I am a new grad and can't wait to get out of orientation!

Nurses New Nurse

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Hi,

I am a new grad and it's my third week on a busy tele floor. Here is the thing. I feel as though I don't need a preceptor anymore and feel I am ready to be on my own. Every day when I come to work I think things would have been easier for me if I could organize my day without anybody telling me what we need to do next or do it my preceptor's way. I feel confident talking to doctors and monitoring my patients. I have caught things before the patient deteriorated badly.

But now I have a question. Am I being too confident? Am I missing something? I feel as though all new grads should feel overwhelmed and need preceptor's help. I just don't want to be one of those new grads who felt too confident and made a huge mistake because they thought they were ready too early and didn't need help.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I doubt she is treating you like a child, but even if she is, choose your words carefully. Good luck.

Specializes in ICU, PACU, OR.

No You are exactly where you need to be. You know you are on the right path when you are itching to be on your own. I would express this to your clinician or educator and let preceptors take a more distant check-in with you during the day. Have them check your work before the end of the day or at scheduled times during the day just to see if you had any issues or unusual things come up.

Specializes in 15 years in ICU, 22 years in PACU.

I think it's great that you like/love your job so well at this stage that you wanna take the lead and be that nurse.

You have heard much good advice and seem capable of taking it.

I wonder if you could have a "practice day", where your preceptor steps back and gives you a full assignment and the power to make all your own decisions about prioritizing, time management, decision making AND accepting full responsibility for the consequences of your decisions. That's where it can get really tricky. How well do you take having things go badly and being at the bottom of that hill of crap raining down on you.

Some people can shrug it off as a bad day, embrace the challenge and be a decent person to their spouse, kids and dog. Wake up the next day and do it again. That takes a good inner dialog that tells you it's OK to fail at perfection (the usual expectation at work) and reality which always falls short. People that don't have some track record of success take the failures to a deep place in their heart and feel like THEY are the failure. It's devastating to see a really smart, promising nurse crushed under that self-imposed load. They end up hating nursing, hating themselves, hating patients, hating life and may even take it out on their dog. (Horrible story: Veterinarians report an increase in people hurting their dog to get pain medication prescriptions.) ..... Oops got off track there.

Anyway, you have someone assigned to you to help you with what you don't know and to share the burden of the less than stellar performance you must go through to learn. Sounds like your hospital wants you to succeed and not be an expensive turnover statistic.

And/Or, will you let us know once you have a full load, (you are kind'a on your own but fortunately, you're still in orientation) and when or if you get this kind of an assignment:

Since you mentioned you mainly have been admitting/discharging patients, but now, the unit's lacking a CNA and since you are so short staffed, your preceptor had to take a patient or two. So your first newly admitted pt. requires running a total of 40 MEQs of K via IV and 3 gms of Mg via IV, and it so happened that the only IV you have working gets infiltrated and your EKG tech calls you to tell you that "Oh your pt. just had an 8 beats of VTACH.

While your second pt. who was admitted for GI Bleed with critical H&H values, well, this pt. only requires a total of 3 units of blood and added some IV Lasix in between bags. Of course, you know that your vitals need to be taken, sounds easy right?; And to make things safer, your hospital's policy, when hanging blood, is for you to be with the pt., what they really mean is that they want you "to stay with the pt." the first 15 minutes after hanging the bag. I'm sure you can handle that.

But wait, it gets even better, your third patient, yes, your third patient, who happens to be severely confused, uncooperative, combative, and a big time fall-risk secondary to ETOH withdrawal and guess what this pt's bed is full of feces and urine and the bed has not been changed since your first assessment (remember, you lack aides, as a matter of fact, the whole hospital lacks assistance and your manager tells you, "Sorry, they can't send us a sitter").

Lastly, your 4th patient, is a potential candidate to go into sepsis and you have the orders ,"thus the power", (very strong word) to prevent this patient to go into full blown septic shock. But fortunately there's an order to transfer this pt. to ICU. But unfortunately, the manager tells you that the ICU is full and can't really take any transfers since the ER's sending most of their critical ones to the unit. By the way, don't forget, the drunk patient's family member who has been asking you to clean the pt's bed and has been complaining to your manager (who happens to be also busy being a manager to a busy floor) that you are not doing anything for this patient. So here you are, as you approach this family member to explain things, your phone rang, "again", a call from your EKG tech "again", and "again" saying your first patient just had another runs of VTACH, this time only "30 beats", that's just a piece of cake. Wait up, did you ever start a new IV on this patient yet?

This type of assignments do happen and you are blessed to still have such a light load at this time and still be on orientation.

The bottom line is, show kindness and respect to your preceptor and you will earn it, they know what they are doing.

Imagine having this patient load, plus patient #5 who is comfort care and receiving morphine IV q2h, family is deciding on inpatient hospice, but have questions and they want to talk with you. Palliative care Dr. just put in an order for a PCA pump and foley.

Wait, you have an empty room assigned to you, and the charge nurse is calling to let you know you will be getting an admission from the ED. Call lights are going off all over the place, the family for patient #3 tracks you down in the hallway, very angry that the sheets and patient have not been cleaned up yet. You let them know you will be there as soon as you can.

As you are trying to put in an IV for patient #1, who is still having runs of VTACH, the ED calls to give report on patient #6. You find out that this patient was admitted for a drug overdose and attempted suicide, and will need a 1:1 sitter, until medically cleared for the psych unit. (But wait, there are no sitters available, which means the only CNA on the unit will need to be pulled from the floor to sit). Meanwhile, you still need to give patient #2 the first unit of blood! Your phone is constantly ringing, this time it's the lab with a critical result for patient #4. The family of patient #5 put on the call light because he is having severe pain, they say. You are about to check on #5 when you pass by patient #4's room, and see him slumped over in bed.

As you check on him, you find that he was just sleeping, but vitals aren't good. BP is 65/30 with a HR of 135! Why was this patient not on tele?? You are about to initiate the protocol for sepsis and call the physician, when patient #3 set off the bed alarm again trying to get up, and is fighting with the CNA. A code green is called. You glance down the hallway and see that patient #6 just arrived on the unit.

Now which patient do you see first?

Imagine having this patient load, plus patient #5 who is comfort care and receiving morphine IV q2h, family is deciding on inpatient hospice, but have questions and they want to talk with you. Palliative care Dr. just put in an order for a PCA pump and foley.

Wait, you have an empty room assigned to you, and the charge nurse is calling to let you know you will be getting an admission from the ED. Call lights are going off all over the place, the family for patient #3 tracks you down in the hallway, very angry that the sheets and patient have not been cleaned up yet. You let them know you will be there as soon as you can.

As you are trying to put in an IV for patient #1, who is still having runs of VTACH, the ED calls to give report on patient #6. You find out that this patient was admitted for a drug overdose and attempted suicide, and will need a 1:1 sitter, until medically cleared for the psych unit. (But wait, there are no sitters available, which means the only CNA on the unit will need to be pulled from the floor to sit). Meanwhile, you still need to give patient #2 the first unit of blood! Your phone is constantly ringing, this time it's the lab with a critical result for patient #4. The family of patient #5 put on the call light because he is having severe pain, they say. You are about to check on #5 when you pass by patient #4's room, and see him slumped over in bed.

As you check on him, you find that he was just sleeping, but vitals aren't good. BP is 65/30 with a HR of 135! Why was this patient not on tele?? You are about to initiate the protocol for sepsis and call the physician, when patient #3 set off the bed alarm again trying to get up, and is fighting with the CNA. A code green is called. You glance down the hallway and see that patient #6 just arrived on the unit.

Now which patient do you see first?

Cocoa_puff :woot:... wow, you just made her assignment easier. Again, things like the set examples above do happen! That's just the name of the game. I'm not sure if the OP's floor is a step down, that is if they have trach'd/vented patients on the floor or s/p cardiac procedures or surgery 2/3 days after.

Nevertheless, I'm liking the OP's attitude of being determined! Just follow what everyone has mentioned and that is to be humble!

BTW... Cocoa_Puff what have you been up to and how's life been treating you? ;)

BE careful! My preceptor told me I was doing great, and I felt the same way you do. She gave me glowing remarks on the records I had to turn in. Then I found out later she was secretly telling management that she didn't think I was a good fit because I wasn't open to "learning".

Problem was that all she wanted to teach me was "charting". charting, charting, charting.

When I asked her to go in some rooms with me, she said "what for?". I said "you know, just to make sure I'm following protocols, make suggestions, make sure I'm covering everything" - I had to convince her to do a head to toe on a new patient with me. After she said - "yeah youre fine" - and that was it. She never acted like I needed any help with actual procedures, or patient safety at all. I passed my meds on time, I called the dr's when I needed to.

Then later she wanted to say I wasn't a good fit, and wasn't open to listening to others because I got frustrated with her after weeks of her sitting in her chair and talking about her boyfriend and the new house they were getting, and the vacations she was planning, and not really wanting to get up and go to patient rooms with me. Other times she would simply leave and run around the hospital with her clique friends.

What bothered me the most was that she kept this a secret from me, discussed it with other co-workers and managers - but everyone kept me in the dark. Let me believe I was doing fine. It came up later after I ruffled someones feathers in an email and they decided they wanted me out of there - so they started making up stuff I did wrong. A manager took a statement from a patient, and restated it in a way that made it look like I said something that the patient actually said - but if I had said it it would have been really really bad. THAT is when they brought up the preceptor stuff, to lend clout to this bogus statement and make it look like I had some kind of history.

It was REALLY shady.

it all depends also on what you learn with your preceptor. I had 3 weeks with a good preceptor, 1 week with a great preceptor, and then 13 weeks with the worst preceptor ever. I guess in her defense -it was the first time she had precepted, but it was really bad.

I also have to take responsibility myself because I did not do what I should have done. I should have said something earlier and asked to be with one of the other preceptors again. So really, its my own fault in the end.

What you are missing is.. you have the luxury of learning a difficult skill within a structured teaching environment. Many new nurses do not.

You need to take every minute of that instruction. You know nothing but book learning.

Cocoa_puff :woot:... wow, you just made her assignment easier. Again, things like the set examples above do happen! That's just the name of the game. I'm not sure if the OP's floor is a step down, that is if they have trach'd/vented patients on the floor or s/p cardiac procedures or surgery 2/3 days after.

Nevertheless, I'm liking the OP's attitude of being determined! Just follow what everyone has mentioned and that is to be humble!

BTW... Cocoa_Puff what have you been up to and how's life been treating you? ;)

I'm so glad to have made the assignment easier for the OP!! :D I wasn't sure what type of floor the OP is on, so I stuck with more med-surg/tele patients. I also admire the OP's determination and how open he/she is to our suggestions and advice!

And I've been doing pretty well! Finishing up my two weeks, and then I'm free! :sneaky: I'm getting pretty excited with the new direction my life is going.

As a relatively new nurse (almost at two years) I understand what you mean. Some people get the "basics" down pretty quickly. Definitely worth staying your full time in orientation but realistically it might not make a difference. People are throwing in all these examples of what could happen that you don't know how to handle - well the odds are significant that they won't happen on orientation either and you will still need to ask questions when it finally arises. I am float pool so I go to almost all our units, including tele, and I have yet to have a code. Definitely will be asking for help with that. I have only had one trach - would probably ask respiratory to help me with suctioning. Whenever I am on ortho I have them remind me about precautions because I only go there once a month, if that. And so on. I think the key part of orientation is learning comfort with patients, confidence, charting, and time management. There is nothing wrong with feeling ready to be off. I am glad you are staying just because it does give you a chance to maybe still have help when unusual things happen. But those first comments about your over confidence were a little over the top, in my opinion. You will *always* have things you don't know. At 6 months I had nurses asking me for help and feedback because people know different things. My coworkers and I often turn to each for help or guidance. When there are 6+ nurses usually someone has time to help although sometimes you have to wait.

One thing I would suggest is ask for a different preceptor. I had two longer ones and 3-4 one day ones and I found it super invaluable to see other styles and learn rationales for why they did what they did. Once you feel comfortable that is the time to expand your chances of learning.

I talked to my preceptor today, and she was very happy to hear I wanted her to back off a little. I asked her questions throughout the day, but organized the day my own way. It went great! I had a full load: one pt on dopamine drip, other on heparin, and other two CHFs who needed diuresis. Everything went well until one went into respiratory distress. Called doctor, got new orders and labs. Then the day was pretty uneventful and smooth. I loved it so much! I still had a lot of technical questions such as where to chart drip rate change, consents etc. But I could breathe free today. She let me make a decision to call a doc and talk to him without interfering and it went well. I am just happy that she allowed me to finally be a nurse.

I also agree that I don't look at busy work as stressful situations. Some nurses gripe about how they have an incontinent patient that they have to clean every hour, or they have so many finger stick glucose checks, or pain meds every 2 hours. To me, the true stress is code blue or when pt is deteriorating badly and quickly. Everything else is just busy work, and I don't mind it. I stay on my feet for all 12 hours and chart in real time so I don't have to worry about it later when true emergency happens. I love my patients, and like doing things for them. Griping is just unprofessional, and it doesn't help to do the job.

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