Career in the ditch. How to get it up and running?

[Flatlander]

I was terminated abruptly at the end of a 12 week orientation from my first RN job as a new graduate. During the final week, I attempted to take a full patient load with minimal supervision. During that week I had an accidental needle stick (to myself) the first day, spiked my own finger with an IV bag spike the second day, and missed a med pass on the third day (I think it was to one patient, I hope it wasn't more -- I don't know because I wasn't aware that it happened until talking to my preceptor after the termination). I attribute these errors to feeling pushed to go faster than I could safely manage. (I take full responsibility and am not blaming anyone.)

The following week I reported for my end-of-orientation meeting with the manager/supervisor and director and was let go. I never had a written performance appraisal or any meeting/input from the manager, director, or nurse educator during my entire tenure, just suggestions on improving from my preceptor. I was never warned that I could be facing termination. The reason given during the meeting was not progressing fast enough, not able to manage full load independently, and that unit was too fast-paced and too acute for my abilities. They were not willing or able to extend the orientation further. I was also advised on termination that other units in the hospital with less acuity would be more appropriate for my present skill levels and was encouraged to apply.

My preceptor told me at 8 to 10 weeks that I was not progressing as quickly as expected due to problems with organization, focus, time-management issues, and medications knowledge. At 10 to 11 weeks I asked her how she felt I was doing. She said "How do YOU think you're doing?" I said I thought it was going better, but that I still needed to get faster at charting, organizing, giving report, etc. She said she thought I'd made "a LOT of progress." During the following week, I continued to work on improving my speed and organization. She called me after learning of my termination and said it came as a complete surprise to her. We talked about the reasons for termination which she thought were the same issues as above -- meds, time management, focus, plus feedback from other nurses who'd noticed the same problems, and then the med omission the final night. She thought I should try long term care skilled nursing facilities as a next step to concentrate on meds and basic nursing skills in a setting with lower acuity.

My confidence is shot. I am fearful of having the same problems in my next position. I don't know if anyone will ever hire me again.

I feel I need to somehow rehabilitate my career. I am determined to somehow succeed as a nurse. In reading this forum, it seems like time management, organization, focusing, and confidence are common problems for the first 6 months to a year. I know that the experienced nurses on the unit also had trouble keeping up with the pace and acuity at times.

I have thought of asking HR for an exit interview to try and find out more about the reasons for termination, but have been told by others on this forum and other employment experts, that I may never know the real reason. However, not having any documented performance reviews leaves one to wonder if there were other issues involved. I am a much older worker and age could certainly have been involved. (I heard a totally inappropriate reference to my age during the last hour of my employment before termination... so one has to wonder what other employees were saying...).

The important thing for me now is to know how to fix what is broken -- is it my skills, my ability to focus and concentrate, my knowledge or lack of same? And how does one go about fixing these things, then convincing a prospective employer that you have addressed these issues....It all just seems so impossible at the moment.

I have purchasd a book on time management for nurses that includes CEU's and am working my way through it. I'm completing other CEU's, reviewing my nursing texts, skills, meds, etc. I'll put the CEU's on my resume and explain my other plans to remedy my deficit areas. I could use suggestions on how to communicate this to prospective employers.

Any other direction and suggestions would be much appreciated. I feel I am in the same boat as the poster on another thread who recently lost her job during orientation and questions her/his "hire-ability" -- I feel I have few options and a career that is swamped and sinking.

Thanks!

[Nurse SMS, MSN, RN]

To be honest, it sounds to me like you already have the "real reason" for your termination. That is a good thing. You now know what to focus on. Utilization of a "brain sheet" can be crucial for a new grad (hit up Esme - she has tons). At your next position be sure to take one with you and make a habit out of using it.

As far as "fixing" the time management issues, I am not sure you can do that until you are back in a nursing position. Do the CEUs, get a job giving flu shots or some such and keep looking for work. In an interview simply stress that the floor was a poor fit for a new grad and that you are motivated. So much of interviewing is about personality as much as anything else.

I wish you the best of luck. Hopefully another opportunity will present itself and soon.

[HouTx, BSN, MSN, EdD]

PP is correct, Time Management expertise is one of those things that can only be achieve by doing. The basis for it is the ability to manage work based on priorities. Every new grad I have ever worked with has (initially) given each task the same priority. This gives rise to the "running around with your hair on fire" mode of working - trying to do absolutely everything on 'the list'. Inevitably, important tasks are omitted, deadlines are missed, etc. because you were busy trying to do less-important stuff.

Experienced nurses have the ability to mentally 'assign' a level of urgency to every task that they need to do. They focus on the urgent (must do right away to keep the patient safe or meet an important deadline) and fit the less urgent (do it this shift) and low priority (try to do it this shift, but it could be passed off without harming the patient or missing a deadline). As new things arise during the shift, they continually re-prioritize and re-adjust their work. Believe me, no one EVER gets 100% of everything done.. that's why nursing is a 24X7 job. The oncoming nurse isn't likely to be too upset if they don't have to deal with high-priority stuff you missed.

Just for the record - I would never have terminated you based on the events you described. Those are typical new nurse issues. I know that your self-confidence has taken a real bashing, but it will recover in time.

[Esme12, ASN, BSN, RN]

Brain sheets! Feel free to change/adapt them for your needs hey are not all mine they are a mixture of many contributors especially Daytonite....

mtpmedsurg.doc] 1 patient float.doc‎]

5 pt. shift.doc‎]

finalgraduateshiftreport.doc‎]

horshiftsheet.doc‎]

report sheet.doc‎]

day sheet 2 doc.doc]

critical thinking flow sheet for nursing students]

student clinical report sheet for one patient]

[Flatlander]

Thank you so much! Your words of support mean more to me than I can say. I am taking your suggestions to heart and your advice about moving forward, too.

Regarding the Brain Sheets: we printed off a a narrative written shift report at the start of each shift. It was a densely packed paragraph and not in any consistent order. I had trouble getting all the information sorted into usable, organized places. Plus there were orders to review, and other things to note from the electronic chart. This seemed to take more time than I could find, even though I came in up to a half hour early on many occasions.

No one seemed to be using a brain sheet, everyone did something different-- my preceptor just kept an hour sheet with times listed down the page and wrote "med" at the hours each patient's meds were due. Another just wrote little notes to herself on a scratch pad. Another had a list of charting areas and assessment items that she checked off as she went.

There were so many things that I just never learned to get organized and it seemed like there was never any time to do it. My preceptor seemed to be directing my movements, so that I never was able to look at the report and get it organized. It was weird. I always felt if I took a minute or two to try to organize my thoughts or my tasks, or look up a med, that I was seen as slowing things down. There were many times I was told, "No, don't do that, do this now." That seemed to undermine my confidence even further. Then I was told I needed to be more confident. I always felt like I was losing the game and didn't even understand the rules!

If I said there was something I didn't know how to do, but that I had been shown once, I was told, "Now, (my name), you KNOW how to do that." In sort of a scolding way. I'm sorry, but if I felt sketchy about something, was it wrong to ask to be shown it again, or given a chance to practice it a couple times with the preceptor? This happened mainly with hanging IV's -- I was just so nervous about making a mistake that I felt the need to go over it a couple times before feeling really comfortable doing it.

I know I'm venting... I hope I'm not excusing my own failings or placing unwarranted blame. I know they were all trying to help, but it just didn't seem to be working for me. I'm really just trying to express how I felt, so that I can try to figure out how to avoid these difficulties in the future. (As you can tell, I'm still a bit confused about the whole thing!)

Maybe our styles were just too different -- a mismatch between my learning style and the preceptors' teaching styles... And it's true that my preceptor had to take care of a full load with me in tow/ or vice versa. We were all under time pressure most of the time. I felt apologetic about taking bathroom breaks, and forget a real break. We would usually take a lunch break for up to a half hour after about seven hours of non-stop running, then go back to work for another 6 hours without a break. Sometimes it was 13 hours straight with no breaks or lunch. NURSING IS HARD!!

[Nurse SMS, MSN, RN]

:)

Yes, nursing IS hard! Feel proud of yourself for doing it. Because you were. Half hour lunches are the norm. I never get more than that and am only now, 8 months in, starting to be able to take a little break in the morning or afternoon.

OK, looking up meds and conditions - those need to be done on your own time unless there is an immediate concern, such as hanging an IV with another drug that you aren't sure is compatible. Your remark on being timid about hanging IVs kind of made me scratch my head. It is a medication and should not take longer to administer than any other medication as long as you have a patent line. Sometimes I think all the looking up of drugs during clinicals creates an unrealistic expectation and paranoia in us as new grads. Nobody gets that kind of time during a real work day. You know what the med is for (ask someone or do a quick look-up, not an in depth study), do your five rights and three checks, you check over allergies and have faith that you will be able to tell if something is going wrong based on your assessment skills. Remember/remind yourself you are surrounded by experienced nurses and the entire healthcare team to run things by if your assessment makes you concerned something isn't right. If something bad happens, it is rare that it is a sudden death scenario. In-depth drug study is for at home most of the time.

As far as asking to be shown something more than once, it depends on what it is. It is natural to be nervous about having to stick people or do something new, but after once or twice it is time to try it for yourself. Being timid isn't going to help you learn. Instead of wanting to be shown something several times, after being shown the first time, at the next opportunity to perform the skill admit you are nervous and ask if they will walk you through doing it yourself. Then the next time ask them if they will simply observe you - believe me, if you are doing something wrong they will speak up or watch as you figure it out. Most preceptors will be happy to watch you, correct your technique and put hands on hands when necessary. But you must take the risk of trying things even before you feel completely comfortable. You will learn faster as well as show those who are teaching you that you are motivated to be independent. Theoretically you did these things at least once in school; therefore you should not need a ton of extra instruction, especially if you are asking for it as a way of dealing with what really just equates to nervousness. You will always do better politically to face your nervousness rather than try to assuage it through avoidance or extra super more instruction. A preceptor is going to respect "I attempted twice and couldn't get the vein - I don't want to torture the patient any further, could you try?" a lot more than "I am not 100% sure I know every step to take so you do it and I will watch. Again."

Best of luck. It sounds to me like you do lack in confidence. I know it is intimidating, but when your next opportunity comes (and it will), manage your anxiety by being more bold in trying things for yourself sooner (remember, supervision is always there, help is always at hand, experienced nurses are always around) and doing homework at home, not at work. It is just part of nursing that you wind up doing a lot of things that you aren't 100% comfortable with.

[Flatlander]

Thanks for the suggestions. That really helps me sort out some of my difficulties. I will definitely take your advice!:)