience working with your new preceptor & following your plan. Good luck!

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