First Nursing Job

[fishofthesky]

I am a brand new RN and I'm 2 months into my first job in the OR. I'm disappointed in myself because I am struggling and my preceptor talked to me recently that there is concern from others on the unit that I am not at the level I should be after 5 months of OR experience (my final placement in nursing school was a 3 month OR placement). From everything she's said it sounds like there is a real possibility that I will be let go as they do not want to spend the money to put me through the OR course if I can't make it there...which is fair enough. I was told about this a week ago and gave it all I had to fix it last week, the assistant head for our area observed me through most of the week (I wasn't told it was official observation till later but it was obvious) and told me the morning of my last shift that I had improved/accomplished a lot and should just keep ramping it up. However, where I'm very worried is that the last case of the day went a little sideways and the surgeon asked my preceptor to take over from me as scrub, I know how I lost control of the scrub and plan to fix it next time and it wasn't helped that I had a circulator who was not very strong (even my preceptor asked someone to find another nurse to circulate for her). When my preceptor and I talked after the shift we were both very disappointed with how the last case went and she told me I needed to spend the weekend thinking very hard about if this was were I wanted to be or not, because I had the potential to be good there I just didn't have the confidence and wasn't bringing it all together yet. I've been thinking about it the whole time and I keep going from thinking I should try my hardest even if they fire me anyways to thinking I should quit before they fire me and try another type of nursing to thinking I should just quit nursing all together. If anyone has been in a similar situation or has any advice for me it will be greatly appreciated, sorry for the wall of text.

[Rose_Queen, BSN, MSN, RN]

No place should be counting that 3 month final placement as OR experience. As a student, you were not (or at least should not) have been acting in the role of the nurse- there are things that only a licensed nurse should be allowed to do (and are restricted as such in my facility's policies). Are you being expected to be learning to circulate and scrub at the same time? That is far too much and far too overwhelming for someone without OR experience to be undertaking. A proper orientation should focus on one role at a time and provide enough time in each specialty to learn the basics.

Does your preceptor's teaching style match your learning style? If not, can you request a new preceptor? There are those nurses who have found that they struggled when working with one preceptor but flourished with another whose style was different.

What are the expectations of the preceptor? Are they clearly spelled out for you? Are they providing daily feedback? If not, why not? If you aren't told how you're doing, how can you set daily goals to improve?

[fishofthesky]

Thanks for the reply Rose_Queen, to answer your questions:

1) We are scrubbing and circulating at the same time, but for the last week my preceptor had me scrub on every case but one so that I could work on communication, which is where I am struggling the most. I am in only one service so far, general.

2) My preceptor has been very supportive so far but I am her first student after a couple years OR experience so this is new to both of us. I was made aware of these problems fairly recently (been working on them for one week since I found out) and the course that they are deciding whether or not to put me in starts in 2 weeks so I don't know that switching now will help very much since for all I know they've already made their decision and just haven't told me I'm out yet.

3) A group of us was hired and told that since we had prior OR experience with our final placements in school we were going to be paired with a preceptor to "observe" over the summer and "help out a bit" until we could take a 2 month online course followed by a 3 month formal preceptorship and orientation. The biggest problem for me is that that I only found out in our first formal meeting a week ago that there were problems so serious I could be out, prior to this I thought I still had work to do but I had time to improve on it. Now suddenly the time is all gone and I feel like I need to be able to do it all on my own right now before I even take the course or have the formal preceptorship! It would be easy for me to think it's a little unreasonable but I've been told I'm lagging behind the other students, so it must be justified. Since all this came to light we've had one more formal meeting at the end of the week of trying to improve and I've been given an assignment to come up with things that I have improved and things that I still need to improve.