orientation: I feel stupid and incompetant

  1. 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!
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  2. 17 Comments

  3. by   deeDawntee
    OK...I want you to take a nice deep breath and....let it out...

    The reason you feel incompetent says absolutely NOTHING about you. You are getting a CRAPPY orientation. It is inexcusable and I would be very concerned and would recommend that you start doing some very proactive self-advocacy because it doesn't sound like anyone else is going to do it for you. I would go to my manager and ask for some time to go through those basic protocols and procedures and get your hands on an IV pump and tubing and whatever other equipment you would like to have more time to master. Perhaps, you could ask to come in a couple of hours early or something, so that you don't feel that you are being so stressed out and pushed so much. You can't possibly know what you don't know. Don't think that just because you need practice on the IV pumps that you don't belong in the unit you are working. That is absurd. What you need is someone to show you and help you practice whatever skills you need to learn.

    The fault here is in your orientation and not with you, and don't you forget it!! Stand up for yourself!!

    you can do it!
  4. by   Tweety
    You are not dump and incompetent, you are new and you're learning. No one, and I mean no one, comes out of school completely 100% ready to go with nothing to learn.

    You should know what you know. You knew enough to make it through nursing school and pass NCLEX. That's a lot to learn. Give yourself some credit and a break. Soak up everything you have to learn without judging yourself.
  5. by   ElvishDNP
    I completely agree with Tweety and Dawn. So many things in nursing, you have no idea how do until you do them once. Or twice, or twenty times. If you've never hung blood, then no one expects you (or no one SHOULD, anyway) to know what to do and how. When I was a new grad I spent many an hour poring over the P&P book just to familiarize myself with things we did on the floor.

    One thing I would like to add: make sure you figure out how you learn things. Are you a visual, audio, or tactile learner? Do you learn things by doing them? Then volunteer, like Dawn said, to do as many things as you want to learn to do.

    Nobody, not even the one who has been nursing for 20, 30, or 40 years, knows everything. Don't beat yourself up. You earned your license and you can do it.
  6. by   NotReady4PrimeTime
    I'm seeing a recurring theme with posts on this forum when it comes to orientation, and it has to do with preceptors' expectations. And it seems to me (correct me if I'm making this up!) that preceptors believe that orientees are there to do the preceptor's work. "Here you are, these are your patients, now off you go." My philosophy of precepting new staff is very different. I know they're there to learn how to work in my unit. Yes, they need to learn organization and prioritization, but they also need a lot of direction to ensure that goal is met. They need to learn the tasks that are common to all patients in the unit, and the pecking order, and the underlying rhythm of the unit. But... They also need the opportunity to see and do things that are new to them but almost routine in our unit. So if they're closing a sternum in the unit when I have an orientee with me, I send them off to watch. They get instructions to observe what the bedside nurse does for the patient, whose responsibilities the different tasks are and what sorts of problems they could anticipate occurring during and after. Then we talk about it later. While my buddy is gone, I resume caring for the kids as if I had been on my own all along. When we have ECMO in the unit, they get sent to examine the equipment and ask questions. If there's a family conference for our patient (we're usually 1:1 because of acuity) I encourage them to attend so they can experience it as an observer with no real stake in it. I encourage questions. When I can't come up with an answer, we look it up together. We negotiate responsibilities in the early days of the orientation and work toward independence in most things by the midpoint so that they can build on the progress made for the last part. But having said that, I know there are nurses in my unit who love having an orientee because they don't have to "do any work". That's wrong. I can't fix it, but it's wrong.
  7. by   hollyberry678
    (word of caution: my laptop keyboard is tiny, and it's easy to mistype, so sorry if I do)

    Thank you all for your kind and thoughtful replies. I wonder if it is my ego that is bruised as well, I have to be really humble right now. I like being on top of things and don't like fumbling, ect. I like to know what I am doing. I will do it right if I know. I will feel awful if I dont do it right.

    Also, even the simple things are making me freeze: for example, though the nursing math never gave me much of a problem in school, when put on the spot the other day, I froze: what the heck was that formula for desired dose mg/ml, ect? I couldnt remember it for the life of me. And I needed to know right then! That's how I feel. Today I forgot to unclamp piggyback tubing, and actually later hooked up the wrong line (one we had just disconnected to run something else) I don't know why I am making these incredibly easy but stupid mistakes that I never did in school. Why am I quaking in my boots at even these simple things? It's these small things that are making me feel even worse than I already do.

    I hope that I can gather up all my strength and get through this time. I need to buckle down. I keep meaning to go over iv lines, ect at home, but when I am home I dont even want to think about it, and I dread the next day. Someone asked me today at work how it was to be out of school and working, and I said, "right now is the hardest part"...they looked surprised. Perhaps if my unit wasn't as acute I would be enjoying this more...I do find this area interesting...if I was on top of things.

    Anyway, thanks for your replies and support. I know I probably should cut myself more slack, but there isnt a whole lot of time. I keep thinking of the deadline of end of orientation. I feel I am barely started and everyone is asking me when I will be on my own!! I feel like my preceptor knows what an idiot I am and wonders how I passed nursing school. How will I know if I am progressing as I should be?? I dont think I am where I should be at all. I do know charting now, but not at the speed I need to be at, I know only basic stuff. I can do a fair assessment. My biggest weakness is meds, iv's, looking them up, preparing them, checking for drip times and compatibilities, ect.: I take so long with these. Anyway, I am rambling, thanks for listening...
  8. by   NotReady4PrimeTime
    You're letting yourself be rushed and that's where your fumbles are coming from. When someone demands something of you, take a breath that will allow you to focus. Even those few seconds slow things down enough that you can process what it is you have to do. If I had a nickel for every time I forgot to unclamp a piggyback, I could retire tomorrow! I've also given both drugs and tube feeds to the bed. I've turned a stopcock the wrong way and had major blood on the bed, the list goes on and on. But the difference is that I don't let it bug me too much. It would only bug me if the patient was harmed. I write myself up for my inattention when I need to. And I leave work at work. If I obsessed over every little thing I didn't do perfectly I'd never sleep. Being safe is far more important than being fast at your stage of the game. If your preceptor is expecting you to be at the same level of function she is, then she's just got rocks in her head. Nursing school does not turn out fully-fledged nurses. All it teaches you are the theoretical bases of nursing and fundamental skills. The rest you learn as you go. And you will be learning as you go for the rest of your career. Please give yourself a break. In one of my other posts from today, I reminded everyone of the fact that it takes a minimum of 1000 repetitions for a new behavior to become automatic. Multiply that by all the new behaviors you're developing and you can see how overtaxed your system is becoming. If you gave 10 IV meds a shift it would take you 100 shifts to have it down pat. That's 20 weeks of 8 hour shifts. When you break it down like that it makes a bit of sense that you won't be running marathons until you first learn to walk. Each time you look up a med, you'll get a bit faster at finding what you're looking for. Each time you look at a monograph, you'll find the information a little quicker. The more times you give a med, the easier it will be to remember infusion times, compatibilities, and all those other niggly things. It comes. Slowly. You wouldn't have graduated and passed your NCLEX if you can't learn. If you're not ready to be turned loose at the expected end of your orientation you need to ask for more time. If your unit values safety and staff development, you'll get it. Don't become like Sisyphus, pushing your boulder up the hill for all eternity. Make a pact with yourself that you'll only fret over work until you pull into your driveway (or wherever you park your car...) and then put it in a cerebral drawer to be fretted over tomorrow. Do something mindless when you get home and take care of you. It'll make you better able to take care of others.
  9. by   fancee free
    I can relate to your situation. I graduated 7 years ago and went pretty much went directly into management in a LTC facility. Well I left about one year ago and took a year off from nursing, for alot of reasons (related to nusing). I returned to nursing and accepted a job in ER and it has been a nightmare ever since. Though a good nurse, I have NO nursing skills and find no comfort in acute care at all. Just when I started to feel a little more relaxed and competent in this new setting, they tacked on endless days of buddy shift orientation, making me feel like the poor little retarded nurse. I was "banned" from starting IVs, as I had to go to a skills orientation, which was beneficial, but there was little instruction on starting IVs, not even a fake arm, just a video which before hand some instructer spewed off a whole bunch of things we were to ignore that was being shown in the video as "we don't do that". This resulted in me being even more confused about starting IVs.

    My orientation days have been stressful, as I am always buddied with someone different and who does not understand what my needs are. For example I explain to me buddy what my needs are and what I am ok with, such as checking vitals, doing assessments etc. Some buddies will let me be and are avail. for questions, which I am not scared to ask, while others hover over me and will take over the assessements as I don't do it in their style or quick enough. This becomes very frustrating and extremly stressful. I pray every night that my buddy is someone who I am compatible with and understands that my skills are not up to par, rather then judge me or treat me like an idiot (I'm scoring a 50% on compatability).

    I can relate when you say your ego is hurt, as mine has been destroyed. I always felt confident as a nurse in the setting I was in, but now I feel like a incompetent buffoon who even lacks the ability to give a pt. oral meds. and needs monitoring to check vitals. I knew orientation would be difficult, but I never expected this.
  10. by   Curious1alwys
    Quote from janfrn
    I've also given both drugs and tube feeds to the bed.
    :spin:
  11. by   Curious1alwys
    Quote from janfrn
    You're letting yourself be rushed and that's where your fumbles are coming from. When someone demands something of you, take a breath that will allow you to focus. Even those few seconds slow things down enough that you can process what it is you have to do. If I had a nickel for every time I forgot to unclamp a piggyback, I could retire tomorrow! I've also given both drugs and tube feeds to the bed. I've turned a stopcock the wrong way and had major blood on the bed, the list goes on and on. But the difference is that I don't let it bug me too much. It would only bug me if the patient was harmed. I write myself up for my inattention when I need to. And I leave work at work. If I obsessed over every little thing I didn't do perfectly I'd never sleep. Being safe is far more important than being fast at your stage of the game. If your preceptor is expecting you to be at the same level of function she is, then she's just got rocks in her head. Nursing school does not turn out fully-fledged nurses. All it teaches you are the theoretical bases of nursing and fundamental skills. The rest you learn as you go. And you will be learning as you go for the rest of your career. Please give yourself a break. In one of my other posts from today, I reminded everyone of the fact that it takes a minimum of 1000 repetitions for a new behavior to become automatic. Multiply that by all the new behaviors you're developing and you can see how overtaxed your system is becoming. If you gave 10 IV meds a shift it would take you 100 shifts to have it down pat. That's 20 weeks of 8 hour shifts. When you break it down like that it makes a bit of sense that you won't be running marathons until you first learn to walk. Each time you look up a med, you'll get a bit faster at finding what you're looking for. Each time you look at a monograph, you'll find the information a little quicker. The more times you give a med, the easier it will be to remember infusion times, compatibilities, and all those other niggly things. It comes. Slowly. You wouldn't have graduated and passed your NCLEX if you can't learn. If you're not ready to be turned loose at the expected end of your orientation you need to ask for more time. If your unit values safety and staff development, you'll get it. Don't become like Sisyphus, pushing your boulder up the hill for all eternity. Make a pact with yourself that you'll only fret over work until you pull into your driveway (or wherever you park your car...) and then put it in a cerebral drawer to be fretted over tomorrow. Do something mindless when you get home and take care of you. It'll make you better able to take care of others.
    Thank you so much for this post. As a new grad, I find it so comforting when you veterans have kind words to say. You really do give us newbies hope. I printed this out to paste somewhere so I can read it over and over when I start freaking out!
  12. by   al7139
    You are not stupid, but it does sound like you are not getting a good orientation. I just graduated this past May, and when I started on my unit (telly/cardiac/medicine), I was totally panicked. I seriously felt like I had never been through nursing school, and that I knew nothing! We are lucky at my hospital. We start orientation in two weeks of classes that familiarizes us with the computer system, the policies of the hospital, and we go through classes that teach us to do IV's, interpret telemetry strips, give meds, code procedures, and we have days that we learn stuff like how to use the IV pumps, get blood sugars, etc. Just basic stuff that there isn't lots of opportunity to do in school. We have lots of guidelines for certain diagnoses, and we learn the proper protocols for them. We don't even hit the floor until we are finished with these classes. We must pass the tests for each class. Even after we get to the unit, we are given a folder with a HUGE list of competencies that we have to be signed off on to do them alone. We have a staff educator that we meet with weekly, and both our preceptors and ourselves evaluate our progress. We are given feedback on what we need to work on, and told what we are doing well with. Our preceptorship can be anywhere from 10-14 weeks long, and we have to have completed a certain amount of competencies and our preceptors must approve us before we are "on our own". It was a good experience for me, but I was lucky to have supportive prople to work with and guide me. They all kept telling me how great I was doing, when I thought I was really doing badly. I am always my own worst critic. The funny thing is that I found after a while, that I really do have the knowledge to care properly for my patients, I just neede the confidence. I too have made some really rookie mistakes, and I probably will make more, since I am human and therefore not perfect. I try to laugh at myself and find myself saying "Duh, I should know that!" at least twice a shift. It will come with time and experience. You will never ever in this career get to a point where you know everything. Even the nurses who have years of experience still ask questions. Give yourself a break. You wouldn't be where you are today if you werent able to do the job.
    Amy
  13. by   nyapa
    I feel I am on the opposite side of the fence. I felt exactly the same as you on this my third rotation. I didn't feel I was keeping up, and that I was letting the team down. I ended up in tears for the whole day after a week. My charge nurse and my graduate clinical nurse educator have given me extra oritentation time. I am so grateful.
  14. by   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.

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