New RN Grad Need Guidance Please :()

  1. 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!
    Last edit by tnbutterfly on Oct 20
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    About NewICUNurse93

    Joined: Oct '18; Posts: 6; Likes: 1

    32 Comments

  3. by   beekee
    In your next meeting with your manager, ask if you can transfer to a lower acuity floor (med surg). If no, be prepared to resign. I'd start applying now, as it's always easier to get a job when you have a job.

    You seem overly focused on "tasks" and "administering medications on time." It also doesn't sound like you are really hearing where you are failing. I get the feeling that you keep doing the same thing, despite guidance otherwise.

    I can't really evaluate whether your preceptors' treatment has been justified, but if you had three preceptors and two felt you weren't up to it, well, it sounds like this just isn't where you should be right now. However, it doesn't mean it won't be right later, after some experience elsewhere first.

    Good luck. Keep us posted.
  4. by   NewICUNurse93
    Ok I'll bite.. what exactly do you mean? The patients are acute but I had orders/daily plan of care that has to followed along with assessments every 4hrs and meds give or take every 3 plus labs which can be any time frame.. are you saying I shouldn't be task orientied? And more? Please clarify to help me out.. also should I ask for a night position? I don't want medsurg I worked as a tech before hand I really just want ICU
  5. by   Newgradnurse17
    Right so first you are being way to defensive.

    When I first started as a nurse I got some bad feedback. Mainly about not being a team player and my documentation. It was heart breaking. I totally cried when I was meeting with my boss, and I'm not normally a crier at all. I felt like I was doing a good job, and suddenly I felt I was a bad nurse who no one wanted to work with.

    It was really hard time, and I really had to go over and above to prove to people I'm good at my job and can be a team player. But I learnt from it. I took the Feedback on board. I was more aware of what I was doing wrong, which meant I could change what I was doing. And I learnt to ask for help.

    Instead of being angry and thinking I knew it all, I ask staff what can I do? I need help with this. Admitting you were wrong and putting in the effort is what's got me to where I am today. Reputation fixed. Enjoying my job more than ever. Full of confidence.

    So while you are still there, ask for help. Talk to your boss and preceptor. Know what your weakness are. There's no need to be denfensive here. They've been talking to you early on and given you a chance to improve. Thinking that you doing well, or that this preceptor is bad, Or that just because your 'cool' with someone that you will automatically get a good mark ect is not going to end well.

    Take the chance to prove yourself. It's hard for all new nurses, no matter where you work. We all have things we need to work on. Don't take it personally. And if you don't feel like it's a good fit, reach out to that person and see if you can move else where. But expect it to be any easier if you move.
  6. by   Newgradnurse17
    Quote from NewICUNurse93
    are you saying I shouldn't be task orientied? And more? Please clarify to help me out..
    no. Never task focus. It's always person centred care where ever you work. You have to see the pt as a whole and not just focus on your tasks.

    Also med surg isn't that bad.

    Also people are trying to help. You can't keep being defensive.
  7. by   beekee
    I'm not there, so I'm only really guessing. Yes, you seem too task oriented. For every medication, you need to know why it's been ordered, what to watch for and it's desired effect. On time is nice, but I'd rather see you think through why you are giving a med.

    So, for a common medication like lasix...what are the labs? Did you check the BUN, liver enzymes and electrolytes? What's the blood pressure? If it's running low, do you want to lower it more? What does your assessment tell you? Is the patient fluid overloaded or are they euvolemic or even dry? Is it appropriate to give?

    After you give it, what was their urine output? We had a new grad not notice that the patient did not void for an entire shift after getting IV lasix. What's the fluid status post administration? And adverse reactions to the medications?

    Nights are not necessarily easier. Less staff around, so if you run into a problem, you better be pretty confident in your skills to address them. When you are meeting with your manager, it can't hurt to try at this point. You really have nothing to lose.
  8. by   JKL33
    I'll give you this much: 8 weeks is a BS expectation for a new-grad trauma ICU orientation. I think it is complete crap to not give regular verbal feedback during orientation and maintain a written progress record. It makes me crazy to hear of experiences where orientees are not given appropriate feedback and then are ambushed with it when it's too late to do anything about it. I'm guessing there's a decent chance a couple of these people do suck, completely separate from the success or lack of success on the part of any particular new grad.

    I'm also pretty sure all of that is irrelevant as far as you moving forward. Go to your current manager and calmly/professionally ask whether there is still a realistic a chance for you to complete the orientation and how you can get to that point. If they don't give you a very reassuring answer, consider asking whether it would be appropriate for you to request assistance in finding another unit/floor that may be a better fit. If they agree to help you with this, take the new position. If they say they can't or won't,thank them for this learning experience and (be prepared to) tender your resignation.

    Also NewICUNurse, I'm sure this has been very stressful, but now that you have it off your chest it would be best to take a deep breath and bring things down about 10 notches if at all possible. You asked for suggestions - my best guess is your communication style is in play here and also possibly difficulty focusing on what's important/big picture. Regardless of outcome, you're going to have to privately take an introspective inventory of what has happened here. For now, stay calm and professional so that you have the best chance of moving forward.

    Sorry to hear of your experience.
  9. by   NurseCard
    Two things that are very common with new grads:

    1) They often do not do well going right into ICU.
    2) They often "do not know what they do not know"

    There's nothing wrong with doing something a bit less acute like Med Surge
    for a while, and then trying ICU again. Nothing at all. You sound young.
    You have nothing but time to learn.

    You also sound very confident. Maybe a little bit too much so.
    Again, it sounds like you have a lot to learn. Your preceptors are
    likely not giving you low marks because they don't like you, or
    are trying to give you a hard time. You aren't asking questions.
    You basically said yourself, you are trying to figure stuff out on
    your own. You can't find your preceptor? Ask someone else.

    Good luck. You'll be okay.
  10. by   LovingLife123
    When they say you aren't assessing well, what does that mean? Are you missing things, or just not putting together what you are assessing into the big picture? Are you not taking action on your assessments?

    It's common for new grads to be task oriented. It can be hard to get them out if that mindset. It also takes time. 8 weeks is not a very long orientation. 12-16 in a level one trauma icu is more ideal.

    I agree that instead of getting defensive, you need to really listen and take to heart what you are being told and work on those things. I would want to know what exactly is going wrong with my assessments and what can I do to improve. I would be calling my preceptor in after my initial assessment and see if they agree with my assessment.

    Do not worry about whether or not you should be getting out "on time" with your charting. It surprised me that only 6 weeks in, you are getting out on time. You should be having days that you feel like you are drowning and the last thing on your mind is charting. That leads me to believe you are missing things on assessments. Or you are seeing things, but not acting on them.

    Have you had any of the sicker trauma patients yet? What kind of trauma patients have you been getting?
  11. by   AnnieOaklyRN
    I honestly didn't read your whole post, as it is longer then my attention span. My thinking is talk to your manager about extending your orientation and just having 1-2 preceptors, NOT 5!! The problem with having numerous preceptors is that you never get anywhere with your learning because you are always starting over, or starting beyond where you were with the last preceptor. Just my 2 cents!

    Annie
  12. by   Triddin
    Quote from beekee
    I'm not there, so I'm only really guessing. Yes, you seem too task oriented. For every medication, you need to know why it's been ordered, what to watch for and it's desired effect. On time is nice, but I'd rather see you think through why you are giving a med.

    So, for a common medication like lasix...what are the labs? Did you check the BUN, liver enzymes and electrolytes? What's the blood pressure? If it's running low, do you want to lower it more? What does your assessment tell you? Is the patient fluid overloaded or are they euvolemic or even dry? Is it appropriate to give?

    After you give it, what was their urine output? We had a new grad not notice that the patient did not void for an entire shift after getting IV lasix. What's the fluid status post administration? And adverse reactions to the medications?

    Nights are not necessarily easier. Less staff around, so if you run into a problem, you better be pretty confident in your skills to address them. When you are meeting with your manager, it can't hurt to try at this point. You really have nothing to lose.
    I agree with this. Again, with only what you've said, we are guessing at what's going on. However, I know when I'm learning a new task, I'm initially focussed on the mechanics of how to do things and my critical thinking isn't there because I haven't had time to develop it. However, you can bet I'm asking questions to make sure I don't miss anything.

    However, to be like that in ICU for everything is dangerous because you don't know what you don't know. You need to be able to evaluate of orders are still relevant for your patients, what's happening based off your assessment and labs.

    New grads arents allowed in ICU where I am and as someone who transferred from med surg to ICU, there is value in having time to learn how to be a nurse, do skills and start thinking critically without the added pressure of having a patient who could die who is on extra machines. It's just an additional burden on top of an already steep learning curve..

    I would say nights are equally busy in ICU but you have less staff to support you. i agree asking if you can step down to a lower acuity unit may prevent you from being fired and will give you a second chance at staying at the hospital you really enjoy.
  13. by   NewICUNurse93
    I felt like whenever I asked questions they'd write it down and use it against me in our weekly meetings like he ask for clarification about this and he's done it once before etc so I kinda got to a point I'd ask something they spend 30mins talking about it and I'll get super behind and they said why was I behind on meds/task or documentation plus he didn't understand blank blank task and asked for clarification after being told once before... like something it's not that I don't understand it that I want to have my preceptor reaffirm what I knew just to ensure since I'd only done it once before
  14. by   DextersDisciple
    Okay a few things that stood out to me:

    -preceptor not giving you real-time feedback and as a result feeling blindsided when your called into the mngers office

    I absolutely hate that and understand your frustration. In an effort to do your best To fix this- ask your preceptor to give you feedback when they see something that need to work on/do differently. If they don't, at least you know you tried on your end.

    -task oriented is expected but not necessarily correct
    I agree that new nurses are very task oriented. The critical thinking comes with time and lots Of it. I still need to Focus more on critical thinking skills and a little less on tasks. But again this is expected from a new nurse and will change over time.

    -8 week orientation is BS
    most I've seen, including my own, are 12 weeks. You should not feel so confident and getting out on time within 5/6 weeks in an ICU as a new grad. I know I was still scared crapless of being on my own after 12 weeks.

    -humility and respect are key as a new nurse
    Over Confidence in a new grad can quite frankly really worry preceptors. They WANT You to ask *appropriate questions (ie things you have already tried looking up first Or can be easily Looked up, not asking the same questions Over and over). They don't expect you to know it all and it is NOT good if you feel competent this early.

    Lots of sage advice throughout the thread that I hope you take. It sounds like your
    Unit Orientation may be flawed but you also need to work on improving on you. If they still aren't satisfied then at least you know you tried your best. Good luck with everything and keep us posted!

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