Day 2 and feeling pretty blue

[Brooke13-RN]

Hi everyone,

I just started my first nursing job on a busy post surg/oncology floor, graduated in May. I had the normal week long hospital orientation where I learned about the computer systems and the HR stuff. After getting my schedaul I saw that I was going to start on the floor this past Monday for a 7 week floor orientation. I was so excited. I thought finally I was going to get to watch how the nurses do it. They would teach me all the tricks.

So, Monday I get to work and meet my preceptor, nice but stern. We listen to report and then we head out onto the floor. I started to follow her into her room, and she said I think I'm going to have you do the assessments on the last two rooms. I thought, sure I can handle this, then we would have more time to do nursing stuff together. Well, those two assessments turned into hanging IV meds. Then I was doing IV pushes, and changing fluid bags. None of which I was bothered with good experience. Luckily I had had a clinical in the same hospital, so I knew my way around the MAR.

About lunch though is when things started changing. First I hung blood on 2 different patients. She was shocked that I had never done this before, but we can't do it in nursing school. She did the check with me and then just left me to do the rest. Then she gave me a phone and said you have to go call the surgeon and get orders on for this pt. This was kind of scary, because it was my first time getting orders and she gave me no more advice then your going to be fine. Then the phone started ringing non-stop and I was getting calls from the different units to take report on transfer pts. It was all just so overwhelming. At the end of the day I was hoping for maybe a hey you made it, but all I got was I hope you know that this was an easy day.

Today was my second day and I thought well this is going better. I had called a couple of Docs for orders and things were going fine. I still haven't quite figured out how to keep everything organized, but I was feeling better. That was my motto today, better. Then about 4 hours after I got home I got a call from the unit to find out if I had hung an antibiotic. I had but just forgot to cross it off in the MAR. I felt so stupid and my day was cast in a whole new light.

So, now what I whined and vented, I want to let you know that I appreciate you taking the time to read it. I know that everything I do is valuble experience, but I was just hoping for one day on the floor where I could follow a nurse to see how my unit flowed.

[MIA-RN1, RN]

Run--don't walk--to your NM or education co-ordinator. You are risking your license and your patients by being expected to perfom skills that you are not equipped to perform. If you don't have the experience, tell them "I can't hang this blood. I have never done it before and I don't feel it's safe to do this without supervision."

Advocate for yourself and by extension for your patients by demanding more supervision and instruction and less alone-time.

[Brooke13-RN]

I am going to speak to my nurse educator tomorrow. I made an appointment with her to talk about my concerns. I'm sorry if I made it sound like I was taking risks with the blood. I nabbed some help from another side of the floor. My point was mostly that my preceptor just left me. If I hadn't been able to get the help I wouldn't have hung it. The other RN wasn't surprised at all saying well that's just how so and so does things.

I do have some concerns and I'm going to voice them first thing tomorrow. Thanks

[RainDreamer, BSN, RN]

Oh wow, it sounds like you handled that very well!! I probably would have cried the whole time and never gone back!

On my first day, I didn't do anything except shadow my preceptor ..... yeah I helped with things here and there, but I mainly just watched. There were A LOT of things that I didn't get experience with in nursing school and my preceptor never acted surprised that I didn't know how to do a lot of things. After all, nursing is an on-the-job training type of profession.

It sounds like you know to ask questions when you don't know how to do something and only to do things you feel comfortable with doing. And you're doing the right thing by meeting with the educator. I would definitely ask for a different preceptor. There's no harm in asking to be put with someone different. I remember my educator telling me on my very first day, that if I EVER felt like I needed to be with a different preceptor for any reason, not to hesitate to ask. She said some people just don't fit, have different learning styles, etc.

This is YOUR orientation. I can tell you right now, from reading what you wrote about this preceptor, she is not precepting you for the fact that she loves teaching. She's only doing it so you'll do her grunt work. She wants to have an orientee do all her work for the next 7 weeks so she can sit around on her butt all shift. That's exactly what it sounds like to me. There are some great preceptors out there ..... nurses that will take you under their wings and TEACH you. They won't act surprised when you tell them you haven't done that before. They won't tell you to call so-and-so or do such-and-such on the first day and not give any advice whatsoever. They will do it first and have you watch. Then they'll have you do it, with them there at your side, encouraging and supporting you. Then they'll eventually let you take your own assignments and do everything on your own, with them there if you have questions or concerns. That's how it should be. Please don't sell yourself short. This is your orientation and you need a good preceptor that is willing to take this seriously and mold you into the great nurse that you'll be.

Good luck to you, I wish you all the best! Let us know how the meeting with the educator goes.

[AngelsRN]

I would see about another preceptor as well . . . some nurses forget that there is a lot we dont do in nursing school. I started back in January and I just hung my 3rd unit of blood August 4th - and we have to hang it 3x with someone before we can do it by ourselves. Advocate for yourself -- if you dont know how, ask the question - it does get easier every day as you get more into a routine and more familiar with everything. Good Luck.

[wonderbee, BSN, RN]

A strong reminder of why we have a bedside nursing shortage.

[blaaveispiken]

Sounds like a nightmare to me, but it sounds like you are handling the situation and advocating for yourself by making an appointment to see the nurse manager. I'm curious as to how they will resolve this for you and if you're satisfied with the outcome.

I too just started floor orientation this week on an oncology unit. We do take overflow med/surg patients and apparently just recently they started taking tele patients. I too am overwhelmed after my first day (night shift), BUT my preceptor is much better than what your experiencing with your preceptor. I got to shadow her my first night and just did a few things. By the end of the shift though I have to admit she had me doing more CNA work (getting vitals, emptying hats, collecting I&O's) while she was changing IV lines, clearing PCA pumps -- things I really should have been observing. Don't get me wrong -- I don't mind at all doing those things, BUT right now I need to learn some of the things I didn't get to do in nursing school before I'm cut loose! My next shift with her I'll be taking one patient, but she will shadow me. I think this will be OK, but I am somewhat concerned, ideally I'd like to shadow my preceptor a few more shifts and have her watch me to do tasks with her.

I feel for you -- even though I think I'm in a better situation than you are, I still think there is much room for improvement.

Honestly I don't think preceptors should be expected to take a full load of patients AND precept -- there should be an additional RN working when an employee is precepting someone. It really isn't fair for the preceptor or the preceptee. Has anyone out there had a GREAT experience with their preceptor? How did they precept you?

[CarVsTree]

I agree with everyone else, too much, too fast. I would see about getting a different preceptor. Sounds like she has a desire to see you fail rather than a desire to teach you.

As for the phone, we didn't start carrying the phone until weeks into orientation (don't remember but I know it was NOT on the first day).

My first day I shadowed my preceptor (and I had teched on the same floor for a year and knew everyone and understood "our" patients).

I also started with just 1pt and then 2, 4, etc. Even to this day (8 months in) if there's something I haven't done before I grab someone to do it with me - no questions asked. I am very supported here and have a very happy home.

[NotReady4PrimeTime, RN]

Honestly I don't think preceptors should be expected to take a full load of patients AND precept -- there should be an additional RN working when an employee is precepting someone. It really isn't fair for the preceptor or the preceptee.

Gee, that would be great... but there are always orientees in our unit. Some shifts there might be three or four of them. It really makes deciding on assignments very difficult, even when we have an extra nurse. And that too isn't fair to either party. I've gone to the charge nurse several times to make sure they're aware that the patient my preceptee and I are caring for isn't appropriate for the preceptee, which means that I will be very limited in what I can let her do. Last time the response was, "Yes, I know that. But you're the only nurse I have on this shift who can take the patient, so it's just gotta be that way." We were very short that night, had a houseful of critically ill kids and five orientees to choose assignmenst for. I really wish they'd fix whatever is causing our rapid turnover so that hiring can slow down, but I just learned that we have four more orientees starting this week and there are seven positions posted and yet to be filled. Sigh.

[RainDreamer, BSN, RN]

Has anyone out there had a GREAT experience with their preceptor? How did they precept you?

Yes, I had a GREAT experience with my preceptor. She precepted me like I mentioned in my previous post .... let me shadow her first, let me watch her do things the first time, then was there while I did things, then gradually let me do things on my own and was available to me when I needed her, etc.

It might be harder though on med/surg type units when you have a lot of patients. I'm in an ICU so we always had 1-3 patients, but there were nights that it was insanely busy. It's hard to learn when it's busy like that. I remember plenty of times being overwhelmed and just in shock. One night after my baby coded my preceptor just gave me a hug. She said in no way will I feel comfortable doing that for a LONG time and I won't be expected to. She was very supportive. Every morning after my shift was over she would tell me "you did great tonight". That is SO SO important. Just 4 little words like that can mean the world to a new orientee.

I had an amazing preceptor, I couldn't have asked for anyone better. She LOVES teaching. She taught me about why things happen, why we're doing this, what's going on with the baby, etc. That's why it's important that preceptors want to precept and that they like to teach. Sure, anyone can sign up to be a preceptor and let someone follow them around, do their grunt work. But it takes someone special to be a great preceptor. They're out there.

[Brooke13-RN]

Hi everyone,

Thanks for all your feedback. I did talk to my Nurse educator today and even worked with her on the floor. We took 2 pts today and did total care on each. It was very busy, but it was nice to have her support today. That's what I think I needed, just some support.

I talked to her about having the phone already and how I felt I overwhelmed. I told her that I didn't feel comfortable talking to the docs just yet because first, I don't even know what half of them specialize in. Then I sometimes don't understand the reason that I am calling for. I told her about the blood and how I was left to figure it out. She told me that it was right that I got help, and she would talk to my preceptor about not leaving me to do things I'm new at. But that's about all I got. I'm not getting a new preceptor because she is "the best".

So, I guess I really didn't get anywhere today. I did get a little more confidence in myself though because my nurse educator told me that I was doing good. She reminded me that it's going to take lots of time to get it all. That she doesn't expect me to know everything. I think it helped to have someone to say hey, you're where you are supposed to be. It was still a very hectic day, but I was able to get through it. I even was able to keep one of my pts out of restraints for the day because I kept orienting him to the NG tube and why he can't pull it out.

Now that I've talked with my Nurse manager I have decided to tackle my preceptor. I only have 3 weeks left with her and then I get to move to nights. I met my night preceptor today actually and she seems pretty cool. She asked me how I was feeling and I told her a little bit about my feelings for the week and she told me that that's perfectly normal and that I would get it, it's just going to take some time. Next time I work, 4 days away thank goodness, I'm going to tell my preceptor that I'm very unsure of myself and would like to slow things down a little. If that doesn't work, I'm just going to bide my time until I get to change my shift.

So, that's where I'm at now. THanks for everyone's support. ~B

[youngatheart]

Brooke- Good luck, I have been in orientation for over 6 weeks now. I have had over 4 preceptors. Ugh, I started with 2 patients and am now up to 4. Next week five. It has been a horrible orientation, My preceptors have also had charge nurse responsiblities which makes them unavailable to me to answer pertinent questions. Feel like I am just wading thru with a thin floatation mat and could drown any minute. Have discussed this with manager about assigning me to people who are not in charge but nothing has changed. Very depressed and feel really left out in the cold. They give me a half of day learning the computer charting and expect me to know how everything works, Not good. I work on a med-surg/pulmonary/renal/tele floor and most of the times patients need total care and with 4 it is very tough. One day at a time is my mantra. I am orientating on days and will be going to nights in oct. Thank God. - tired of the rush on days doctors orders, people going down for tests, admits, discharges, audit checks it is so overwhelming! I just got off 12.5 hours with only a 20 minute break can you tell? Sorry for the vent but really how much can we take?