Words of encouragement?

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    I would love any words of encouragement. Overall, my orientation as a new NP is going well, but internally I am struggling. I keep wondering if I have made a mistake. I admit, much of my turmoil is the challenge of going from being an expert RN that everyone turned to, to the new kid and new NP that has to learn and earn the trust.

    In particular, there is an RT that wants to challenge every order I give. Last night I caught her rolling her eyes and huffing at having to do something I'd ordered. I suspect comments were made in the patient's room about how she disagreed with my orders, given the way the family member acted when I went back in. When I later decided to escale the support I am pretty sure I overheard her say, "Well duh!" in front of the parent.

    Honestly, I am not sure where this hostility is coming from, other than she just may be a difficult person to deal with. If she wasn't so aggressive, I would love to discuss with her why we each prefer a different approach and maybe in the future we can get there.
  2. 8 Comments so far...

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    Relax, I still feel that way some times. Pull the respiratory terrorist aside quietly and elisit their input on the order they rolled their eyes at. I feel like any minute they will find out I am flawed and lose respect. I err on the conservative side and if I have a question in my mind, I call a coworker for input. It's how we learn, along with a lot of outside reading. Take it easy on yourself and I'll do the same.
    tryingtohaveitall likes this.
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    Lol, thanks, Tim. Good advice. Being on orientation, I am running most things past my preceptor. I'm sure I feel more sensitive being new. Sometimes the order has come from the attending and they still want to argue and fight it, so I guess it's clearly not just me.
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    I work in the ICU too, but with adult patients. What I found in the years I've worked in this setting is to know the culture of the ICU you're working in. I came from one setting where RT's depend on the NP's orders and carry them out without question to the current ICU where RT's have a lot of autonomy based on protocols. The former unit is a heavy surgical ICU where our orders are surgeon-driven based on their preferences. The current one is a mix of everything from Neuro to Medicine to Surgery to Cardiac but is heavy on respiratory failure from ARDS type lung injuries, pneumonias...the typical MICU stuff you encounter.

    I have to say the culture shock was realizing RT's did stuff on their own and had heavy input on vent management. What have worked for me is to establish a relationship with the RT's from the get-go. There were things I learned from them in this ICU that I didn't know in the last one I worked in. Discussing our plans together before I write the order and playing around with settings that we both come up with have made a tremendously harmonious relationship with most of the RT's. I said most because once in a while I still end up working with "rogue" RT's who mean well but come up with the wackiest vent and weaning ideas that I disagree with. One the other hand, I find that the rest of the provider team (physician, fellow, NP's) feel the same way about those certain RT's and have voiced support that we stand our ground when confronted by them.
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    Juan,

    Sorry it took me a few days to reply to your advice. Thank you so much for taking the time. I appreciate your wisdom and will keep it in mind. I have great respect for teamwork and respecting people's knowledge base and expertise. Upon my boss's advice, I am going to try to talk with her the next time I see her, explain I'd like to have a good working relationship and apologize if I came across poorly. Honestly, I think she was angry before I ever said a word to her, so while I will be very careful to be polite and respectful, I think there are/were deeper issues here. At any rate, onward and upward.
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    You have orientation and a preceptor?!!! I had a week of this is how to use the computer system and bill and oh theres the bathroom. Im sure it's just different for different specialties. Discuss any concerns with your preceptor. My guess is that RT just has a bug up their butt and you're not there to do the extraction. I personally would just wait it out or try to get the low down from someone I feel comfortable with at that place. Good luck and just remember your new grad RN days, those were truly nerve wracking
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    Yes, this is a critical care NP position so there's an extensive orientation, thankfully for all involved.
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    Juan and Nursetime,

    Just wanted to update and again thank you for your advice and encouragement. Things are going MUCH better. I think I way underestimated the effect of the change in employer and role. I was able to make nice with the RT and have overall developed a good rapport with the staff.

    I hope you're both doing well in your areas. Have a great week.
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    Quote from tryingtohaveitall
    Juan and Nursetime,

    Just wanted to update and again thank you for your advice and encouragement. Things are going MUCH better. I think I way underestimated the effect of the change in employer and role. I was able to make nice with the RT and have overall developed a good rapport with the staff.

    I hope you're both doing well in your areas. Have a great week.
    Great. That's what I love about ICU...it's a team approach and RT's are one of the keys to your success. It's easy to win the admiration of nursing staff since you already have a nursing background.


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