Question on new grad preceptorship experience

gigglestarsRN · Nov 8, 2012

Thanks for all the responses. What had me feeling so overwhelmed the day I wrote that, was that the unit was very understaffed so everyone was busy-warp speed busy-- not even a medic could help. I had 3 very critical patients and lots of questions, I tried making some judgement calls on my own when I could not find another nurse to ask, and made some mistakes. Nothing that hurt a patient, but I just felt stupid. I know that is normal too, to second guess yourself as a new grad, and learn from your mistakes, but still I couldn't shake the feeling of being thrown into the fire so to speak. I needed to be in all my rooms at the same time, literally! I just can't figure out how to prioritize to the sickest patient when they all feel sick. I got 2 ambulances within 15 minutes and was arranging a pt transfer to surgery and then had that patient pulled out of a room and put in the hallway to make way for a stemi! I just don't know how to prioritize in a situation like that. I had surgery on the way so needed to complete the pre-op work, had an incoming stemi, plus a new patient to assess, a patient that ended up having a snake bite, so it was serious.

I am giving serious thought to stepping away from the ER until I get more time management skills and really solidify my basic nursing skills. I do have confidence in my ability and know I can deliver good care, but the pace and stress placed on staff to turn rooms over is overwhelming, plus I feel there is lack of support and low morale with people quitting. 5 people have left since I started and I know of new grads who started before me who report the feel like they are drowning still and as soon as the meet their 1 year are planning on leaving. It just feels unsafe. I am not a quitter, and this is what is holding me back. I question whether I am giving it a fair shake but feel the lack of support and communication is daunting for a newbie, that and the constant pressure...it's maybe just boiling down to not being a good fit. Have any of you started out somewhere and then just felt in your gut it wasn't right? I don't want to throw in the towel too soon, but if I listen to my gut, it's telling me to move on rather than commit to this place beyond orientation. I also find I miss connecting with my patients more--when it is not so busy and I have more time to care for them I feel much more satisfaction. Maybe it should have been obvious to me that the ER is not a place that kind of care can happen, but rapid assessments and stabilization are what's the priority, getting that stemi on the monitor, iv access, blood drawn, respiratory to the bedside, defibrillator pads placed, get them to cath lab-GO! whew. Its exhausting. Rewarding in its own unique way, but for a new grad trying to put it all together, it doesn't leave a lot of time for teaching, and when you throw in low staffing and poor morale, it doesn't feel like a recipie for success.

Any tips would be appreciated :drowning:

Anna Flaxis, BSN, RN · Nov 8, 2012

You already know the answer. Best of luck to you in your future endeavors!

pedsEDRN16 · Nov 16, 2012

I was really lucky as a new grad in the pediatric ER. My orientation was just over a year and consisted of 8 weeks on the general pediatric floor, 2 weeks in NICU, certification classes, trauma classes, and 8 weeks in the adult ED/triage. My advice: never be afraid to ask for help. Resources are always available =) I'm going on 3 years now in the Peds ED and I love it =)

gigglestarsRN · Nov 17, 2012

Wow pedsEDRN, that is a fantastic program you got into--way to go!

Not much has changed for me. My orientation was extended, but it feels a bit of a sham because when I work with my preceptor she is rarely in the room ever with me or even discussing my plan of care, orders, priorities--you name it. I am operating on my own, with help from other nurses, and ocassionally her, when I get ambulances with patients needing lots of care. I think her feeling is I should be able to do it on my own since I won't always have help, which I understand in theory, but what bothers me is I feel totally unsupervised and lack the guidance of an experienced nurse, so that defeats even being on orientation anymore. I am only approached by her when she has a question about something I have done, or missed. I would rather discuss things in the moment, rather than after the fact. I feel like I am missing out on a well run preceptorship experience.

I did have the good fortune a few days ago to work with another RN when my preceptor was on vacation. It was night and day--she was terrific! I honestly feel I can say that I learned more in 4 days with her than in 3 months with the other. She challenged me with questions about incoming patients when we would get an eta on an ambulance--what do you need to have in the room for this kind of pt, get the room ready, call RT, call registration etc. She would make me delegate to all who showed up and manage the room start to finish. It is great learning and I love it! She is always there to offer insight, lend a hand or simply give me a tough question to think about. I wish she had been my teacher all along. My current preceptor is hostile generally and others notice it too, it makes for a very stressful day, on top of an already stressful work environment.

Another bright note, I have been offered an interview at another hospital, on a floor that made me an offer days after I accepted my current position last summer. I have a friend on the floor who speaks well of management and her coworkers. I am glad for another chance, as I feel that even if I didn't have issues with my lack of training and being pushed to be ready for high acuity unstable critical patients as a new grad, the environment in the Ed where I work is low in morale--6 people leaving in 6 weeks and 10 nurses short....it is poorly managed all aound, it just doesn't feel worth it, which to me is a bad feeling since I am not someone who just gives up or walks away from a challenge. I guess if you have read this far you can tell I struggle with all this--it is so unfamiliar to me to have these challenges. I am not a young person either, I have 20 years of experience in different fields of work, and it amazes me to see how nurses treat each other. I had heard about it, but just wasn't prepared for what I have experienced. I digress though...just wanted to give a quick update. I have also taken advice read on other threads to record interactions with management as well as incidents that could be used against me in a file or taken out of context simply because they may decide to try to fire me. I haven't done anything wrong, but lately my manager has taken things I have said to my preceptor out of context, and been insulting and rude. Just trying to protect myself. Again, I appreciate the shared stories and feedback. Thanks all~~

Anna Flaxis, BSN, RN · Nov 17, 2012

Thank you for the update, and I'm glad to hear you got a job offer!

Your preceptor's thinking that you should function on own during preceptorship so that you will be ready to function on your own once you're out of preceptorship is faulty. While it's true that we gain confidence through experience, that is putting the cart before the horse, so to speak. You should have some time exactly like the second preceptor you described, who is willing to spend the time with you teaching you, asking you questions, and generally supporting you. As you gain more experience with that support, you will need it less and less over time. You may still feel not quite ready to go off preceptorship when it's time, but you will be able to function at a semi independent level and ask for help from more experienced co-workers less and less.

I had a similar preceptorship experience to yours, but I was not a new grad, and I had come from a high acuity unit prior to starting in the ED, and still, there were times where I had a lot of questions or didn't know what/how to do things, and my preceptor was not there to help me. It felt very sink or swim. Luckily for me and my patients, I swam, like you probably would if you stuck with it.

I think part of the issue is the preceptor's frame of mind, as well as the culture of the ED you're in. If the ED is understaffed, then they can't spare a single nurse to "hold your hand", so to speak. They need everyone on deck, and that means your preceptor is taking patients and unable to provide you with adequate supervision. This is not uncommon, and neither is your experience.

I'm glad things worked out for you, and wish you the best of luck in your new job.

gigglestarsRN · Nov 18, 2012

Thank you Stargazer, it really is as you describe and I agree with you 100%. I wanted to prove I was up to the task, and gave it 100% but in the back of my mind felt it was unsafe for patients to have me doing sink or swim with them. It basically meant if I did everything well, I heard nothing. If I forgot to chart something or didn't complete an order fast enough, then I would, and be made to feel like a failure, like I should know these things. Well heck, how to you learn if you don't get taught? By making mistakes, and that is not fair to anyone, to leave a new grad to make mistakes because the unit is too short on nurses to properly supervise. Fortunately I never made any real errors that impacted a patient.

Another update, I still have not been given a schedule for next week and have not received replies from the NM about when to come in next. My gut tells me she is hoping I will just quit, but this is simply wrong to treat an emloyee this way, especially a new grad. I don't feel it is my duty to badger her for a schedule, it is her resonsibility to get back to me in a professional manner. How should I handle this? In a way I never want to go back to that unit again and if I am done, fine, but have the guts to tell me and handle it like a professional. Fingers crossed for my interview next week.

Anna Flaxis, BSN, RN · Nov 18, 2012

Maybe your NM knows that you're looking elsewhere, and is hesitant to invest any more in you knowing that you're planning on leaving. I'm assuming the NM works Mon-Fri and you won't hear anything until Monday. I'd say if you don't hear anything by Monday afternoon, give your NM a call.

Ruby Vee, BSN · Nov 18, 2012

Thank you Stargazer, it really is as you describe and I agree with you 100%. I wanted to prove I was up to the task, and gave it 100% but in the back of my mind felt it was unsafe for patients to have me doing sink or swim with them. It basically meant if I did everything well, I heard nothing. If I forgot to chart something or didn't complete an order fast enough, then I would, and be made to feel like a failure, like I should know these things. Well heck, how to you learn if you don't get taught? By making mistakes, and that is not fair to anyone, to leave a new grad to make mistakes because the unit is too short on nurses to properly supervise. Fortunately I never made any real errors that impacted a patient.
Another update, I still have not been given a schedule for next week and have not received replies from the NM about when to come in next. My gut tells me she is hoping I will just quit, but this is simply wrong to treat an emloyee this way, especially a new grad. I don't feel it is my duty to badger her for a schedule, it is her resonsibility to get back to me in a professional manner. How should I handle this? In a way I never want to go back to that unit again and if I am done, fine, but have the guts to tell me and handle it like a professional. Fingers crossed for my interview next week.

If you feel that the ER isn't a good fit -- for whatever reason -- have you discussed this with your manager? Now is the time to do that.

I don't work in ER, I work in ICU. When an orientee is considered a potentially valuable employee but a poor fit for our ICU, my manager works very hard with human resources to find another position within the system that might suit better. My question is whether or not this option was offered to you, or whether you've opened the door to that discussion.

DC Collins, ASN · Nov 20, 2012

That really is a tough one. The question to ask yourself is, once you are officially on your own, will you have the support of the other nurses? Is the teamwork in the department (not just with you, but what you observe around you between existing staff) there? Is it strong?

I have only been an RN for 2 years, and went straight into the ED. It *is* a tough way to go, but I have been blessed to work with a VERY strong team which is always there for each other. IMHO, there is No Way to jump into the ED without strong teamwork. Once you have a critical patient, especially if it is a type of case you have little to no experience with, pt safety is paramount. Hell, the paperwork alone can be daunting.

With my coworkers, we hear of a high-acuity ambulance arriving we drop what we are doing whenever possible and jump in to help out until we know the pt and primary nurse are settled. Its just that simple. If your coworkers do this, you are set. If they do not, you may want to finish your residency and then start looking for another ED.

Best of luck to you, I hope it goes well!

DC :)