M/S 1st year--don't know if I can do this...........

  1. Hi there,

    I'm a relatively new grad and have a target date of Sept 18 to be off orientation on a busy medical/tele floor in a big city hospital.

    I've had a few different preceptors due to scheduling--no big deal. Lately, I've been with one that can sometimes be really supportive (you're fantastic!) and sometimes really harsh (you really need to multitask. you're distracted. you have to be able to keep more than one thing in your head).

    Basically, I try to stick to a routine (check on patients in am, do assessments, get meds out starting at 8:30am). Well, sometimes that plan gets all out of whack! Yesterday, I had 5 patients and all 5 of them had to go for procedures in the AM and none of them had consent for anything! The OR called for someone to go at 8:30am and the pre-op checklist wasn't done and consent wasn't obtained. Plus, the patient is screaming for pain meds (starting the calls to OR,"can I give the meds or can't I?). It's a teaching facility so it always takes a while to figure out which intern/resident to call for what and you have to wait until he/she gets back to you.

    Anyway, I ran around the whole day (5 minute lunch at 2pm) trying to manage interruptions, track down missing lunch trays, get consents, hang blood (had to do own vitals-techs nowhere to be found), fetch ice water, put people on the potty, medicate for pain q2 hours etc. Plus, I had a transfer and an admission in the afternoon. I didn't get my assessments charted until 2pm and didn't start my notes until 6pm before night shift came in.

    So, here comes the comment about multitasking, etc. from the preceptor. I'm a bit sensitive as I've always worked very hard and have never been told that I can't multitask. She mentioned at end of shift that I didn't do some things she told me to (like hook someone up to IV). I did need help w/the blood and I didn't get to a dressing change. and my charting was late. She said that these 5 patients were easy.........how is it going to be when I have 6 hard ones? As for being distracted..maybe so. I was exhausted by 6pm and couldn't remember a blood pressure I took and, yes, I did forget a few tasks as other things seemed to be a priority.............I felt like saying, "If I cannot multitask, how did I get all the meds into people at the right time and remember to do those assessments and not stay after an hour for charting, etc.". I just said, "uh, huh".

    Anyway, I'm really discouraged at this point and really don't know what is going on. On other days, I've had 5 patients and things have been fine. Other preceptors didn't really have any complaints and mentioned that I'm pretty independent.

    I CHOSE this preceptor because I thought she was supportive. I guess she's looking out for me in a way and making sure I'm ready to be on my own but I sort of feel like I'm being whipped. I have a feeling she wants to extend my orientation and I feel that there are some good days and some bad days.

    This is the first day following a shift that I'm thinking and worrying about work and nearly in tears.

    Perhaps M/S isn't for me?

    Any suggestions?
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    Joined: Dec '05; Posts: 60
    ED Graduate Nurse

    28 Comments

  3. by   traumaRUs
    I am so sorry you had such a negative experience. Have most of your other shifts gone ok? Med surg is hard: its busy and hectic and the pts are always coming and going. Delegating the tasks that a tech can do will help with you focusing on your own tasks.

    Please don't be too hard on yourself. There is a lot to learn and its much different than nursing school too. Hang in there. When the preceptor makes general comments, pin her/him down as to what could be done better? What would they prioritize as being the most important?
  4. by   Tweety
    Try not to let this one day discourage you. Sounds like you had a very typical day in med-surg. There are going to be these days, sometimes multiple days in a row like this.

    Ask your preceptor to give you tips throughout the day on prioritizing and organizing, rather than at the end of the day saying "you didn't do this and you didn't do that".
  5. by   suzy253
    Wow..it sounds like I just wrote this thread about me and having the same negative feelings. I'm a new grad as well and yesterday's shift (3-11) was so trying on me. I work on a med surg/step down telemetry unit as well and am extremely sensitive and hard on myself. After last night, I'm totally second guessing myself wondering if I will ever, ever be up to snuff. I'm not at all looking forward to going in to work today...kinda scared about what will lie ahead and not feeling good about myself at all. Awful feeling!
  6. by   EDGRADNURSE
    Hi there,

    Thanks for the replies. Suzy253, I'm sorry that you feel the same way and hope that your shift goes well tonight.

    TraumaRUs, at this point I can't tell you if any of my shifts have gone ok. I always feel very out of control. Most of the time, I can get my assessments done and meds out by 9-9:30am. However, as the day goes on, things get worse and worse. There are always big problems (patient condition) and big changes (many residents/interns and other docs changing orders 4x per day and I have to take them off and put them into computer-although we have a unit secretary). I always feel so out of control and I don't like it one bit. I don't feel that I get a complete picture of my patient's condition. Never get a chance to look at the charts, at results of tests, etc until, say 4pm.

    One thing that really disturbed me was that, during my 5 minute lunch, my preceptor said, "the blood is ready to hang". I said, "ok, I'll go get it". She then said, "do you have consent?". At that point, I ran down the hall, egg salad spewing from my mouth to catch the resident and then had to answer 2 call lights on the way back. I mentioned that to my preceptor (about answering the call lights and she said "yup, that's how it is"). I almost feel like she was sitting back and watching what I forgot and seeing if I remembered it. I don't like that feeling. I have told her, on occasion, "I need a break" and she just looks at me.... How can anyone expect a nurse to run run run for at least 7 hours without 5 minutes to think. I believe I'm supposed to think while multitasking. She was pretty specific w/her criticisms-need to hold more than one thing in my head and the list of what I forgot to do.

    As I said, I chose this preceptor as she was quite nice at the beginning. However, as I get closer to being on my own, it's getting ..not so good and I'm beginning to think maybe it is me and not my preceptor and I'm not cut out for M/S.

    Nights are slower but I can't work nights because my husband is disabled and I have a 19 month old son.

    Any tips for "multitasking?". I'm doing the best I can. A past preceptor said, "do one thing at a time" which I believe is correct. I cannot keep jumping up from one thing to do another immediately that just came up.

    Sorry for whining...I'm usually a positive person and I KNOW that I'm a competent nurse. Just exhausted and I don't think they'll keep me if I cannot get up to speed really fast.

    Thanks for everything.
  7. by   Tweety
    To be honest, I can't multi-task. I have to give each thing my full attention. However, sometimes we have to be flexible and change mid-task to another priority. You also have to stop to ask yourself "can the person that just rang wait while I get this consent first since that is what I'm in the process of doing?".

    It all comes together with time. I know you're sick of hearing that, but it's true.

    Do you have a report sheet to keep lists. I usually loose mine, but on it I can keep of "to do" list.

    It's hard to always think of everything.

    There comes a time with the preceptor needs to withdraw and let you do it all to get a feel for what it's going to be like on your own, but you still have over two weeks and the idea is not to let you sink and sit back and watch. Perhaps next time when you stop to answer the call lights you can say to your preceptor "while you're standing there doing nothing can you get that light".....but in a more diplomatic way of course. LOL

    Also remember, your preceptor can't read your mind. You need to continually give her feedback such as "how do you personally multi-task, I'm having a problem with it, I was told to do one thing at a time, I need more specifics from you other than "you need to learn to multitask" because that's not making sense to me right now", "I'm overwhelmed right now and seriously need a few minutes to finish my lunch can you please get the consent for me".
    Last edit by Tweety on Sep 2, '06
  8. by   gonzo1
    med/surg is a great place to learn, but it is very challenging. From everything I've ever heard, it takes at least 6 months to feel even somewhat confident. As you are there longer you will pick up tricks from the other nurses that will make you more effecient. I was still learning things after 2 years, before I went to ER. Just keep your eyes and ears open and you will pick things up. Be kind to yourself. Some of the best nurses I know did poorly in orientation. One of my favorites is a male nurse who told me they told him he'd never make it. Now he is a preceptor, in NP school and has won a couple of awards. And remember just because a nurse is a preceptor doesn't mean that they are good at it, most do not have a very good orientation or training to be a preceptor and are not really good at training.
    the med/surg floor I worked on the other nurses were very supportive and happy to share tips.
  9. by   NotReady4PrimeTime
    I'm sensing a theme in the posts on this forum... med-surg seems to be the leading cause of nurses leaving the field, sometimes before the game has even started. This would be one of the reasons that many states and other nursing organizations are advocating a legislated nurse-to-patient ratio. Why would anybody want to go into a profession if they knew they'd be continually criticized for their inability to carry an unrealistic and unsafe workload? Where they knew they'd work hundreds of unpaid overtime hours every year in order to complete all the tasks expected of them during their shift? Where they knew they'd never have a proper (legally mandated) break from their workday, even just to go to the bathroom? Where they knew that no matter what they do or how well they do it, it is never going to be appreciated by their employer or the people to whom they give their care? Gee, I think I'm going to learn how to hang drywall.
  10. by   willdgate
    I agree janfrn
  11. by   RNLisa
    Quote from janfrn
    I'm sensing a theme in the posts on this forum... med-surg seems to be the leading cause of nurses leaving the field, sometimes before the game has even started. This would be one of the reasons that many states and other nursing organizations are advocating a legislated nurse-to-patient ratio. Why would anybody want to go into a profession if they knew they'd be continually criticized for their inability to carry an unrealistic and unsafe workload? Where they knew they'd work hundreds of unpaid overtime hours every year in order to complete all the tasks expected of them during their shift? Where they knew they'd never have a proper (legally mandated) break from their workday, even just to go to the bathroom? Where they knew that no matter what they do or how well they do it, it is never going to be appreciated by their employer or the people to whom they give their care? Gee, I think I'm going to learn how to hang drywall.
    All I can say is AMEN to that! I agree wholeheartedly.
  12. by   PANurseRN1
    I think sometimes people confuse being "supportive" with "never saying anything that could be remotely construed as criticism."

    You should be getting feedback, both positive and negative from your preceptor. It would be unrealistic to expect her to say you were doing everything right and there was nothing to improve.

    Instead of taking it personally, use it as a launching pad. When your preceptor tells you about something that needs to be improved, ask her "How would you have handled this situation?" or "What do you think I can do to be more organized?"

    It is part of her job to watch what you're doing...that's part of being a preceptor and part of being precepted.
  13. by   RN2B07
    First of all, you CAN do this. I have been working M/S for 6 months and it really does get better. I had a horrible preceptor and sounds like you do too. What really helped me was to make up a sheet that has all info about my pts. and tasks needing to be done. If I need a stool sample, I write it and make a box next to it. Then I check it when its done. Prioritze your day. Things will always come up. Honestly, I left in tears many times. But the best thing for me was coming off orientation. I was scared as hell. But felt free and able to prioritize my own way. You need to hang in there! Give it at least till you are off orientation. Just tell yourself, you are still learning. I tell myself that everyday when I feel overwhelmed. Good Luck
  14. by   bigmona
    it sounds like we have the same preceptor. i have had days like you described and then all she tells me is "you really need to have all your notes done by this time" and asks me twelve times if I've done chart checks. i've tried to explain that i don't know how i could possibly go any faster and i feel like i'm doing the best i can. it's not like i'll forget to do a note if she doesn't remind me. i feel like she thinks i'm a five year old at times, the way she speaks to me and reminds me to do things i already know i need to do. gee, thanks, as if i already wasn't overwhelmed- your nagging really helps me feel less stressed out!:icon_roll not to mention her frequent coffee breaks- and then the annoyed tone i can hear in her voice when i call her phone to ask a question if i can't find her in person.

    at times i think it's okay, when i get off orientation, i will just be that much more resourceful and equipped to handle things on my own. but i also am SUCH a believer in teamwork and it's saddening to realize how alone i feel at times. when i was in school, us students only made it through the day sometimes with each other's help and support.

    i can totally relate to all you're going through and see now more than ever why many new grads don't stay in the profession very long. i'm one of those tempted to leave and i am NOT a quitter. right now i'm choosing to stay based on the fact that others say it does get better after six months to a year.

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