Really need some advice about orienting/vent

[kimmicoobug]

I am not sure if this is a vent or if it is asking for advice. But, I am frustrated with my job as a new RN. I am on week 3 of orienting. My first two weeks, I oriented on ortho neuro. My preceptor had me shadow for two days, then I took a patient and did total care, including the computer work, MAR, and various forms. The next day 2, the next day 3, the following 4. I felt that things went very smoothly, and I received so much positive reinforcement. It was great.

Then I was sent to med-surg. I was there as a student, but it is just a wee bit different as an employee. The first day, she gives me 4 patients (didn't really think this was a problem) but I didn't know where anything was, I didn't know how to use a lot of the stuff. We had a post-op and I didn't know the policy for a post-op. I felt as if I was getting chewed left and right. I had three nurses roll their eyes at me when asking where things were. One even got tight-lipped when I asked her how to transfer a call. My preceptor here just seems to want things only her way. I personally think she doesn't want to precept, and really, that is fine. Today, she assigned me as med-nurse. I had seven patients total. Now, this doesn't seem so bad, but there was just so much stuff going on with them. And I had four students that I had to give meds with and do procedures with. Everything was fine (boring) until it was time to pass 2100 meds at 2000. All the patients (and students) TPN and lipids, had IV pushes, abx, and dressing changes that needed to be done on their patients. All the meds were on time (by 2200), except for the dressing changes(about ten on one patient. Just seemed that crap hit the ceiling during those last few hours as far as time management goes.

So, after posting all of that, I think what I would like to ask some of the more experienced med-surg nurses that orient new employees or new nurses: How do you like to orient a new nurse? Any suggestions? I am a quick learner. But, I hate to be treated as if I am stupid (felt that way all night, and even one of the students commented on some of the comments the nurses were making about the "new" nurse.) I want to be a good nurse, I want to succeed. I am trying to remain positive. The bright side, only seven more days on this unit. Then I orient to OB.

[kimmicoobug]

I apologize for the bad grammar and typos. It is terrible. I am just VEEERRRYY tired.

[renerian, BSN, RN]

I am sorry your med surg preceptor overloaded you before you knew the unit. I remember those days, you feel like a fish out of water. My preceptor was an A1 witch. Just hang in there, it does get easier.

renerian

[bergren]

The nurses' and staffs' treatment of you whould be a real eye openner for the 4 students they assigned to you. No worry they will have to orient them - they will look for work elsewhere. It is interesting that they assigned 4 students to you, the newest nurse, as if no one else wanted to work with students. Illustrates their whole attitude toward teaching and developing new professionals. Just BTW - how often does this floor get students? I am wondering if they are overwhelmed by many schools rotating through their unit.

What you are decribing on the med surg unit is not orientation - it is throwing you to the wolves. The hospital should have a "script" for the precepting nurse to follow for orientation. Day one = 1 patient, etc.

The rolling eyes, not telling you how to transfer a call, any other passive aggressive behavior is a reflection of the lack of individual maturity and a lack of leadership on the unit. Treating new nurse like this (otherwise referred to as "eating our young") was common in decades past. Most hospitals and managers will not stand for this in the era of severe nursing shortages. Orienting new staff is part of their job description and a professional responsiblity. At the same time, they are endangering patients. Keep good notes. Try to stay positive. At the end of the day - ask the preceptor to review your day and give you pointers for the next. Ask the nursing ed people for a description of the preceptor role, what guidance / assistance you should be expecting and get some feedback from them about how to remedy the situation. Try to use the "I" word as much as possible. "I" am struggling, or am "I" am needing more guidance than I should at this point? "I" am asking too many questions - where should I be finding this informaiton without perstering others.... As opposed to complaining about their behavior. If asked how it is going, try to mention some of the people who are helpful. Find out who was the newest hire just before you - they are often kind to the next new nurse and they can tell you who to stay away from and who is a good resource. During down times, first look ahead and see if there are some things you can prepare ahead of time (i.e. gathering dressing change supplies, etc.). If there is true down time, try to identify the most knowledgeable or the most empathetic staff and ask if you can observe a treatment you have not seen before, or ask to look at their assignment sheet to see how they organize their work load.

Do you know what unit you are assigned to permanently? Can you request the ortho neuro unit?

Good luck!

[Jayne LPN]

JUST REMEMBER....WHEN YOU DO GET YOUR CHANCE TO BECOME A PRECEPTOR.....TREAT THEM LIKE YOU WISHED YOU HAD BEEN TREATED......SO MANY NURSES HAD SUCH BAD PRECEPTORS, ONLY TO TURN AROUND....AND DO THE SAME WHEN THEY ARE GIVEN A CHANCE TO SHOW A NUEW NURSE THE ROPES........

AND NEVER LET THEM KNOW HOW MUCH THEY ARE GETTING YOU FLUSTERED....IT SEEMS LIKE IT ONLY MAKES THEM DO IT ALL THE MORE.......

[kimmicoobug]

Bergren--Thanks, I needed that!

After rereading my first post, I realized that this whole situation is not OK. Some things about this unit. The director didn't seem to bother to inform the preceptors that they were precepting. There has been rumors that this unit was a sick unit. They have tried to heal it in various ways--flexible hours and shifts, keeping the difficulty of a patient load to a minimum, and decreasing patient loads from 7-8 to 4-5. 6 on a bad day. The few days that I have been there we have been full, and my nurse still only had four patients. I was talking to a few friends of mine who are floated quite a bit to this unit. They said that because I will become a "fluff" nurse, aka. OB nurse, that they are probably harder on me than the other new grads on that unit. I was talking to a guy whose home unit is this med-surg unit. He is taking 2-3 patients, and feels his orientation is great. He has been there for 3 weeks.

I will be speaking to my mentor in OB and let her know what is going on. I was precepted by her as a student and she is great. I figure I can grit my teeth and bare it for only six more days of this "orientation". I will be asking for words of advice from her, as well. There is a nurse educator that is working very closely with us new grads. We will be doing an evaluation, and I will be sure to give a very HONEST evaluation, so they can tweak this program for next year's graduating class (program is new).

Sigh. I just hope orientation really does get better.

[kimmicoobug]

Jayne, You are very right about getting not getting flustered and keeping my cool. I will do my best to keep my calm. I have tried to express my "lost" feelings to my preceptor and it is pretty much a "get over it" reaction I get from her.

[Love-A-Nurse]

could it be they know you aren't there to stay on their shift? either way, no excuse for the way they are acting. i agree, doesn't seem like an orientation to me.

[MandyInMS]

hi kim :) doesn't sound like orientation to me either..on our med/surg floor we start a new nurse shadowing a skilled nurse for 2 days or more, then taking 1 patient, the next day maybe 2...depends on the nurse also..how comfortable he/she is...everyone is diff...we NEED nurses and try to make the transition as painless as possible.

[Tweety, BSN, RN]

Good luck. Med-Surg is hard, very hard, very busy. Seven patients would keep the most experienced nurse busy if they were properly doing their job. Keep that in mind.

But also express yourself, make your needs known. Ask for help. Did your preceptor know that you were in the weeds, or were you too afriad to ask. I guarantee if you went to the manager and expressed concerns, the preceptor would say something like "she seemed to be doing fine and wasn't asking for help, so I thought she was o.k.". Precepting needs are based on the invidual new grad, there really are no hard and fast rules.

There comes a time when the preceptor must become a shadow. Three weeks probably isn't that time, especially your first day on the unit. But I hate when at the end of orientation the new grad is still splitting the patient load from the nurse instead of talking the whole load. At the same time, throwing someone to the wolves isn't appropriate.

Anyway you cut it, med-surg nursing is tough and overwhelming. Ask for what you need. Remember as some wise and wonderful nurse says "we will get as much as we take". Good luck.

[scrubbed]

You are not alone, I just quit a job because of a poor preceptor with a bad attitude and a big mouth. IT's not you!

[Rapheal]

My preceptors were great and also prevented the nsg supervisors from using me for general staffing until I had completed orientation. The other staff members were not so nice and they used (and use) informational power to bully me.

Spoke to a new nurse 2 days into her orientation. She was having a rough day and I offered my support. On the 3rd day she was used as general staffing. I suggested to her preceptor (we are friendly) that she put her foot down and tell the nursing supervisor that she needs to orient and will not be used as staffing. The preceptor was afraid to challange the nsg. supervisor.

Saw the new nurse at the end of her third day on her way out and she thanked me for being nice and told me she was never coming back. She promptly quit the next day.

I have noticed that when somebody is new and thrown into an unfamiliar environment they tend to loose their sense of direction. Everything tends to look the same and they might find themself in the wrong hallway or forgetting where a certain supply room is. They should not be made to feel stupid because they cannot find something.

Being new is tough and a new med-surge nurse is thrown into a whole new culture. There is a period of "reality shock". Just do the best you can and try not to let any frustration show on your face. There will be bullies, you will be overworked and overwhelmed. This site offers great support to vent. You will do better. Your time management skills will increase and what was previously thought impossible becomes manageable. You will become more confident. You will learn better, faster ways of doing things from other nurses. Just hang in there kid and the fact that you "want to become a good nurse" shows that you are a caring individual. Feel free to pm me when you need to vent or need some encouragement. Good luck little soldier.