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| No. 10 | 
Jul 23, 2008, 04:42 AM
 Re: New and Drowning
Sunbird-
I agree you need to have something change in your orientation because it does not seem like a learning environment. As a preceptor let me tell you that orientees often feel they are drowning when they are infact doing fine. A good preceptor will let you learn by doing but will not let you drown, it should be supportive and constructive. PALS is what I would take first but I also took ACLS and have used knowledge from both.
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Jul 24, 2008, 11:14 AM
Re: New and Drowning Originally Posted by janfrn  Let's see if we can draft a script for you...
Start off by saying that you're so glad you accepted this job in PICU (and make sure you use the word "accepted") because you know it's a great place to work. Say that you've already learned some new skills and have made some new friends. Go on to say that you know you still have a steep learning curve, and are confident that you're up to the task. But... your learning style doesn't seem to be a good fit with your current preceptor's teaching style. Say that although you have experience as an LPN you really are a new RN and your new scope of practice is so different, you feel you need a more hands-on approach in preceptors, someone who doesn't expect you to know more than you do because of your background. Say that you also are someone who needs a lot of feedback, both good and bad, so that you can adjust your learning plan. Add anything else you think would be tactful but accurate in explaining your discomfort with the situation. Keep the focus on you and your learning needs and not on your preceptor's shortcomings. Ask if it would be appropriate for you, your preceptor and your nurse educator to meet and discuss your progress (something that should already be happening, but seemingly is not). Then go through with the meeting if that's what happens. At the end of the meeting you'll have an idea if this preceptor understands what you're looking for; if not, then would be the time to request someone else complete your orientation with you. If you keep it about you, and what's best for the unit, you can't miss.
(Feel free to cut and paste if you think that will help.) Well said, Jan! This new nurse absolutely needs a new preceptor. | | No. 13 |
Aug 01, 2008, 07:18 PM
Re: New and Drowning Originally Posted by PICNICRN You hang in there!!! I agree with the other posts... You need a new preceptor! Unfortunately, not everyone should be a preceptor for new nurses. I have seen many RNs who are excellent at the bedside and LOVE to take all of the "sickest" kids and think that this is the experience that a new RN needs to learn how to make it in the PICU- they are NOT good preceptors! I always start my orientees with simple assignments at first to learn the basics(safety/assessment skills/common gtts and TIME MANAGEMENT) and then work or way up to the more complex pts as comfort level improves. I would hate to see you give up on this specialty due to a poor orientation because it is truely a special place to work! Please speak to your unit educator and find the right fit for you.... and let us know how things go!
Good luck!! 
Do you have any advice for the new grad going into PICU? I just completed my hospital orientation and I start on the floor this week. I have a crazy schedule and I don't know how that will work. I will be working rotating shifts and I will be working two days and two nights in the same week! I am very afraid of that, and I have never worked a night shift before. Ever!
| | No. 14 |
Aug 01, 2008, 11:05 PM
Re: New and Drowning
" Do you have any advice for the new grad going into PICU? I just completed my hospital orientation and I start on the floor this week. I have a crazy schedule and I don't know how that will work. I will be working rotating shifts and I will be working two days and two nights in the same week! I am very afraid of that, and I have never worked a night shift before. Ever!"
Well........... my advise would be to make sure you are getting a good orientation! Ask lots of questions- no question is a stupid question! If you don't feel like you are "catching on" speak up EARLY, your unit manager will be eager to help you develop into to a safe PICU nurse and will be willing to facilitate you. Brush up on your patho and always ask yourself why?(why this med, how will it work on my pt, what changes will I expect to see in my pt after a certain procedure or med fro instance) Always try to anticipate problems. Brush up on your PALS. If you encounter a new dx, med, or treatment that you are unfamiliar will- Look it up! Take every opportunity to learn! I have been working PICU for 12 years and I learn something new everyday- that is one of the reasons I love it!
As for your schedule.... That sounds pretty crazy! I have heard of rotating shifts but not in the same week! Will this be your regular schedule, or just for orientation? Just try to get enough sleep if thats possible  !
Good luck to you on your first week... I hope you love it!! Please keep me posted on how it goes!!
| | No. 15 |
Aug 01, 2008, 11:41 PM
Re: New and Drowning
Don't be too hard on yourself. I have been a RN for two years now and before this had worked as an LPN in a long-term care facility. I didn't know anything about the hospital at all. I started working in ICU step-down and some of the patients should have probably been in ICU. Anyway, it was hard for me to catch on. It is unreasonable to expect that you will know everything or be perfect from the start. All nurses have been there. Some just forget. It took me a good 6 months to feel comfortable at work and to not agonize or have panic attacks before work. Don't give up on yourself. Just learn from your mistakes. I assure you after you do them once, you don't usually do them again. You'll do fine. Trust me, if I can make it then you can make it. Good Luck!
| | No. 16 |
Aug 02, 2008, 11:53 AM
Re: New and Drowning Originally Posted by PICNICRN Well........... my advise would be to make sure you are getting a good orientation! Ask lots of questions- no question is a stupid question! If you don't feel like you are "catching on" speak up EARLY, your unit manager will be eager to help you develop into to a safe PICU nurse and will be willing to facilitate you. Brush up on your patho and always ask yourself why?(why this med, how will it work on my pt, what changes will I expect to see in my pt after a certain procedure or med fro instance) Always try to anticipate problems. Brush up on your PALS. If you encounter a new dx, med, or treatment that you are unfamiliar will- Look it up! Take every opportunity to learn! I have been working PICU for 12 years and I learn something new everyday- that is one of the reasons I love it!
As for your schedule.... That sounds pretty crazy! I have heard of rotating shifts but not in the same week! Will this be your regular schedule, or just for orientation? Just try to get enough sleep if thats possible !
Good luck to you on your first week... I hope you love it!! Please keep me posted on how it goes!!
Thank you. I will definitely keep you posted. I have six months of orientation so that will most likely be my schedule until Jan/Feb. They are going to put me in PALS sometime in September, any advice for studying for that ahead of time?
Thanks again for the advice. I hope I love it as well.
| | No. 17 |
Aug 02, 2008, 03:39 PM
Re: New and Drowning Originally Posted by PICNICRN As for your schedule.... That sounds pretty crazy! I have heard of rotating shifts but not in the same week! Will this be your regular schedule, or just for orientation? Just try to get enough sleep if thats possible !
Good luck to you on your first week... I hope you love it!! Please keep me posted on how it goes!!
Actually, the two days - two nights rotation is fairly common and one of the "friendlier" ones. Police forces, EMS, fire fighters all work similar rotations. By only working two nights at a time, one's body clock doesn't reset to night mode and the switching back and forth is easier than if one worked more nights at a time. (Evidence-based, multiple studies on shift work...) In Canada where the vast majority of facility-based direct-care nurses are unionized, the contracts in place lay out rules for scheduling, and rotating shifts are the norm. Almost everyone is expected to work rotating shifts with a certain percentage of their hours on nights and weekends. The most difficult rotation I've ever worked was a four week repeating schedule of four nights starting on a Thursday, three off, two days, two off, three days, two off, two days, three nights and seven off. Now I work in a unit that permits a degree of flexibility in rotations and I work one day, one night, three off. For anyone working rotating shifts, a sleep routine and a habit of protecting one's sleep are vital for good health and good nursing. Some of the threads on night shifts have really good tips on how to make it work.
As for PALS advance preparation, I'd recommend buying the AHA Guidelines book soon. Read through it a few times without trying to memorize anything, working on having it all make sense first. The BCLS part shouldn't cause too much stress, since we all recertify that on a regular basis. Then start getting to know the drugs used in pediatric codes (the list is shorter than the ACLS list): why do we use them and what do they do for the patient. Once that's clear in your head, learn the usual doses. In my previous hospital we were stuck in the Stone Age and didn't have computerized emergency drug sheets; each admission we calculated the emergency drugs and filled in the sheet by hand. They were then checked for accuracy by a second nurse. That is a great exercise for helping to remember doses. You can make yourself a spread sheet with the drugs and their standard doses down one side and a place for calculations based on patient weight down the other. Pick some random weights and do the math. After awhile you won't need to refer to the doses on the left because they're in your head. Maybe you can connect with someone who's taking it with you and study together. Don't panic and you'll be just fine.
| | No. 18 |
Aug 02, 2008, 04:25 PM
Re: New and Drowning Originally Posted by janfrn By only working two nights at a time, one's body clock doesn't reset to night mode and the switching back and forth is easier than if one worked more nights at a time. (Evidence-based, multiple studies on shift work...)
Wow, I didn't know that. I thought it would be worse on the body!..Thanks for the advice regarding the calculations and PALS also.
| | No. 19 |
Aug 02, 2008, 04:40 PM
Re: New and Drowning
You're most welcome. I'm not going to lie to you and tell you that you won't be tired, because you will. Especially at first. After awhile when you've found the routine that works best for you, it will get better. One of the workshops on shiftwork that I attended talked about circadian rhythms and how long it takes to adjust to a change. The studies found that around 72 hours into a new pattern of behavior, such as working nights, the body has started shifting alertness, temperature regulation, hormone production and other circadian cues to the "new" norm. The discussion based on applied physiology was quite fascinating and gave me more than one "AHA" moment. I often wondered why I always had to get up to pee at 10:25, 12:05 and 2:15 on the dot, no matter how hard I restricted fluids on nights... ADH, secreted at night, pushes K+ into the cells and drastically reduces the amount of water the kidneys siphon off. Then in the morning, ADH secretion shuts off, the K+ rushes out of the cells and the kidneys go into overdrive to correct the serum K+... et voila, a litre of pee. The research suggests that working no more than two or no fewer than four in a row will be easiest on the body. The twelve-hour-shift model is a bit more difficult in some ways than the eight-hour-shift model but in other ways it's easier, because you're working a third fewer calendar days. But like I said, it's paramount that you develop a routine and protect your sleep.
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