Admitted I should step-down...your advice?

  1. I graduated in mid-June and have been working in a critical care step down unit. I have been trying so hard: I was getting to work 45 minutes early to prep., charting on breaks (until they told me I could not anymore), and staying late w/o declaring the time to finish my charting. My employer didn't intend it this way, but due to circumstances, I didn't have a permanent preceptor and ended up working with about 9 different nurses over orientation. My manager told me they almost all (preceptors) had concerns about me. For some reason, I'm just not getting the hang of it. So yesterday, I asked them if I could move to a unit that provides a lower level of care. I feel relieved, because I had too much anxiety and fear. More than anything, I became traumatized by the impatient preceptors. I don't want to leave the unit, I want to keep trying, but I just can't image another day of the stress, anxiety, and fear as nurses tell me I am not managing my time wisely, failing to prioritize correctly, making mistakes, struggling, etc. I hate throwing in the towel, but I'm starting to get afraid that I may hurt someone becuase I feel I'm pushed so much to go faster and when I ask questions, I have to deal with impatience from the other nurses. (I did make some medication errors --calculation and timing--over orientation, but thankfully no one was hurt). I realize that I started at a level of care way over my head and I want to go to the simplist unit in the hospital. These units (below) have openings and hire new grads. I was thinking about the rehab unit or general medicine. What do you think is the simplist unit for a new grad? Would you recommend mental health? I'm also considering that I shouldn't work in a hospital at all and work in a convalescent home instead. Where is the least stressful place for someone who is scared of stress right now? Thanks.

    Oncology/Hematology
    General Medicine
    Comp. Rehab Unit
    Orthopedics/Trauma
    ENT/Plastic/Urology
    General Surg/Transplant
    General Surg/Neuro
    Neurosurgery/Trauma
    •  
  2. 9 Comments

  3. by   augigi
    Rehab may be better if you want routine, unchanging care. Don't think medical ward if you find med calculations difficult.

    A better response would be to work out why you are having trouble. Can you go to another hospital with a good orientation? This is 99% of the trouble - you can train most people to work most areas if you give proper orientation.
  4. by   gonzo1
    I started in ER as a new grad with very poor orientation much like you describe. Quit after 4 months of hell. Went to med/surg, learned a lot, had a better orientation and did well. Am now back in the ER and doing great. Rehab is a nice unit because you are not dealing with really sick people on a lot of drips etc. I wouldn't recommend long term care as orientation at those locations are usually 2 days and you are on your own. Work in rehab or similar spot at hospital and gain your confidence back (it took me a long time) and then go where ever you want to go with a fresh outlook. Don't despair, this has happened to many, many people who found a spot with great orientation and are now excellent nurses. Good luck and God bless.
  5. by   busyernurse
    Reply to supernova004 - I feel your pain. Although I have been a nurse for 15 years, recently I took a job in a new facility. Of course, this facility had gone to computer based charting, including a "rolling emar" cart where you scanned the patient's armband and all the meds you were giving at that time. Well, my first day, everything went as scheduled, but I am the type that learned better "doing", and my preceptor was the type that "I'm in a hurry so I can go downstairs to smoke".
    Needless to say, my second day at work,n my preceptor decided to take off early, and I mean REALLY early for low census. I was the only RN on a 25 bed unit, and had 5 patients of my own. Of course, I had never used computer based charting and the LPNs were less than helpful. Now, I knew patient care, but I was up a creek w/out a paddle as far as med administration. It was a "Prozac" day!!! Whatever your decision, keep your chin up!
  6. by   supernova004
    I think the hospital offered a good oreintation. 12 weeks: half in the classroom and half on the floor. I didn't realize we'd spend so much time in class...I would have preferred to have had that time on the floor with a preceptor. I learned a lot, but the pace of the unit and the diversity of Dx is too much for me. The worst part was that I felt I lost the confidence of staff/RNs: atmosphere of show you once and after that, you should know. Any bonehead mistake or act of omission was strongly frowned upon. They seemed to expect perfection from new grads.

    I don't think I could get a better orientation anywhere else, but I wonder if I could find a more supportive environment where they would give me time and room/space to perfect my talent.
    Last edit by supernova004 on Oct 10, '06
  7. by   tamari07
    I would definitely consider a less acute unit. I decided to work on a neuro unit versus critical care. I did clinical practicuum in the ICU and learned tons, but I knew that'd be way too intense as a new grad. My first year of nursing I want to be able to learn the basics and get a routine down. Maybe on down the road I'll consider ICU stuff. Since your facility is allowing you to transfer I'd definitely consider a more less acute unit. And concerning the med calcuations, that will come with time. Just practice some of the common calculations like drips per minute and so forth. I wasn't very good in math, but learned ways to understand calculations. I'd definitely practice some calculations and brush up on those skills. Good luck in whatever you do!
  8. by   medsurgnurse
    There is nothing wrong with you as a nurse. It takes time to develop the skills of an experienced nurse. Rehab is a great place to start. Patients are there for extended periods, so you may be assigned the same patients everyday. you can develop prioritization, speed, and time mangement skills without the high pressure of critical care. And if you could do favor to the new grads...... go to one of the student nurse forums and tell them about your experince. I find many new nurses want to go straight to critical care. And many are shocked to find how hard it is to cope. Good Luck.
  9. by   hica19
    I am on the exact same boat. I had a position in acute pediatrics where the patients on the floor were sick enough to be in ICU in any other hospital. I first thought it was a great place to learn new info and to gain speed. But then I realized it is over my head. The clinical nurse specialists were also concerned with me. Today we agreed I should resign from my position and find something that is less acute. I was told though that after I gain more experience, I could apply back in. I feel rotton right now and don't want to throw in the towel like you said, but I think for now it's for the better.
  10. by   PANurseRN1
    Quote from supernova004
    I think the hospital offered a good oreintation. 12 weeks: half in the classroom and half on the floor. I didn't realize we'd spend so much time in class...I would have preferred to have had that time on the floor with a preceptor. I learned a lot, but the pace of the unit and the diversity of Dx is too much for me. The worst part was that I felt I lost the confidence of staff/RNs: atmosphere of show you once and after that, you should know. Any bonehead mistake or act of omission was strongly frowned upon. They seemed to expect perfection from new grads.

    I don't think I could get a better orientation anywhere else, but I wonder if I could find a more supportive environment where they would give me time and room/space to perfect my talent.
    I would not call 9 different preceptors a good orientation. I call it punting the new grad off on one staff person after another.

    New grads need consistent preceptors. Preceptors need to be nurses who have experience and the patience to work with new grads/staff. Just because a nurse has boatloads of experience does not necessarily mean he/she will be a good preceptor.

    Not every new grad is ready to step right into critical care. You need to evaluate why you wanted to start in critical care. Did you love it as a student? Did you do well in your critical care clinicals?

    Before you transfer to a different dept., I would make sure that you know exactly what kind of orientation to expect and that includes how you will be precepted. It may be that some time in a different area will give you the experience you need to become a good critical care nurse. You may find out that your passion lies elsewhere. Or you may find out you need to work in a different facility.
  11. by   rn undisclosed name
    First off I think the big problem is that you are going between so many different preceptors. I can't tell you how many different preceptors I had, however, only one was a bad preceptor. It makes learning extremely difficult because you're being told so many different things on how you should do things. I currently have 2 preceptors and it is much better but it would still be nice to just have 1 but it is doable. I have done so much better with the 2 preceptors.

    I am also in a critical care step down unit. I would talk to them and tell them that the environment is not conducive to learning. You really should be following one person's schedule. Perhaps you could request whoever is the best of the preceptors and feel you would learn the most from if you decide to stay on that floor.

close