Help for crazed TEN?

[WendyP61]

I am a trainee enrolled nurse on my first ward placement. Went very well with first TAFE block and was looking forward to practical application of the theory buddied up with one or two RNs (as has been the case for others in my group).

Turns out things are a little more DIY on this ward than I'd anticipated. Having trained staff myself in my previous life, this is very disappointing.

Maybe it's the give them enough rope philosophy - either hang themselves or run with it. I am still trying to work that out.

The NUM is related to the Invisible Man and I found out for sure that I had a preceptor when he decided to introduce himself after I had been on the ward for 2 weeks ... sort of remember a preceptor was mentioned but I've been too bamboozled with everything else that's going on.

A week ago I was ready to walk away and forget the career change. If this was what being TEN was all about, how was I going to cope with being an RN?

One of my assigned patients was transferred to rehab minus dressings on a couple of JUST healed skin grafts. When I asked what I should do with her earlier in the shift the reply was "Oh get her showered and packed up ... " supplemented by " ... and give the ambos the big envelope out of her patient file ..."

OK - reading the transfer procedure in the ward info folder (assuming I ever have time) is now on the agenda, but shouldn't a more senior member of staff have actually CHECKED the patient physically before they wheeled her away to see if her wounds were adequantly protected?

I still have visions of the grafts peeling off at the other end when they pulled back the blankets.

The rest of that afternoon was spent looking after an occasional incontinent patient; one who couldn't use her arms and another who was a very agitated first day post op. The latter didn't get moved or washed until very late in the day, also missed some of her medications.

If DIY is the name of the game when it comes to training, so be it and maybe I am just experiencing an unexpected effect of the RN shortage first hand.

Any tips for task prioritisation, or is it Murphy's law that I will have one patient nicely soaped up in the shower when another will page with a sudden (urgent) need to be assisted to the loo? Oi vay.

How about optimal placement of the pan? I seem to be doing a lot of pushing and shoving - and now understand why we encourage early ambulation! Had a bit of a disaster with "angle of trajectory" on a female patient - overshot the front of the pan. She was a bit on the plump side, are skinny patients easier to position?

Am I just being too hard on myself as the TEN co-ordinator seems to suggest? I don't expect to be performing brain surgery by Week 3, but I also don't feel like the theory is gelling in practical terms.

PS

What is hospital etiquette about leaving at the end of shift?

In my previous life, one was paid to work certain hours - yet I found myself being laughingly questioned by a CNS the other day who wondered why I was still on the ward when others on the a.m. shift had (in his words) "buggered off" at least 20 minutes earlier.

I had noticed some familiar faces were missing, however, being an obvious newcomer to the ward, didn't want to be perceived as "slinker" - the minute I handed over my pager. The CNS made me feel like a prize bunny - should I slink with the rest?

[Clarissa26]

Well, I trained an an EN before completing my RN training, with both being on the ward is always a big step up, but then step from being on the ward as a student to being a nurse on the ward is even bigger.

I have to say that having your preceptor introduce himself after 2 weeks is not only crappy but almost illegal, I don't know the exact numbers but they are supposed to be on your ward for a certain amount of time each day, they are the ones assessing you, they have to see you perform every task to be able to pass you on it.

I was ready to walk when I did nursing, and I infact did the first time I tried to complete my degree, had a facilitator say I didn't have the interpersonal skills to be a nurse, bugger her I say, because I went back and completed it, and am planning on traveling now, so stick with it.

As for your patient that was transferred, you shouldn't have been in charge of anything, you are supposed to be wokring WITH a nurse, shadowing her, doing tasks as you feel capable and confident enough to do that are within your scope, it sounds like they are basically using you as a extra pair of hands and if I was there I'd go nutty, your there to learn, not to do the things they don't have time for or want to do. First thing you need to do is call your course coordinator at the TAFE, tell them what is going on, ask what your roll is suppose to be, ask for a hard copy, give it to your preceptor to give to the ward. It's not your job to tell the nurses there whats going on, they should have been told by your preceptor, but you'll often find they don't get told what your objectives are or your capabilities are.

As for pan placement, it'll come, but you always get that odd one out, you think it's all good, then a full bed change comes along.

I think your are being to hard on yourself and not hard enough on everyone else. The preceptor needs to pull up their socks, the ward nurses need to stop treating you as the hired help and include you in their day to day work.

Now, as for leaving at the ned of the day, it all depends on who is on, what day it is, how busy it is. I have found in nursing that if you can get an early mark, take it because you never know when you'll be stuck there for an hour after your meant to be home or get no lunch, take it and run.

I found all my pracs hard, cried on everyone of them when I was training as an enrolled nurse, bit different when I had some experience and did my degree. I think you should keep going, try to get into a different hospital next time, you'll usually find private hospital nurses get flogged a bit more that public, at least thats what my experience is. It would be interesting to know what hospital you are in.

Stick in there, just think, it can only get better, thats what I tell myself everyday, hahaha.

[gwenith, BSN, RN]

Agree with all of the above - great post!!! I would most definitely talk to the course co-ordinator at TAFE - you are NOT there as an umpaid assistant - you are there as a trainee. I would also talk to the NUM and ask for a different perceptor don't make a habit of complaining to the wrong people or being a silent martyr. Speak out this is not acceptable AND they know it.