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

elliern88 · Apr 24, 2012

Hi there!

I am not a NICU preceptor so I can't really tell you for sure, but I am inclined to think that it is not appropriate for your preceptor to leave the floor for that period of time. Even if she feels you are very competent and will be fine to be alone( which is probably why she is leaving you), They should still be close by in case you have questions.

I mostly wanted to respond becaue I can completely relate to you because I also had an infiltrate on orientation!!! I know exactly how you feel, I went home and cried, it was all I thought about for days. Believe me, you will be OBSESSED with checking your iv sites from now on, and that is a good thing :). You will get over it, I did. And you will learn from it. I have been on my own in the NICU for a couple months now, and it is tough. But I ask a million questions. We have a few nurses on nights who are very seasoned and know everything but don't like orienting or helping new grads. I get some pretty snippy replies sometimes, but I don't care. I still ask! Rather that than make a mistake.

You will be fine. Almost every NICU nurse I know has made a mistake that "haunts" them. I still think about that TERRIBLE feeling the day I saw that infiltrate. Those who say they never made a mistake are either lying or perfect.

The important thing is learning from your mistakes. It does make you a better nurse, it made me aware of how sensitive the patient population is. They can't tell you their IV site is hurting, like an adult could.

So, don't worry. You aren't the only one to have that happen to you! The important thing is to take care of yourself as much as the babies! I got totally stressed and could barely eat and sleep for a few days. That made it so much worse, get plenty of sleep, go for a run, go shopping, whatever you need to do relax!

Good luck! :)

NewNicuNurse1336 · Apr 24, 2012

Thank you sooo much for your post!!! You don't know how much what you just wrote helped this new nurse :)! I do feel bad and I have shed my tears over it, I've been obsessing over it and you are right I will be watching those IV like hawks. I've spoken to my mother (a vet. nurse) about it too and she told me that I need to talk to my preceptor about how I feel. That I need her to stay with me, especially after what happened. Thanks again

Bortaz, MSN, RN · Apr 25, 2012

If she isn't on the unit, she isn't precepting you and should be called on it. She does you not a lick of good by leaving you there alone. If you're capable of handling that patient load without your preceptor by your side, then you don't need her anyway. They might as well end your preceptorship.

Where is your charge nurse while this nurse is gone for hours?

babyNP., APRN · Apr 25, 2012

It is hard for us to say anything exact because we are not in your situation. However, I've been a NICU RN for almost four years now and have precepted many nurses...

The IV infiltrate is on her as well as it is you--or at least that is what my educator has told me, since the preceptor is still responsible for the patient. Of course you will be checking all IVs hourly, but those pIVs, you need to be on the dot on the hour, every hour. If you make a flow sheet for yourself where you list what times you give meds, etc, then you can add that to each hour to remind yourself. IV infiltrates shouldn't happen, but they do. Learn from your mistake, figure out what you're going to do so that it never happens again, forgive yourself, and move on.

If you have been on the unit for 4 weeks, you should be able to take care of 3 patients fairly independently. People do move at different paces, of course, but at the end of 4 weeks, it should be tight, but manageable for you. Your preceptor should always be available to you, although they should not be actively doing any of your cares. 3:1s can be tough (can you imagine 4:1? Luckily I only do that when I do agency nursing and not at my home place) and it takes awhile to get the knack down. You just need to be very organized from the get go and leave no time to waste--every minute that you're waiting for a feed to beep off or for a mom to change a diaper, you should be doing something else like catching up on charting or listening to breath sounds, etc etc. It is a learned skill and nearly all new grads have this problem at first. I know I did and many nurses spend an extra week or two on orientation just getting to organize their care in a 3:1. If it hasn't been a full 4 weeks (a little confused? how many weeks of actual time with bedside care have you done?), there is a bit more leeway and you should be able to utilize your preceptor more.

Don't beat yourself up; this is what 99% of new grads go through. Even if your prceptor doesn't actively do care for you, they should be around to answer questions and if things get more emergent like a patient crumps. Talk to your educator, talk to your fellow new grads and see how things are going for them...

Keep us posted on how things go as this sort of thing does get asked a lot about what it's like to be a new grad and your experience could be invaluable to future new grads reading this. Best of luck!

Nursingluv101 · Apr 25, 2012

I'm a float and work in NICU, I noticed most of the preceptors do leave the new nurses on their own. They are there as a resource. Make sure to check IV lines every hour and document it, if your unsure get your preceptor .

Bortaz, MSN, RN · Apr 25, 2012

How can she "get her preceptor" if the woman is off the unit for long stretches of time?

Nursingluv101 · Apr 25, 2012

I guess she would have to go to the charge, and ask her. Then the Charge could ask "where's your preceptor?" it is hard to be a new grad but I also think your preceptor should give you the sense of being on your own. If you aren't ready to

Be left alone then talk to your preceptor. I'm just saying I see preceptors leave new nurses while they go

On there breaks or Help other nurses . I don't think it's that uncommon.

Bortaz, MSN, RN · Apr 25, 2012

I'm just saying I see preceptors leave new nurses while they go
On there breaks or Help other nurses . I don't think it's that uncommon.

And I don't think that's the case based on what this new nurse is posting.

She said,

did you leave the new nurse alone most of the time (as in left the floor for 30 minutes to hours)

That is absolutely unacceptable, IMO. And it is amazing to me the nurses some hospitals choose to use as preceptors...especially in a critical care unit like NICU.

NicuGal, MSN, RN · Apr 25, 2012

By the end of 4 weeks that is an acceptable assignment and you should be doing it with minimal help. As for the preceptor...we back off when you are in with feeders after that time frame. We are watching to see if your time management is good and if you are struggling thru anything. As for the IV...you should be checking your IV and line reconcilation with each hand off...show the IV to the on coming nurse, say it has looked like this, it flushes etc and trace the line back to the pump and check the label with her. IV infiltrates can happen within an hour, the IV can look fine and then boom it looks bad. Just remember to check hourly and with handoff especially.

Now the preceptor...we will go help out if needed when our orientor is at this stage, but she should be available to help you and answer questions. Do you have a review with the CNS or manager alone? We do and then the orientors can express any concerns they have. Also, I find it hard to believe that no one would say something to her...we do if we see someone struggling and the preceptor is off doing something else. She needs to be close by, esp when you are taking vents,etc. At this point, the preceptors don't stray far. Or say to her,"I'm not comfortable if I can't find you to help me or when I have questions" . Doesn't matter how nice she is , she needs to be there for you.

eCCU · Apr 26, 2012

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..... :hrnsmlys:

Best wishes:cheers:

babyNP., APRN · Apr 26, 2012

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? Yeah...it 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..."