Difficult first experience as a new grad

[Jessica1019]

Hey guys,

I graduated from a local community college with my ASN in December. Going into nursing school I wanted to work in critical care, my clinical experience in one of our hospitals solidified it for me so the month before I graduated I started applying to units in the surrounding areas.

My first choice hospital went into a hiring freeze the month after I applied, so unfortunately I wasn’t able to get a job with them at the time. But I got a call back from another, went to the interview and was hired. I was so excited! However, that excitement soon diminished when I started orienting under my preceptor.

He has been working in the unit for 5 years, so he’s very knowledgeable. Aside from orienting me he also has a clinical student from a local university who does 12 hours of clinical every day that he works. 

My first day of orientation I was told just to observe, which I did very closely. The following shift he gave me a less than critical patient, and I was left to my own devices while he was either hanging out at the nurses station or teaching the student things that I felt would have been beneficial for me to learn as well (zeroing A lines, changing vent settings according to orders… etc). If I ask for help, he sends the student into the room to show me how to do things while he does other things. 
 

During my last shift he seemed genuinely annoyed at the fact I had even showed up. He asked me to pull medications for a patient then asked what each medication was for, when we came to metoprolol he asked what it was & I replied with “it’s for his blood pressure”, he chuckled at me and said “Okay we have a degree now so it’s time to start talking like it.” So I said “it’s a beta blocker” to which he replied “a Beta 1 blocker” in a condescending manner. He also told me that, after only knowing me for 5 days, maybe I should go to med surg to get some foundation and that the ICU isn’t cut out for everyone. He then questioned why I wanted to come into the unit because “some people only want to do it because it’s only two patients”.  I have done everything he’s told me to, and also helped other nurses while they’re busy. 
 

Now that I’m in the unit, I don’t even know if I would want to keep working there with a new preceptor. They are not the safest place to work in term of patient care. For instance, he asked me to pull a high risk drug for one of his patients, I followed orders as I was hoping he’d show me how to work the pump but instead after I pulled it he handed it to the student to go hang without any supervision. I was terrified the entire time he hanging the medication because if something had happened it would have been my name attached to it but at that point it was basically the blind leading the blind because they’re pumps are very outdated and I haven’t been taught how to operate them. 
 

I am really torn because this was my first real nursing job and I was so excited. But at the same time I don’t feel like I’m being oriented quite like I should be. Has anyone dealt with something similar? I’ve considered speaking to the director, but she and my preceptor are best friends and I’m afraid I’ll get boxed out even farther in an already “cliquey unit”.

[Nursetom1963, BSN]

I want to suggest you speak to the director, but you kinda already put the squash on that.  He sounds like a real winner for sure, but there are few other options.  Kinda gotta agree with him on one point; ICU is advanced, and you need good foundational clinical experience (and with the hospital and it's systems) before working in there.  Either speak up and ask more questions, even if it annoys him, or see if you can go to a med surg or tele floor to start.  Maybe even another hospital.  Good luck.  

 

[mimibrown, ADN, BSN]

Oh dear, this sounds like a very unsupportive environment. You need to tread very carefully if your preceptor is friends with the director. I’m not sure exactly what your preceptor is thinking by having a student teach you things. It sounds alarming.
 

I think it would be best to go to another unit. If you ask for another preceptor, it might be perceived as an insult. Your current preceptor could talk poorly about you to whoever takes over. It could cause you to have a bad reputation among your coworkers, which would be an uphill battle to overcome as a new grad. I have been in toxic environments before, and I think it’s best to cut your losses and move on. 

Critical care will always be there in the future if you want to go into it again. I suggest trying to transfer to medsurg or a step down floor. It’s hard enough to learn as a new nurse. Having an unsupportive and neglectful preceptor sounds like a recipe for disaster. It’s probably not the answer that you want to hear but I have learned that a toxic environment rarely improves. It’s not worth the stress even if it’s your dream job.

You have a long career ahead of you. You want to be in an environment where you can learn and ask questions without being talked down to. I don’t think this unit  is the one.

[Wuzzie]

Do you have an educator? That is who you need to start with.

[Jessica1019]

Hey guys,

I want to thank you for the words of encouragement and advices. After consideration I decided to part ways with the hospital I was at. I decided it was not worth the stress, anxiety or potentially my license. 

[JBMmom, MSN, NP]

Sounds like you make a smart decision. As was already mentioned, critical care will always be there. And with the state of staffing these days, they'll have open spots! While I do know new nurses that have been successful going directly into critical care, I think you can gain many valuable skills in other areas that will still translate to critical care if you return there. Good luck!