New nurse with job that is causing anxiety and depression

[nurseGi]

HERE IS MY STORY: I graduated in May with my BSN from a university, i was a good student..graduated with honors. I took the NCLEX in the summer and got my first job in a large hospital in december. I am working on a geriatric med-surg floor. When I found out I got the job i was so excited and happy, just where I wanted to start out to gain good experience. The first month (december) was fine, I had 3 weeks of in classroom learning and started on the floor with a preceptor the 4th week. I started with 1 patient and moved up from there (im now up to 5), Nurses on my floor can get up to 8 patients. I noticed my preceptor was very care-free and usually busy with her patients to even teach me things.

When january rolled around I had a meeting with my preceptor, manager, and my educator. My preceptor told them that I wasnt progressing as well as I should and also told them (infront of me) that she had high expectations from me cause i graduated from a good school and didnt think she would have to teach me even simple things. I went on to say that nursing school now is more on book theory, going to clinical once a week is not going to give us the experience we need to start on a busy med-surg floor and know what we are doing and feel comfortable. I also told them that i felt that i wasnt being taught well cause of how busy my preceptor was. My manager moved me to 8 hour shifts from 12hrs so i would be there 5 days a week instead of only 3 and experience more. I was devestated after this meeting, i felt incompetent and that I wasnt doing well. The 8 hour shifts were HELL..1) because they dont pay for our lunch so really we have to stay 8 1/2 hours and 2) by the time im done with all my documentation on my patients it is 10 hours a day 5 days a week. My manager told me to show motivation so she could see if there was "hope" or not. Can anyone agree with me that this would me emotionally and confidence draining on a NEW GRAD? I feel like my preceptor was watching every move i was making now. I would have her write down my progress after each shift, I would read it and it would be all negative things. Not one time have i been told good job or that I have improved on something, when I knew truly that I have been learning a lot and progressing. I've been depressed for weeks (i never suffered from depression before).

I had a meeting with my manager yesterday and she said I will be starting 12 hours shifts this week and that she is going to extend my orientation by 2 weeks (now i have a month longer) cause I am still not ready to be on my own. My manager told me that I interviewed unbelievably well and she knew it was going to be difficult to train a new grad but basically not this hard. She also proceeded to tell me that she was going to get rid of me a week or 2 ago but decided that there "might" be hope. I then broke down in her office and cried. She told me crying was normal and that other new comers have cried before cause it is a stressful place to work. They had new grads struggle in the beginning and end up OK. She told me she needs more motivation from me (10 hours/per day not enough)? I also stayed after clocking out one time to work on my IV skills, she mentioned that they cant keep giving to me and that it is a 2 way street. I don't know how much i've got left to give, I cry every day on the way home and everyday before going in. I love nursing, my patients love me..I truly think nursing is for me, maybe I am just in the wrong place? I feel like the pressure is on and that they are watching me closely, Im scared that I am going to get fired soon. Getting fired within 3 months of getting hired would probably make getting hired anywhere else 100x more difficult. I dont wanna sit home for a year and look for another job (i have student loans to pay!!) and also go through telling my friends and family that I have failed at my first job. I want to share with everyone what my experience has been like so far and I want to hear if some of you feel the same way or have gone through the same situation, i hope none of you are cause this really sucks.

[Sugarcoma, RN]

OP do not be disheartened, other nurses have experienced similar. The brutal reality of your situation is that you have found yourself on one of those less than stellar units (probably why they were hiring in the first place) with management who has no idea what a new grad is capable of or needs in order to progress.

I agree with others who say start looking for another job but I would say do not leave this job until you have another offer of employment. It is rough out there right now and most units who are hiring now and especially who are hiring new grads are less than stellar themselves. If you can manage to stick it out at this place for at least one year you will be much more marketable and can move on to better opportunities.

The first thing you need to do is recognize that the transition from student to practicing nurse is a very rough one even when under the best of circumstances, so don't beat yourself up and don't let it ruin your confidence. Next you need to show your manager "something" to let her know your serious. (As if volunteering your time for them, and working that ridiculous 5 day schedule wasn't something! Ugh) The first thing I would do is request a different preceptor. Tell your manager that you would like to see if maybe a new teaching style might help you progress faster. Now address what they consider your shortcomings. Have they told you what SPECIFIC concerns it is that they have? When I say specific I mean "is not efficient at starting IV's" rather than "is not developing as expected". Do you have copies in writing? If so make a list of the specific concerns and your plans for rectifying them. Is it organizational skills? Communication with staff/patients/etc? Lack of knowldege regarding pathophys? It must be specific in order for you to address it. If it is not and is just a bunch of broad mumbo jumbo tell them you need to know what the specific concerns are because you are implementing a plan for improvement. Then go down the list and address it. Even if you do not intend to stay at this place these steps may help you keep collecting a paycheck until something better comes along.

While you are drafting your plan of improvement, draft a generic resignation letter as well. Keep it in your work bag/purse/etc. Whenever you are called into the office, put it in your pocket. If you feel you are going to be fired and you will know because there is always a pre-amble. No one ever calls you into the office and says you're fired right away. It will start off with as you know we have had some concerns about your progress blah blah blah and if this happens cut your manager off with I am aware and feel it would be mutually beneficial if we just parted ways at this point. I would like to give you my letter of resignation. Your manager will most likely be relieved, agree to accept your resignation and you avoid being fired. This way when you interview and get the why did you leave your last job question you can honestly say you resigned and then go on to give them a generic non bashing reason. I cannot stress that enough....never bash a previous employer in an interview.

If you receive an interview ask what the ratio is but be aware you will likely be lied to. Ask about their turnover rate. Ask about unit education, if there is any type of support for new grads such as residencies etc. Ask about length of orientation and if not offered ask for a unit tour! Look around and pay attention to what you see. Do the nurses look harried? Are they running around like chickens with their heads cut off? Make sure to offer to shadow for a shift or part of one. Always shadow! When you do shadow look for the staff directory!!! Most of the time it is in the schedule book. Say something like I would like to see how you handle requests for certain days off then thumb through that book and look for a directory. If you see lots of names crossed off and new names written in instead of typed in (most units update it once a year) that is a sign of high turnover and could signal a bad unit.

[sugarwahine10]

You are obviously very smart, care about doing a good job, and have stuck it out while getting little support from your management. I would quit now. It will be much harder for you to get another nursing job if you are fired. I wouldn't even give them 2 weeks notice, they might fire you in the meantime if you did just to be mean--you can't really use them as a reference so who cares. They aren't preparing you to work on a busy floor and just making you feel bad about your capabilities. Run, don't walk, from that place. It will be a blemish on your work record if you get fired. Waitress or something in the meantime until you get another nursing job. That job isn't worth your time or your nursing license. When you are interviewing for another nursing job, just let them know that your last nursing job wasn't a good fit for you and don't bash the management. Good luck!

[Sugarcoma, RN]

I am angry and frustrated at the behavior of a majority of hospitals these days. They are petulant, selfish, mean, lazy and self indulgent. I just don't know what is wrong with people today.

I am so angry and disappointed and the lack of empathy and guidance.

I couldn't agree more!

I mean seriously, lets take a brand new grad fresh from school and full of idealism, give them a preceptor who probably would rather be walking on broken glass than precepting and who probably knows all of nothing about teaching. Of course, she/he did take that two hour hospital course on precepting; but only because she/he hasn't had a raise in forever and they offered an extra buck or two an hour for precepting.

Lets pair that with a manager who has little to no experience working with new grads. Said manager needs and really wants an experienced RN to take some of the weight off the other staff RN's before they start to leave out of sheer desperation when some other less than stellar unit at another hospital starts bleeding their staff. Of course said manager can only get administrative approval for the lowest rung on the payscale which is the new grad, but hey its better than nothing.

So lets have this new grad follow around their preceptor for a few weeks on a unit that probably resents the added work a new grad presents to the rest of the staff and treats the new grad accordingly. When this formula doesn't magically produce a competent nurse in the shortest amount of time possible, ready to take on a ratio that an EXPERIENCED nurse would struggle with well we can just blame the new grad. YOUR not developing, YOU need better time management, etc. etc. Management speak for YOUR the problem which only serves to create self doubt and guilt. I mean they are putting so much time and effort into YOU, you really should be grateful and try harder. And try they will, after all they need that magical one year of experience before they can go anywhere else and they know that there are 10 unemployed grads waiting in the wings to take their place should the opportunity arise. A vicious cycle that just keeps repeating ad nauseum.

[ktwlpn, LPN]

the 4th week. I started with 1 patient and moved up from there (im now up to 5), Nurses on my floor can get up to 8 patients. I noticed my preceptor was very care-free and usually busy with her patients to even teach me things.

As a new grad you need and deserve a preceptor's undivided attention.The preceptor should not have an assignment of her own- especially not in the first weeks of your orientation.As the weeks go by an you become more independent then he or she can pick up a few. That's a crappy orientation you are getting.

[Heart2015FNP]

It wouldn't surprise me that you are actually doing quite well and you are considered a threat to the unit. The culture of season nurses eating their young is still an issue. I suggest going to your HR rep. and request a transfer. Keep your progress notes as proof of the hostile environment. You are not crazy. You are being bullied.

[poppycat, ADN, BSN]

I don't think you have failed at all. Your preceptor & manger are the ones who have failed you. This is a horrible way to treat a new grad! Please look for a workplace that will nurture you so you can become the nurse you wan to be.

[RCBR]

"It is rough out there right now and most units who are hiring now and especially who are hiring new grads are less than stellar themselves."

So very true. The good units have low or no tunover, thus offering few and far in between hiring opportunies, and when they hire they will pick from an extensive list of experienced nurses who who have asked to work there (word gets around abou the good units). It is usually the crappy units that take new grads. That is the case in my hospital, and from talking to other peoople who graduated with me, elsewhere too. If you jump ship now you might be exchanging 6 for a half a dozen, or landing in an even worse unit. No point asking about patient/nurse ratio or turnover during interviews; they will never be truthfull to you about it.

I am going to be the odd man out here and tell you to ride this storm out. But with a different attitude. First, never cry in front of anyone, especially your preceptor or management; you will not elicit pity or compassion but derision for you will look weak and emotionally unstable. Cry only where no one will see you. Second, show confidence in your clinical skills. When you are going to perform a nursing skill, act and pretend like you have done it a thousand times. Do not show insecurity, do not let others think you don't know what your are doing (but never do something you don't know how to do). Third, try to find an informal, unofficial preceptor amongst your fellow RNs. Not all nurses eat their young, you will find that some are actually willing and able to help you. You obvsioulsy need help and coaching and your preceptor is not giving it to you but maybe some of your colleagues will. Fourth, you will be a stronger and better nurse after you pass this transition. It is the strongest fire that forge the strongest bonds and you will emerge a much stronger person and nurse after this ordeal is over. You you feel proud of it and will have grown a thick skin which will help you through the rest of your career. But if you make it through it, don't ever inflict the same treatment you received onto the new grads who will come after you. It is only by refusing to treat other new nurses like we were treated that we will stop this sick cycle of older nurses bullying and eating the young nurses.

[IloveNursing2214]

This sounds like bullying to me as well ... So sad .

[Heart2015FNP]

If you are exhibiting signs of depression, low self-esteem, and panic attacks within three months of employment. You will not get better "fighting back." without removing yourself from the hostile environment. Trust me. I know. This is unacceptable for a new graduate to go through. Their expectations should apply to a season nurse. It takes 4-6 months to precept a new grad. Do yourself a favor and go to HR for a transfer. They don't deserve you. Read your policy on workplace harrassment and present your proof. Those actions will make you a stronger nurse...that's fighting back.

[nurseGi]

Thank you all so much for your insight. They assigned me to a new preceptor, who is better then the other. I was put back on 12s (started yesterday), and the new preceptor taught me things the other preceptor never mentioned.. that I should have known by now. They tell me that I have a month left on orientation.. and this is gonna be like a crash course for me. Yesterday was hectic.. and I am never been so anxious in my life. This preceptor pulled me to the side after the day was over and told me what i needed to work on and told me she could tell something was wrong, she asked if i was happy here, and of course i started tearing up again and crying...cause i am NOT happy at all. Of course I didn't tell her that, i just said I am just overwhelmed and stressed. I also told her that i feel like i didn't get the proper education in the beginning of my orientation and now it is reflecting and I don't have much time left to prove myself. She told me its a normal thing to be going through and a lot of other nurses on the floor have been through the same. She told me she had been a nurse for 20 years in a nursing home and came to the unit and also felt overwhelmed and as a new grad it is going to be even tougher. She told me i could do this, i just have to come to work everyday and feel confident (so hard with all that has happened) and really try to know my patients in terms of there illness and history. I feel like an idoit crying infront of her, but I am a sensitive person and I have never been through something like this before. I come from a very supportive family, and its what I am used to. I have today and tomorrow off, and I have to come up with a list of my strengths and weaknesses to present to my manager and preceptor. I really need to take on a different attitude when I go there, i think I am living in fear and its reflecting on my performance, and also the comments I receive from my manager are a big let down.. but I just gonna try as hard as i can and what ever happens.... happens, atleast I can say I tried.

[imintrouble, BSN, RN]

Schools are doing a disservice to their graduates by emphasizing theory over the practical.

The last two new grads we had, didn't know how to hang a piggyback.

No exaggeration. They didn't know about fld compatability. They'd never placed an NG or a foley. Their IV insertion skills were limited.

We want to blame 1) the preceptor or 2) the orientee, depending on what side of the spectrum we're on. Maybe we should be blaming the nursing programs that graduate nurses, who don't have the clinical skills to do the jobs for which they're hired.

[VANurse2010]

I mostly agree with this post, but I'll add some qualifiers from my own experience. Sometimes, depending on region and availability of clinical sites/facilities, the education programs aren't always *able* to provide extensive clinical times. Particularly in rural areas, even the clinical time you do spend will mostly be dealing with 90 year olds with COPD exacerbations and pneumonia. Not that there's anything wrong with those patients, but they don't provide the most broad-based clinical experience. That said, students should come out of school knowing how to place a Foley, start an INT, and hang a piggyback. NG tubes ... That one I don't know. I don't think anyone in my nursing school class had that opportunity in 1.5 years of clinical.

Schools are doing a disservice to their graduates by emphasizing theory over the practical.

The last two new grads we had, didn't know how to hang a piggyback.

No exaggeration. They didn't know about fld compatability. They'd never placed an NG or a foley. Their IV insertion skills were limited.

We want to blame 1) the preceptor or 2) the orientee, depending on what side of the spectrum we're on. Maybe we should be blaming the nursing programs that graduate nurses, who don't have the clinical skills to do the jobs for which they're hired.