Novice ER Nurse needs help please

[Lunar]

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. : )

[bethaj17]

Thx for your input!!

[canoehead, BSN, RN]

Sorry Lunar I did not read the whole thread, but I read the OP.

I've been in nursing since '87, and as a new grad I went home every day for at least the first year thanking God I hadn't killed anyone. So I've got to congratulate you on taking on an ER job and making it as far as you have. I'm not one of the nurses that thinks a new grad in the ER is impossible, some people are just built with ER in their blood, or OR, or PICU. (not me though)

My first shift floating to the ER after being a nurse for 15 years ended in tears, I swore I'd never go back. I oriented on a PICU for about 2 months, and had to stop cause my brain just refused to handle any more. I couldn't look up a drug and walk over to the bedside and administer it because I couldn't retain the information. I put my stethoscope on a baby's chest and saw him have a run of vtach from the touch.

I thought I'd never be able to handle any critical care job, that I was stupid or defective. I also got a new appreciation for the regular med/surg people that maintained a daily routine for people that were bedbound and sick. Denture scrubbing isn't glamorous, but getting all those yucky things done makes miles of difference to someone who is helpless and wonders if anyone cares about them. Will their nurse notice if they start breathing funny- well probably, because they noticed when they needed a hairwash.

Fast forward a few years, I've floated to ER, ICU, and OB. I'm currently working the ER and am able to take the sickest patients that come to us. Yeah, I took a break when I was overwhelmed, but with experience I was able to achieve the goal. If you choose to soldier on you have my admiration, but if you decide to fall back and get a stronger foundation that is just as valid and responsible a decision.

My point being that just because you didn't "make" the ER team doesn't make you a bad nurse. And it doesn't mean you won't succeed in a few years and be a more knowledgeable and flexible nurse than you imagined possible.