Nothing against type A nurses, but I started a new job and my preceptor is very type A. She wants to know everything, be in control of everything, and is just go go go without giving me much opportunity to get my own workflow going. I am pretty new to the ICU and get all my patient care and charting done in good time. Today I took 3 patients and still had time to help the others nurses out. This is a small unit so I don't want to give the wrong impression. I wish there was any easy way to say chill out, let me work through it, and just be there as a resource and support for me.

Nothing against type A nurses, but I started a new job and my preceptor is very type A. She wants to know everything, be in control of everything, and is just go go go without giving me much opportunity to get my own workflow going. I am pretty new to the ICU and get all my patient care and charting done in good time. Today I took 3 patients and still had time to help the others nurses out. This is a small unit so I don't want to give the wrong impression. I wish there was any easy way to say chill out, let me work through it, and just be there as a resource and support for me.

Here's the thing: most of us would like something different in a preceptor than what we got. I'm fairly Type A as well, and when I started my last job, I got a Type A preceptor who had less than 10% of the experience I had. She wanted to be in control of every situation, wanted me to prioritize exactly as she did, complete the work on her time schedule, etc. I tried very hard to comply because she was the preceptor and I wasn't. In the end, it wasn't about my nerves, it was about patient safety. If you're on orientation, you suck it up and do it the preceptor's way. Unless the preceptor makes an egregious error.

As a type A preceptor, I would say we are supremely aware that we are annoying buzzing little flies around new staff whether it is warranted or not. I have to internally reminds myself to step back and let the nurse do her thing. I've had my trainees simply tell me "let me sink or swim. I need to do this on my own so I can be competent." As long as you're respectful about your request it should be OK to politely ask her to step back the next time she buzzing around your workspace :)

You're about as likely to find a unicorn in the ICU as a type B nurse.

It's good that you're managing your time! BUT...

How critical are these pts? Being a small hospital, are they comparable to a typical stepdown pt? Or are they truly critical -- ventilated, vasoactive drips, medically paralyzed, ARDS-y, on a cooling protocol, on CRRT or ECMO or an IABP? If they are the latter type, if tripled and still have downtime I'd wonder how well you're putting all of the pieces together, vs focusing on *tasks.*

If you are truly on track with the critical thinking, goal oriented stuff, it may help to verbalize your thought processes with your preceptor.

For example, say you have a neurosurg pt on hypertonic saline to keep their Na level 145-155; Na was 135 at 1200 and 143 at 1800. You might say, "I know neurosurg wants it higher, but that is a BIG increase. His urine output has increased a lot and looks dilute. Do you think it could be DI? I think we should notify neurosurg and see if they want to order more labs."

That could eliminate some of the interrogation "how have his Na's been trending? What do you think about that increase? What is his UOP? Could anything else contribute to his UOP, such as a diuretic or pt auto-diuresing? What should you be concerned about with these numbers?"

Nothing against type A nurses, but I started a new job and my preceptor is very type A. She wants to know everything, be in control of everything, and is just go go go without giving me much opportunity to get my own workflow going. I am pretty new to the ICU and get all my patient care and charting done in good time. Today I took 3 patients and still had time to help the others nurses out. This is a small unit so I don't want to give the wrong impression. I wish there was any easy way to say chill out, let me work through it, and just be there as a resource and support for me.

Take comfort in the fact that (although Type A may both enjoy it and be very good at it) it's not really a walk in the park for them (uh..."us") to try to let things roll and see where it ends up.

Trust me when I say this is mutual give and take.

You can gain a little more leeway by doing excellent work, verbalizing correct though processes, seeking honest feedback, and then kindly asking to make a plan for increasing independence.

[it's slightly possible that being new and having all of this free time is part and parcel of not being given much independence....because it does tend to beg the question (which in fact, has already been asked above!)]

Good luck ~