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Conflicting evals

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I have had a lot of evals up until this point and all were positive with a few minor things on them that they said I could improve and will improve with time and motivation. Not being so afraid of speaking up to the docs and reaching out to them (fixed :) ), working on troubleshooting my IV sticks when it isnt straightforward (flash but no advance etc), and some on time management since they upped the patient load for me.

Fast forward to now. Out of the blue I get pulled aside by both management and one of the many preceptors I've had and told they feel I'm not progressing and that I don't know what I'm doing. I'll admit it was a rough day considering we had new skills and a patient with a condition I've never ever seen before so I needed help with it. However, I thought I was doing ok considering I had a glowing eval from the day prior. They said they want to see improvement and assigned me someone to help. I could use help with time management its true, so I didn't fight it. However, I can't help but feel a little betrayed. If I'm that bad at this, why has it been weeks that no one said anything? Why did no one pull me aside and say hey I see you're struggling with this, why don't you try x, y , z? My confidence has taken a nose dive and I'm worried about being fired even if nothing was hinted at. I only have about 5 days to start to show improvement or as they put it "reevaluate the situation." Anyone have any tips or tricks to help me improve my flow and time management?

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Can a preceptor/ new grad offer advice to this member...

First, you need to find out exactly what it is you need to improve upon.

"Time management" is kind of nebulous. Are you staying late to chart? Then you need to practice charting as you go. Are you late on medications? Then you need to be more observant of the clock and plan to give medications half an hour early. Are you missing important timed tasks, such as rounding? You need a time management tool to help you keep track of when/where/and what.

IV skills only improve with practice. Talk to your manager and see if you can schedule some time in pre-op. You'll get lots of practice there, and the nurses will probably help you refine your technique. Also, YouTube is a great resource. You can practice the steps at home until they feel natural and then practice them on live people. Volunteer for every new IV start that is needed on your unit. Especially the hard ones. If there is an IV team or resource/float nurse available, take them with you to coach you.

Also, you said this day was more complicated than your norm, so your deficiencies probably didn't show until then. It's impossible to predict how someone you are precepting will do with new skills and tasks until you see them performed.

However, you really need to talk to your manager and find out exactly what the concerns are. Treat it as a nursing problem. Assess, diagnose, plan, implement, evaluate.

Find out what the concerns are, diagnose your underlying problem (confidence, skill level, etc), make a plan for improvement, implement the plan, and evaluate how you are improving.

Good luck!

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

I totally agree with PP -- you need (and deserve) more specific information if you're going to have a shot at accomplishing the desired improvements. In addition, ask for the criteria that will be used to evaluate "success"... if it isn't numerical (ex: 4 successful IV sticks), then you should be provided with an exemplar - written 'case study' type of document that outlines all of the characteristics of successful performance (ex: admitting a fresh post op patient from PACU).

As far as time management goes, I have found that it usually boils down to one's ability to prioritize. You certainly can't control the continuous onslaught of new information/tasks that you have to cope with... so the only alternative is to slot everything into the right category. Is it?: 1) something I have to handle right now or ASAP, 2) something I need to handle within 4 hours, or 3) something that I can delegate or put off until the next shift if I can't fit it in before then. Sometimes it helps to visualize a traffic light... Red for #1, Yellow for #2 & Green for #3.

Just an update. So I talked with my new perm preceptor and asked them for honest, specific feedback. They gave me pointers like grouping tasks together, taking a moment to think about whether I have everything and what I'm expecting the doc to order next, and are helping me prioritize tasks. I'm up to 2.5 pts on average (I can handle 3 stable or 2 involved and help sometimes with a 3rd). Next week I'm going to have 3 from now on (sometimes I don't know how I'll ever handle 5). In some ways this might turn out to be a blessing in disguise, but my confidence is still a little shaky. The one thing that did help me with that was the fact they told me that I'm not a hot mess; that I'm very smart and have the critical thinking skills I just need to work on a few things.

tsm007

Has 2 years experience.

Just an update. So I talked with my new perm preceptor and asked them for honest, specific feedback. They gave me pointers like grouping tasks together, taking a moment to think about whether I have everything and what I'm expecting the doc to order next, and are helping me prioritize tasks. I'm up to 2.5 pts on average (I can handle 3 stable or 2 involved and help sometimes with a 3rd). Next week I'm going to have 3 from now on (sometimes I don't know how I'll ever handle 5). In some ways this might turn out to be a blessing in disguise, but my confidence is still a little shaky. The one thing that did help me with that was the fact they told me that I'm not a hot mess; that I'm very smart and have the critical thinking skills I just need to work on a few things.

Are things getting any better for you? I'm feeling in a similar boat.

Things are better than they were before. I don't know everything and I still feel uncomfortable but I have kind of come to terms with the fact that I'm going to feel that way for awhile. The more I see something the more comfortable I become with it and I am not alone I have nurses and docs there if I feel out of my depth and can't find the answer on my own. I can handle 3 pts and have made the move to 4 just recently. Hang in there tsm.

I went through this as a new grad. I was totally convinced I was to be fired. It made me anxious and make more mistakes. It was difficult to get praise from preceptor and then have them tell your manager something else. I learned from my experience that 1. They are telling you in advance to correct the pet before it is a problem. I learned to ask for clarification. I had them outline goals for improvement. For me it was your actually great with time management from preceptor to being pulled into a meeting to work on my time management. As a new grad your in a fishbowl with everyone looking at your everyone for me this is nerve racking. I learned that preceptor are people and some avoid conflict (which is annoying but my preceptor never precept ed before me). I also asked for clarification. Get an outline of specific goals and work to accomplish those. Hiring new staff is expensive they don't want to waste the time and money put into you.