did/does anyone else have so much "issues" their first year?

skimpstah · Jan 4, 2011

stick it out!!!! don't let others tell you what you're capable of. Only you know that...show them.

Kim5/08 · Jan 4, 2011

Just my two cents based on your own comments to the situation and I mean this to be something to think of constructively and from less of an emotional standpoint.-

Since the beginning it's just been drama-to-drama issues, mostly with my manager and her "expectations" of where I should be at"
It is her job and necessary for her to have expectations of where you should be at. You did say you are at the end of 6 MONTHS of orientation. What is the standard for your ICU unit? Is it longer than 6 months? Don't you have some sort of training guidelines/check-off booklet? Where do you stand according to these training expectations?
and then with a preceptor who I feel is one of those "New Grads don't belong in the ICU" types of nurses, b/c that's how it worked out for her, so of course her standards of me are less than good.
Her standards of you are less than good? Or do you mean her perception of you? If it is her standards, I would expect a preceptor to have high standards. Are you being trained/oriented according to you facilities guidelines? I do have to say, I do agree a new grad does not belong in the ICU, unless perhaps they have prior medical experience as an LPN or tech and are already familiar with the ICU setting.
Plus the feeling of being very overwhelmed with the many drips, multi-tasking alot of precedures, different speciality Drs, core measures, etc! AND now to make things
Depending on census and patient load, any nurse can be overwhelmed on any paticular day. This does not necessarily go away (again depending on acuity of the assignment and support staff), but the question is how you deal with the situation. You need to be an excellent multi-tasker and critical thinker under pressure.
worse, I've been placed back with the "difficult" preceptor because there's only 2 that are willing to precept and I've already been with the other one for 12weeks, so my manager feels she needs a "break".
Imagine your stess and anxiety in this situation. I can very well see where the preceptor needs a break. She is not only accountable for herself, but you as well.
So after the first day of being back with the "difficult" preceptor, she tells me I should "reconsider" going to a step-down/tele unit, like she did, b/c this will help me with my "disorganized" thoughts, that I still can't "put the whole picture together" and that I don't have "critical thinking skills necessary for the ICU" and lastly she wasn't too impressed with my progress............
Even though it is not what you want to hear, you have been given constructive criticism, if it was delivered in the manner you describe here. She did not tell you that you are no good as a nurse and should quit, but suggested where you could gain valuable experience at a less hectic pace.
Like I need her to tell me this! Way to precept, thanks alot! It's not like Im not having difficulties enough that I need your down-talking to bring me right back up!
By your own admission, you are having difficulties. Yes, she SHOULD tell you this, if it is the case. It is not her job to stroke your ego. Encourage you, yes, but not coddle you. You have the lives of very critically ill people in your hands.
I was already considering it anyways, but know I just feel the urge to prove her wrong and "stick-it" to her!
Again, you were already considering it anyway. I pose this question to you: Do you want a nurse caring for your loved one in ICU who feels overwhelmed and not yet seeing the big picture before they even get the assignment? How are you "sticking-it" to her to stay on? You seem to be miserable, way to stick it to HER!
But in other things, I did get this post-partum pt to ICU last week, placenta abruptio and fetal demise. I knew exactly what to do like the back of my head! How to assess, what to prepare for, psych as well as physically. I mean, it was fun for me. Which that hasn't happened for a while since I started my orientation with ICU
So, you know your area of interst, which does not seem to be the general ICU setting but your origional area if interest. My opinion is you should do what you are passionate about!
I don't know if I should try another 6 more months and wait how I feel/doing on the ICU unit, or if I should break my contract now (and have to pay them! which I will have to do anyways if I leave before 3yrs after my orientation is done!) and presue a different specialty or what? My plan was to finish my BSN, which I start this summer and be done by 5/12, and by then I'll have 2yrs worth of experience and then try to leave! You know, but in my own terms, not bullied out! Like Im feeling now! But I just don't know.....

This is unfortunate, but has been necessary for facilities to do. If they don't require staff to stay for xx period of time after providing a sign-on bounus or whatever it was in your case, folks would stay to get the experience only to quit and go to the next facility where they will be offered more money because they have experience.

Again, based on what you have stated here, it does not seem to me you are being bullied out if you are not yet prepared/experienced for the position you are now in. Think about this. You are not Paying them, but RETURNING the money given to you based on the expectation that you would be employed for a certain period of time. Six months worth of training is A LOT of money and time invested in you for that unit. If they don't keep you, they have to start over and the time and money spent on you is down the toilet. Also, my question is if you do not stay in ICU, do you have to return the money? Or is it if you leave the facility all together? If it is if you leave ICU, I see the dilemma, but if it is for leaving the facility, then you have the option of working elsewhere in the hospital as was suggested to you.

Now, you are planning on going back to school and will still work in this unpleasant situation? Not a very healthy thing for you to do to yourself.

Why not go to a step-down/tele unit with less pressure where you can hone your critical thinking/multi-tasking skills? It would be a very good argument for you to say "I'm enrolled in my BSN completion program now and need a little less stress at work at this time so I can be able to preform my job to the absolute best of my abilites and focus appropriately on my studies." If you have the need to "stick-it" to her, do it by moving on to greener pastures, improving yourself, and then become the preceptor you yourself wished you had.

(And so you know where my opinion is coming from-I'm not in management nor do I have the desire to be. I've been a nurse for only 2 3/4 years now and my nurse educator just a month ago made me a preceptor for which I was provided no training and receive no additional pay for the extra responsibility and stress.)

shoegalRN, RN · Jan 6, 2011

I agree with the previous poster above me.

With that being said, I think maybe you should consider going to Stepdown/Tele. Don't try to "prove" to your preceptor you can do ICU if you are totally feeling overwhelmed. It's nothing wrong with going to Stepdown and it shouldnt be taken as an "insult" or a "downgrade".

I also started off in ICU and realized quickly it wasnt for me. I had an orientation from hell, different preceptors from hell and it wasnt a good learning environment or a good place for a new grad to start off in my opinion. I left for the ER, and I also worked Stepdown (PRN) so the ICU experience did help me. ER and Stepdown were really good fits for me and I have no desire to return to ICU.

As a preceptor, it is her job to evaluate your progress and set standards for you. If you are not up to par for the amount of time you have been on orientation, it is her job to point that out to you (the earlier the better). If I were you, I would be looking at openings within your hospital system and start getting your resume together. If you are trying to go back to school for your BSN, I would not want to be stressed out with work as well. You can use this as an excuse to transfer to Stepdown.

Not everyone is meant to be an ICU nurse. And it's nothing wrong with it. If ICU is something you really want to do in the future, I would suggest spending a year or two on Stepdown and then go back to the ICU, maybe in a different hospital.

Good luck!

Compassion75 · Jan 7, 2011

I also tend to agree with the posters above to a certain point. 14 years ago I started out as a new grad in a cardio vascular recovery unit which was very stressful and did not have a good preceptorship experience but made it. However when I decided to transfer to a stepdown unit I think I left the hiring manager with the impression that I thought step-down was a step-down which is not a good thing. This is where most new grads make their mistake. And actually my ICU instructor in my last semester of my ADN program had suggested a slower paced environment. Her exact words were that I was very deliberate, methodical, in my nursing but a little slow. I believe I took a little offense to this statement, but she foresaw what I later know now to be true. I eventually ended up leaving the hospital unfortunately due to continued lack of support and not able to transfer. At the time I continued working at a long-term-care/subacute unit as a charge RN. It was here I honed my skills in medication management, wound care, trach management and suctioning, IV therapy and central line care, dealing with a variety of diseases such as chf, diabetes, AIDS, cancer, COPD. U name it. Also taking doctors orders, proper documentation, documentation according to Medicare guidelines for skilled nursing, skin assessments, how to pronounce patients, and valuable skills in tube/peg feeding management, placing ng tubes, foleys, time management, priortization and triaging, and supervision of cna's and lpn's. It was here that I also got my first initial experiences in the ltc setting with hospice which is where I have been for the last 12 years of my 14 year nursing career .The experienced lpns i must say took me under their wing as well as the RN's and mentored me. I can proudly say when I returned to the medical-surgical ICU setting I was alot more well-prepared and orientation was alot less stressful. I also had an excellent and very supportive nurse staff developer, manager, and preceptors which are also key ingredients in my success.

The break away to a less-stressful and more supportive work environment really helped me to mature as a nurse. Also working nights was helpful because the nurses are a little more laid-back, work together closely and more supportive because of less staff and distractions at night, and the slower, slightly more quieter pace allows new grads the chance to pace themselves more. Plus pay was a heck of alot better at nite which really helped me alot financially. Just remember to take all criticism and correction constructively and wisely. It will make you a better nurse in the long run.

Nurses unfortunately continue to eat their young, but you must also pay your dues. No nursing experience is ever wasted no matter what the setting. A stable job history is a must esp. in these economic times. Try to transfer to nites if u can in your ICU setting to see if that will help. If that is not is not possible then go to the telemetry/step-down unit. But stay and pay back the hospital if at all possible. It will benefit u in the future, you will be a stronger nurse, financially stable, and gain valuable experience. In my day it cost approximately $30,000 to train a new nurse in six months and that was 14 years ago. Also with budget cuts and because u only did six months, technically u are still considered a new grad, and new facility will consider u a high risk investment, and u may not be able to procure another job in a timely fashion putting u in dire financial straits. And do not start the bad habit of job-hopping early in your career because it will catch up with u and delay your development as a nurse. Trust me I learned the hard way. If u must change facilities try to find a step-down/long-term acute/subacute care like I did with a variety of patients and disease proceses. But by all means commit to staying at least a year in all jobs as a rule of thumb unless u are jeapordizing your license by staying. U will eventually be able to get the jobs u want in the long run because of the experience behind u. I had already been working as a cna/student nurse at both facilities before I became an RN and also kept the ltc/subacute prn after I graduated which was why I was able to later switch because I had an established work history. Sorry this was lengthy, but I would that all new nurses could learn from and be spared my mistakes.

Always remember no area of nursing is easy and will come with stressors of its own, but the key to longevity in nursing is finding your niche and remaining in it and also please continue your education to a BSN at the minimum, preferrably MSN. All new grads this is a must and I would finish it ASAP. Just in case you get burnt out in the hospital setting or get an illness or injury that doesnt allow for bedside nursing, there are so many doors open in nursing outside of the hospital setting with advanced education. The future of nursing is rapidly moving into the homes and communities opening doors into home health/hospice, case management, managed care nursing, telehealth, pt and nursing education in all types of settings, and advanced practice nursing.:redpinkhe:nurse: