Feeling inept :(

hikernurse · Sep 10, 2008

OK, for the easy question. At least in my unit, unless the residuals are more than an hours worth, we refeed and do not subtract it from the next feeding. If it is more or bilious, we let the NNP or MD know and go from there.

Now for your main question. I started in a NICU as a new grad last summer. There are still many shifts I have questions. I don't think that is ever going to end :rolleyes: . Orientation is tough. There is an awful lot to learn in addition to learning basic nursing skills--blood draws, time management (no matter which department you work in), when--and how--to call the doctor, etc.

If you feel you are backsliding, my guess is your stress level right now is too high to take in new information. I could be way off on that .

First, never be afraid to ask questions. If you are asking the same questions over and over, get a notebook and write the answer in it. You can use it as a reference, well forever if you want :).

Second, have you tried talking to your unit educator? She (or he) may well ease your mind about where you are and where you should be. If you are a bit behind--and each person has different needs as far as orientation, that's OK--she will probably have some good concrete suggestions. Also try talking to nurses who started just before you for ideas. Don't talk your preceptor down on the unit; that's never a good idea--not that you'd do that anyway.

I've recently started precepting and it's a lot harder than it looks :). You have the responsibility for the patients as well as the responsibility for teaching someone new how to do things and why. I'm not trying to downplay her frustration, just giving a little background. In fact, the first thing we were taught in our precepting class is that people learn much better in a supportive environment. Makes sense.

You sound very discouraged and I understand how you feel. It will get better, just give it time.

Another thing to think about is that orientation is a time to expose nurses to the unit and that includes babies above your ability level at this time. Likely, when you are on your own, you will be given easier babies. Plus, if your unit doesn't pair you up with a "buddy" right after orientation, find your own. There are always nurses around who are more than happy to help and answer even the dumbest questions. I've found the dumbest questions are much better than making dumb mistakes . And much less paperwork...

Hang in there. Take time to assess what you've learned and I bet you've learned a lot more than you think you have.

IttyBittyBabyRN · Sep 11, 2008

Don't quit!!! It is like this for everybody--I promise!!! I just changed from one unit to another after doing this job for 7 years and I still felt like a new grad orienting at the new unit. Once you get on your own, you can stand at the bed and just think about things for as long as you need to and it will be so much better than when someone is watching over your shoulder making you nervous. And if you have 4 different preceptors, you will learn 4 different ways of doing things. You have to eventually just take it all with a grain of salt and pick out what is actually mandatory that you do a certain way and what you can make your own decisions on. I came from a unit with written policies for almost everything to a unit that has almost no written policies except for critical things. It took me forever to be confident in making my own decisions about things like when to wean babies to open cribs, when to call the doctor, etc. The most important thing for you to always remember is DO NOT EVER DO ANYTHING IF YOU DO NOT UNDERSTAND WHY YOU ARE DOING IT!!!!!!!

Realistically, it is not going to hurt a baby if you toss or don't toss his residual from feeding AS LONG AS NOTHING IS WRONG WITH HIM. At my first job as long as it was under 1/2 of the original feeding and looked "normal" we would discard it and continue feeding. At my new job, the docs are a lot more paranoid about belly issues, and would most likely stop the feedings and xray the bellies, etc. I've learned that if the feeding amount was small to start with, often there will be some left in their b/c there isn't enough to stimulate the stomach to push it on through. I don't ever worry if my baby has 2cc of a 4cc feeding left as long as everything else is normal. However, if the baby had 15 of 30 ccs left and I knew that the feeding wasn't hung late, I would do a lot more investigating before feeding them again.

All of this will become second nature to you eventually. Just hang in there and DON'T HESITATE TO ASK QUESTIONS. If your preceptor isn't very friendly, ask for a new one or pick someone really nice to vent to!!!! Good luck!!

elizabells, BSN, RN · Sep 11, 2008

Sweetie, I just passed the 2 year mark and still feel like a blithering idiot at least once per shift. And I know I'm not - mgmt just asked me to be a buddy to new nurses, which is not like a preceptor, but still, a vote of confidence. There are eleventy billion things to know in the NICU, and you'll never ever know them all. What will change, though, is that it'll get easier to say, okay, now I know that, and move on to the next thing.

And dude, can I tell you, I still agonize over every residual. Keep showing them to people (other nurses are sometimes even better than the MD) if you're unsure. Far better to have a reputation as the girl who shows residuals and diapers to everyone on earth (not... that that's me or anything) than miss a case of incipient NEC.

Sometimes I think orientation is like boot camp - it's there to break you down. I thought about quitting every day, thought I was the dumbest box of rocks ever to pass the NCLEX, and you know what? Once I was on my own, things just started working out. I don't know why, I have no explanation. But it happens.

twizzlers67 · Sep 11, 2008

Thank you all for the great advice and words of encouragement. Hikernurse I think you're right when you say the information overload makes it difficult to learn new things. And Ittybittybabyrn it does make me feel a lot better to know everyone feels this way. I guess it just feels so much different when you're in the middle of it and know that you have so much more time before you feel semi-comfortable. I can't wait to get to that point and be able to give advice to other new orientees. In fact what you said, and elizabells mentioned too, about being off of orientation and just being able to stand at the bedside and think for a minute without feeling the pressure of someone watching you is nice to hear. I think that is what I am missing when I begin to get flustered and make mistakes. All I can think about is how I must appear to the people around me and I don't get a chance to allow myself to stop and think about what is happening and what I need to do. I absolutely will find a buddy to help answer my questions and keep me from losing it when I'm having a rough day. Orientation truly is a boot camp ughh I know I just need to suck it up and keep truckin through it! Thank you guys, I feel a lot better about where I am at and hopefully I can come back to your posts when I'm feeling discouraged.

elizabells, BSN, RN · Sep 11, 2008

You'll get there, twizzler. I knew I was going to be okay when I had an attending standing over me, barking at me about getting various drips attached to various lines, which ended up being like one of those logic puzzles you did in middle school. I turned around and said, very calmly, "If you'd please give me one moment to think, I'll have that taken care of for you." In the time it took him to pick his jaw up off the floor, it was done.

Hell, even our attendings toss parents out when they need to do a procedure. Having someone breathe down your neck while you're trying to do something/figure something out is the easiest way to ensure you screw it up.

BittyBabyGrower, MSN, RN · Sep 11, 2008

So you have any type of conference with the unit managers or CNS? Our orientation is set up so that each week the orienter and the preceptor sit down separately with one of the two and go over their log and listen to any problems or concerns.

Don't worry too much. It happens even to the ones of us that have been their for ages...you get off track and your whole day goes to poop.

Do you have a cheat sheet that you write on? By that I mean a sheet with each hour listed and what you need to do, and on that sheet put things that you need to remember or things you want to look up or have questions about.

As a preceptor I can tell you it is easy for us to get frustrated on our end because the farther behind you get, the farther behind I will be when I jump in to help. It gets to be a vicious cycle and with the sicker kids you have to stay on track, hence the cheatsheet with hourly reminders will help you. Sometimes things do turn in a lecture as we go on because if you aren't displaying the "knowledge" then it is assumed you need a reminder. I'm not getting down on you or sticking up for the preceptor, but just a different view on what is happening.

The other thing I would suggest is at the end of the shift you sit down with your preceptor and go over the shift and what went wrong and what you need to concentrate on, you have to have open communicaton or the rest of your orientation is going to be rough.

Hang in there, things will click, it just takes time!

twizzlers67 · Sep 11, 2008

No we don't have any one on one meetings set up with a CNS or manager although it'd be a nice thing if we did! I do keep a cheat sheet with things to remember and I go over it on my days off from work to try and familiarize myself with the info. it does help to have it handy on the unit. I think it comes down to time management and prioritizing.. like me forgetting to fortify the breast milk at the beginning of the shift then having to get it ready in a hurry for the feed and feeding late. then after hanging an ng feed realizing I never checked a residual! Little things like this that I know will come with practice and time but it's so hard not to beat myself up over when I make one little mistake after another. And I absolutely agree it's good to take a step back and see if from the perspective of my preceptor. I can't imagine how tough the job must be (and kudos to all of you for taking on new orientees!) and I am very thankful to have her there to ask questions and help out when needed. I think the issue is that I feel like a burden on her and I get so nervous to make mistakes because I know that will only make more work for her and that's the last thing I want to do. And I know I'm new so I will make mistakes but just to see the frustration on her face makes it so difficult to bring my self-confidence back up from a tough event. I think I will try to open up the line of communication with her and let her know how I'm feeling about my own progress and maybe she will be able to help me understand a little better about where I should be. Thanks again for your response!

I'mANurse! · Sep 12, 2008

Keep your chin up! I have been off orientation for 2 days, and up until now I totally know how you feel! I was beginning to feel like nothing was completely clicking and that I will never be able to master this whole nursing thing. I even spent yesterday looking for new jobs because I was convinced that I was not cut out for the NICU. But with all that being said, being off orientation is not as scary as I thought it would be. In fact, it's a lot better not having someone constantly watching you and you'll be surprised at how you are able to put together everything you have learned and feel somewhat competent! I only had a little over a month for orientation and when I saw my patient assignment for my first day on my own I was ready to say "I can't handle this." It was a crazy assignment in my opinion for my first day and i literally had no down time, but I survived! And then today was a really really good day for me. I finally felt like a real nurse and that I had control over the situation and I knew what I was doing! Believe me, it's a totally different feeling! And it was weird, but I was more on time with my feeds and assessments then when I had my preceptor helping me out! Go figure.And I'm sure we will all still have our up and down days. I've had my breakdown at work, and I think it's only made me stronger.

But I definitely would recommend having a cheat sheet. You said you have one, but does yours have a place to write down what you need to do at what hour, what's going on with each system, when meds are due? I have one made up that works great for me and if you want me to send you a copy, just let me know and i'd be happy to share!

NeoNurseTX, RN · Sep 12, 2008

Sweetie, I just passed the 2 year mark and still feel like a blithering idiot at least once per shift. And I know I'm not - mgmt just asked me to be a buddy to new nurses, which is not like a preceptor, but still, a vote of confidence. There are eleventy billion things to know in the NICU, and you'll never ever know them all. What will change, though, is that it'll get easier to say, okay, now I know that, and move on to the next thing.
And dude, can I tell you, I still agonize over every residual. Keep showing them to people (other nurses are sometimes even better than the MD) if you're unsure. Far better to have a reputation as the girl who shows residuals and diapers to everyone on earth (not... that that's me or anything) than miss a case of incipient NEC.
Sometimes I think orientation is like boot camp - it's there to break you down. I thought about quitting every day, thought I was the dumbest box of rocks ever to pass the NCLEX, and you know what? Once I was on my own, things just started working out. I don't know why, I have no explanation. But it happens.

I ask a lot of people about residuals, too. Better safe than sorry, but I get different answers like.. a 7 cc residual on a 7cc/hr continuous feed is okay..some say it's not. Our P&P manual has disappeared and..sigh. So I just ask several different people.

I also feel better now that I'm off orientation, too...like I may not be an idiot after all!

Galore · Sep 12, 2008

I almost feel like I could have written this post. The NICU is my first job out of school and I'm 2/3 of the way through orientation. This past week my preceptor said that I'm doing great but I'm way too slow. There are definitely days where I come home and just want to cry because I feel like like my whole day was mentally exhausting. At times I feel like I'll never get to the level I'm supposed to be and there are a million things to learn, but I try to take it one day at a time.

Have you tried talking to your preceptor in a nice way about how she makes you feel? It's a tough situation when the person mentoring you is making you so nervous. I also know that looking back on clinicals, my toughest teachers were also some of the ones I learned the most from so maybe it will benefit you in the long run.

elizabells, BSN, RN · Sep 12, 2008

This whole "you're too slow" thing makes me NUTS. Of COURSE you're slow! Do they want you to rush and screw up? If you were as fast as they were and still able to do stuff right, you wouldn't need to still be on orientation!

GAAAGGGHHH!!!