Question on new grad preceptorship experience

  1. 0
    Hi~ I am a new grad from May 2012 and was hired into an emergency department at a hospital in town. I feel so blessed to have the opportunity and know I have my work cut out for me in this demanding specialty. I started in late July and we have a 16 week orientation that will soon be ending. I had a rough start due to not speaking up soon enough regarding not clicking with my preceptor. I was afraid I would be deemed as rocking the boat or causing problems with an established nurse in the dpt. I know see that was wrong, and would recommend anyone in that boat to speak uop for themselves. I have had about 8 different preceptors and only in the last 6 weeks have I been steadily with one and I am happy to say it has worked out rather well.

    My question is this though, I know as orientations are drawing to a close, we are expected to handle a patient load on our own which I feel I am able to do unless with a high acute zone, but to me this is to be expected, as we have so much to learn and experience, how can we be expected to know how to safely or intuitively care for really sick patients all on our own. There was a recent experience that I had a day as I described, with some very sick patients and a preceptor no where to be found, or taking their own patients due to being short on RN's. I felt like I was drowning and learning some things trial by fire. I was frusterated, I was aksing for help and not getting it. At the end of the shift, and after giving it some time to process, I contacted my preceptor for feedback. I was honestly surprised to not get any without asking. The feedback I got was somewhat discouraging, that they felt I wasn't ready to be on my own with that acuity (agreed!) and that they had been instructed by the manager of the dpt to let us be on our own without help to see how we did. I was told the preceptor could see I was flustered and frusterated, but they had to let me try to sort it out on my own.

    My gripes are:
    ~I was not told I was being put in this situation, to be tested as to how I could handle patients completely on my own, ahead of time--I think this would have alleviated some of the frusteration I was feeling as to why no medic or RN could seem to be free to help me.
    ~Patient safety was not put first.
    ~I am not off oreintation so why treat me like I am.

    Overall I have felt this workplace to be a supportive environment but the last 2 weeks have felt like hell. I feel adrift and unsupportive. I feel like I am stranded and where did the teamwork and training go--out the window? Or is this just part of their process, to test me?

    I have resolved to continue on in a professional manner, to do the best I can, and to remind myself of how far I have come since graduating in May. I know the ER is a tough nut to crack, but I feel that given the support, along with my continued studying on my own time, will serve me well. I just don't know if these recent experiences should be a red flag to me, or is this simply the way most departments work when a fledgling nurse is ready to be on their own?

    Any thoughts would be greatly appreciated.

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  3. 20 Comments...

  4. 1
    Honestly, I hear a lot of escuses but what it boils down to is you were "frustrated" and "flustered" by taking your own patient assignment of acutely ill patients when you are at the end of orientation. In my experience, many people have more than one preceptor (and personally its what I prefer for myself). It is also normal for education department to ask you to demonstrate that you can fly on your own shortly before you come off of orientation. I think it is common to feel slower than everyone around you and that you require more support from other nurses than they require from you. It is not normal to feel that someone should be hovering over you while you care for the acutely ill in the ER as that it what we do.

    I believe that you would feel flustered and frustrated by an independent assignment regardless of the care area as this is specific to you. Your experiences are outside of the norm for new grad ER RNs and it sounds like maybe a less acute area would make sense to you. Since I don't know you, I will simply tell you that I don't think anyone here knows the answer to this problem but you. Can you handle the assignment without feeling flustered and frustrated or would your anxiety be less in a less acute area?
    DC Collins likes this.
  5. 0
    I completely understand your feelings, I have been in the ICU for 6 months and I am a 2012 grad as well. It's hard for experienced nurses to remember how frightened and stressful it is to be a new nurse, knowing that you hold peoples lives in your hands and fearing that you will miss something crucial due to inexperience and end up causing harm. I get the shudders every day at work but I am slowly learning to stay calm and try to think my way through a problem before going for help. Sometimes I figure it out, other times I go get help. The nurses in my unit are pretty dang amazing at helping out with any question. Sure, some can be a bit abrasive and they certainly like to see how far I can go on my own while they sit back and make it look like a breeze. You were justified in feeling upset, they should have let you know that they were letting you fly solo, I know I would have been better off knowing that little tidbit instead of feeling ignored and abandoned. Just because you feel flustered doesn't mean you can't handle the ER. I still get flustered and frustrated but I am learning that I can step back and take that 5-10 seconds to think hard and prioritize according to my knowledge base, and then I move along. I don't think there is any cure except experience and time
  6. 0
    How were your clinicals set up in school? I was taking 4 patients complete cares on a step down unit/tele by myself. I think this helped me feel better on the job. I also worked as an lpn in LTC which makes you feel stressed and use your critical thinking skills. In my experiences in the er during school rotations is that if it is a true emergency then the others nurses all help out. I think that by the end of a 16 week orientation that you should have the knowledge to assess and treat the "normals" of the er, example...chest pain, fever, broken bones, dehydration, and etoh abuse. If something unusual were to come in like a rhythm strip you did not know or an illness like possible meningitis I think that it would be appropriate to come up with an action plan and ask another nurse for their opinion on your plan. I never received 16weeks orientation anywhere. I got 3days in LTC and saw everything from gas pains to an AMI to a gi bleed. My current job I got 40hrs orientation. You just need to be more confident. it does take time and experience but maybe what you see as your dept turning their backs on you is really them supporting you in flying solo. That day will come and maybe they felt you were relying too much on the seasoned staff and giving you the chance to build your confidence
  7. 0
    Having multiple preceptors during your orientation is pretty common from what I see. You had a nice long orientation, MUCH longer than I had, that should hopefully prepare you enough to take on a full, or almost full, load of stable patients and to do ok with support with unstable patients. In my orientation, there was never a "heads-up" that I was going to take on patient care by myself. Depending on the craziness of the day and the staffing level I had many preceptors who would take on their own patients while I took care of mine, with support as needed or not. If you are at the end of your orientation, you should examine what exactly you felt flustered about: did you take on a load that was too much for you, were your patients too sick to have that many, was it normal new grad flutters or do you maybe want to look into a less high-acuity, stressful area of nursing? What help did you ask for that you did not get? I don't know the details, so I can't make a call. However, NOW, while you are still in orientation but almost done, is in my opinion the perfect time to "test drive" you to see if you might need more orientation time or in what areas you need the most work in.
  8. 1
    Nursing is trial by fire. You would be experiencing this no matter what unit you were on. I'm just amazed you got sixteen weeks' orientation! That is simply astounding!

    Patient safety first? Don't get me started!
    camiluvsNURSING likes this.
  9. 1
    Orientation for new grads has been 16 weeks in 2 of the 3 emergency departments where I have worked. That time frame is also, I believe, recommended by the ENA (will try to find a link ...).
    Anna Flaxis likes this.
  10. 0
    You are correct, Altra, about the ENA's recommendation. Mine was only 12 weeks, which is the standard length of orientation in my area (pediatric ERs are usually longer here, 16-18 wks). Wish mine had lasted 16 weeks!
  11. 0
    The only new grad programs in my area are in the ICU, and those are six month preceptorships where at the end of the six months, you must apply for an open position on the unit. In the ED, new grads are rarely hired and receive the same orientation as experienced RNs. Mine was closer to 16 shifts than 16 weeks! As a new grad RN on a PCU, I had 10 shifts of orientation.
  12. 0
    Help!!! I interviewed yesterday for icu fellowship and the interview last 15-20 min. I was interviewed by 2 nurses manager from icu. They were extremely nice, but they only asked me 3 questions, and asked me to ask them questions. I asked them about 7 questions, and I asked for a tour they were really happy that I asked for it. They showed me everything and introduced me to the staff. My concern is that in the end she told me to email her next week and ask about the process. She also told me to put on the email things we discuss do she knows who I'm. Is it a bad sign. She said to email her so she can tell the DON about me. I asked how many openings she said 6 and is interviewing 20 people. I'm really anxious about it. This is a dream opportunity. I'm a new-grad no experience. Thank u!!!

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