New RN Grad Need Guidance Please :()

Nurses New Nurse

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Hello everyone!

So where to begin.. I'm a new grad working on a level one trauma ICU and my orientation period is 8 weeks. I've completed 6/8 weeks and it's been a learning experience for sure considering it's my first job as a nurse. But now I'm in a dilemma with my new nurse job, and I'm really seeking out realistic answers to my problem because I don't have any family that can directly relate to my situation to give good advice (working in a hospital setting and understanding patient care/being a new nurse/school) so here it is..

I started working this job without the expectation that'd like trauma ICU, and find out I love it! Anyways the dilemma part... I'm afraid I'll be fired before getting off orientation/at the end of orientation. This is a problem for me for two reasons. 1st-I love the hospital, it's where I wanna work and just happens to be a university so I can go back to school, but if I'm fired/terminated I can't be rehired? 2. I don't wanna quit my job, I love it.

My orientation has been weird, I've had 5 preceptors during 6 weeks. 4 weeks were with just one preceptor and this guy gave me high marks on my weekly evaluation. 1st week 4/5 in all categories..2nd week 4/5... so he doesn't fill in my 3rd week or 4th week until I start my 5th week told me "I'll sign it when I get a chance etc" I figured no problem, I've been doing good we were cool its just a checklist, patient care 1st right?..

I come in my 5th week and I get called into my managers office to evaluate my performance, so I come in there and find out my 3rd and 4th week we're both 1.5/5!!! Like where did this come from? I haven't killed anyone, meds in time, labs on time, never leave late for charting, my charting is decent (charting is difficult when balancing patient care depending on the level of acuity for the day especially as a new grad most of my questions were about charting/policy) so basically we have an hour and half long meeting talking about mistakes I've made (what the ****?!!)...

I'm clueless that I was even making all these mistakes because my preceptor never said a word to me. Then I have to read a sheet of paper basically saying if I don't improve/show signs of improvement by the end of orientation I'll be terminated.....I was mind blown about the whole thing, and to be honest which is typical to say as a new grad but I felt I was doing really well considering I was by myself most of weeks 2-3-4, meaning unable to find my preceptor at all and directing patient care, but I made mistakes here and there I didn't always have a resource (preceptor) always available but I try to figure **** out myself or ask someone else..

So I mention this to my manager that these evaluations are a surprise to me because he hasn't said a word to me, and I feel like I've been caring for patients without him even around to ask questions.. so long story short my manager probably thinks I'm an idiot after that meeting.. we swap my preceptor out with someone else. Guess who? The woman who made a new grad who went through orientation with me quit on her second day during lunch and just never came back (btw she precepted there).... But I buckle down work twice as hard, because I felt I had to change my managers mind after that crap.

So I start my 5th week had two preceptors the woman who made someone cry/quit and another girl. The other girl really liked me even went by the manager office to put in a good word for me because she knew of my situation and we have a busy good day, so we got along great. The woman who made a new grad quit was decent to me but really surprised me when she rated me so low on my 5th evaluation 2.8/5 I had her for 2/3 days for my 5th week so she got my weekly evaluation over the over girl.

Fast forward she gives me 2/5 for my 6th week.. says I don't assess my patients correctly told me to check the monitor and check residuals before completing my initial head to toe Assessment (what the..**** is she talking about??) anyways we had a almost two hour conversation where I had to defend myself and my right to work there even after all my tasks and meds were completed on time that day she in her own way tells me that maybe this isn't the right place for me at the end of conversation. To which I just thank her for her opinion but say I'm completely committed to proving I'm a good fit and I want all the feedback I can get..blah blah was probably what she thought when I said that but it's true I'd really like to be given more direction to do well it is a morning position I'd even do nights if I had too. Supposedly nights are a "different beast" but I've heard it calm and they aren't as clicky as the morning crew ( only a few come to mind)

Problem is what's gonna happen when they see my evaluation is worse than my last week? What do I even say when I feel like she being nitpicky about the order in which I do things (all on time btw just not in order she apparently had told me) I don't wanna get fired because then I won't be able to afford school in the spring.

Do I turn in my 2-week notice? So I can still be hired by the hospital? Or reaching to our chief of nursing who told my class in orientation to call her if orientation wasn't working out and she'd try to find a better fit in a different department? Ideally, I'd like to stay but from a logical point of view if 2/5 of my preceptors don't like me and I've been with them the most I can't really say much. What should I do?

Sorry this was way too long I've literally got no one right now to share this with... I appreciate the input!

Specializes in ED, med-surg, peri op.
But expect it to be any easier if you move.

DONT expect. Oops.

It won't be any easy.

I'm in my first job as well. My training/orientation is 12 weeks. With my preceptor, feedback is immediate. I find this helpful as I can correct things immediately. I also thank him for his feedback. Day one my preceptor told me that he likes to train people and if people leave soon he takes it personal. Listen to what he says, just improve week after week and we're good. He'll look at my documentation and I'll have feedback by the next shift. Past few times I had to ask if there was any feedback on documentation and was told keep up the good work. We sit at the end of every day and discuss how I felt and his observances. As time has passed, I've gained confidence and the talk consists of what to work on next shift. Now it's gaining new skills as opposed to improving things learned. I only have a few weeks of orientation left at this point.

While I sympathize that having that many preceptors and no feedback is frustrating, you need to take a big dose of humble and never assume anything. Ask daily for things you can improve on. Training is a two way street. You also need to voice you want to learn an improve daily instead of just during weekly reviews. I'm in a different field but don't think the amount of orientation time is fair for all you need to learn. Maybe for someone with experience in a med/surg but certainly not a new graduate. My unit manager offered to extend training if the person feels they need it. I am the middle of 5 new people on the unit. It costs a lot to train you and am not sure why they'd invest the time in the first place if they didn't want you to succeed.

Best of luck to you

Specializes in Tele, ICU, Staff Development.

We were all task-oriented before we got the big picture.

I too am a new grad nurse. I am working in a trauma one CVICU. This coming week will be my fourth week off of orientation. I completed a 12 week orientation and I was previously a nurse extern for one year on the unit while in nursing school. I have seen experienced nurses with several years of experience in med-surg, ER, and even other ICU's come to this unit and struggle. Even now I go to work every shift with the fear of God in me. These types of units are not for the faint of heart that's for sure. I agree with several of the previous respondents in that your first step now is to have a realistic discussion with your manager and educator. It is not impossible for them to offer a lengthened orientation for you if they/you feel it could be beneficial. In regards to feeling uncomfortable on the unit or with the patients (new admits, surgical pts, crashing pts etc.) you, as I do, will continue to feel that way for the foreseeable future. As far as the assessment issues go, as you feel more comfortable the processes will start to become second nature. You will begin assessing the whole room, situation, monitor, patient and even visitors/family without even realizing it. The only other advice I have is to be proactive in everything you do. If you have an issue/question and your preceptor is not available there are multiple other resources on unit. Pod charge, unit charge, senior nurses, NP/PA, resident, fellow, etc. One of my preceptors told me something early in my externship that I have thought of at least once per shift as a nurse. I asked him if he thought that I should let the Dr. know about a change in a patients status relating to vitals. He said, "It is always ok to ask and to inform the team, it is not ok to miss something". Hopefully you will be able to figure something out that will be beneficial for you and the unit as a whole. Lastly, I have never heard of only eight weeks as an orientation in the ICU. Did you complete a classroom based portion first? Critical care classes etc? Best of luck!

Specializes in ED, Cardiac-step down, tele, med surg.

8 weeks isn't long enough for a new grad. Most new to specialty orientations for experienced RNs are 12 weeks long. You should have been given feedback after every shift and meetings every week with the NM. With that said, taking feedback, both positive and negative is an important skill to learn. It should involve a conversation on how to improve moving forward with specifics. It dosen't sound like that's what you are getting. I would have a frank discussion with your NM, tell her how much you appreciate the training you are getting and expain what you think you need moving forward or that you would like to transfer to a lower acuity unit.

I started on a cardiac step-down unit and now work in the ED. I was a very good student in nursing school but don't think I could have cut it in a critical care unit as a new grad. Now you know what you really love and have a goal in mind, to work in the ICU. Building your skills by going to med/surg for 1 or 2 years would only help you. You'd still learn a ton of stuff and gain more confidence too. Try not to take this experience personally, use it as a lerning experience to grow.

Specializes in anesthesiology.

Sounds like you're in a toxic environment, I'm sorry. I think your best bet is to figure out how to play the game and just survive through this training period. You should try to find out the policy if you "don't make it." I think our hospital would relocate you to a lower acuity unit if you didn't get through the training.

Specializes in anesthesiology.

All that is normal, I would have never been able to handle that on my orientation and you shouldn't have to either. I was a new grad into the ICU. I was a tech in a different ICU during nursing school and was a straight-A student with my full-time tech job, and that patient scenario is completely unrealistic for a trainee to handle. And the fact your preceptor gave a "whole bottle", whatever that means, like 2-5 mg Versed (not a ton of medication) makes it sound like she's an idiot for saying she "almost killed them." Patient would have went to sleep, that's about it.

Specializes in anesthesiology.
I will admit there was one day was not so go good was definitely a humbling day having two patients with no report from previous nurse one was bleeding out (new adm.) and the other is trying to actively extubate himself.. I was probably all over the place since my preceptor was the first one 1-4 weeks and he was like you got em let me know if you need help... but that was weeks ago and my really bad day (I felt overwhelmed by it and owned up to it later) that I was like woah I need to really learn from this.. otherwise I feel like I've been doing really well with Assessment, careplans, communicating with our team, helping neighbors, meds, and labs... I'm weak on admitting patients an hour and half before my shift ends (it freaks me out but not because I have to stay late but because I don't look like an employee running the clock) like it's soo much and I need help in that area but it seems they believe I should be making vast improvements when they said my first 4 weeks won't count because we have no idea where you actually are.. now 2 weeks later I'm being told by my preceptor you aren't ever doing stuff right.. yet my assessments/orders/meds/prodcedures are on time and I'm always asking questions and open to criticism, even though I've barely at all been praised for what I am doing right

All that is normal, I would have never been able to handle that on my orientation and you shouldn't have to either. I was a new grad into the ICU. I was a tech in a different ICU during nursing school and was a straight-A student with my full-time tech job, and that patient scenario is completely unrealistic for a trainee to handle. And the fact your preceptor gave a "whole bottle", whatever that means, like 2-5 mg Versed (not a ton of medication) makes it sound like she's an idiot for saying she "almost killed them." Patient would have went to sleep, that's about it.

Specializes in Critical Care; Cardiac; Professional Development.

Honestly? It is impossible by your posts to tell exactly what is going on other than that you aren't a good fit for this group of people. That could be them, could be you, probably a combination of the two.

Request to transfer to another floor. I understand you only want ICU, but presumably you also want to eat and pay your bills and continue to grow and develop. You won't always get to have what you want right out of the gate but that doesn't mean you won't get it in the long run.

Good luck and I am sorry you are hurting. I think it sounds like you have a lot of potential.

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