I am a new grad and started working on May 27th. I am training in the Surgical ICU, but will be in the Transplant ICU after my orientation, which ends the first week of September. I have been with my preceptor since about the last week of June. I feel like I have definately made progress since then but on Wednesday, it seemed like my preceptor was just like ****** at me all day. It was her fourth day working. The day started out ok, when I was doing my assessment the pts BP started dropping, and he had an art line that I thought could be positional, so I was trouble shooting it and while I was she came in and asked what I was going to do about it. So, I called the dr... got orders etc. It just seemed like she had an attitude with me all day. Throughout the day I asked some questions about things-IV meds, etc. At the end of the day she said she thought I had taken a step back, said it was good to ask questions, but she thought I was asking too many questions about things we had already done (with the meds). I told her I just didn't want to make a mistake or med error. As far as calling the dr, I am still trying to get the hang of figuring out which doctor to call because that is kind of confusing to me in our ICU. I just need some advice on this situation. I didn't feel like we had taken a step back; I want to use my resources and preceptor while I have her to use... I just don't know what to do about this. Thanks!

You are more than half way though your orientation, so you should be on the down ward slop of being able to handle things on your own. So it depends on what type of questions that you are asking. Are you asking the same type of question now as you did in the beginning, because you should have graduated to more advanced questions with less frequency.

Did the problem with the BP rattle you and put you back into asking question in a previous manor that you had already stopped doing?

What are the protocols on that unit for a falling BP. Are you meant to wait and call the MD and get orders or are you meant to treat it with fluids and pressors while someone else calls?

How long were you taking to tell if the A-line was positional, had it been positional before this event?

If you didn't change the number or type of questions from before the event to after , only took a minute to check for position and understood what to do to correct the BP, then I think that your preceptor was possibly having a bad day and taking it out on you.

Things to learn from this. When you get your pt, find out who his/her MD is and what number to call if an emergency occurs. What are the policies for a dropping bp. Every day is a learning opportunity that you can take and grow from. Go back and talk with your preceptor about what you learned from that day and just what does she see as your greatest need at this time so that you can improve.

I think what she was talking about when she was talking about the questions were some of the IV meds that I had asked questions about. I have never worked with IV pumps before June, and I am still trying to get the hang of them when someone has a ton of drips going. On one of the bags I had to hang it said to only run it piggyback and I had nowhere to put it, so I had asked about that. I did not know I could just add another channel and run it byitself when it said to run it piggyback. And I am still trying to get the hang of who to call since there are so many different teams in the SICU, that has been confusing to me--now when I am in the TICU, I will of coorifice know who to call, the transplant docs. I am taking it as a learning experience like you said though, I want to be the best nurse I can be. Thanks!

That seems like a normal question to me, even if your off orientation. We clarify meds with an on-line med site and with each other all the time.