Concerns, asked to resign, etc.

Jules A, MSN · Apr 2, 2015

It sounds like you are genuinely trying but just aren't able to manage the fast pace. Just anecdotallly the nurses who have not made it on the units I worked were older new grads 40+. I get that isn't politically correct or true in all cases but the lack of speed and dexterity was an issue and as I recall personally absolutely did start to happen around 40. I would also guess older new nurses might be more aware of the gravity of what we do and might be overly cautious compared to younger ones.

Floor nursing might not be a good fit for you but hopefully this new job will be just what you are looking for. Best wishes.

allnurses Guide · Apr 2, 2015

Were these both acute care jobs or were they LTACH or rehab or SNF?

Coming from an acute care perspective, as a preceptor, I show once, have them do once and then send my fledgling in to do it him or herself, trusting them to ask for assistance if needed. When I was precepting, it drove me nuts to have someone hovering over me as if I were still in school, so I try not to do that to my new nurses. Everyone learns differently, it is true, but you aren't in school anymore. You should not need to be observed four, five, six times.

The thing that stands out to me in your post is that you are doing this "as fast as you safely feel you can". There are a LOT of new grads who struggle to make the transition from the way things are done in school and the way things have to be done in "real life" in order to be able to keep up. It sounds like this may be your issue as well. If you are checking...and double checking. Great. If you are checking. Then double checking.... Then double checking your double check.... Then checking once again to be sure... and then checking again at the bedside....you are too slow and causing a lot of your own woes. The five rights need to be checked every time. But not all five, five times, if that makes sense. I see many new grads so fearful of making a mistake that they create extra work for themselves. I also see them failing to combine tasks (such as one of their checks being at the bedside, in front of the patient, at the same time as educating their patient on what is being done or given and why). You have to learn to multitask or you just won't survive. You also have to learn to delegate or you just won't survive. If you are trying to do everything yourself and everything one thing at a time, it isn't going to work in today's acute care environment. Your post is vague so I have no idea if any of this rings a bell for you.

I cannot say if you are not cut out for acute care or not. Two jobs both tossed around four months in is indicative of a failure to progress at an acceptable rate. You aren't in school anymore and a preceptor still has his or her own job to do as well as supervising you. You are expected to not need the same amount of assistance as a student would but you are expected to ask for assistance when you DO need it.

Much of time management is delegation, keeping a brain sheet to keep you on task, learning how to cluster activities and learning how to extricate yourself from a room in order to move on quickly to the next thing on your list while at the same time keeping a calm, reassuring demeanor for the patient. It isn't easy. You may have struggled with some of these things or all of them.

I don't think you are a failure as a nurse. I do think perhaps acute care is something that may not be up your alley and perhaps you should look into a different kind of nursing. That will probably hit a sore spot and I feel badly for that, simply because all nursing is important and all nursing is valid. You may excel at another type of nursing that a bedside nurse would not.

I disagree that 40 and up is some kind of benchmark. I see a lot of older new nurses who have been moms and executives and chefs and lawyers and who come into nursing and rock the house. It just depends on the personality, the level of anxiety and the ability to think about and do more than one thing at a time. That is not necessarily age related. I was 41 when I started. I thrived and am sometimes asked to show slower nurses incurring incremental overtime how to manage their time better.

Farawyn · Apr 2, 2015

Every preceptor is different. Maybe because you are older and have phleb skills they feel more comfortable leaving you, and then you drown. ASK for more help at your next job. You will find your way.

I was terrible my first job, a large med surg floor, nights. I would tell my preceptors I was fine and then panic. They stuck it out with me, thank God, but the first 3-4 months were rough.

RNsRWe, ASN, RN · Apr 2, 2015

In a nutshell, not being well-matched to one type of nursing setting doesn't mean you can't find a good match in another setting. Explore options, see in what other direction you could go that might allow a slower pace.

Good luck to you.

LostKitten · Apr 2, 2015

I was terrible at delegating. I hated asking aids to toilet patients etc. I also struggled with grouping tasks. The first job was in an inner city ED, the busiest in the state, the second at a rehab facility where the seasoned nurses were pulling their hair out, and at times leaving in tears. I came to the conclusion that acute care wasn't for me before I left school, but it's always said you need you "pay your dues" so I felt this was my only option to community health or other similar jobs. Now, my resume looks like I'm either a bad nurse, or a job jumper, and worry no one wants to give me a chschool Either way, thanks for your input!

Libby1987 · Apr 2, 2015

FWIW, I'm a high producer, perfectionist and multi tasker, I'm the one who boggles my coworkers and new nurses alike..and I don't think I could start out on today's floor and survive. No problem when I graduated, but the pace and expectations are so different now.

I make good living in HH. You still have to be able to juggle and stay cool in chaos, but you at least have the option, if you're willing to donate the time, to learn at your own pace. The only real deadlines we struggle to stay up with is the cutting into our personal time, but getting the patient care done timely and competently is very doable. If speed is your only issue, HH (WITH A REPUTABLE COMPANY, I can't shout that loud enough) might be an option.

The precepting part, if I see someone has good potential but my approach or the learning opportunities weren't ideal, I re-evaluate and adjust, and inform my admin it's worth the effort. If I'm not seeing it despite making adjustments, I'm upfront with my admin about it.

Coming from the side of experience in a particular field, you develop increasingly accurate judgement on how much effort it will take as well as the nurse's probable max potential. If you can see after a few months that the new hire will not satisfy the job description, even if they haven't made a specific type or number of mistakes, it's a gamble to keep trying.

RubicsCube · Apr 2, 2015

How can you tell if a HH company is disreputable? Word of mouth?

SierraBravo · Apr 2, 2015

I felt like I needed more help in both jobs I had, but was afraid to speak up because I didn't want to look incompetent. Was this my mistake?

This is the one thing that stood out to me in your post. Going forward, you need to get over being afraid to ask questions or ask for help or else I can almost assure you that you will be in the same exact situation you are in right now.

Being a new nurse is tough right out of the gates. I feel like it really comes down to the orientation and support system, which are two things any new nurse (or new grad) should be asking about during the interview process.

When I precept, I explain the process or procedure, then I show them, then they show me and I go with them for the next few times until I am comfortable knowing that they are competent in the skill or procedure. The problem with showing them once, then having them show you, then setting them free assuming that they will ask for help when needed is illustrated by the OP. Not every new grad or new nurse feels comfortable asking for help when they're not sure of something. Therefore, it's the preceptor's responsibility and duty to ensure that the new nurse is competent. Just my $0.02.

Libby1987 · Apr 2, 2015

How can you tell if a HH company is disreputable? Word of mouth?

Hospital based is usually safe if not as flexible.

Stand alone independently owned need thorough vetting.

Who are the post ops going to, ie who are the hospitals referring to?

The number of knees and IV's are a good indicator.

Ask your Dr's office who they refer to.

Ask out patient physical therapy, they receive HH patients.

Trust your spidey sense during the interview.

Ask (insist) on a ride along, if it doesn't look organized and legit care appropriate for the patients, it's not.

Glass Door.

caliotter3 · Apr 2, 2015

Sometimes "not fitting" has nothing to do with job performance and everything to do with personality mesh with the already present unit culture. When this is the case, there is nothing you can do about it. Reasons for poor job performance, while perhaps with some basis in fact, are only put up as excuses to mask the true intent of getting rid of the person that the group has decided will not fit in.

Ruby Vee, BSN · Apr 2, 2015

Is it my training? I've heard from some people that preceptors are glued to your side, but that's never been the case for me. For example, I was shown how to hang an IV to gravity, and never watched again. I was previously a phlebotomist for years, so they told me I already knew how to stick. Which I did, but an IV is different. I felt like I needed more help in both jobs I had, but was afraid to speak up because I didn't want to look incompetent. Was this my mistake?
I'm not out to blame anyone, I'm just reaching out to those who have been in the business for years. Is it common for new nurses not to "fit"? Are preceptors usually glued to your side doing tasks together, or do you show them once or twice and then send them to try it alone? When do you decide that someone is just too slow, even though they are clearly working hard?

Speaking as someone who has been precepting since 1981, the idea that you were afraid to speak up because you might look incompetent is a gigantic red flag. No one expects a new grad to be competent, especially not a seasoned preceptor. We expect you to be SAFE. That means asking questions whenever you have the slightest doubts, calling for help when you need it and knowing what you don't know.

Preceptors, like orientees, have different styles. The best of us can accommodate the orientee's preferred learning style, but not every orientee gets the best preceptor. Unfortunately, sometimes everyone with a pulse and a license has been asked to precept because there just aren't enough seasoned preceptors to go around. I would expect that after four months, however, you would be independent enough not to need a preceptor glued to your side unless you were faced with an incredibly sick patient or a brand new task.

As for deciding when someone is too slow -- that varies, too. We don't have enough information about your situation. Were you constantly behind, no matter the acuity of your assignment? Or were you able to "step up the pace" as the situation demanded? Were you able to prioritize? Or did you tend to do everything in a set order no matter what else was happening? I understand you wanting to do vital signs before you give the medications, but did you have to do vital signs on EVERYONE before you gave the Lasix to the woman who was too short of breath to lie down? Were you dithering, dawdling or spending inordinate amounts of time "comforting" someone when someone else needed to be prepped for surgery? Did you avoid tasks you didn't like or didn't feel comfortable with instead of just wading in and getting it done? I've known nurses who spent more time justifying why they hadn't done something than it would have taken them to just do it in the first place.

Also, keep in mind that "not a good fit" can encompass other, more nebulous factors as well. The new grad fresh from a famous Bible college who sat down next to me at the monitor station her very first day and informed me that "All the men who work here are immoral." How did she expect me to respond to that? They were all my colleagues and one was my husband! The traveler who told me the first day I precepted him that "You're going to hell because you failed to honor your husband." (He'd asked me if I was married; I told him I was divorced.) The new grad who angrily responded to any attempts to "chit chat" with "That's none of your business" or "I'm not here to make friends." Maybe not, but nursing requires teamwork and no one who responds that way looks like a good team player. The career changer who was married to one of the attending and kept trying to throw HIS authority around didn't really fit in, either.

Maybe none of this applies to you. We can't know that. But think about it. Maybe it will help.