Being let go during orientation in ICU

[hyed]

I am very sad and a little frustrated today because my manager just talked to me and wanted to let me go during orientation in ICU. I was lucky that I got an ICU job as a new nurse. I had clinical in ICU before so I feel I know basic critical care nursing, but I guess I am wrong.

1) It's not about the task, it's about communication

I am very focused on my task (meds), and I have hard time multitasking (listening to family, overhearing from doctors etc). It is even worse when nurses and doctors use abbreviations and medical jargon that I have never heard of!

For example, when I report lactic acid is high to a doctor, he just said, "Do a D-dimer". I have no idea what a D-dimer is and I don't know how to look it up when he expects me to put his verbal order in.

I have a preceptor, but a lot of time I feel people just talk to her instead of me. So I missed out a lot of information.

Talking to doctors on the phone is also frustrating. I am new to the job and also new to the hospital. When I receive a phone call, they just say things quickly, I did not even get who they are. There is one time I was told by my preceptor to call a doctor, let him know that he's the new consulting physician. So I did look up his name and phone and paged him. I told him specifically that the patient's name, room number that is newly assigned to him. He said, "I don't know what you are talking about. That doesn't help." and hang up on me. Later I found out he's always like that. He doesn't really like when attending assigned him to be consulting physician when he feels there is not much he can do about.

2) I feel I need to be perfect, not making any mistakes.

The manager said he let me go because he doesn't want to compromise patient safety. God knows I am always check check check. I am so fearful of making med errors. But I feel a lot of minor mistakes (not med mistakes) are due to my lack of experience. I was never told that or my preceptor showed me briefly before I can try on my own and master my skills.

For example, drawing blood from lines. My preceptor showed me two different ways doing that. I was a little bit mixed up from drawing blood from peripheral line and arterial line. So after flushing the picc line, I did not attach the syringe to the line pot, I attached the vacutem to the pot, but of course it doesn't fit. So I was there thinking, my preceptor was yelling "What are you doing? I taught you this before." After the second time, I remembered and able to master the skill.

But this becomes a reason for my manager to let me go.

It's very frustrating because I feel I know what to do, but very slow. In ICU, people changes orders all the time. I do not have much time sitting on computer, waiting to see there are any new orders. When I am busy with things, and come back to my preceptor, she will say, "ok, there is a new order." I feel bad that I cannot multitask or keep up with the ICU world.

Finally, I start to pay close attention to new active orders, like monitoring facebook newfeeds. I saw there is a new order of "Mg draw". so I grab all the supplies and went to my preceptor and told her what I am going to do. She said, it's an add-on. so just call the lab and let them know. They could use the blood sample the night shift has drew" I feel so dumb that I did not see the "add-on" words.

3) I feel so lonely and depressed.

I am nice person in general, and trying to "obey the order" get things done quickly. But when patients sense my "not outspoken", they take advantage of it. They would be very rude to me, but very nice to my preceptor, even though I am the one doing the care, she is chatting with them. I feel so little.

I feel no one to talk to, because no one would understand this. I even feel a lot of nursing falls into "gray area" that if an experienced nurse made all these minor errors, they would just shrug it off. For example, I failed to insert an IV on a patient. I feel so bad that I lack of the skill. My preceptor tried, but she failed too. But she's able to get over it quickly, like it's nothing to do with her competency. I don't know how to manage the stress and self-doubt.

[thinwildmercury]

I know how you are feeling! I am not in ICU, but I think new grads everywhere experience similar things. I have had two very harsh preceptors in the past. Our personalities just didn't mesh well because I am more laid back and they are more rigid. I don't take pt safety lightly, but for example, I had a late med once-a flush. I had flushed this pt's line several times that shift but I just needed to scan it. One of my preceptors freaked out over this. I juts shrugged it off and said I would scan it when I was done with what I was currently doing. There are already enough real concerns for me to worry about, I don't need to make any up!

I also had another preceptor who got frustrated when I forgot a step when drawing blood from an art line. I had never done it before and it simply takes me a few times to be proficient at something. As embarrassed as I was when I had to ask her to show me again those first few times, I did it. The look on her face always made me feel bad (and probably more nervous therefore I retained less info), but I just don't see something once and know how to do it. Some people can but not me. That doesn't mean I'm a bad nurse.

I also understand the frustration of being out of the loop with your own patients because everyone talks to your preceptor instead of you. It is so hard once you no longer have a preceptor because now it's all on you and you haven't really practiced all the communication you need with other departments.

Are you being let go? Or are they giving you another chance? I think it would be ridiculous to let you go after all the money they invested in you so far, they should be trying to work with you. good luck to you in your future!! It is so hard being a new grad, and you are not alone!

[SoaringOwl]

Wow, ICU is such a hard place to start. I admire anyone who has the courage to try to tackle that at any point in their career, much less from day 1.

hyed, I also can't see something once and memorize it. I'm a former special ed teacher, and all of us special ed teachers know this old Chinese saying: Tell me, I'll forget. Show me, I'll remember. Involve me, I'll understand." It's normal to need hands-on practice before you master a skill, watching is not enough. Most preceptors don't have degrees in education, so they don't know this.

Your concerns sound normal to me, and maybe your employer is expecting too much from a new grad. I hope you're in a residency and not just an orientation. I believe every new nurse in a hospital needs more than orientation, we need support for a while to become good nurses.

Good luck. I'm sending you positive energy.

[Lev, MSN, RN, NP]

(((Hugs)))

You are not alone - this is not the first time this has happened. Take a day or two to think about it, recover, and even grieve. I know it sounds funny to take time to grieve, but losing an opportunity can be very devastating.

The question is: Where are you going to go from here? No doubt, you've learned from your experience and you can come out of this a better and more compassionate nurse when you are welcoming a new grad one day. Has your manager given you the option to transfer? If not, I would request a meeting with your manager to see if it's possible to transfer to a "lighter" department. You showing interest in working for that facility may be all it takes to secure a position on another department and have the manager pull a few strings.

Think about it. You were not a bad employee. You didn't do anything wrong (that I know of). You make no mention of harm coming to a patient. You just weren't a good fit for that unit, with that particular preceptor, with that manager, in this situation, at this time. When you are given a new chance with factors more in your favor, I'm sure you will succeed.

[forgivenfaith119]

I'm so sorry this happened to you! Can you ask your manager if you could be transferred to another unit like med/surg even if it's PRN? It seems kind of silly to invest that money and not give you that option.

[sissiesmama, ASN, RN]

[quote=Lev

Thank u! U read my mind!

OP, like PP said, not u, but just maybe not the right preceptor, right unit, right shift ....

I was in a similar situation right out of school. At first my manager was awesome and I thought my preceptor rocked. After maybe a week, my preceptor m

[DavidDudley]

ICU is tough. I recently cross trained there from the ER. I quickly found out that it was way too overwhelming for me and I got out of there real quick. And I have almost 4 years of nursing experience, half of which has been in the ER. So don't feel bad.

[hyed]

Thank you everyone. I think a lot about the loss of job. It's hard, and makes me doubt myself. I know they have really invested on me, and I tried hard. I woke up at 4:30am for my 7:00am shift, just trying to look up information before the shift report. I am trying to learn, and ask questions, but I still made some silly mistakes that make people doubt my ability.

Example: I was helping my preceptor turn a patient with Bipap on. My preceptor took off the patient Bipap and put a nasal canula on. I was busy there just trying to help turn the patient, clean him off. My preceptor told me, "Turn it all the way up." I know she's talking about the oxygen, but at that time, I was hesitated because I have never turned a nasal canula all the way up to 15 that high. I thought it was for low oxygen level like maximum 6L.

English is my second language. I looked at the equipment, and think, maybe she means she wanted me to turn the suction all the way up? so I did. She thought I could not tell the difference between oxygen and suction! I just did not know that there is a different type of high flow nasal cannula that the tubing is different. You can turn it all the way up.

I doubt myself and the miscommunication led me to make a stupid mistake.

[hyed]

Many people did not know how difficult it is to be a RN when English is my second language (my native language is Chinese). I am very fluent in English, and studied in US, passed the NCLEX. But communicating in ICU is a total different issue. When I get nervous, I cannot talk straight even my mind is very clear. When someone misunderstood me, I wanted to explain, but I feel people just won't understand. Like my preceptor would think I cannot tell the difference between oxygen and suction. That's really not true. When people throw an incomplete sentence, it's very hard to perform.

[sissiesmama, ASN, RN]

Oops! Couldn't edit fast enough!

My preceptor told my manager I was a moron and she didn't understand how I passed boards. Thankfully she gave me a another chance with a new preceptor and it made all the difference.

Good luck! Keep us posted!

Anne, RNC

[SierraBravo]

OP, I admire you for your determination and tenacity. But here is the thing... the ICU is not for everybody, and the ICU at the hospital you work at is obviously not the right place for you right now. Would a different preceptor make a difference in your being successful in the ICU? Maybe, maybe not. It's hard enough to learn how to be a nurse when you're a new grad, let alone being a new grad in the ICU. Couple that with english not being your first language and trying to learn all of the ICU jargon and it becomes exponentially more difficult. Some of my nursing school classmates got hired right into the ICU's, and most of them are still there doing a wonderful job. I think it takes a particular type of person to be able to work in the ICU. You said that you have trouble with multitasking; that is something that you must learn how to do and will come with time. I have empathy for you, but soon you have to brush yourself off and decide what your next move is (trying to transfer to a lower acuity unit, etc...). And that's not to say that one day the ICU won't be a good fit for you...

[sourapril]

Sounds like to me that you didn't have a good training. Personally I am against hiring new grads for ICU or any other critical care units. If the residents can spend 3-5 years in their training post med school, why shouldn't a nurse who is going to work in ICU spend more time in her orientation? If you feel passionate about critical care nursing, try a smaller hospital, less patient load, or work as a float nurse, so you get a variety of experience.