Is There Hope for Me? (Warning....a bit long)

[jfosterrn]

New member, longtime reader. I don't know what is wrong with me. I have had 3 positions in the last year since I graduated and all of them start off great and end up with me leaving over personality issues! I am 41 years old and nursing is a second career for me. I started right out of school in the ICU. I didn't want this, but the manager wanted me very badly and told me not to worry, I'd do fine. I did really well in school and I think that influenced her a lot

When I got to the floor, I realized I was in way over my head, acuity-wise. My preceptor was great, but many of the long time ICU nurses felt that newbies should not start out in ICU (I agree) and were less than helpful to say the least. The unit had hired about 6 new grads. Certain nurses reported every little thing we did or did not do. ICU was not not for me anyway as I enjoy talking to my patients.

So after about 4 weeks, I transfer to MedSurg and all is going great for about 4 weeks with my preceptor who, though much younger than me, was terrific. She then decides to leave for the CCU. I am put with another preceptor (very old school), who is a great nurse, but fairly condescending when she taught. I just could not deal with her style and did speak up for myself, as so many nurses on this website tell us to do. Well, of course that did not make things any better and I lasted for about another 2 weeks. I felt that I might be terminated due to getting a bad evaluation, so I resigned.

Now I have been at another hospital for 3 months and seem to be having similar issues. My preceptor was great and all was good until I got off of orientation (days) and put on nights without a resource person to go to. At my 90 day evaluation with my manager, I get told that I have great skills, am wonderful with the patients, but ask too many questions, and generally talk too much and don't listen well. She never spoke to my preceptor or any of the other nurses that I worked with for 6 weeks. Nor did she ever mention any concerns to me during this time. My preceptor's written evaluation regarding my nursing and communication skills with co-workers and doctors was graded as "meets all standards" and many great comments, yet my manager stated that she was very concerned about these issues that had been brought up after I was on my own

If this is my personality, what can I do to improve the way I am perceived? How can I change? I don't want to blame others for my failings. I feel horrible. Any suggestions, candid as they might be, would be appreciated.

[katkonk, BSN, RN]

First question....DO you talk too much? Do you ask too many questions? What are the questions about...policy? procedure? pathophys.? pharmacology? Are you asking questions just to ask questions? Do you feel that you are being perceived as "too needy"? What do YOU think?

[roser13, ASN, RN]

If I were you, I think I would swallow my pride and set up another meeting with the manager who evaluated you. Take your preceptor's evaluation with you.

Ask for concrete suggestions that will help you address her concerns. Show her your preceptor's remarks as a way of addressing your confusion with your evaluation. Flat out ask how she suggests that you modify your patient care methods and peer interaction.

While it may be in part your "personality," that doesn't mean that you can't change your work habits. As an older nurse entering the work force, I found myself having to modify many habits. (Who says you can't teach an old dog new tricks ) I especially had to stifle myself in situations where I thought I knew best, and learn to listen to those around me. I think it's a hazard of entering a new career with more-than-average new nurse's life experience on board.

Good luck. For your self-esteem and for the sake of your nursing career, I think you need to do whatever it takes to make a go of this position.

[jfosterrn]

First question....DO you talk too much? Do you ask too many questions? What are the questions about...policy? procedure? pathophys.? pharmacology? Are you asking questions just to ask questions? Do you feel that you are being perceived as "too needy"? What do YOU think?

Thanks for responding. Yes, I think I do! But I don't think that I am aware of it when I am doing it. Does that make sense? I am a bit animated and originally from NYC so I am different anyway! But I want to change. I just keep trying, but for some reason I am not successful and don't know what I am doing wrong.

[shoegalRN, RN]

I've learned in nursing it's best to be quiet and observant. Do more listening than talking, even with your patients.

I, too, started off in the ICU and found it was not for me. Not only was I being set up to fail, I figured out that I just didnt have enough experience as a nurse period to be in such a high acute area. I lacked confidence and those who have been in ICU since the beginning of time picked up on it. I was eaten alive every night I went to work. I shut down and didnt want to ask questions in fear of whichever preceptor I had that night would blow the question out of porportion and send emails to the educator and director (as they have done in the past). It was a hard environment to learn in, especially since I felt like I couldnt ask questions.

I am a repetitious learner and I have to do things several times before I feel somewhat confidant with developing the skill. I also need consistancy, and ICU was not the place for that. I felt I needed to develop basic nursing skills before I decided to jump in feet first in such a high acuity area.

So, I switched to the ER and I love it. I found out I really like doing skills, such as IV's, foleys, NG tubes, things of that nature. And it's a gradual process because my ER does not throw you out to the wolves to be eaten alive. You work your way up to the more acute areas, such as traumas. I also found I like my patients awake for the most part.

I am also the type that ask alot of questions, but I don't ask the same questions over and over. I usually ask a question AFTER I have looked something up and don't have a clear understanding of it. I write things down in my folder so I don't have to keep asking the same questions. And I'm building my confidence.

Considering your personality, do you think you could maybe "tone it down" a bit while at work? I am an outgoing person by nature and I enjoy being around people. But when I'm at work, I'm professional, I smile, I talk in a professional tone, and I leave my personal life at home.

Also, ask your co-workers for some constructive feedback so you can work on those areas.

Good luck!

[mustlovepoodles, RN]

I agree, the common denominator is you. Although,you seem to have some insight into your behavior, I'm guessing this might be long-time behavior that you either haven't noticed before or hasn't been brought to your attention.. I agree with a previous poster who suggested that you seek out another meeting with the manager to talk specifics about what you could improve upon and how. It's not enough to have vague goals. Then need to be quantifiable or you're not going to know if you're improving. If the manager is not receptive, then i suggest you seek out a therapist to help you work through your issues. There are lots of reason we are the way we are, but we can't keep doing things that result in a bad outcome thinking we will get different results. There has to be change or you will continue to repeat this cycle.

I think some of your questions probably are a baffle for new nurse insecurity. Totally understandable. Some older nurses like to be in a position of mentoring new nurses. Some do not. It *can* be annoying to work with someone who is constantly talking, constantly asking questions, exhibiting "pesty" behavior. As an older nurse myself, it makes me kinda go "Huh? Did she not go to nursing school or what?"

I iwish you the best. I believe you *are* cut out to be a nurse, but you might benefit from some assistance. You were wise to recognize your limitations early. I couldn't work ER or OR, but I was fantastic in NICU. Go figure. Your niche is out there. You just need to get out of your own way.

[fiveofpeep]

I really hate how often I see people posting about evaluations claiming that the new grad asks too many questions. Its like first they tell you that its dangerous not to ask questions but then if you ask too many they think you're incompetent.

On a similar post a while back, someone wrote something that made a lot of sense. They said that often new grads ask questions to verify their own internal thought process. For example, the new grad is thinking hmm that BSG is really low maybe I should give D50 and then they ask what they should do instead of suggesting it. This is a way to verify your competency without allowing yourself to be vulnerable. This makes alot of sense to me.

People also tell you not to appear pretentious and because of my young age I worry about that so oftentimes I ask a question instead of stating something so I dont come off as a know it all.

There's so many conflicting rules in nursing etiquette.

[PostOpPrincess, BSN, RN]

There is nothing wrong with asking a lot of questions. But you have to be quiet enough to listen to he answers.

[DLS_PMHNP, MSN, RN, NP]

There is nothing wrong with asking a lot of questions. But you have to be quiet enough to listen to he answers.

Very wise, indeed.

[nicole109]

I'm going to go out on a limb here, and I'm going to say, continue to ask questions. Eat me alive if you will...but you just spent however long in school to become a nurse, and like so many others, when you get out there on your own, it's an entirely different ballgame--and if you just try to wing your way through it--there is generally someone's life at stake here. On the other hand, you do have to listen to the answers people give you, and you may have to figure out your best learning style, so that you aren't asking the same questions over and over again. But if you genuinely have questions, then you should be asking them, and if my manager ever put on an evaluation for me that I was asking too many questions, we would have had a problem. As a nurse, or anyone in the health industry, things are constantly changing, and we work in an arena where we should always be learning.

I, too would go back to your manager and re-open the discussion with your manager about things that you can do to better yourself on the unit, this will help you to grow both personally and professionally. Seek out your co-workers as well, use them for feedback, so that you will have someone to double check your meds with or when you need someone to look at your patient if you have a question.

And, stop job hopping! The rest of us are having a hard enough time finding jobs, stay where you are, give it some time. The grass isn't always greener on the other side, and nowhere is going to be perfect. You are now working in an estrogen dominated field...add that to the caddiness, drama, and eat your young attitudes that 50% of the nurses out there have (sorry but it's true), and you are bound to run into problems.

And last of all, good luck, this is a thankless but amazing profession...as you will come to find. You will find your niche, and hopefully fall in love with your job...and there is a lot to be said for that.

[katkonk, BSN, RN]

Adding my

Communication skills are like any other, they need practiced and honed. i.e. Psychologists and clinical therapists do not get to be good at therapy without much practice...over and over and over. Practice focused listening-see if you can mentally repeat back what the person just told you. If you can, you got it. If you can't, then your mind was somewhere else. MAINLY, re: asking questions...often times phrasing the question is what it is all about. Rather than saying "Do I do this or that?" or "What should I do about this?" you can approach the person you want to ask, and say "I just need your wisdom on -whatever-"...This is what's going on (give a BRIEF synopsis) and I'm thinking that I need to do this, (and tell them the rationale for your proposed course of action) but I just want to make sure that I am on the right track. Then they know that you have thought it out, asked a question in good faith, and if you are on the wrong track, they will tell you. If you are right, all they have to do is say, yes..you are right. How you approach people makes the difference. I also agree, if this is a trend that has been in the making for many years, perhaps a few sessions with a counselor/psychotherapist in which you practice communication and listening skills may help. I took many psych. counseling courses when I was in college the first time, and professional (and therapeutic) communication is not as easy as it looks or sounds. Also, if your review says "meets standards" then just go on from there. If you re-hash with your boss, it may seem like you cannot accept constructive criticism, and it may do more harm than good in the long run. And...as already mentioned...stop the talking! Co-workers need to concentrate on what they are doing, and their patient's problems are. Speak professionally and talk with others WHEN appropriate, otherwise put a sock in it ! I mean that in the best possible way :)

[kanzi monkey]

T I am a bit animated and originally from NYC so I am different anyway! But I want to change. I just keep trying, but for some reason I am not successful and don't know what I am doing wrong.

I think I get where you're coming from. My whole life I have either "really fit in" or "really NOT fit in". Unfortunately, in my first few years of nursing I've found that I don't naturally fit in with nursing culture--or healthcare culture, honestly. It's been kind of painful and I've found myself being very hard on myself at times. I've learned a lot about negotiating stressful interpersonal situations. Definitely don't have all of the answers for you, but maybe a few words of advice. First--really observe what's happening around you. If you feel like someone that you don't know very well (ie, all of your co-workers in a new job setting) is treating you unfairly don't react or say anything right away. After you've worked with that person a little longer you may understand a little bit more where they're coming from. If they're truly being nasty, at that point you can tell them so. One of my favorite co-workers is someone who I thought was an evil b!@t%$ when I started my job. And she kind of is--but now that I know her I also know I like her for reasons I couldn't have predicted when we first met. Second--think about what you're asking when you have a question. If your question relates to a patient you are IMMEDIATELY worried about, ask it and don't second guess yourself. If you have a less pressing question--about a policy, a medication, a disease, etc, remember to ask yourself the question first. As a new nurse I made the mistake of thinking that senior nurses were familiar with most policies/treatments, etc. They're not. But they DO know how to look things up or find out things on their own. Learning to find resources on your own will help you loads--and helping you learn where to find them IS part of your preceptor's responsibility. Of COURSE you will always have other questions you may want to bounce off your colleagues--but only after you've done your own research.

Finally, don't try to change who you are. Just don't. Give it a little time.

Best of luck!

-Kan