I currently have three more shifts with a new grad, who has already had three months of orientation, but isn’t catching on and got six extra shift of orientation.
Her preceptors for her orientation were very good and our hospital follows a skill-based orientation and we have to follow tiers based on their skill set. Her preceptor and I worked a majority of our shifts together and so I was aware of the progress she was making throughout the past three months. Confidence, managing two patients, delegating, and assessing a critical situation are some of her weaknesses so her preceptor held her back on the tiers because she couldn’t manage assessing AND passing medications at the same time.
My struggle is that we had two patients the last two days and it was like I was her crutch. I had to remind her that she had another patient, to pass meds, and just other basic stuff. She would stop people walking by to have them check on our other patient or have them get her stuff when I wasn’t doing anything and she could’ve called me and asked me.
I understand that starting out in the ICU is definitely different, especially as a new grad when you’re learning all the basics plus having critical patients, but I just feel like the hands-off approach, reminding her to do things, is giving her too much freedom to be relaxed and not focus on the tasks at hand. Does anyone have any recommendations or suggestions for me? I want to make sure she's successful, but it’s almost to the point where the ICU is too much for her unless we can find something that works for her.
@ruby_jane and @jess11RN in case clarification is needed, the concern doesn't stem from someone not pulling everything together in 3 months' time. My response is based upon @Silvem23's statement that basic elements are not coming together in that time frame. The type of situation I'm envisioning is one in which success would not be found at 6 months, either.
I agree with you that in the position the OP has been given (to work with this orientee for the final few days), it is good to make her own assessment of the situation; that is only right and fair. But at some point it isn't rushing to judge to say that the most basic things should be in hand at this juncture, even if the multitude of critical care details are going to take a much longer time to come together.
It is compassionate to be honest about situations like this. If a fair orientation experience has been offered/provided, it isn't difficult (or judgy) to determine that it isn't going to work out when basic issues are involved.
When people struggle with the basics, that means that during all of that time there hasn't been able to be a lot of building going on; instead all the time has been spent in one lengthy attempt to continually reinforce this basic thing or that basic thing.
These situations are unfortunate but every now and then they just are what they are, even if we feel truly sorry/empathetic for the person's disappointment, etc.
RNNPICU, she could handle one patient, but not a critical one as of now. I had to tell her to turn off sedation for the sedation vacation. I had to tell her to titrate down on pressors since we had more than adequate blood pressures, but she only did it because I told her to and didn’t take initiative to continue to titrate. Also, I told her that any fluids running less than 15 mls an hour needs a tko (our policy) on one day, then the next day...same patient, same med, running at 2.89 mls for a couple hours and she didn’t even realize it, but said she wanted to ask for an opinion since we were diuresing. Valid statement, but she should’ve spoken up sooner because we could’ve tried turning off the pressor or ask the providers if they wanted to try albumin. Turned off the pressor, pressures dropped to 70-80’s and she was reluctant to turn the pressor back on. She’s also afraid of speaking to the providers, which the nicest ones in the world were working that day, and their recommendation? Turn the pressor back on.
I feel like I do well at helping my orientees recognize what they struggle with and try to come up with solutions, but it’s like every day we start all over again and she’s forgotten important things or she focuses on one aspect of the patient rather than the whole entire picture.
Oh my Silverrn23. It sounds like you have created a wonderful environment for learning and allowing for this new grad to grow. From what you have described it sounds like this just isn;t the environment for her. As you have stated all orientees will struggle with prioritizing or coming up with solutions, but that is something that can be taught. You should not have to start at square one everyday.
It really may be that this is not the environment.
I am sorry this person is having issues and ICU doesn't seem like a good fit for her at this point of her career (not as an absolute but maybe time to get med/surg or step down maybe a better fit). I hope your facility is listening to preceptors unlike the hospital I work at. One person we had was unsuccessful and when preceptors expressed concern about her ability they fired the preceptors. Well she went through all the main preceptors and ultimately ended up on the floor.
I agree -- how is SHE feeling? I am three months into orientation and advancing like I should, but I find I'm much more receptive with some preceptors than others. My main preceptor is amazing, but I find I "need" more of her help and I'm not sure why. I'll work with the very same patient at the same level of stability or instability with another preceptor the next day and I'm more indepedent. I think some receptors, while amazing educators, promote critical thinking more than others.
We have lost several nurse residences because ICU is not for everyone. I wish everyone the best here, but it sounds like you all need another meeting to shore things up. Have her explain HER goals, then explain your goals for her. See if they align! You may be surprised.
I’ve had a couple new grads (towards the end of orientation) that seem to do better when I explicitly tell them that these are YOUR patients. YOU are responsible for them. I am here to answer questions, bounce ideas off of and to catch you if you are falling. Sometimes, they like to hide behind the security of the preceptor. Let her fly (but stay close behind) and see if she takes flight.
Specializes in Critical Care; Cardiac; Professional Development.
Wow. From the way she assesses and charts, I am honestly dubious she could survive on PCU or even Med-Surg. She doesn't sound like she has a sound routine for assessing her patients, so she forgets things, doubts herself, goes back to do it all over again, loses her place in her charting, doubts herself, goes back, etc. Being at a lower acuity won't help that. She is letting the charting software tell her what to do rather than relying on her own knowledge and critical thinking.
I read your post and I can't help but feel for the new grad. When I graduated from nursing school, I KNEW I wanted to be in ICU. When I wasn't hired for ICU, I accepted a telemetry position. With 7 months worth of telemetry under my belt, I transferred to ICU. They gave me a few months orientation and threw me to the wolves. I failed. I failed miserably. I told my boss that I wasn't confident, I still needed more orientation. She took me off the schedule. I felt awful, but at least felt validated after the clinical specialist came to me to apologize because she felt that they had failed me.
Don't get me wrong, some people do amazing in these areas right off the bat. But generally speaking, I just don't feel like 3 months orientation for a brand new grad in the ICU enough time. It's not fair to you, her, or the patients. She either needs more time or she needs to gain more experience in a less critical care area (I'd suggest the 2nd choice).
BUT...has anyone sat down to ask how SHE feels (without fear of penalty)? Is she overwhelmed, is she second guessing her choice, or does she think that she is doing an amazing job? What does she think that she needs? I think that factors into decisions as well.
I remember everything being intimidating when I first became a nurse. Even if someone was kind but asking questions, even then, I got nervous. Perhaps she is so nervous she can't think, therefore retain information or it is information overload for her.
Thank you for this. There’s so many of us that agree, she can handle lower acuity patients, like med/surg or PCU, but when it comes to ICU patients, it’s like she freezes.
She could just be intimidated by the new role and responsibility. I'm just curious why she is asking other nurses for help? hummm? I've trained individuals who just dont seem interested in the position and dont take notes and ask me for refreshers as situations arise. very frustrating to say the least.
I remember everything being intimidating when I first became a nurse. Even if someone was kind but asking questions, even then, I got nervous. Perhaps she is so nervous she can't think, therefore retain information or it is information overload for her.
Yes!! It was such a painful transition!! But perseverance pays off!
On 5/3/2019 at 6:06 PM, JKL33 said:
@ruby_jane and @jess11RN in case clarification is needed, the concern doesn't stem from someone not pulling everything together in 3 months' time. My response is based upon @Silvem23's statement that basic elements are not coming together in that time frame. The type of situation I'm envisioning is one in which success would not be found at 6 months, either.
I agree with you that in the position the OP has been given (to work with this orientee for the final few days), it is good to make her own assessment of the situation; that is only right and fair. But at some point it isn't rushing to judge to say that the most basic things should be in hand at this juncture, even if the multitude of critical care details are going to take a much longer time to come together.
It is compassionate to be honest about situations like this. If a fair orientation experience has been offered/provided, it isn't difficult (or judgy) to determine that it isn't going to work out when basic issues are involved.
When people struggle with the basics, that means that during all of that time there hasn't been able to be a lot of building going on; instead all the time has been spent in one lengthy attempt to continually reinforce this basic thing or that basic thing.
These situations are unfortunate but every now and then they just are what they are, even if we feel truly sorry/empathetic for the person's disappointment, etc.
I totally agree with you. I would rarely agree that it is a good idea for a brand new nurse to start in the ICU. I only shared my story to try to give the prospective of the person on the other end, not to judge at all, so please don't think I shared my story to promote any negativity.
I never ended up returning to ICU because I realized that it was too much for me. Unfortunately, I had to live through it in order for me to realize that. I think this nurse will eventually realize it as well (which is why I was asking about how she feels about the situation). Everyone has their nitch and she'll find it eventually, just probably not in the ICU.
JKL33
7,038 Posts
@ruby_jane and @jess11RN in case clarification is needed, the concern doesn't stem from someone not pulling everything together in 3 months' time. My response is based upon @Silvem23's statement that basic elements are not coming together in that time frame. The type of situation I'm envisioning is one in which success would not be found at 6 months, either.
I agree with you that in the position the OP has been given (to work with this orientee for the final few days), it is good to make her own assessment of the situation; that is only right and fair. But at some point it isn't rushing to judge to say that the most basic things should be in hand at this juncture, even if the multitude of critical care details are going to take a much longer time to come together.