Trying to learn from mistakes

Extra Pickles · Aug 19, 2016

Hi
So I am a new nurse and I was fired from my first job after a month. My preceptor and I didn't get a long and as much as I tried to figure out ways, we clashed a lot. I didn't want to get my manager involved just yet, but by the time I felt it was necessary, it was too late. I know I can come off strong, and when I am confused about something, or felt that it was unsafe, it was easy to question my preceptor because I didn't feel comfortable. My preceptor had a few times went outside the scope of practice and that ruined my faith in them, and often times would force me to change my assessment to something that I felt was an inaccurate picture or left things out that I felt were necessary to give a bigger and more accurate picture of the patient. In addition, I felt I was scolded from checking my patient too often (who were kids btw) when the alarm would sound, and then I erred by not checking them enough and couldn't seem to find balance to them. Also, I felt I was misaccurately represented to my manager, and when I would explain what happened they would say, "that doesn't sound like so and so" and I realize that human nature tends to trust those who know in longer, but it sucked. Another instances, I had checked the a pt who needed more O2, because O2 was low, and I stimulated them by tapping on their chest ( as shown to do) and checked their mask and it didn't increase their stats so I increased the O2, but was then told I didn't assess enough before deciding to increase O2, and should have called my preceptor before doing that, when it felt that my preceptor had put me in charge of this particular patient when a friend went on lunch and did what I was instructed to. I was told I was being confrontational when I said, "I was doing what I was instructed to do to keep their sats up" too loud when my preceptor scolded me from doing that...and now I find myself without a job, and it was already hard to find a job as a new nurse, now even more difficult for being let go from my first job....I am not even sure how to recover from this or anything...

If you don't want to repeat the firing process you'll have to take responsibility for what happened that got you fired the first time. You have a long list of issues in which you felt wronged, you weren't understood, you feel you did things exactly right but others found them wrong. You were told you were coming across as confrontational. but after all that you only give excuses as to why you were right, why they were wrong, and how you shouldn't have been fired.

the way to recover and move on is to learn from your mistakes. everything you wrote says you haven't.

ottersloveoysters · Aug 19, 2016

Just to understand the full picture, what reason did your manager give for letting you go?

I see a couple red flags here. You say "I know I can come off strong...." so how would you approach things differently in the future? How would you change your tone or phrasing?

A month is not a long time. You say you and your preceptor did not get along. Were things ever going well? At what point did the situation start to seem tense/uncomfortable? What would you do differently if you encountered the same feelings in the future?

Learningtobenurse101 · Aug 19, 2016

The manager let me go for being confrontational with my preceptor, and for the fore mentioned not checking the pt enough/overly checking the pt balance issues, and the O2 mentioned above, and also confiding in someone about my preceptor and trying to figure out ways to handle it without going to the manager instead.

I guess one thing I would do differently is to start with statements like, "I feel" "I am concerned about.." "I am uncertain about this" "could you please clarify" "could you please teach me". Though when I tried to ask her questions, I felt stifled and my preceptor wasn't open to it so I had to seek out other ways to obtain information, that should have been a red flag to me, but I am not even sure my manager would buy it considering she said, "that doesn't sound like the x person I know"...well...that just is a sucky feeling not being trusted, do you have any ideas?

Originally my preceptor and I got along mainly because I felt like she trusted me, and also, she always stated that the assessment is my own, and what you see, so it can't be wrong as long as you are documenting that way, but then she kept wanting me to change it and made me feel uncomfortable about that...that maybe started a week in or so. Then about 2 weeks in is when she did things that were out of scope of practice and I mentioned that to them, but also felt very uneasy trusting her much after that and was more on my tippy toes/feeling like walking on egg shells.

I guess what I would have done differently is expressed my concerns also early on, and maybe I could have been set up with a different preceptor early on, and maybe that would have made things different...

I am very protective of the pt population and unfortunately can come on strong when I felt like their safety was put at risk, and I need to learn how to be a better advocate for my patients..

Any thoughts?

Learningtobenurse101 · Aug 20, 2016

I feel that my problems came from a lot of miscommunication, and that is the main thing that I am taking from this. I needed to learn how to better approach the individual, and when to get my boss involved rather than having my pride in the way to get it resolved. Unfortunately, it was my pride that caused my fall. In addition, better strategies on how to communicate can help decrease the chances of being viewed as confrontational. Do I felt that I was wronged? Heck yes I do, however, I didn't help the issue either by not communicating effectively which is what I believe caused the root of this issue.

I don't feel my preceptor was a good fit for me, nor a very good teacher since they did stifle my curiosity in trying to understand the floor by telling me to be a "yes ma'm" quite almost in those exact words. I have no problem following instructions as long as I don't feel it is unsafe for a patient, and have no problem questioning when I feel it can be unsafe for the patient. The trick is, how to go about it, and that I do not have down, that I do need to learn to achieve because I do know that it isn't just what I say, but how I say it.

And there are plenty of things that I felt that I did wrong, such as, I should erred on the side of over checking a patient than under checking a patient. That was my mistake there. I should have assessed more prior to increasing o2, maybe it would have been unnecessary and an easy fix. Also, I could have tried harder to get a hold of my preceptor and/or the other nurse, though in this case, what I would have done differently since I tried to get a hold of them and couldn't via our communication device, is stepped outside the door and grabbed someone to go get them.

Unfortunately, this particular floor that I am on does a lot of things incredibly different than almost all floors, and I was relying on previous knowledge from my school and other clinical experience of what I was taught to do, and didn't realize to the extent of the differences until it was too late.

Learningtobenurse101 · Aug 20, 2016

Also, to be fair for my learning process, it happened yesterday, so please give me a little of a break while I am trying to shift through all of this and learn from it.

meanmaryjean, DNP, RN · Aug 20, 2016

What exactly do you feel your preceptor did that was outside the scope of her practice?

Been there,done that, ASN, RN · Aug 20, 2016

The manager let me go for being confrontational with my preceptor, and for the fore mentioned not checking the pt enough/overly checking the pt balance issues, and the O2 mentioned above, and also confiding in someone about my preceptor and trying to figure out ways to handle it without going to the manager instead.
I guess one thing I would do differently is to start with statements like, "I feel" "I am concerned about.." "I am uncertain about this" "could you please clarify" "could you please teach me". Though when I tried to ask her questions, I felt stifled and my preceptor wasn't open to it so I had to seek out other ways to obtain information, that should have been a red flag to me, but I am not even sure my manager would buy it considering she said, "that doesn't sound like the x person I know"...well...that just is a sucky feeling not being trusted, do you have any ideas?
Originally my preceptor and I got along mainly because I felt like she trusted me, and also, she always stated that the assessment is my own, and what you see, so it can't be wrong as long as you are documenting that way, but then she kept wanting me to change it and made me feel uncomfortable about that...that maybe started a week in or so. Then about 2 weeks in is when she did things that were out of scope of practice and I mentioned that to them, but also felt very uneasy trusting her much after that and was more on my tippy toes/feeling like walking on egg shells.
I guess what I would have done differently is expressed my concerns also early on, and maybe I could have been set up with a different preceptor early on, and maybe that would have made things different...
I am very protective of the pt population and unfortunately can come on strong when I felt like their safety was put at risk, and I need to learn how to be a better advocate for my patients..
Any thoughts?

Care to elaborate on "confrontational"? There are right ways and wrong ways to question policy and procedure. I suspect your inquiries included inappropriate tone of voice and body language.

In the future.. remember, you are not in the place to question your preceptor. Keep you head down.. get through orientation and then you can practice as you see fit.

Best of luck in your next endeavor, let us know how it's going.

Learningtobenurse101 · Aug 21, 2016

In this case, that part isn't in question. Without going into detail about it, everyone agreed that it was out of scope of practice including managers.

meanmaryjean, DNP, RN · Aug 21, 2016

In this case, that part isn't in question. Without going into detail about it, everyone agreed that it was out of scope of practice including managers.

It was important enough for you to mention it in your original post. I will ask again, what was 'out of scope of practice'?

Ruby Vee, BSN · Aug 21, 2016

The manager let me go for being confrontational with my preceptor, and for the fore mentioned not checking the pt enough/overly checking the pt balance issues, and the O2 mentioned above, and also confiding in someone about my preceptor and trying to figure out ways to handle it without going to the manager instead.
I guess one thing I would do differently is to start with statements like, "I feel" "I am concerned about.." "I am uncertain about this" "could you please clarify" "could you please teach me". Though when I tried to ask her questions, I felt stifled and my preceptor wasn't open to it so I had to seek out other ways to obtain information, that should have been a red flag to me, but I am not even sure my manager would buy it considering she said, "that doesn't sound like the x person I know"...well...that just is a sucky feeling not being trusted, do you have any ideas?
Originally my preceptor and I got along mainly because I felt like she trusted me, and also, she always stated that the assessment is my own, and what you see, so it can't be wrong as long as you are documenting that way, but then she kept wanting me to change it and made me feel uncomfortable about that...that maybe started a week in or so. Then about 2 weeks in is when she did things that were out of scope of practice and I mentioned that to them, but also felt very uneasy trusting her much after that and was more on my tippy toes/feeling like walking on egg shells.
I guess what I would have done differently is expressed my concerns also early on, and maybe I could have been set up with a different preceptor early on, and maybe that would have made things different...
I am very protective of the pt population and unfortunately can come on strong when I felt like their safety was put at risk, and I need to learn how to be a better advocate for my patients..
Any thoughts?

A different preceptor may not have helped you much, even assuming that there WAS a different preceptor for you. Sometimes there are barely enough preceptors to go around.

You say your preceptor started out trusting you, but that changed. Your assessment was your own, but you say she came to suggest changes in your assessment. You seem to think she wanted you to change your charting, but I am wondering if she saw things in the assessment that you missed or interpreted incorrectly and was trying to get you to see those things as well. The statement that your preceptor started out trusting you but then lost that trust in you is a red flag to me. You did something to make her lose trust -- whether than was inaccurate assessments or "coming on too strong" or something else again.

Your preceptor is an experienced nurse; you were brand new. So are you SURE you weren't missing something? Are you SURE she was practicing outside her scope? That seems like something most precpetors would avoid teaching.

You seem to be making excuses and failing to take responsibility for your own failures and placing your judgement above that of an experienced preceptor. Please think long and hard about that.

Libby1987 · Aug 21, 2016

When a new nurse is hired, the hiring managers are hopeful and the preceptor, whether wanting to precept or not, is motivated to increase staffing. They definitely start out wanting the new nurse. It's not until further into the orientation that it becomes evident that the new nurse isn't going to work out. The new nurse rarely looks inward in these cases, in my experience. Denial is powerful. And complicated by not yet realizing their knowledge gaps. Which then turns into the new nurse making something of a straw man argument, which further supports that they're not going to work out. Managers learn to not to drag out orientations that are unlikely to be successful.

I've read a lot of new nurses accuse their preceptors of being unreasonable or difficult to work with, I've experienced it myself as well. I'm beginning to think that the more the preceptor is claimed to be difficult to work with, the deeper the denial and the wider the knowledge gaps of the new nurse.