Discouraging orientation

Hi,

I recently moved out of state and started a new nursing job in a pediatric ER. I have app. 5 yrs nursing experience prior to this job-2 1/2 as an adult med/surg LPN,1 as a PICU RN, and 15 mos as a pediatric floor RN.

I am currently three months into my orientation(they claim it takes 4-6 mos) and I am starting to have a really rough time. The first two months,I seemed to be doing ok,my primary preceptor(we'll call her Annie) was very thourough at explaining how the ER worked,was encouraging,gave positive feedback,etc. My secondary preceptor(lets call her Bonnie) was a bit more stressful-she moves at a fast pace and is all about getting everything done five minutes ago. I wasn't with Bonnie as much,but it came to a head at the beginning of February,when I approached my educator and asked for advice on how to approach her about the difference in our paces.

From this point on,my orientation has gone DOWNHILL. The educator,whom I'll call Sally, gave me good advice at the time,but a week later in our regular meeting with Annie,stated that i was having a lot of trouble and needed not to work with Bonnie anymore.That was fine with me,but then Sally kept making vague remarks about how I needed to "take a step back," and go back to handling 2 patients with more efficiency. After the meeting,i asked sally for specifics-I had thought I was doing at least all right,I had never received any severely negative feedback. Sally kept saying "well,how do YOU think you are doing?" and "we've hit a setback,but we'll keep moving forward." I was puzzled,and asked Annie,who just said that Sally was just making general comments.

Then I spent a day working with Sally to "evaluate" me,and at the end of the day,I asked for feedback,and she shugged,threw the question back at me,and said "well,speed definately needs to come up." I was starting to get a little frustrated,but still not sure how all of the sudden I was doing so badly.

I spent a large chunk of Feb in required classes,my schedule was all over the place,but I thought I was improving on what time I managed to get on the floor.I went back up to three patients,and still got mostly positive feedback from Annie. Then,last week,everything fell completely apart.

I had a patient come in with asthma via EMS. As one of the many,MANY mixed messages I've received in this orientation,I was told that we had to do the computer triage form for EMS patients "right away." I looked at the girl,put her on the monitor,and she was on O2.I started the form,and Annie came in asking me what she sounded like.i said I hadn't done the full assessment yet(again,I was told to to an "eyeball" assessment first,then triage,then come back for full).She hurried me off the computer,had me listen to the patient,then start on this standing protocol that they have. Later Annie told me that with respiratory kids,it was better to assess them first,get them the treatment,then do the form.

OK,so I flubbed that one,I get it,but we talked and I figured it was resolved. But in the meeting a few days later with Sally,Annie(who had otherwise given me several positive remarks,and had been helpful in chaotic times) went on and on about the above patient,as well as mentioning that I "got flustered" when there were several orders on multiple patients at once. She admitted that I knew which one was the priority,but kept recalling how I was "stressed" and she had to tell me "one thing at a time."

Sally kept shaking her head,saying that she wished the respiratory assessment piece had "clicked already" and that I had had several resp. patients,I should be better by now. The whole meeting was very discouraging,and left me feeling very down on myself,my nursing abilities,and my orientation. As the meeting was 30 minutes into our 12 hr shift,I spent the rest of the evening flustered,making stupid little mistakes and then the big one.

I had a resp. kid at the end of the night,I could tell that she had some retractions but she was playful,squirming around,and was difficult to auscultate sounds and really assess her work of breathing. I thought she wasn't too bad off,told Annie so,and of course,when Annie went in,she was calmer and you could see that she was retracting heavily.I felt completely stupid,and even more so when Annie came out of the room,chewed me out,calling me "scary" and saying that she didnt know what to do with me anymore,and that she was told that I had experience,but it didnt seem like it.

Needless to say,i ended the nigth in tears,although two other nurses talked to me afterwards trying to make me feel better. I spoke to my manager the next day,who suggested switching preceptors and starting fresh,and working extra to increase my resp. skills.I was agreeable.

Then i spent the last two days with my new preceptor,Cindy.At first,she was nice,telling me that it was ok to start fresh,she had no preconceived notions,etc. The first day started out ok,but I know I made some small errors(wording in charting,not moving fast enough,having a little trouble with task prioritizing) and she seemed a little annoyed with me at the end of day one. Day two,I tried to do better,and I think i did,but we had a difference in pulse measurement,I used a different cath kit then i had been,thus messing up my sterile technique,and finally,one pt I assessed as not appearing as dehydrated as she thought(we had differing views on how dry his lips were,and how active he was-he was austistic and it was 11pm). I ended the day again feeling like a total screw up,going home in tears.

I have another meeting Wedsnesday with my mgr,Sally,and Cindy.I'm scared that they are going to get rid of me because they think I am incompetent. I know that i have experience,but in my past jobs I wasn't diagnosing and mentally planning the treatments for each kid. I know that my resp. skills need work,as I am used to simply noticing a kid with difficulty breathing/wheezing,and calling RT or the MD and following through with treatment.

I am not making excuses-I know that I need work. But after several weeks of so many mixed messages(take time with patients,but move faster;charting can wait,but hurry up and finish it;you can ask questions,but dont ask me,tell me what you want to do;etc etc etc) I dont know what to do. My boyfriend tells me that my lack of confidence is killing me but I dont know how to feel better when I'm being torn down so much. And after initially getting decent feedback to all of the sudden being ripped apart every day,I feel like I want to just crawl under a rock.

I apologize for rambling,but if anyone has any advice as to what to say in the meeting,how to improve and get better,or if I'm in danger and should just run,please tell me.

Thanks.