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Discussion

Am I ready to be on my own?

I'm a new nurse that graduated from an ADN program. I'm nearing the end of my orientation on a med-tele floor and don't feel like I'm ready to be on my own. I started the orientation in mid-August, it has included class time as well as having a preceptor on the floor. I haven't felt good about the preceptors that I've had, but I've been trying to make the best of it. When I was in school I had a great clinical instructor (a nurse that worked on a cardiac unit and back in school for her NP). She taught me the way my brain works - methodical, systematic, organized. So I was hoping to have similar qualities in a preceptor. The first preceptor I had for 2 weeks was extremely disorganized, so I talked with my manager. She assigned me to 2 other nurses, because of the scheduling and the other choices, that was the best she could do. One had great time management, the other good patient care. But being older nurses, they take so much for granted that they really don't "train." I've asked questions, but feel like I've had to pick a lot up by osmosis and I only know so much to ask questions about. Even when I've asked questions, I receive a response like "just do this." But for me I need some substance - why am I doing this and how does it relate to the patient in front of me. So I worked with them for several weeks until the classes were over. Then I got switched to night shift and started over with yet another preceptor and learning a totally new routine. She showed me the tasks for night shift, but has pretty much let me go on my own and is available for questions.

I'm concerned because I feel like I've learned the "tasks" and the routines of the shifts, but I don't feel like I've received any insight into how to approach patient care - what to look for and what to consider with the many different types of patients that we deal with. How to take all that stuff I learned in school and apply it to the patient sitting in front of me. Insight from a clinical perspective. For example, here is a patient with pneumonia, these are generally their issues..., you need to look out for.... and check....

I've also had a conversation with my clinical instructor, the one I mentioned that I like, and she agreed I may not have had the best orientation experience which makes it more difficult.

So because I fear for my patient's safety and loosing my license, I'm very stressed about being on my own. I know some of this is normal, but I don't feel like I have what I need. So I'm trying to consider my options. It was said to me I have 6 more shifts and then that is all they can do for me. I don't feel that it is a matter of time, but of the content I've received. So I don't know if I should look to be moved to another unit or look for a different job in another hospital where I might get better training.

I'd appreciate any insight.

Thanks!

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    Have you looked around you at the other nurses on your floor to see who might we approachable with questions, who might take you under her wing and see that you're safe and supported? There are nurses on every floor who aren't the nurturing kind, but every floor also has at least one person that is happy to answer those "stupid" questions and to act as a sounding board for thinking things through. Seek out someone like that who can give you guidance when you need it. You can't be expected to have all the knowledge that it has taken your coworkers their whole careers to collect, the instinctual recognition of a patient in trouble, the automatic actions that we develop with time and familiarity. Start looking for that supportive person on your very next shift and start developing a relationship with that person NOW. And don't hesitate to remind people that you are NEW and you need time to grow, that you want your patients to receive safe and competent care and you're going to need their help and experience to get you there.

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    I've been a nurse for almost two years now and I always have more experienced nurses around me to ask if I'm ever unsure.

    I love the autonomy I have as a nurse, but you bet your bottom dollar that I will ask my fellow nurses if I'm ever unsure about anything.

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    competence and insight comes with practice (work experience). there is nothing wrong with feeling the way you feel but no amount of time on orientation is going to make you better at being a nurse because orientation is a crutch to some degree. you need to be on your own to grow. with that said, if you think you need more time because you feel unsafe, then request more time! otherwise, join the rest of us off of orientation and learn as you go. as the other posters said, you are never truly by yourself. there are others (nurses, rts, physicians etc.) who can be used as resources. gl!:twocents:

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    What you want the other nurses to teach you will only come with time. You need to be proactive and freshen up on signs and symptoms of adverse complications in your speciality field. My manager told me that she doesn't expect me to know alot when I come off orientation because it takes time. She said I should be able to read MD orders and implement them, pass meds and do the daily task of the unit. The rest will come with time. I think you will learn so much more when you come off orientation and do things on your own.

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    I agree with the others. Just because you have a preceptor doesn't mean you can't go elsewhere to ask questions. My preceptor and I did not get along AT ALL when I first started out. She was a horrible teacher! I would find other nurses and ask for their help and the majority were very happy to do so. Even now that I have been a nurse a year and a half I still ask questions from more experienced nurses. Unfortunately, you'll run into your problem most places you go. I felt the same way when I finished orientation.

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    IM on that boat right now...im not ready to be on my own. Im a new grad working on a rehab/longterm 22 pt floor. They started orientating me on a diff floor where i basically learned routine for that floor and was not allowed to pass meds. Then they sent me to my original floor but opposite side where i did assessments and treatments. After a while i passed meds here and there but not enough to be confident. Now Im on the side that will be considered my floor but i have only passed meds there once! and i just got word that they want to take me off of orientation. THis floor is hectic and unorganized and the med pass is unreal. What about when i get admissions? and I dont even know how to go by when pts labs come thru what do i do next??? their computer system is soo different everything is broken down. IM scared I dont want to be unsafe, overstressed and be bothering the other nurse for help!!!! PLus I was originally told they offer 6 weeks of orientation and now im bein told otherwise. I just feel they are desperate to fill my sched for x-mas eve, x-mass day, the day after and the day after that.

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