Backsliding in new specialty

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Specializes in IMCU with a little bit of peds.

Hi everyone.

I've been a nurse for two years, mostly in an IMCU but in the past 4 months I have been on a peds unit that also gets ante/post-partum, gyno surgeries, and NICU stepdown.

I've always been passionate about women's and children's, and I thought this unit would be perfect for me. But

I'm not adjusting well. Both myself and my manager are worried. I feel like a new grad all over again in many ways, and somehow I have lost my "nurse sense.” The worst example is when I let a kid's IV infiltrate pretty badly. The kid ended up OK and was discharged the same day but I got in trouble.

My manager told me that in general, I am not where I should be with things. It sounded less like hard skills and more like "nurse sense" that I seem to be lacking. We discussed ways for me to improve and I gave it my best effort. 

Soon  I was put on a 30 day probation because I was "doing better but not better enough.” I'm almost at the end of that period and feeling so scared.

essentially, my nursing judgment, prioritization, critical thinking, etc are just not there. This wasn't a problem in my first job and I was often praised for being a "great nurse.” And now it's just gone and I don't know what to do. Has anyone else backslid before? 
I always try to center myself, write things down, ask for help, etc but I still end up doing things like prioritizing charting over physical tasks, or not helping others enough, or forgetting any of the many policies I'm still learning. 
I can always see how my actions are wrong in retrospect, but in the moment, I don't even realize what I'm doing. Like I'm in a trance or something, which is new and terrifying. Therapist thinks I am "dissociating as a stress response.” Thoughts? Sorry for the long rant.

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What kind of organized orientation and mentoring have you had during this transition to (what I consider to be) a significantly different population and specialty? 
 

Correction: specialTIES

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Specializes in IMCU with a little bit of peds.

I think I had 6 weeks of orientation, most of it was days and then I was switched to nights which I knew I would be. 
I had bi-weekly evaluations where I would be rated on a scale of 1 to 5 on various skills/attributes. I started off getting some lower scores but got better in time.

Towards the end of my orientation my manager had a meeting with myself and the charge nurse for that night saying she had some "concerns" about me being on my own, and that perhaps I am second guessing myself from being watched so closely. Probably true.

The ensuing shift went well, and just like that, I was off of orientation.

I get the sense that my manager genuinely wants me to succeed but just doesn't know what to do with me.

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Specializes in Tele, ICU, Staff Development.

I hear being overwhelmed, fear, and paralyzing stress. Changing from one specialty (IMCU) to three others (peds, ante/post-partum, NICU stepdown) is a massive shift. You can't even solely focus on one of the new specialities. On top of that, you're on night shift, which may be affecting you.

All this to say, there are understandable reasons for your response. Does your therapist think this is a temporary response (I think it is)? Very best to you.

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Specializes in IMCU with a little bit of peds.

My therapist feels that this is a response that I can overcome and even be stronger than when I started. She gave me a couple of pointers including pretending that I am teaching/precepting someone, which has helped a bit. But that was only one session of therapy and I don't have another until my work week is done.

I also have a doctor's appointment coming up to see if I can get on some type of medication for anxiety. I even want to be evaluated for ADD, as I've had suggested to me by loved ones.

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Specializes in Community and Public Health, Addictions Nursing.

OP I changed jobs 6 months ago and the change involved readjusting my specialty a little + majorly changing my work environment.

I hear you about feeling like you're a new grad all over again. Have you built up any friendships or strong working relationships with your new coworkers? That's something that has definitely helped me settle into my new job.

I've also been spending some of my own time reviewing nursing education that I need for my new role. A lot gets covered on the job, but I'm 15 years into nursing so I know I need a refresher as part of my role change. 

That's awesome that you have a therapist! I do too and something she's been helping me keep in perspective is making sure that my new job fits me as much as I fit my new job. I can stress out a lot about proving myself to my new job, but now I'm getting better at making sure my new job is also meeting my needs and goals as a nurse.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

If you were a great nurse, and worked with confidence before, I am not convinced that you've actually backslid, especially since the complaints  are "critical thinking" "judgment" and "you're not where you should be". These smack of an unsupportive supervisor. How do I know?

Because they are vague, possibly even meaningless. True feedback gives you something to work with.

Example:

Currently you stay an average of 1.5 hours extra to finish charting and the goal is to get you to less than 15 minutes extra. It tells you what's wrong and what needs to change. 

If it's about a knowledge gap, education should be offered and there should be no talk about you lacking basic nursing ability. If your supervisor really thinks it's your fault the IV infiltrated, then the educator should sit you down and go over with you what you did to make that happen and how you can prevent that from happening again. And you improve. Plain and simple. No mysterious brain power needed, just plain old learning through experience.

You can't learn in an environment that is not about education but instead about blame, superiority or a belief in some kind of magic or genetic nursyness that only some people are born with. In other words, your supervisor needs to cut the crap.

Criticizing your judgment, critical thinking, etc is not appropriate. You didn't lose those things. And if you are dissociating at work now, and did not before, there is something wrong with your environment.

 

 

 

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That's a lot of new specialties. I feel like six weeks wouldn't even be long enough. I did once with a job and it was because of the lack of support. I was constantly being hung out to dry and when I'd ask for help was told things like I'm too busy, maybe someone else can, you should've already been taught this, I don't know either...and I realized the more stressed I was the more I just couldn't get my bearings. I ended up leaving that job. I miss things about it but I've learned as long as I have good support and guidance I can learn anything new and do fine as evidenced by succeeding in new positions. It sounds like it's not you, it's them.

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Specializes in FNP-C, CCRN.

I would explore how much you like the new type of nursing. If you like it, and find it interesting then try to work it out. If you really don't like it, it will be harder to learn the job and more stressful. I believe people thrive best in the discipline that is most interesting to them. I've been in this situation a few times in my career, where I liked the type of nursing but had bad orientation and bad teaching and a lot of anxiety, it took a lot of hard work before I got very good at the job and eventually thrived and got to pass on the teaching to others. Keep up the good work.

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Specializes in IMCU with a little bit of peds.

Alright, let me update you folks on everything.

They've officially fired me for performance issues. Not the news I wanted to receive or give but here it is.

The specific issues that they cited to me were prioritization (like knowing whether to prioritize a physical task or a charting task and juggling between the two), nursing documentation, and assessment and recognition.

I really tried there, but it just didn't feel right. It felt like I wasn't clicking there mentally and couldn't, despite previously succeeding at a job I was tired of.

I should also mention that they gave me 30 days to improve. But, I was off for the first two weeks of that time, on vacation. When I brought this up as a concern at the time, they told me that if I showed them two weeks of good solid performance, that would be enough proof for them. Ouch.

Add to that, the unit is actually over staffed, so I got flexed twice during my probation period. So, my 30 days to improve became 4 and a half shifts. Tell me how that was supposed to work out.

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So let me get this straight...you had 6 weeks to orient to 3 disparate, complicated specialties, were given vague explanations of your "deficiencies", were not offered any assistance/education to improve but instead were left on your own to try to figure it out AND didn't get the full 30 days? Girl, they did you a favor. Pick that chin up and move on. You'll find your place. 🤗

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^Yep. 

Sorry I haven't been back after asking the question about your orientation but this is why I asked in the first place. Someone who has been successful in a place like IMCU doesn't just go elsewhere and "fail" on the type of things for which these people were criticizing you. Not often anyway. 
 

Learn what you can from this experience and move on. 👍🏼

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