Feeling inept :(

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Hello everyone, I apologize for this post now but I need somewhere to vent my feelings. I'm halfway through my orientation to the nicu and I feel like I might not make it to the end. The first few weeks I felt great and felt like I was catching on but now I feel like I am falling behind...and even backwards! I forget the most simple tasks and get flustered, then fall behind. My preceptor isn't very encouraging either and can be very judgemental and critical when I make mistakes..which ends up putting me under even more pressure and stress to get it right and I get so nervous with her watching me that I mess up. I used to do a great job at drawing labs but now I get so anxious and my hands start to shake and I can never seem to get it right or fast enough. My preceptor just took the ampule right out of my hands yesterday and did it herself. I can see she's getting frustrated with me and my pace and my forgetfulness but her attitude and lack of support at times (she can be supportive at other times) just makes learning more difficult. And when she corrects me on a task it comes off less as a reminder now and more of a lecture. At this point I just feel totally inept for this job and it only shows as we move on to more critical patients. I nearly had a breakdown during lunch the other day because I got so caught up in my mistakes and it seemed like the more I fell behind, the more I made! So much of this job I feel comes with judgement and experience..all of which I'm lacking so how can I ever get anything right? For example..checking residuals..something so simple yet I never know whether to chuck or refeed. I know that if its undigested you should chuck, and anything more than 50% or billious.. show the MD..but how about if its say 6 ml of partially digested milk..do i refeed this then subtract the volume from the next feed or refeed and feed over top??..its such a judgement call i feel but i never know what to do and then always end up doing the wrong things (chucking when my preceptor wanted that refed..ugh). There doesnt seem to be any standard for this. It feels like there isn't anyone I can talk to who understands..venting out on here does help some however. Any words of advice or encouragement would be much appreciated! Because I'm thinking I may not be cut out for this job :(

I am right there with you! I started on my NICU the beginning of June. I had NO experience, not even as a student. I've had good days, bad days, and everything in between. It really does get better when you are able to take a deep breath and think, "Okay, what do I need to do first?" without having a preceptor standing over you. There will always be days that you mess up or forget to do something. This is how you learn. Never hesitate to ask questions! I NEVER do anything without verifying with another nurse first if I have ANY question whatsoever. Sometimes you will feel like an idiot for the questions you ask, but you are in a continuous process of learning! I found myself a "buddy" nurse who I have no hesitation bothering with every silly question that I have. She has been a lifesaver! Seek out opportunities to learn, go watch other nurses, read up on things you feel not so comfortable with, etc. And remember:

"Finish each day and be done with it. You have done what you could. Some blunders and absurdities have crept in. Forget them as soon as you can. Tomorrow is a new day. You shall begin it serenely and with too high a spirit to be encumbered with your old nonsense. - Emerson"

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You will survive. I felt the same way during my orientation over a year and a half ago. There are still some days that I feel like I'm floundering and don't know what to do. I still ask about residuals, and lots of other things.

It sounds like you need to talk with your preceptor, educator or manager. Some times the preceptors and interns don't get along. I had one that I almost requested a new preceptor because we clashed.

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Twizzler,

I just finished my 4th out of 12 weeks on orientation, and I have days too where I feel like I am not cut out for this. Friday we had a kid on a vent and I was trying suctioning, and the suction was at a weird angle, so I had a hard time pulling and the little ones heart rate starts dropping...my preceptor intervened and everything was okay, but I felt like a complete failure. Also on that same day, I was trying to do an ABG draw and blood was all over except in that stupid little stick! Fortunately, everyone that I have worked with has been very nice about everything and I love my primary preceptor. Even the other two I have had have been nice. I would definitely say that you need to talk with someone about your preceptor - but first talk with her. She may not realize she is making you feel that way! If that doesn't work, then go to your manager. I really think it is important for there to be a supportive environment in order for anyone to survive.

Hope all goes well and keep us updated :)

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My story:

-had a great preceptor, very supportive. gave me credit for being "book smart", for looking things up/asking questions etc, but even near the end of my 12-week orientation, confided that she had serious concerns about my time management and ability to handle an assignment. Great, this was at about week 10, just days away from being on my own. Certainly not bad enough to justifiy adding more time to my orientation. Just enough time for me start dreading getting tossed to the wolves...

-on my own, first few months are very rough. some bright points, my ability to handle a full assignment is much better when I'm on my own..no safety net, so I just get it done. Many minor mistakes, but everybody fed on time, no missed/grossly late meds, no dirty diapers (not a lot of baths those first few months, lol. always admitted it to the oncoming nurse, no covering up). So, coming on six month mark, things are tough, I'm barely keeping my head above water (never once took a break, by my own choice, hid that fact from coworkers), seriously calculating how to buy out my contract and get out of dodge, somehow hanging on

-hit 6 month mark, and the very first day I work I am floated to picu (6 months is earliest a new-grad can float). Stubborn mule I am, I trudge on up. Now, I have had exactly 1/2 of a shift with a vented kid in my 6 months in the nicu (very stable, extubated halfway through shift). So, I get to picu, and am given a toddler with an IJ line (never seen before on my unit) and a nicu grad vented, with a trach, crazy sick, about a zillion meds...and the nurse next to me is a peds float. I still shudder when I think of that shift. It was horrendous. Just like nicu, I worked furiously, "head above water", only real help was a godsend RT. Was there two hours after my shift documenting. Went home in a state of shock and horror (I'm not exaggerating, it was the most horrendous experience of my 33 years on this earth).

-so, next day, I'm back in my unit. And you know what? It seemed like home. My assignment was the same type I had the day before my float...and the stress was gone. Just like that. I even took a break!

-at the 7-month mark, a few charge nurses decided (with the best of intentions) to build on this momentum. I got three assignments over the next few weeks that the docs called "the sickest kids in the unit". Vents. Pressor drips. A kid in persistent SVT that was cardioverted twice, given adenosine three times, coded two or three times. Transfusions: PCLP, ffp, cryo ("what the hell is cryo?"). My smallest premie yet (24 weeker, ~900gm). And you know what? I survived. I did more than survive, I actually did GOOD. I took good care of those kiddos (with lots of teamwork and support, of course). And the nausea on the way to work, the anxiety dreams that started the second my head hit the pillow; gone.

-I hit my 1-year mark this past Wednesday. There is still so, so very much I need to learn. There are still things that will terrify me. But I can go into work, accept my assignment, get report, scrub, take a deep breath, look at my kiddos, and say, "Alright, let's get started. What's my plan, what needs to be done, who's up first?"

(Man, I'm making my quota of rambling posts this week, that's for sure).

The point, at last, is this: you can do it. You will be on your own. You won't be drawing labs because your preceptor told you to, you will be drawing labs because that is YOUR kiddo, and he needs them drawn, and it is your job, and you are good at your job.

Seek out the challenges, ask for assistance, take care of your babies. You are a NICU nurse, and you are going to be great.

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Twizzler,

I just finished my 4th out of 12 weeks on orientation, and I have days too where I feel like I am not cut out for this. Friday we had a kid on a vent and I was trying suctioning, and the suction was at a weird angle, so I had a hard time pulling and the little ones heart rate starts dropping...my preceptor intervened and everything was okay, but I felt like a complete failure. Also on that same day, I was trying to do an ABG draw and blood was all over except in that stupid little stick! Fortunately, everyone that I have worked with has been very nice about everything and I love my primary preceptor. Even the other two I have had have been nice. I would definitely say that you need to talk with someone about your preceptor - but first talk with her. She may not realize she is making you feel that way! If that doesn't work, then go to your manager. I really think it is important for there to be a supportive environment in order for anyone to survive.

Hope all goes well and keep us updated :)

I just want to tell you that some babys brady with suctioning, especially if they have thick secretions that you have to coax out. A baby having a brady during suctioning is going to happen sometimes, so put that one away.

Art draws are messy.

Remember that orientation is to learn skills, you will polish them up and put your own stamp on how you do things later. It seems to me that my first year off orientation was spent ensuring that all my tasks were done (pretty much surviving my shift). The second year of nursing has been spent figuring out a lot of details, a lot of why we do things, a lot of finding what works better for me.

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Specializes in OT, Palliative, ICU, NICU, Wound Care,.

Oh, poor you and me too....I am almost finished my post grad course in NICU and after 18 months it is slowly starting to come together. I have had days where I ended up crying in the toilet as I felt my preceptor had 'had enough' of me. It turned out she was really stressed too and we had a talk.

The one thing that I have found to help me the most is to allow myself not to know things! It is ok to be in student mode..it is ok to have to ask each time about residuals. On our unit every baby is different and each nurse does the whole residual thing slightly differently. I simply ask with each baby and there is NOTHING wrong with that.

I too think you have info overload and are probably your own harshest critic - when you are stressed, feel judged and unsupported you are not given the chance to practice at your best level.

I URGE you to be assertive and either talk to your preceptor or manager about the way you are feeling in regard to having 'things taken out of your hands'. Unless the baby is in a dangerous or life threatening situation this is just NOT ON from a preceptor. I have been assertive (with heart beating so fast and adrenalin pumping) with 2 senior nurses on my unit and the outcome has been fantastic. They are both now aware of how I was feeling and how their behaviour was rude or unsupportive. They are very respectful to me now.

STICK WITH IT..it gets better..I figure (like me) the first part was easy because you dont realise quite what you dont know to not know. If you get what I am trying to say. I think it is almost ignorance for the first few weeks then you start to realise how much you need to know and really dont know.

I am in my course with 7 other NICU students and ALL of us have had moments where we have had a 'melt down' at work and considered not staying on. stick with it..

You are not incompetant - just learning in a hard environment...NICU is a highly specialised area that takes time, patience and support. Be easy on yourself.

Rani

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