HELP!! NEW nurse feel like Im getting eaten by sharks

thecrossfitrn, BSN, RN · Jun 25, 2016

Your situation sucks, and I'm really sorry this is happening to you. As a charge nurse, and someone who precepts frequently, I can tell you that what's happening is 100% not okay and you need to address it as exactly that.

My advice is to make this situation known to someone higher up. Use your chain of command and keep going up the ladder. If I were in your situation and my Clinical Manager didn't see it as a problem, I'd go to the Director. When units allow their nurses to train other nurses this way it creates an environment of hostility and safety issues. This "seasoned" nurse is basically telling new nurses that it's not okay to ask questions, and that is absolutely unsafe and can cause fatal errors, especially if you're not an ICU nurse, but being thrown into it. If you're not comfortable going to the next person on your chain, go to HR and let them know what's going on. I'll bet you it wouldn't be the first time that your HR department has had complaints of the same manner.

Tough is one thing, putting patients at risk is another. You don't deserve to be treated this way, and this is reprehensible behavior from someone who should be guiding you to become a great nurse. Please make it known, because someone else will eventually be in your shoes.

missmollie, ADN, BSN, RN · Jun 25, 2016

You're right to question the preceptor when you're not sure what to do in the situation. You're a new nurse, you don't know. You might try to approach it differently, rather than ask her what to do, tell her what you'd like to do and see if she approves. Instead of "Should I call the doctor?" maybe try "I would like to call the doctor because the bp is 80/40 and I'm not comfortable with that," and see what her response is. Start to think about what you will do when you don't have a preceptor, and start to take control of tasks with "I would" rather than "Should I" statements.

You've had so many preceptors at this point, and I feel that is tough situation to be in. Try to stick with the next one you have, and dig in. That first year is a whirlwind, but you're going to be more confident in everything at the end of the year. Best of luck!

PewpSmith · Jul 2, 2016

Can I just give advice about the friend request on Facebook coming from my own personal experience? Don't add this person. Until you have been there a reeeeeaaalllly long time and you actually would call that person a friend for sure. You never know who that person is buddy buddy with and they could just be combing all of your stuff LOOKING for anything possible that they can laugh about and gossip about. Saw something a while back that said "Be careful who you open up to. Only a few people actually care. The rest just want something to gossip about"

HeySis, BSN, RN · Jul 2, 2016

I started passing meds on my first pt. and his bp was was low. he had been in the lows 100s all day and than the last couple hours he was in the 90s. I took it twice, systolics in 80s and than 77/46. I asked my preceptor, do you think I should call the doctor. Because i know things are done differently on icu. (that dont call codes or rapids, they tend to it their selves, ((mind you i was hire for stepdown and not icu))
In response to my question: (Very harshly) she said Im not going to feed you the answer, .. I told her what I wanted to do and she said yes thats what I would do.

First let me respond to just this part. Rather than asking "should I call the doc?" I would have said "Pt BP is trending down from low 100's to 77, I would like to call the MD, can I review my SBAR with you that I have written down to make sure I did not miss anything that this particular MD will want/need to know"

I have had instructors that will say "I'm not going to feed you the answer." and it's totally about tone how that message is received. So while I understand that her tone may have been shutting you down, can I also ask you to reflect and see if you could have misinterpreted that due to the experience from the night before??

Also changing the questions from "Should I do this?" to "This is what I would do, is there anything I missed?" This lets your preceptor know what you know and only have to train you on things you missed... not on everything you already know.

I realize that you were not hired for the ICU, but even so, it's good experience to precept there and a chance to hone some critical thinking skills. It's a busy unit and three patients are a lot for any nurse in the ICU to take on. Your preceptors need you to show as much independent thinking and problem solving as you can.. then check in before you take action. It can change the tone.

I passed my meds, charted, got new orders for doctors. and asked if I could be sent home because I was not feeling well. I really wasnt feeling well at all (I would not lie). I previously asked not to be put with her and they put me with her anyway. I was being talked to if i was dumb and it was making me feel discombobulated.

I probably would not have gone home. You were feeling well enough to come into work and though the experience had you feeling out of sorts, that's not contagious. I do disagree if they told you it was ok to go home and then are holding it against you, if it was going to be a mark on your record that should have been brought up by the manager before she told you it was ok to leave. But it does sound like it was the stress not making you feel well, and running home doesn't solve that problem.

Said I putting up walls, because I shouldve told my preceptor face to face how I felt about her attitude. And that I was taking her actions the wrong way. ( Im not trying to make enemies!!) I just started crying in their office it was so embarrassing.

I understand. It can be very overwhelming trying to make that transition from student to nurse. There are new policies, just finding things, trying to learn new co-workers names, what they do, where things are.....

I would advocate for a more direct approach in the future (like your supervisor hinted that she wanted, but with some ideas not just the criticism). When you heard the nurse apologizing for you the night before, I would have found a time to say... "Hey I heard you apologize for things I missed in the other room. Can you tell me more about what I missed so it doesn't happen again?" It is very direct without suggesting that the nurse did something wrong. You may have found out you misheard, or there was some other miscommunication... but it would have given you both a chance to talk about it. I shows a desire to take responsibility and also that you won't be treated like an escape goat (if that was what was happening). But it does it nicely.

If that had not worked (and if she truly is sharky, it might not have) you could have at least told your manager that you went to clarify any mistakes you made, that you did try to work out the problem nurse to nurse before going to management. This shows a maturity on your part that most managers will appreciate.

One last piece of advise. Although your manager was not good at describing what she wanted to see, as in "next time this is how you handle it" rather then just telling you not to put up walls. That doesn't mean she's against you. That style is not natural for most people. We grew up learning how to do things by being told what not to do (don't run into the road). I'd write down what you have learned and how you think you could have approached thing differently to have a better outcome. then I would go back to that manager and ask for a meeting. I would start by saying "this is what I have learned and next time I could do (and list them)" and ask for further advice from her, "is there any other ways I could have approached this, or how would you have approached this".

So take a big breath, remember how much you have learned and that you can do this. Give yourself a break for not being perfect and give others the same break. And go back in with a "I've learned from this attitude". If the place is really as bad as you feel, you will know that at least you took the high road and how you handle the situation will be above reproach. The skills you learn there can help you in any environment.

Best of luck.

boston.nurse · Jul 3, 2016

She didn't misinterpret anything. Its Nurses like you that keep the eating of the young relationship going. She obviously heard the preceptor talking about her. Why would she go up to her and apologize for something she had no control over. That is the point of having a preceptor, who gets paid extra for precepting. Is to precept. Also the assistant managers were totally out of line for telling her that she should have spoken up. To tell her she's building walls. How so? That is really unneed a statement. And unhelpful one. If I was her I would go to HR. Try to move off the unit as soon as possible

Also how dare you, comment on if she was well enough to come into work then she's well enough to stay? Totally inappropriate. If someone is not feeling well. I commend her for not wanting to work over someones lives if she's not feeling well. Would you want someone who is not feeling well working over your loved ones lives? For you to say when someone becomes ill is sad. This is not the military.

She did her part by reaching out to the right people to let them know that she did not feel comfortable with the preceptor. She was told that she wouldn't be with her. Then that's the only thing that was left for her to do.

And people are wondering why new grads are dreading coming to work, sitting in their cars crying before work. That is so unhealthy and abnormal. I know every job has stress. But the posts I've seen on here from new grads saying how they dread going to work, thinking about getting on medication just to keep up. Its absolutely ridiculous.

calivianya, BSN, RN · Jul 3, 2016

That is the point of having a preceptor, who gets paid extra for precepting. Is to precept.

Not everyone is paid extra to precept. My unit does pay extra, and it's a whopping $1 per hour. Big deal. After taxes take about $4 away, I can get a $8 lunch in the mediocre, overpriced cafeteria every shift. That's such a huge reward.

I agree that preceptors should precept well, but I also know that not every preceptor wants to precept. I wasn't asked, I was just assigned someone to precept this summer. And my hospital makes a lot of big noise about how it asks for volunteers to precept. We are supposed to go to a preceptor class before ever precepting someone - my unit leader is now making a big deal about me getting signed up to go since I am already precepting. I refuse. I'm not going to pretend I volunteered for this when I didn't.

That being said, my person has no idea that I didn't want her. It would be rude to tell her that I was angry when I heard I was getting her, and it would be rude to treat her like she's a major inconvenience. She's even told me she's glad she has me because another orientee who is a friend of hers is having a bad experience, so it seems like I am doing an excellent job as an actress.

I'm not excusing the OP preceptors' behaviors, but acting like being paid to precept is such a huge deal is ridiculous. I think I should make double time if I am going to have to have all of my current responsibilities PLUS be teaching someone else my whole shift. Preceptor pay is a joke, and not even remotely adequate compensation for all the extra work that having an orientee brings.

To the OP - it wouldn't hurt to change units. The culture of your unit is not acceptable, period. It is hard to learn with someone beating you down. I doubt these people are going to be any more receptive to your questions when you're off orientation than they are right now. Not wanting to answer you when it's their responsibility to answer you is a huge red flag.

HeySis, BSN, RN · Jul 4, 2016

She didn't misinterpret anything. Its Nurses like you that keep the eating of the young relationship going.

I would like you to know that although I have been an LPN for many years and trained new employees in that role. I just graduated with my RN this April, I am in a residency program and being precepted around my facility (as we do several shifts on any units that our "home unit" interacts with regularly.)

The advice I gave was what I do when interacting with my preceptors. I have not had a negative experience, so I was honestly hoping to help OP have a more positive situation.

Maybe I am the only person to overhear a conversation and thought I understood it totally, just to find out later that I was wrong. Her statement said she didn't feel well and then went on to say how the situation

I was being talked to if i was dumb and it was making me feel discombobulated.

I can understand how this would make her not feel well, but it is very different from having a sore throat, cough, N & V, which she didn't mention at all.

I'm not excusing anyone's behavior, but since her preceptor isn't here I can't advise her to take responsibility for her actions. I can only ask OP to look at the situation, see how she take responsibility for making the best out of it.

My preceptors didn't get paid extra, and often didn't know I was assigned to them until the morning I showed up on the unit. That can be really hard, and we may not always see people at their best.

OP is no longer a student, and she does need to speak up, in a non-confrontional way, when issues arise. Which is what I was advocated. And no matter where you work, you will find at least one person in which those skills will come in handy.

And just as you want to give OP the benefit of the doubt, why am I so bad at wanting to give her preceptor, (who she never actually talked with about the issues and is not here to give side of the story) the benefit of the doubt. And why do I eat my young because I say "So take a big breath, remember how much you have learned and that you can do this. Give yourself a break for not being perfect and give others the same break."

I'm not copping a tone here, so please don't read that into my post.

I still believe that OP can learn to advocate for herself, present questions in a way that shows what she already knows and learn to be assertive without being confrontational, before taking it up the chain of command.

nutella, MSN, RN · Jul 4, 2016

OP - how badly do you want to work there?

Nursing is rough all around the first year. Some preceptors should not precept in my opinion and I asked once to get re-assigned.

Having said that - you need to move towards working independently. Critical care can be very tough. You need to be able to make good decisions and show critical thinking. You need to be organized. And critical care nurses usually stick together.

I am not saying you need to suck everything up but you need to move towards independently working and at the same time stay humble towards the established nurses.

jadelpn, LPN, EMT-B · Jul 4, 2016

OP, you can put up walls, fences, barbed wire--whatever you would like to--it is a weird thing to say--and subjective.

What I can tell you is this--you need to know your resources and where to find them. Not everything needs to be 20 questions. You do your shift assessment, and give your preceptor a rundown, and what it is you are doing about any findings that are concerning, and do it.

If there's a change in condition, you need to let your preceptor and your charge nurse know, and what it is your intervention if going to be.

If you learn by asking questions, then you need to learn a few different ways that answers can be found. I am not suggesting you go all cowboy and just do stuff in fear of asking too many questions--however, you need to learn to swim--and when you ask questions, listen to the answer so the same question is not asked again the next day.

ICU is a specialty. And if you are not oriented completely to step down, it is not wise that you then move over to ICU. I am of the thinking that you need a really good foundation before you can specialize. However, if this is where you are assigned, I would be clear on resources and where to find them other than your preceptor--who can be a good resource, but only one of many.

Listen to report--really listen, and take notes if you need them, use a paper brain even. Review your chart, your orders, your meds, and note them. Get a good sense of where your patient has been for 24 hours, and how they are trending. If their BP is too high (and that is also subjective, as sometimes an MD wants it on the higher side) too low (and again, dependent on where it was and what the goal is) or any other findings on your initial shift assessment that are questionable, THEN speak to your preceptor and your charge nurse about your plan (call the MD and document you did so with any new orders or with "no new orders")

OP, you need to take initiative with the overall picture of your patients. You need to formulate a plan and initiate same once you state what that plan is. Then you can receive feedback on your choices.

nutella, MSN, RN · Jul 4, 2016

OP, you can put up walls, fences, barbed wire--whatever you would like to--it is a weird thing to say--and subjective.
What I can tell you is this--you need to know your resources and where to find them. Not everything needs to be 20 questions. You do your shift assessment, and give your preceptor a rundown, and what it is you are doing about any findings that are concerning, and do it.
If there's a change in condition, you need to let your preceptor and your charge nurse know, and what it is your intervention if going to be.
If you learn by asking questions, then you need to learn a few different ways that answers can be found. I am not suggesting you go all cowboy and just do stuff in fear of asking too many questions--however, you need to learn to swim--and when you ask questions, listen to the answer so the same question is not asked again the next day.
ICU is a specialty. And if you are not oriented completely to step down, it is not wise that you then move over to ICU. I am of the thinking that you need a really good foundation before you can specialize. However, if this is where you are assigned, I would be clear on resources and where to find them other than your preceptor--who can be a good resource, but only one of many.
Listen to report--really listen, and take notes if you need them, use a paper brain even. Review your chart, your orders, your meds, and note them. Get a good sense of where your patient has been for 24 hours, and how they are trending. If their BP is too high (and that is also subjective, as sometimes an MD wants it on the higher side) too low (and again, dependent on where it was and what the goal is) or any other findings on your initial shift assessment that are questionable, THEN speak to your preceptor and your charge nurse about your plan (call the MD and document you did so with any new orders or with "no new orders")
OP, you need to take initiative with the overall picture of your patients. You need to formulate a plan and initiate same once you state what that plan is. Then you can receive feedback on your choices.

I am somebody who went into ICU right after graduating from nursing school and it was not a problem at all. BUT it is important to move towards independence and other nurses need to trust you. After all, you help each other out , cover each other and so on and forth.

When you are a student it is fine to ask all kind of questions. When you are off orientation as a nurse you need to just do your work and use the preceptor only as a back -up. ICU is very clique-y and rejecting one preceptor may be ok but it is very hierarchical to begin with...

Been there,done that, ASN, RN · Jul 4, 2016

AM now has you on her radar. Of course you will be marked absent, you went home "sick" ..that is an occurrence.You are going to come across "strong" personalities frequently. Especially in ICU. You are not going to have the ability to switch so you do not work with "mean" people. you must attempt to deal, not run away.

You have been hired for the unit, and already thinking of "running". A bad referral is not automatic from this instance. You have a year to earn your reputation.