New Grad RN wanting to leave after 3 months

[RNAnony]

When I started in the ICU, it was my dream job. I had worked at my current hospital for a year and a half as a PCA in the Float Pool so I was familiar with the ICU environment and pace. Part of my interview was shadowing for a few hours and I knew I loved it and the RN I shadowed gave me a great recommendation.

My first concern is that my orientation is only 16 weeks. I'm at week 14 and I don't feel ready to be on my own. There are still general nurse things I'm not sure of (putting in orders, doc phone numbers, where things are in the equipment room, etc), I know I still technically have 2 weeks to get the hang of those things but my manager is pressuring me to leave my orientation ASAP, and she said she doesn't want to keep wasting money. I understand money is a concern but I don't feel safe practicing on my own yet.

They warned me my night shift preceptor was a very blunt and honest person, and I am too so I wasn't too concerned. But I'm at my wits end now. My night shift preceptor is one of those people that just doesn't trust other people to do her job. She isn't happy with anything unless she's the one doing it. I have a lot of respect for her as a nurse but as her orientee I don't know what to do. She won't ever admit that she doesn't know something. She berated me for not getting a rectal temp on a patient who's platelets were 46. I will be trying to change my patients linens and she will rip everything out of my hand and make me step aside while she does it herself. So I came to my manager again just to let her know how that I feel worthless when I'm working because even though I know everything I'm doing is fine and the right thing, my preceptor will yell and have a fit over the smallest things. My manager told me to grow up, put my big girl panties on, and just deal with it. The turnover rate is so high that there are no other nurses to orient me because all the other night shift nurses are new.

I guess my question is, should I look for another job? My orientation has been a mess. Half the time they don't even know I'm supposed to be there, despite multiple schedules being handed out. My orientation is the same orientation that people who have been nurses for 10+ years get. Should I find another facility that is better equipped to orient new grads?

[amoLucia]

"Same problems, different faces".

Words of wisdom from a co-worker/supervisor from an early job that I've never forgotten. No guarantee that any new job would be any different; it could be exceedingly WORSE.

[Nightmaren, BSN, RN]

Very good point from the poster above.

Do you have a nurse educator overseeing your GN residency? In our program, she was the one who was above the managers and ensured that all learning objectives were being completed properly. She was our advocate.

Also, is there any chance of getting assigned another preceptor? A tactful way to ask might be to request following another nurse to see a different perspective as you orient; a preceptor's attitude can make or break a person's orientation!

[lfish]

I am a new grad nurse one month out of orientation in the ICU. Not knowing where certain things are in the unit, MD contact info, etc is not a reason to stay on orientation, IMO. Your fellow nurses are an invaluable resource to you, even off orientation. If you don't know how to do something or want a second opinion, just ask.

We're new. We shouldn't know everything. Even experienced nurses get stumped from time to time. And a new nurse that doesn't ask questions is dangerous. ICU patients are a complex puzzle; try to think through the problem, and bounce ideas off a nurse you trust.

For your last two weeks, I would push to have your preceptor take a strictly observational role (if she will consent to it). If not, I would give it a few months after orientation before I would make the decision to call it quits. You're going to learn in the struggle. It will be stressful, but you need to give yourself the chance to see if you can adapt and learn, without the threat of your preceptor pushing in and doing tasks for you.

[amoLucia]

to lfish - Amen! to your first paragraph! Wise words!

to OP - your best-est BFF for non-licensed nsg things should be your unit secretary/unit clerk. They're invaluable for all the details that are sooo nec. Earn her support without being a bother and you'll likely come out ahead.

[JKL33]

Agree with the above that the day-to-day unit-related details will be learned over time and you will get through it by using your resources on the unit.

However, I think the whole thing sounds like a disaster. I'm sorry you've been treated poorly since going to night shift (and I do think a couple of your examples are beyond "putting your big girl panties on" when they happen day after day) - but if there's truly no one else on your night shift who is fit to precept you because none of them have enough experience, that likely means that your current preceptor has been doing nothing but helping new grads for who knows how long. It can be very rough, especially when also carrying one's own assignment, especially when there's no end in sight, and especially if you know they aren't going to stay around.

I, too, would ask if you can start trying to manage your patients over this next couple weeks, using your preceptor as a resource. Ask questions when in doubt. See whether things start to smooth out a little.

I also would see what else is out there. It may not be a viable option, but I would be looking, for sure. The people here who should be your advocates and encouragers sound too fed up and frazzled and hardened to provide any support. Not the least of which is your manager. I don't know if you've had problems meeting goals in your orientation, but I do know that if she talked to me like that (and I didn't see how it could be applied as "constructive criticism" or "tough love") I would not sign up for that program for the long haul. They have culture problems.

[Ruby Vee, BSN]

However, I think the whole thing sounds like a disaster. I'm sorry you've been treated poorly since going to night shift (and I do think a couple of your examples are beyond "putting your big girl panties on" when they happen day after day) - but if there's truly no one else on your night shift who is fit to precept you because none of them have enough experience, that likely means that your current preceptor has been doing nothing but helping new grads for who knows how long. It can be very rough, especially when also carrying one's own assignment, especially when there's no end in sight, and especially if you know they aren't going to stay around.

.

I'd cut the preceptor some slack -- a new grad has absolutely NO idea how difficult it can be to be precepting constantly with no end in sight, and no visible results because the new grads just quit as soon as or even before they've had time to become competent. Learn what you can from her, overlook the rest.

As far as your manager -- going to her with feelings isn't the most productive approach and doesn't make you look like a grown-up. No wonder she told you to put on your big girl panties. It's your job to manage your feelings, not your manager's. If you must go to her, ask her how she thinks you're doing, what she identifies as areas for improvement and if there are any areas of major concern. Rather than complain that your preceptor "yells and has a fit" (which I find difficult to believe), describe the exact behaviors that you find objectionable. Perhaps the preceptor's negative feedback isn't constructive, she uses demeaning or condescending language or her body language is off-putting -- perhaps your manager knows this, but doesn't have anyone else who can precept you, so she's frustrated. But sharing FEELINGS rather than FACTS with your manager is unlikely to result in good outcomes unless you have a "touchy-feely" manager.

You're two weeks from the end of your orientation. Identify your resources now. The unit secretary can help you with issues involving paging physicians, scheduling tests, finding results and all manner of other things. If she can't help you with something, she likely knows who can. RTs, PTs, pharmacists and CNAs can also help. I've met few CNAs who cannot tell me where to find some rarely-used piece of equipment. The pharmacist can tell you whether these two drips are compatible and the RT can explain vent settings, CPAP, blood gases and any number of other tasky things and critical-thinking concepts. Find out where your policy and procedure manuals are and how to use them.

The first response held a true gem of advice. "Same problems, different faces." The grass truly isn't greener.

[laurenontheloose]

Hey. You can do this. Here's how:

-Ask the support of your colleagues. If you cannot learn to ask, you will drown.

-Keep a journal of your experiences, for instance. When you had that DKA patient, we did x y and z... I struggled with q1hr BS but overall was able to correct the acidosis and get the patient out of the unit.

-Ask for what you want. Momma nurses will run over you if you don't demand to let you be independent. The flip of that, is that they may leave you to crash. Both are good learning experiences though.

-NO ONE feels like they are ready to be on their own. NO one. Not even one. This is where you get your wings and fly. Be motivated to not be the one who continually drowns.

-If you feel like its just too much, then ask your educator or speak with someone higher up about trying to go to your step-down unit or medsurg floor.

[RNbubu]

In my unit, new grads get 12 weeks of orientation and nurses with experience in med-surg or tele transferring to ICU get 6 weeks. 14 weeks seems a reasonable amount of time.

With that being said... try and do your best not to leave so soon. It will be hard to explain in need interview why you left after only 3 months and before being even out of orientation. It will look like you are blaming others.

[Orca, ADN, ASN, RN]

I don't work in an ICU, but even after 22 years of nursing and 16 with the same employer, not a day goes by that I don't ask somebody about something. No one knows everything, and using the resources around you lightens your load.

[jdub6]

16 weeks is shorter than some new grad ICU programs but the thing is youre 14 weeks in. Finding another job if you leave now will be tough and you may not be given new grad orientation at this point. Try really hard to make the best of where you are for 1-2 years MINIMUM.

Remember its normal for new grads anywhere to be overwhelmed, to not feel comfortable and to struggle for months. If you feel you need to leave research the new grad posts here and try to talk to other grads at your facility to be sure its not just normal new grad jitters. And have a new position in hand before you walk unless you're independently wealthy or on the verge of suicide or a breakdown or the like.

Others have given you good advice on using your resources and making the most of your situation. Try going to former new grads with 1-3 years experience, they may be more willing to teach than your preceptor who may be burned out on precepting and may not remember what its like to be brand new. Those who are semi-new can remember what was most useful to them when they were learning.

[sharonstoutshaffer]

I have read through the suggestions you have received and what to share my gratitude for all of the staff who have taken the time to be supportive and respond to your question. RNAnony, there is no right or wrong answer to your situation and it is important for you to "listen" to the suggestions you have been given and use what works for you. These are a few thoughts of my own that might be helpful for you.

1) You stated "I know everything I'm doing is fine and the right thing". Focus your attention on what you know you can do "correctly" and reinforce to yourself what you are learning. One way to do this is a technique called the Evening Review. Take 10 minutes every evening and keep a journal of what you have learned and what you know; list the questions you have; note any concerns you have; just write down as much as you can about your experience so that you can reflect upon how you want to manage the next work situation. Pay attention to your successes. Our brains tend to remember what is negative and it is important to attend to what is positive.

2) You have lots of great suggestions that you can use to help your situation. Choose the suggestions that work for you and remember you have a lot of influence over what happens. Recognize that there are some things you can "control" and some things that you cannot control. Choose to manage those things that you can and let go for now of what you can't.

3) Be very cautious of making a quick decision to leave when you are in this stressful transition. You can choose to leave the unit, but if you do so, make sure you are not reacting without deep reflection about your options.

4) You stated you have a lot of respect for your preceptor as a nurse. Have you told what you respect about her? I do not think you should tolerate the behavior you describe long term, but know that her behavior reflects on her-not you.

5) Be gentle with yourself. Do some things that support your sense of wellbeing and remember that while this is a stressful time, you will be able to manage. Your self-care is really important.