A really bad day in the ER for a new nurse resident

[godbless-yute]

Ok, so I feel like I've had the crappiest (if that's a real word) day of my residency......The day starts off with me being assigned to a substitute preceptor because my preceptor decided she wanted the day off. Not a real problem....Our room assignment is in the area for the higher acuity pts. Around 0930 the flood gates begin to open...STEMI alert...Stroke Alert...one after the other. In the meantime I'm running from room to room trying my best to take care of my pts (ALONE...my substitute preceptor basically abandoned me). When I got report from the monitor tech that I was getting a stroke alert pt (complete with textbook deficits), I went and told my preceptor so that he would know to at least stay nearby since I had not had one of those pts before and the ETA was only 5 mins. All he says to me is "ok" and continues the convo he was having with co-worker he was chatting with. At several points throughout the day I would notice him sitting at the desk fiddling with his ipad, while I'm being pulled in different directions. ALONE (well without my preceptor), I took care of an "at home abortion" c/o vag bleeding, a stroke alert, 2 chest pains, and an elderly person w/ multiple complaints (who came in circling the drain)

At no point did he ever ask me if I was ok, and when I would ask for help, he would just come in and take over. I was only assigned to be with him for the first 8 of my 12 hr shift. As were wrapping up with a pt. before he leaves, he asks me what I thought about the day...what I think I need to work on. I told him that I thought I needed to work on being able to think ahead to what I will have to do next w/ a pt, and knowing what labs and procedures etc go with what chief complaints. I also told him that I think I need to work on starting IVs (I missed the first three that I tried today).

So his feedback to me was that my IV technique was good, and that its just a practice thing that will come with experience. He also suggested that I look up disease processes and what goes with them so that I can know what to expect next and also keep the pts better informed. I thought that was good constructive criticism and had no problem with it. However, he went on to tell me that he mistook me for another resident who is an experienced nurse, so he was wondering WTH was going on with me. He also said that he said to my supervisor " I dunno about this one, she's acting like a new grad". So when the supervisor tells him that I am a new grad his response is then "oh, well in that case I guess she's ok then".

So here's what really irritated me .....at no point during the 8hrs we worked together did he feel the need to 1) clarify who he's working with, 2) at no point did he feel the need to actually precept, and 3) he went to my supervisor about my performance without first addressing it with me. His new grad comment came off to me like "new grads suck and you're acting like a new grad"......and then when he finds out that I am, he basically says its ok cause I'm supposed to suck. All the residents have been rotated through about 10 different preceptors, and all my other preceptors had positive things to say about my performance with some suggestions here and there. Now I second guessing everything because I don't know if they were rating me as a new grad or just as a nurse period....Now I don't know if the ALL felt like I suck as a nurse, but I'm good as a new grad

I just really needed to vent. Thanks for reading.......and if you ever have to precept anyone, please actually try to teach them something before you completely flush their confidence down the toilet

[sara.g]

As a 4th quarter student who is trying to prep for my 12hour clinical tomorrow and yes another 12 hour on Sunday, I can only imagine how frustrating and hard your day was. My only comment to you is, give yourself a pat on the back for finishing the day. You pulled through it and it seems as if some nurses/preceptors forget they were once students. Empathy is something I see many nurses lack when it comes to students. But thank you for sharing your experience and go have a pint of ice cream and be proud that you made it though another day! Nursing students/New grads unite!!!!

[+one]

I basically had the same day as you did. The one that was supposed to orient/precept me was on a vacation. so today i was working with a seasoned nurse from my facility.

basically she did everything on her own while i did my own thing. It seemed that she was treating me as if I have been working in my facility for months or weeks now.

I have been hearing good feedbacks regarding my performance as compared to those new hires that my facility has right now. But it seemed that this morning I was out of my game ever since the way my preceptor today treated me. Oh well my shift is done, time to watch basketball!

The next time I work with her I'll put my game face back, I know how she plays her game, how she runs her offense, another day of learning again today. (OMG, my team is losing, arggh!! )

[Quidam]

Betcha learned a lot today. :hug: And I think that it may have been somewhat of a compliment that he said since you were a new grad then you did ok. Really there is a world of difference between an experienced nurse learning a new area and a new grad learning an area...especially something like the ED. Sounds like you did a fine job in very difficult situation. Be proud.

[indonurse_uci]

You did a great job anyway for a new grad, really i think that your preceptor actually did give u a compliment (when your supervisor tells him that you are a new grad, his response is then clearly told us so). Anyway, i think his negligence on those three aspects is what i can't tolerate... too bad, but the good news is "you made it"

Sympathy and the sense of togetherness are what we (most nurses) lack of, and thank's for sharing your stories... remember we were once students and just exactly the same with other new grads, treat them like what we once hoped we were treated like......

Go nurses, Go new grads

[PostOpPrincess, BSN, RN]

You are a new grad.

You will have these days until you are a preceptor.

It's survivable...but don't be too hard on yourself....

good luck.

[Rabid Response]

Sorry your day was so bad. I would take the "new grad" comment by your substitute preceptor as a compliment, albeit a backhanded one. I am beginning to believe that most of the problems that arise in nursing stem from lack of communication. At the beginning of your shift, your preceptor should have taken 30 seconds to a minute to assess your level of experience, what your self-professed strengths and weaknesses were, and to plan the shift accordingly. So much of your anguish could have been prevented that way. It sounds like your preceptor's brain only started to kick into gear at the very end of your shift, but that was too little too late.

Some nurses, even some very good ones, should not precept. I really dislike the nurses who think that precepting is a license to do as little as possible all shift. As others have mentioned, keep this experience in mind for when you are experienced and assigned to precept someone else or working with a newer nurse who needs a little support.

I hope that you get to work with your regular preceptor again next shift. I'm sure that you will appreciate him/her much more from now on!

[oramar]

You did an amazing job under the circumstances. There is a major system problem here if the preceptor got to he end of the day without knowing exactly who you were. I fault him(I think he was a lazy so and so) but I fault the system also.

[raine]

I agree completely with the other posts. In addition it would have been beneficial for someone in charge who knew you were coming on to a new preceptor to have introduced you and made sure all the details were clear. Even if this sub-preceptor thought you were someone with experience...his job was to make sure you did your job in accordance with the procedures in THAT ED. His liscence is your liscence...what would he have had to say if something had really gone badly? It sounds like you did an amazing job under the circumstances...and remember there are usually other people around who are willing to help out...seek them out...ask for help...go to the person in charge if things are getting out of control. Keep up the good work!

[back2bRN]

You were thrown in and guess what you doggie paddled!!! You didn't sink or give up, you did it!!! Way to go.Remember you are new, as we all were, give yourself a break. It sounds like you did just fine.

[Missy BSN, BSN]

I completely emphasize with you. I'm currently doing an internship in the ER and everyday I feel the same way as you described. It's reassuring knowing that I am not the only one that feels this way. I think our preceptors are so comfortable in their careers that they forget how challenging and fast-paced the ER is for new grads. Don't lose your confidence and don't let one bad day get you down. I think you did great under the circumstances. :)

[Footballnut]

Sounds like a really terrible day! Give yourself a hand for doing such a great job. Your preceptor certainly could have given you more guidance. It doesn't sound like he was paying attention at all.

What do you like best about your other preceptor?