Anyone else with PICU orientation woes...?

Pediatric Critical Care Columnist · Apr 13, 2009

I'm so sorry to hear about your unfortunate experience. Some people are just not cut out to mentor others and it sounds like you've been saddled with one. There could be any number of reasons why she's treating you like this and I'd say most of them would be her issues and not yours. She might be someone who doesn't think new grads should work in ICU. Or she may be one of those who believes that there is only ONE correct way to do anything but you're not privy to those methods and if you want to work in HER unit you should have learned them before you arrived. She may be someone who feels threatened by new staff to the point where she can't see any benefit to having them around so she's chasing you away. She could be someone who cannot relinquish control of any aspect of patient care and resents having to do so for an orientee. Or she might be insecure in her own skills and position on the unit. Then again, she might just be a miserable person! I work with at least one of each, so I can see how it might be for you. She obviously has no idea how to be an effective preceptor or to give constructive criticism. Your manager doesn't sound like a very sympathetic sort either. Do you have a clinical nurse educator you could talk to about what you've learned and how your orientation is going? Is there someone else on your unit whose style and personality more closely mesh with yours who could take over your orientation? It would be such a shame to throw the baby out with the bathwater here.

Don't be discouraged if your orientation is extended. In this environment that could be a blessing. And remember that orientation is only the first stage of learning how to function well on your unit. When you're turned loose on your own, you're only going to know the basics of how to do your job. Each patient and family will teach you something. Right now you're focused on the details... everything you do is mentally broken down into steps as you do it. It takes a minimum of 1000 repetitions for an activity to become second nature. So give yourself some credit and some room to grow.

Don't wait for things to get better, find a way to MAKE them better. Use your language skills to create a script for speaking to your CNE and manager about changing preceptors. How can you word your request so that it doesn't sound whiny (your word, not mine)? "I'm feeling as though my learning style isn't compatible with Mary's teaching methods. She's really good at bedside care but I don't feel as though I'm able to emulate her the way I'd like. Perhaps my preceptorship would go better if I were partnered with Rachel for the rest of my scheduled orientation." It's all in the presentation.

Let me know if there's any way I can help.

ms.rcnyc · Apr 14, 2009

You are definitely not alone in a miserable orientation experience. I am having one myself in med-surg. I am sorry it is going so badly for us but it is good to know I am not alone in how I feel. I too was very excited to begin work, thought I had found my niche in life, and received nothing but positive comments in clinical rotations. Now I feel completely incompetent and abused daily and wonder what I have gotten myself into.

My nurse has been in the profession for 33 years and precepted many orientees. Everyone says how good she is at precepting (including my manger and nursing education) but I just dont see it right now. Professionalism is lacking, native languages are spoken amongst staff and critiques are done in patient's rooms! Everytime I have said something it has been completely misinterpreted so now I just grin and bear it and focus on the skills she is teaching. I have been told things like "you need to be faster" as if a new grad who has only been doing this for 3 weeks doesnt know that already. Easy for a 30+ year pro to say. When I asked for tips on time management and organization I am told "it comes with time" and "you need to relax...you worry to much." I am given no constructive criticism yet I am told to "be more confident." I now attribute my frustrations to a cultural diference and a poor unit atmosphere so there is not anyone else o turn to. I have never had anyone so up my backside ever and it is hard not to be anxious in a situation when you are not given room to breathe and figure things on your own and thus build confidence. I could go on and on.

Thanks for letting me vent. We'll get through this and one day I think/hope I will appreciate the experience. I plan on paying my dues here for 6months to a year and then move to a more positive unit. We all deserve to feel fulfilled! Best wishes to you!

js33305 · Apr 13, 2010

it is very interesting to happen upon your message thread. i too am having picu orientation woes, but from the opposite position: i am a nursing preceptor, and frustrated daily by my orientee's inability to grasp even the most fundamental of nursing tasks.

i can't make excuses for your preceptor and the negative orientation experience that you are having. one is unable to learn in a punitive and unsupportive environment. when i began my own picu career, i too had a nightmarish preceptor who made me cry and hate nursing altogether...and at that time, i was a 30 y/o guy! in retrospect, however, i am now grateful for my preceptor having pressured me so hard: the stress you are receiving now is itself a lesson, and only a mere fraction of what you will experience on a daily basis when out in practice.

intensive care environments require individuals who can think, act, and move quickly. if you'll notice, most of your colleagues on the unit have type-a personalities, are extremely detail oriented, and are bossy, opinionated, micro-managers. these are all qualities you must possess as a critical care nurse...because your child's life is on the line. you need to react within seconds to an emergency. you must be able to simultaneously manage multiple stat tasks at once. you must be bossy enough to speak up to a physician when you don't agree with or understand the current plan of care...because you are a patient advocate and your patient can not speak for them self. and, i'm sorry, in the course of your picu career, you will be screamed at by physicians and made to feel incompetent...but the trick is learning to let negativity roll right off, choking back your tears, and remaining hyper-focused on your patient and the task at hand.

what frustrates me most about my current orientee, is that there is no sense of urgency in anything she does. no sense of panic...which one needs. she also has no critical thinking ability, and this scares me. it is also concerning to me that this woman graduated from a four-year, accredited university, passed her boards...and yet came to us seeming unable to perform even the most basic clinical skills. she is unable to perform even basic med calculations. we are six weeks into her orientation and she is still unable to operate the iv pump correctly. what happens 8 weeks from now when she has dopa running and her kid's pressure is 20-over-nothing?

i have spoken to my manager, and expressed my reservations. i even stated quite bluntly to my orientee: i am not a nursing i instructor, and cannot waste valuable orientation time reviewing nursing fundamentals. my manager believes in "learning curves" and "allowing time for growth." meanwhile, i'm losing sleep and pulling out what's left of my hair worrying about her when she's finally on her own!

Pediatric Critical Care Columnist · Apr 13, 2010

what frustrates me most about my current orientee, is that there is no sense of urgency in anything she does. no sense of panic...which one needs. she also has no critical thinking ability, and this scares me. it is also concerning to me that this woman graduated from a four-year, accredited university, passed her boards...and yet came to us seeming unable to perform even the most basic clinical skills. she is unable to perform even basic med calculations. we are six weeks into her orientation and she is still unable to operate the iv pump correctly. what happens 8 weeks from now when she has dopa running and her kid's pressure is 20-over-nothing?

you could be talking about most of the new staff members who have been oriented to our unit in the last couple of years. it's really scary. but what's even worse it that our manager believes that a senior practicum on our unit while finishing up nursing school is an orientation and they're turned loose after only a handful of precepted shifts. i could tell you stories that would curl your hair. one incident was so serious that i filed a report about it and got barked at "because it had already been discussed with the grad nurse"... but what about the next grad nurse who nearly kills a patient due to similar factors?? they seem to lack the insight to recognize when the fit isn't right. neither management or the new nurses can admit it and move on. then on the other hand...

i have spoken to my manager, and expressed my reservations. i even stated quite bluntly to my orientee: i am not a nursing i instructor, and cannot waste valuable orientation time reviewing nursing fundamentals. my manager believes in "learning curves" and "allowing time for growth." meanwhile, i'm losing sleep and pulling out what's left of my hair worrying about her when she's finally on her own!

when those of us who've been around the block a few times take our concerns to our management, especially the "nothing is urgent" and "there are no critical thinking skills there" issues, nothing comes of it. i also find that they give certain individuals a lot more credit than they're due, either because of where they worked before or because of other intrinsic factors, and they can be the most dangerous of all because they're led to beleive they're "already there". case in point - a newish nurse to our unit but someone with 8 years of seniority at our hospital was given an admission that was clearly beyond her level of functioning and experience on our unit. we knew this kid was going to be really sick when he came out of the or and our staffing was adequate in number but not in seniority... so they gave the assignment to mmm... let's call her lucy. when the charge nurse was asked why lucy was taking the admission and not someone with more experience, the reply was, "lucy has worked on xyz ward for a long time and she's a really good nurse, she'll be fine." did i mention it was a night shift? so the kid comes to the unit, he's really unstable, lucy misses the signs of impending doom and the child arrests at 5 am. the physician on call isn't the sharpest tool in the shed and the outcome is... poor lucy feels horrible and even though she really is a great nurse, isn't ready for the acuity of the patients she's been getting. it won't be long until she goes back to xyz ward because that's where she feels good about her work. and nobody wins.