orientation: I feel stupid and incompetant

[hollyberry678]

I am being oriented on a station I worked on while in school-- it is very interesting but extremely high acuity. ICU pts are being transferred here after one day in ICU, for example, following major surgeries, ect.

My preceptors (2- different shifts) have been nice, but I am realizing how little experience I got in clinicals. Clinicals, I realize focused more on making sure I did beds and baths for example- something I have done a million times.

My preceptor expects me to know things I just dont know- like PICC lines, syringes and needles, very basic stuff maybe I should know. Even programming the IV pump is new!! I can't 'just know it'. and if she has to go over it with me step by step I fell like an idiot!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I think I should have started on a simple med-surg station maybe..or maybe on a brand new station where I can BE BRAND NEW!!

What should a new grad know and not know?? Also with meds, I feel I am rushed to get them, as my preceptor is staring down my shoulder, hurrying me up...I need more time to think things through!!

I am really struggling!!

Also, the paperwork, they are so quick, and I can barely do the aperwork/charting for one person!

[RoyalNurse]

Hollyberry678,

I felt exactly the same way starting orientation. No one really tells you exactly what you "should" know when you first start nursing, but you can really pick it up from their reactions.

I'm in my tenth week on an ICU, and I still have problems with giving IV meds, (holding the syringes, alcohol wipes in one hand and the port in the other), especially with my preceptor standing right there with her arms folded and an exasperated look on her face.

I'm still of the opinion that all preceptors should be required to take a preceptor class, one that reinforces what they were like as new grads, and gives them some skills for teaching. Why are we still of the mindset that you have to almost lose your mind and all self-confidence to get through orientation?

IThe wonderful nurses on allnurses.com have been my preceptors so far.

[pirituba]

I feel the same way I am working in a community health center in a pediatrics unit. My preceptor stands behind me, she called me a student last week, and I can't seem to be able to take the apical pulse or any vital signs correctly she does not let me breath. I feel stupid and Friday my supervisor told me that I have no basic nursing skills (which I do have skills and I know how to take vital signs) Monday morning I am going to talk with her that I don't want to be trained by that preceptor because she is defaming of my charactor and she is intimidating me (which is a violation of the non-harrassement policy) I hope everything is going to go well and mean while I am going to start looking for another Job.:balloons::monkeydance:

[Dolce, RN]

Cut yourself some slack. You can't be expected to know everything as a new grad. That is unreasonable.

I hate to tell you the very sad reality but it is so true. You just don't learn that much in nursing school. Nursing school only really prepares you to learn how to become a good nurse. You do not graduate from nursing school as a fully-functioning, independent nurse. You still need time, teaching and experience to give you confidence. So far you are doing great! At least you have identified the things that you need to learn. Keep asking questions! Go home and research on your own. You already sound like you are well on your way.

[Medic2RN, BSN, RN, EMT-P]

Hey Hollyberry! I've only been nursing for 10 months now and I can empathize with you!!!

There are so many things being thrown at you all at once, it makes your head spin - am I right? That's why you feel as though you're freezing up with relatively simple tasks. You're also being very hard on yourself. I have the same tendency.

This is what I have done to be somewhat more comfortable with it all.

I have found in the past year that I have studied more than I did when I was in school. Everyday I go home from work, I look whatever I encountered up to learn more. I didn't have enough experience with feeding tubes - looked it up. If I saw that a patient on my floor had one, I went to the nurse and helped her do things with the tube feed to learn and be more comfortable.

If I had a patient with _____(traction, CPM, vents, etc) I would make sure I talked with RT, PT, OT, etc. and used their expertise to learn more about it and they LOVED the interest and loved to teach me all about it. Boom - just got hands on instruction with experts.

You'll see a common theme with medications, the same ones again and again - I've looked them up to study the common ones and feel comfortable administering them. With others, find the resources to use in the future and with some - I'll call and talk to the pharmacist directly. They have always been happy to help.

I keep a small notebook in my scrubs pocket with lessons from my many duh moments.

I've learned a lot from some nice doctors who took the time out to explain things. Ex: if you have a critical lab with this; make sure you know the values of this, this and that before you call the Dr. It's helped me avoid future Duh moments.

I also have a mantra I recite to myself at times while at work, "I can do one thing at a time, I can do one thing at a time." It helps me concentrate on the task at hand, then I can prioritize the 50 other things I need to do next.

I've had many Duh moments and will continue to, but I keep learning!

Talk to your supervisor or nurse educator about your concerns, perhaps they could help. At least know that there are many of us dealing with or have dealt with the same issues. You are not alone!!

[80's fan]

Royal Nurse,

I am a Nurse Educator in an acute care community hospital. I plan/implement Nursing Department Classroom Orientation and have never been happier. I welcome the opportunity to teach new grads. I follow up with them, keep tabs on them, and pull them aside while they are on their unit to see how they are progressing. I am in a sort of "neutral" position, making it comfortable for new grads to openly and honestly discuss matters with me. You are all so important to the field, as you are the future of nursing! As for precepting, there should absolutely be a preceptor course. In addition, weekly meetings among the manager, orientee, educator, and preceptor are crucial. In closing, please give yourself a break. Nursing school does not prepare you for what it is really like to be a new nurse, you must live it. It will be worth it.

[madink]

Boy can I identify. I recently graduated in June. Our last clinical rotation we work at a hospital with a preceptor. I requested my preceptor; I knew she was tough, but I also knew she had a lot of knowledge and figured I would learn a lot from her. My whole experience was a nightmare. She had ZERO tolerance for imperfection or lack of knowledge. I was expected to know things that I had little/no experience with. Living in a rural community, nurses rotate to different departments. If we were in ER I was to observe only, if we were delivering babies, I was to help in some areas and not in others, if we were in med-surg I was to take 100% care of pts. Most of this was not communicated to me at the time. I never knew what she wanted from me and was too intimidated to confront her. I should have gone to my nursing instructor after the first time I got chewed out, but figured I could handle it. WRONG!!! It almost cost me my nursing career because I was failing clinicals for the first time in 2 yrs. It did cost me my job at the hospital ( I was a former employee there and my DNS wouldn't hire me) so I took a job at a LTC facility after graduation. If I had a different preceptor I believe the outcome would have been much different. Preceptors need to lower their expectations; Be patient; NO power games please; Be approachable, if you're not we won't ask questions; Treat new nurses the way you would want to be treated; Finally, if you don't enjoy precepting, ask your DNS to find someone else.