Bad Nurse or Nursing Politics? SO CONFUSED!!!

[gemmi999]

I am 11 weeks into a 12 (or 16) week orientation for an Emergency Room New Grad position. Last week I had my "eval" with my direct supervisor and preceptor and they told me a few things:

- I needed more experience with ICU patients (it has been a slow 12 weeks in the ER in terms of ICU/Critical patients)

- I am well on my way to being a good ER nurse

- They felt I could more then handle myself on my own because I know my resources and ask questions

- I need to learn to be "rude" to patients or cut them off if they're a talker, because it ties up my time. Aka time management.

End result of my eval was I'd get a week or two of ICU experience by floating to ICU and working with more critical patients, and also learn the hospital policy on drips, etc. Afterwards I'd be sent to do a week of orientation on nights and then I'd be on my own.

I did my week in ICU this week (Monday/Tuesday/Wednesday) and today I was speaking with the ICU supervisor and the Critical Care (ER/ICU) manager about my move to ER nights. Neither of these people have worked with me before this week. They were both hired in the past two-three weeks for their positions in the hospital. The two of them pulled me aside and said that they'd spoken with the ER Supervisor (who gave me my eval last week) and he told them he didn't think I was ready for being on my own.

I expressed that this was not what was conveyed to me last week, and the ICU supervisor and the new manager stated that basically he wasn't a good supervisor necessarily because he didn't give constructive feedback and he wasn't direct like the two of them were. I asked if they had specific examples of why they didn't think I was ready to be on my own and they did not. They stated that I "wasn't quite there with the critical thinking" that I would need in ER, and I wasn't fast enough.

Their solution to this is to have me work for another solid month in ICU two days a week, attend an ER course (that I was previously signed up for) 1 day a week, and spend 4 hours 1 on 1 with the ICU supervisor going over ICU protocols, setting specific goals, etc.

I stated this would be okay, but I was going to follow up with the ER supervisor because I wanted to make sure he felt that he could come to me with constructive criticism. I was told not to approach him more then three times by the pair of them, that I should "put it behind me".

I approached him after my shift and explained what had happened, and he stated that was not what he said. He did say I wasn't quite fast enough, but that speed comes with time. He also stated that the only thing he said about my critical thinking "not being there" was that I had no experience running most ICU drips (Except insulin and heparin) and that with experience comes critical thinking skills. He also said that he had heard wonderful things about me this week in ICU, and that they really liked me. Finally, he stated at the end of the month I could chose with department I wanted to work in--ICU or ER.

I do not know what to make of this situation. I am not sure if I'm really not ready to be a nurse, if I'm lacking in critical thinking skills or if it's something else all together. Any advice would be appreciated. I'm really not sure what to make of the situation.

Thank you!!

[canigraduate]

I'm confused. Were you hired for ER or ICU? It sounds like you have too many people that you report to.

My advice is to go by whatever your direct supervisor says.

[Postpartum RN]

Wow. To me it almost sounds like the icu wants to keep you there for themselves..and therefore said those things to you...I don't know but that's the first thing that came to mind for some reason. Why else would they be so invested and interested in orienting you so much on their unit?.......fishy...sorry it's confusing

[kalycat, BSN, RN]

I agree with the above poster. I immediately thought that perhaps the ICU wanted to keep you! Do they have staffing or turnover issues that might make it more appealing to recruit in a less than transparent manner??

I would consider your immediate supervisor of record to be the person with whom you should concern yourself. It is his/her opinion that matters; additionally, I would try to get as much performance feedback as possible in writing, even in an informal email that summarizes your discussion, just to help eliminate any ambiguity. Sounds like a stressful situation!

[CrunchRN, ADN, RN]

I would take what you are being offered. it is a gift. Put ego aside and benefit greatly from this chance for great training.

[gemmi999]

Thank you to everyone who commented! I'm not sure if ICU is trying to '"poach" me, but there is one thing I learned from this. I need to work on my self-confidence! After everything that happened yesterday I was doubting myself as a nurse! I kept thinking: "what if they really think I'm not ready...what if I'm not ready...what if I hurt a patient?" It was almost enough for me to request a switch to med-surg or another, slower paced unit.

Then, last night I started thinking in depth about what I like about nursing, and it's advocating for patients and being there for the patient. I especially like doing that in the ER because I never know what I'm going to get and it's a constant shifting, changing environment. I think about the patients I've gotten report on at 0700 that are supposed to be d/c and when I looked at their paperwork realize that there was never an x-ray ordered and the patient had some crackles/diminished breathing in one side of the lungs. So I order an x-ray and the patient ends up admitted to the hospital.

I guess what I'm going to take from this is use the month in ICU as a time to focus on time management, learning care of critical patients, reviewing drip protocols (which are kind of...sporifice in the ED) and advocating for my patient. Then I'm going to go back to ED and put all of that into practice.

I keep thinking about what my preceptor said my last day with him: It takes a year (at least) to start feeling really comfortable in the ED. I'm not supposed to know it all yet, but I should try figuring it out by myself and then know who to go to if I have a question/need help.

[HouTx, BSN, MSN, EdD]

Critical thinking doesn't just apply to clinical situations. One of the most important requirements for CT is to rely on data and evidence rather than on assumptions, first impressions or opinions. Practical application? Never accept hearsay as the truth. You did good - by going directly to the source, rather than listening to (biased) interpretations of a conversation.

So - from my point of view, you definitely have acquired Critical Thinking ability - as revealed by your actions.

[Hydrocodone APAP]

When confused calm down, and calmly break it down.

[Lev, MSN, RN, NP]

Wow I would have killed for your opportunity to spend time in ICU!

[FeleciaSmith]

Critical thinking in a nutshell: pouring piss out of a boot with directions on the heel.

what they are saying is that this is not clinical the decisions you make impact lives and they need you to get passed the gloss and work. Get you a drip book and understand what you need to. Quit looking for criticism from management they have enough to do without you wondering if you great enough. Don't get the rep of being a whiner and if someone says don't ask, don't bust your gut asking.(that critical thinking they were talking about) knowing when to hold em and when to fold em. Go get the knowledge you need and only you know what that is. Call your old school and ask one of you clinical teachers what was your weaknesses.

Youll be fine. Get stronger and only you can do it!!

Best Wishes

[Iknowwha2du]

These orientations nowadays are unrealistic and to put it bluntly suck! Nursing experience over time leads to a better nurse but with the short amount of time you have to catch on, you are almost being set up to fail. I know others have done it etc., but their are others that have been let go etc. It is a dog eat dog world. The more you are exposed to over an extended period of time, generally the better you will become. Many people learn differently. As long as you can practice safely in the end, given you are given more then 12 weeks to learn or whatever, that is all that matter. Hospitals are doing a disservice to patient care by expecting people to catch on in such a short amt of time.