New RN struggling with first job out of school

Nurses New Nurse

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Hi all,

I am a second degree BSN graduate who recently landed my dream job at a pediatric hospital. I was hired into a position rotating through four units - PICU being one of them. I received 3 weeks of orientation on each unit, then was scheduled to work in the PICU off orientation with a resource nurse for a few weeks. I am just finishing this resource period and do not feel any more confident about practicing independently. I honestly never expected to be an ICU nurse right out of school, so the learning curve has been very steep for me. I feel that I am still struggling with new nurse things, like performing a good assessment, time management, starting IV medications, etc. My resource nurse was getting frustrated with me for being "too slow" with tasks and would criticize my performance in front of patients and families. It took everything in me not to cry inside patient rooms. I had to remove an arterial line and central line the other day before transferring a patient and I wanted to do so independently since I knew I would be on my own soon. My resource nurse hovered over me and pointed out how I was doing things wrong throughout the procedure. I finally just said "Do you want to do it instead?" and she said yes and took over. I know I have a lot to work on personally in terms of increasing my confidence and skill set, but I feel unable to grow in my skills if I am being criticized every time I try to perform them. I generally take criticism well and do not "talk back" to people, but the constant criticism of the way I practice has been really discouraging for me. My resource called my manager later that day and told her she doesn't think I am a good fit for the unit. I am unhappy there, but I also think I have not had enough orientation or support from staff I've been working with. I feel like a failure since I have spent time orienting on this unit without achieving an end goal. I am meeting with my manager soon to discuss the plan for me. I do not think I will be returning to the PICU but I am scared that I will be fired for poor performance. Any advice on how I can improve as a new graduate would be greatly appreciated!

Specializes in PICU, Sedation/Radiology, PACU.

I'm sorry you're in this position. Orienting as a new graduate nurse can be very overwhelming. Orienting on 4 different units, I can only imagine, is much more difficult. In fact I'm surprised that a float position, especially one including PICU, was offered to a new grad. PICU host arguably the most complex and diverse population of patients, and my orientation to PICU was 13 weeks, which is more orientation time than you've been offered for all 4 units. It doesn't sound like you're getting the support you need from the nurses and honestly I'm not surprised your struggling. I think almost any new grad in your situation would be.

My practical advice would be learn as much as you can. Find out where the policies and procedure live and read them. They can be very helpful when you're learning the steps for new skills. Remember that your assessment will drive your plan of care, and picking up on changes in status is one of the most important parts of nursing, especially PICU. Slow care is better than bad care, so take your time and double check your meds. Ask questions when you need another opinion, and try to ask them of the nurses who don't mind helping.

When you meet with your manager, I suggest you be honest about your experience so far without pointing fingers. Explain that you don't feel your 3 week orientation was adequate and you don't feel the resourcing period has benefitted you as much as it could have in terms of gaining confidence, but you feel you could function more capably on a general floor. Advocate for yourself in asking for additional orientation to PICU before being assigned there again.

FutureNurseInfo

1,093 Posts

I truly am sorry to hear about your struggle. I am at the very beginning of my career change (yes, a career changer), and I know I will be job hunting in a couple of years. Even though working in peds is my dream (I have been a teacher for 6 years), I do understand that it may not be a good fit for everybody. When you said you had 3 week orientation for each unit, did you mean you had 3 weeks in all, or 3 weeks for each of the four units, totaling 12 weeks? Have you ever been formally evaluated during your orientations? What does your resource nurse tell about your performance other than that "you are slow"? I think you should really talk to her and ask for a detailed feedback. Ask her how you can improve. I understand constant telling that you are not good without an actual support system may seem like an impossible environment to work in. Also, when you speak to the manager, explain your concern and ask for more orientation time or a plan to improve. Do not just give up. The best part of learning is to always know what you do know and what you do not.

k3depro

3 Posts

I had 12 weeks total - 3 weeks on each unit. I met with my manager at the end of the 12 weeks to discuss how I was feeling coming off orientation. I told her my concerns starting in the PICU and asked if I could start in a different unit first to get more comfortable with my skills in a slower paced environment. She felt that I needed to come off orientation and see how I did in the PICU with a resource. I decided to try her plan and now I am ending the resource phase of my orientation. Like I said, I still do not feel comfortable in the PICU, which is why now I am meeting with her to figure out next steps. With regards to my resource nurse, her feedback is that she thinks I overthink everything and need to just get things done more efficiently since the PICU is very fast-paced. The problem is that I can't do things faster when I am unsure how to do things in the first place. I try to look up a policy/procedure beforehand but my resource also rushes me through that and tells me I need to just get things done. Also, if I spend too much time in a room when I go in to get my hourly tasks done, she asks what I was doing in there for so long. Sometimes I am just talking to my patient or their family member, which I don't see a problem with. But she suggested to me that I don't waste so much time doing that....I don't consider that a waste of time, as it's part of how I get a more detailed picture of my patient's hospitalization and events leading up to it. Ultimately, I do not think the PICU is for me, so I am definitely going to tell my manager again that I need to move to another unit. I really appreciate your kind words of advice and good luck to you in your nursing career! I do not plan on giving up, as I love working with my pediatric patients and their families.

k3depro

3 Posts

Thank you for the encouraging words! I know ultimately it is my responsibility to become successful, so I do not plan on pointing fingers. My goal is to feel more comfortable practicing independently and gain confidence with my skill set. I know I am not the only new RN struggling with this. I just think a general floor may help me gain the confidence I need. I hope that my manager is understanding and we can figure out a good plan for me. I love the hospital I work for and my patients, so I do not want to give up!

FutureNurseInfo

1,093 Posts

I guess just do what she says, and once you gain some experience you will be able to make your own decisions about the care of your patients. I do feel your resource nurse is being too pushy. I mean, does she not remember herself in your shoes years ago? If I were you I would ask her to come to one of my former classrooms and teach for a day. I would see how fast and efficient she would be in that situation. I am sure she would burn and reap her head of even before the day ends. Btw, I was being sarcastic. I would never say such a thing, nor should you. I was saying it just to illustrate the point. Your resource nurse should realize just because you graduated from an RN school does not mean you are ready to practice like a master. It takes time. But then again, who cares to understand, which is sad.

NuGuyNurse2b

927 Posts

Been there, done that, bought a t shirt. Your snappy remark "do you want to do it instead" does you no favors - it only makes a bad situation worse. Most of the time, you getting hired is contingent on your manager finding someone who's willing to precept you. Yes, they get paid an additional differential for doing it (actually, some places don't even...) so it's not completely altruistic, but despite your experience with her, your preceptor is probably doing as best as she can to orientate you to the unit. Maybe her style doesn't jive with yours, but you need to meet her half way. You are not expected to be a master at your job, and even by 1 year, you will not be. It's unrealistic to expect that of you, and trust me, she knows that. But nursing is a sink or swim job - if you're not swimming in orientation, you might have to have an extended orientation (which doesn't look good for you ) or you will simply be a loss in investment for the organization and they'll have to find a replacement once you are let go. If you have to show up half an hour earlier to look over your assignment, gather your thoughts ahead of time, so be it. She's already on the payroll, it's your job to shine and let your manager and co-workers know that they hired the right person.

And next time, instead of "do you want to do it instead" say something more diplomatic like "you know, preceptor, I don't want to harm the patient, can I watch you do it this one time and i'll take the next one?" - it's all in how you address your peers, because that's a reflection on you, not them.

Specializes in CVICU, MICU, Burn ICU.

Was there a didactic learning portion to this orientation? In this area, new grads are not hired into critical care areas unless they are hired into an internship or residency. There is a reason for this, and you wrote about it succinctly. I agree with you that a critical care area may not be a good fit for you right now. That doesn't mean you won't do well (even very well!) on a floor or even step-down unit. Also, critical care nursing is tough. Even for experienced nurses going into that specialty, it takes a couple of years to get comfortable and even then, you are ALWAYS learning. :)

Best of luck to you.

Specializes in Critical Care, Education.

Some great advice & feedback from PPs.

I just wanted to point out that some personality types are more suited to critical care than others. There isn't a great deal of literature on this issue (seems like a huge oversight to me) but there is anecdotal/smaller study evidence that indicates critical care areas are much more suited to assertive, take-charge personalities.

Waaaay back in the day, when I was in grad school (MSN-Critical Care CNS), one of my professors had several years of data on students in the program.... voluntary personality assessment results. She was interested in characteristics which were most likely to occur in critical care nurses. Since the subjects were from a pretty limited sample, the data were not strong enough to support publication but were very interesting. Those assessment results indicated that the majority of her female students showed up as "androgynous" personality types. That's a nice way to describe those of us that are more pushy & enjoy being in charge. As I recall, qualities of collaboration and empathy were rather low.

Long story short - there are a wide variety of clinical environments. If you're persistent, chances are you're going to find one that suites you to a tee.

bella14k

143 Posts

I sort of know the feeling, and especially starting out in PICU. Does this position absolutely require you to work in PICU? can you work in 3 of the units out of the 4? If worse comes to worse, and they find you are not a good fit, try to negotiate for a different unit. Have you been able to prove your competent on the other units? I would hope they wouldn't fire you just because one unit isn't working out. You could also ask for a different preceptor, and don't be afraid to-just prepare yourself for how you will ask that question and be ready to back it up. I asked my manager one time and she said "No shes good for you, it'll be okay" and I ended up working with the same nagging preceptor and eventually passed orientation.

Also think about the underlying reason why you're not doing well. I can understand that you have performance anxiety, and I wouldn't blame you, especially with a preceptor who is always criticizing you. This is easier said than done, but try really hard to embrace the criticism, don't think about her, just do your work and focus on what YOU would do and what's best for that patient. Like I said this is so much easier said than done because prioritization and time management really come with time, but if you're not making any improvements, than maybe you need to study more outside of work including skills, or come to work earlier so that you can organize your day and have a better idea of what your day will be like.

Just a few things I thought I'd share, I hope it helps in some way.

jennylee321

412 Posts

I don't think new grads should be starting in picu to begin with, let alone having an insufficient orientation there. It's also hard to start in a float pool position as a new grad but I think it would be more manageable if they let you start your independent practice on the floors and then train you in picu once your feeling comfortable. You'll have better time management that way before having to learn the extra skills required in PICU.

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