Disastrous New Grad Orientation

[rndog]

I am a new grad (Dec 2007) who chose a position on a Peds ICU over one in an ED because I did an externship there last summer and absolutely loved it. Unfortunately, my orientation was a disaster. I had at least 10 different preceptors, worked predominantly nights (which is ok except that I was left alone more times than not), and my primary preceptor saw me as having been there last summer so had huge expectations as to what I should already know. I met with the nurse manager on 3 separate occasions to express my concerns but nothing changed. The experience was so bad that it really took a toll on my self confidence and I no longer want to work on the unit. After 9 years as a paramedic and a cop, self confidence had not been an issue for me until now. Now I'm off orientation and really regret my choice. I've stuck it out for over 5 months but I'm miserable. Can anyone suggest what I should do now?

[Tweety, BSN, RN]

It's hard to say because most of us were pretty miserable, scared, overwhelmed, regretful, and having feelings of not being prepared and inadequate that first year or so, especially in critical care areas. I'm not saying it has to be that way but being a new grad is tough wherever you go.

At this point they are unlikely to give you any new orientation and you're going to have to leave the past behind and make the best of it. You might want to give it a full year before making any decisions, because maybe things will click and you'll get your grove on and find it more tolerable and actually like it. If you can't possibly hang in there that long, then perhaps talking to HR about a transfer might be in order.

[Chloe'sinNYNow]

RNDog,

I thought I was reading my own bio there! :icon_hug: I agree w/ everything Tweety said and just want to add that the good news is you made it past orientation. Now, without them breathing down your neck, you will rediscover that self-confidence.

I had the same horrible multi-preceptor experience. Good news is you were allowed to speak to management whereas I was led to believe by power-hungry egocentric monster preceptors that the buck stopped with them and I'd be jumping the ever-respected chain of command if I dared to speak to mgt. With your meets on record, HR should have no problem transferring you if that's what you decide.

Did you say you were a paramedic before? Wow! That's a trade that takes exemplary confidence and in the pre-hospital field where your resources are few to none. I admire and repsect the heck out of you.

You've got it in you RNDog. You just let those power mongers rob you of it, temporarily. If you so choose...

Good luck w/ your decision,

Chloe

RN-BSN, BA

[nursemike, ASN, RN]

Ditto what Tweety said, but also I'd suggest, if you can, find one of the more experienced nurses you can share your feelings with and maybe get some ongoing advice. Is there one of your preceptors you got along with especially well? Or anyone who knows what they're doing and is willing to mentor a newbie?

I used to joke that they were going to have to extend my orientation so everyone could have a chance to precept me. One night, I was paired with a nurse who had just finished orientation, herself! But I did see some advantages to getting to see a lot of different approaches, and one of the nice things on my unit is that the mentoring didn't end when the official orientation was done. I wonder if that may be less typical in an ICU, where I imagine everyone is pretty focused on his/her own assignment, but I'd be shocked if there weren't at least a couple of nurses willing to advise you when needed. After three years, I still need a second opinion from time to time, but I also notice that from time to time, my mentors are asking for my advice. (Scary! But once in awhile, I even know what to say. How'd that happen?)

It is, unfortunately, pretty typical to go through some miserable times during the first year, and at least some occassional miserable shifts after that. I don't think this is entirely a failure of the system. I think a good bit of it just comes with the job. The work we do demands a lot of us. A loss of confidence seems pretty normal, too. If you aren't at least a little scared, you probably haven't grasped the enormity of what we're doing, and the best, most experienced, most confident nurses I know are still humble. It's hard to be cocky when God is looking over your shoulder.

If you can find someone at work to bounce your ideas off, be it the nuts and bolts of the actual tasks or just how you feel about coming in to work, that can help a lot. Or--and this is speculation, since I've never worked ICU--it might be easier to form those sort of relationships in a med-surg setting. On my unit, night shifts seem to be more collaborative than days. I've done a few day shifts, and it's hard to avoid a bit of tunnel vision. On nights, we have fewer distractions, but also fewer resources, so we have both the opportunity and the need to work together.

You may also be going through something else I went through--going from being pretty proficient at one job to a novice at another. It isn't an easy adjustment to make. But it does force you to grow, and at least you know you've mastered another difficult, demanding job in the past. You'll master this one, too, but it is going to challenge you.

Next time I feel the need to challenge myself, I'm going to challenge myself with something easy.

[NotReady4PrimeTime, RN]

Good advice nursemike, as usual. I've worked in PICU for going on 11 years and I've had my share of self-doubts about what I can handle. When I look at the assignment sheet and my patient is the one that has the crowd around her bed along with the ominous red cart, I still think, "What are they thinking? I can't handle that kid!" But it's situations like that where you learn to pick up on the little cues you might otherwise have missed that tell you something's not right. They force you to think, to act and to grow.

My critical care orientation in my first med-surg/trauma PICU was brief. Only a month. In that time I was buddied with at least half the staff, it seemed. Some were really good at preceptoring and others were content to let me sink. But I stayed with it. After 4 1/2 years I decided there was more I could learn, but not there, so I took a job in another city. My orientation in my current unit (a mixed cardiovascular surgical/ECLS/neurosurgical/trauma/transplant/general PICU) was seven shifts. I had three different preceptors. My last buddied shift we admitted a CV patient from the OR, something I still haven't figured out because we have a second phase orientation to learn all that stuff and I didn't have it, but there I was doing an admission anyway. Then I was on my own. I've been here almost six years, and although I have issues with much about my workplace, I know this is where I have to be.

Last week I attended a meeting on complications of pediatric lung transplantation (we will eventually begin doing them and have three kids on the list) with four of our senior RTs, our CNE, one other staff RN and our PCM. When I looked around the room I thought to myself, "What am I doing here? Everybody else here has so much more expertise and smarts than I do. There has to be a mistake." And THEN the doctor started talking. They ARREST when they're turned? Forget that! I'm staying away from that scenario. But you know, when I thought about it later, I realized that TPTB are seeing something in me that I didn't know I had, and I feel pretty good about it. If I had given in to my fear and my feelings of inadequacy all those years ago when I too had 15 different preceptors and no consistency in anything, and when I made my first dozen HUGE errors in judgement, I'd be missing something that I know I've come to be good at. Please don't just pack it in without giving it and your coworkers a chance. You might find a mentor in that bunch who was never your preceptor but who is open to helping you find your way. Send out some trial balloons; you'll know when you approach the right person because s/he will jump right in. If, at the end of a year, you still feel like you need to move on, you can do so knowing you really gave it your all. And don't forget you can always bounce stuff off us!

[NsgChica]

I have experience the same situation. I had 7 preceptors so far. I had the type of preceptors that don't precept but watch you do all their work and complain when something doesn't get done correctly.

I was feeling really down and insecure in my role. I talked to my nurse manager and told her that I would not stay on the unit if my orientation continued in this non-conducive manner. We made some schedule changes and now I am with a preceptor I absolutely love and respect. My precpetor really takes the time to review things with me, which is very helpful. I will be off of orientation in one month and I am still unsure of myself. However, I am told that confidence comes with time.

[cherilee]

If it gets better, shortly, grrreat

If not, dont sweat it, take what youve learned, go somewhere else. dont accept anything less than a supportive work environment, TRUST ME

there are enough jobs out there for nurses, you dont have to settle

[Virgo_RN, BSN, RN]

I had ten days of orientation with three different preceptors. Talk about feeling unprepared! Just know that it is not a sign of weakness to ask for help.