New NICU nurse, feeling very disheartened ;( Question to Preceptors - page 2

I had a question for nurses who have been preceptors to new nurses, whether you liked it or not Did you spend all your time with the new nurse as she took care of her the patients or did you leave the new nurse alone most of the... Read More

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    Most hospitals now have internship programs in place for new novice nurses in the ICU. When i graduated and was accepted into ICU internship for level 1 trauma we had 6 months internship 3 month classes from hemodynamics, EGGs, how to manage a DKA you mention it we had it. By the time we hit the floor we had the basics plus we rotated in all 5 ICUs during the last 3 months had conferences at the end of the day to discuss patients. All the new graduate Nurse preceptors were specifically chosen and had to undergo preceptor-ship training. It was a great experience, so from my perspective 1 month in NICU expected to take care of 3 patients seems like a little too much. I am currently a preceptor and the program is now 1 yr internship. Recently when i had a new graduate in the CCU it took 1 month for just 1 patient without PA catheter, IABP dont even start mentioning the pacemaker modes!

    One of my former interns told me the first day she came to the unit to meet me i wasn't available and one of the other Nurses introduced her to a patient that was on IABP, intubated, PA catheter, Pacemaker and like 8 drips. She freaked out and did not move. She did not know what to do for the patient all the basics flew out of the window!.......She is now a Charge Nurse and am very proud :-)

    Hate to say it but the Novice is not prepared for the critical thinking in the ICU in 1 month. Just have to listen to Laura gasparis Neuro lecture to know this. I would recommend to have a mentor that you can go to and of course read your critical care books. The ICU is a wonderful place to learn so just be patient it will all work out.....

    Best wishes
    2BJenurse likes this.

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    With all due respect eCCU, I don't think you can really compare NICU to the adult world; we are our own world .

    First thing is that the NICU often includes its own step-down and many times the patients are mixed in with others--what I'm getting at is that when a NICU nurse refers to a 3:1, these are relatively stable patients that, while requiring total care, on room air or nasal cannula, and PO or NG feeds. I'm talking a 10 minute assessment, 20 minutes PO feeding time, and then doing that q3hours. It's not really an ICU assignment and is really a nursery or level II assignment. Of course, this is assuming what the nurse meant, but I'm willing to be 95/100 this is it (just heard today about a NICU that does 3:1 with vents, which strikes me as very unsafe). So essentially, should a med-surg new grad expect to take care of 3 patients fairly independently? can be tough, but should be just about doable.

    You also have to remember that we have different ideas about the ICU in general as we frequently have vented kids who are not sedated at all and you deal with active babies trying to pull their ETTs out or trying to keep them intubated without going right-main stem when you only have 1cm or less between being intubated and extubated. Sure we have kids on multiple drips and crazy stuff, but we have a different focus than the typical ICU. Where else do you calculate to the 0.01mL (and give 0.01mL!) and argue with the docs, "Do we really need all these labs? 3mL is an awful lot of blood and we'll have to transfuse..."
    karnicurnc and NicuGal like this.
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    I agree with the above...our new nurses do a modified internship....they really do not need the adult skills since we are pretty specialized. A lot of what we do needs to be hands on. We do show them how to set up our lines, how to change broviac dressings, but do they really need to spend the day going around hanging blood and such...not really since we don't do it the same as adults, our vitals are the same, but our process is different. Changing a trach on a baby is different than an adult, where else do you need 3 people...two to change and one to hold. can't cause an adult to have a brain bleed just from suctioning, so that is something that can't be learned on the internship round. Most of our drips are not commercially available, we have pharmacy mix them and we have to check if the dilution is right according to baby size and type of access...we don't always have central lines. Neonates aren't little adults, or even little children! The basic concepts are similar but it is like apples and oranges. We only start them out on stable kids, sure one can go bad, but that is why the preceptor is there. When we get into the next 4 weeks we start taking stable vents, etc. Critical thinking skills are starting to come into play in that first 4 weeks...who gets done first, why that patient needs done first, why do I do this and that, how to prioritize the care.

    We do 3:1 with vents, but we have a stable vent kid with two easy feeders. We do this a lot and it really isn't that bad. We are in pods and not separate rooms, so we can keep an eye on the kids. Better than the dim dark ages when we would have 2 horrible vents and a feeder, and that was norm.
    karnicurnc likes this.
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    Quote from NicuGal
    We only start them out on stable kids, sure one can go bad, but that is why the preceptor is there.

    AHA! There we have the crux of the situation from the OPs viewpoint. Her preceptor is NOT THERE, for hours at a time.

    All of our discussion has politely avoided the main concept...missing preceptor...and led the discussion into different (ephemerally related) topics about patient loads and acuity.

    Her problem is that her preceptor is not available to her, a new nurse in (to most new nurses) the scariest place in the hospital...for sometimes hours at a time.

    We could train a monkey to do vitals, change a diaper and feed 3 feeder/growers q3. But that monkey can't respond when that kid crumps. Neither can a new nurse...even with four WHOLE WEEKS of orientation. 4 weeks of orientation might be as few as 8-10 shifts.
    karnicurnc and celyseRNBSN like this.
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    On a lighter note, I sure have been enjoying the activity we've had lately in the NICU forum. Love being able to pick y'alls brains and try to expand my limited knowledge.
    karnicurnc likes this.
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    I think I did say she needs to speak up. And hopefully this person's coworkers say something too...we had one preceptor like that and we were on her like ducks on junebugs. Sometimes you have to be your own advocate since no one else will. Our orientors have meetings with our CNS and UM on a weekly basis, so something like this would have been nipped in the bud if the person mentioned it. And if she disappeared for hours, then she needs to speak up.
    Bortaz, RN likes this.
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    Bortaz hit the nail on the head. It is grossly inappropriate for the preceptor to be out of the room for hours at a time, period!! The amount of time the orientee has been working there is irrelevent. As long as he/she is on orientation that preceptor needs to be available at a moment's notice. All it takes is one incident and one savvy parent to find out that the person taking care of his baby is in training and her "teacher" was nowhere to be found. Shame on that preceptor. I have been training new hires (both with experience and new grads) for more than 10 years and I am horrified at this preceptor's actions. Her manager needs to know what is going on before something very bad happens, for everyone's sake.
    Bortaz, RN likes this.
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    I am a new NICU nurse as well. I have finished my orientation and have been on my own for 5 months. Your preceptor should not be leaving you that long. This is a very specialized field with a huge learning curve. They don't teach you this in nursing school. Its very emotional and overwhelming. NICU nurses i have been told eat their young. I have had some rough times during orientation. I know how you feel I had a infiltration during orientation I felt horrible. My advice is if you dont feel comfortable with your preceptor than ask for a new one. I would straight up tell your preceptor that you are uncomfortable with her leaving (she shouldn't be leaving that long) if that doesn't solve it talk to the Charge Nurse. It does get better and infitration does happen. Learn from your mistake and apply it to be a better NICU nurse. I have had a lot of emotional days at the NICU and sometimes wonder why I choose this field, but it does get better. Always ask questions even if the nurses don't want to give answers always, always, ask questions. you will learn to like it. if you have questions let me know Its rough being the new nurse... GOOD LUCK

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