I am new nurse (just finished last day of orientation) and I need some insight!!!
ok so I have been on a stepdown unit which is connected to an icu. My orientation has been going fine. I've had tough preceptors (which I think helps) but non to the point where I feel like I couldnt ask questions. That is how I learn by asking questions. I know what I would do, but I like to run it by the nurse I am with while on orientation. Since my orientation I've had about 5-6 preceptors which is fine. I feel like I learned something from them all. The last week they put me on icu with a preceptor who was very cold, when I would ask a question her reply would be (You dont know that? You havent done that? ) if I had I wouldn't be asking!! (She knows im a new grad)
We had a new admit, who was VERY sick. So she wanted me in the room while the patient arrived. Our other patient was very stable (could have been a medsurg pt) Once we were done helping our new admit (who eventually turned to a 1:1) after 2 hours. She asked me why I had not passed medications on our other patient, or tipped her urine. I was in the new admit room hanging her drips, IVs, and making sure she lived the entire time! I heard her in the hallway talking to the new nurse who was to take our other (Stable) patient how, it was so many things I didnt do. How she apologized on my behalf. WHAT?! I finished the night out.
...I felt like the learning environment was not conducive to me growing as a nurse. Especially right before I was to get off orientation. I felt confident and after a night with her, I was questioning everything. I know nights are going to be hard. And its expected. But when you have a seasoned nurse making you feel incompetent, its not helpful or productive.
So I asked for a new preceptor to the clinical coordinator who has been working with the orientees. She explained that these things happen and that she would set me up with a preceptor. I say okay, feeling relieved.
The next time I go to work. I am told that I am with the same preceptor and we have 3 pts on ICU. It was my last night of orientation, and I held my tongue, thought well I guess I will just have to deal with it.
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. I looked at my watch and realized I had 10 more hours of the attitude and decided against it. I asked the charge the nurse to be placed with someone else. They paired me with someone else who is equally as mean to orientees. 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.
The next day Im called into the assistant managers office, told that I was going to marked as absent for that day. 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. Mind you this unit is short staff. And the nurse Im with, is seasoned. I didnt expect them to say anything to her. If thats her personality thats her personality. I just wanted to be assigned to another preceptor.
Soooo I love the hospital. The first question I have is when transferring units in the same hospital do they always call your previously unit and ask for a referral. I can see them saying she puts up walls which I dont!! at all. I am very friendly. My other preceptor from ICU even sent me a friend request on FB. . I know everyone says stay on a unit for a 1yr. but whats the point if they are probably going to give me a bad referral?
Specializes in Oncology; medical specialty website.
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 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.
I think your comments were just fine, and you gave helpful, encouraging advice.
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 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.
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.
this is amazing advice!!!! Read this post again and learn from this wonderful nurses advice. Hang in there. You WILL get through this transition period. It's the hardest part of your nursing career and if you approach it in this manner it will get better everyday. Don't let a bad shift lead you to think you are a failure. Even seasoned ICU nurses, myself included, have bad days, tough shifts where everything seems to just go the wrong way. Learn from your experiences and you will go far! The best of luck to you. Hang in there!!!
With all due respect, this was the last day of your orientation, not the first. I can understand your concerns but complaining about your preceptor on your last shift and then going home when it was not resolved to your satisfaction sounds just a little entitled. I don't condone lateral violence but maturity is integral to competence and frankly, you are coming across as a victim. Nobody deserves to be abused but sometimes personality conflicts arise and it doesn't give you permission to take your marbles and go home. I would suggest you look at your own behavior first and determine what you could have done differently rather than reacting defensively.
We had a new admit, who was VERY sick. So she wanted me in the room while the patient arrived. Our other patient was very stable (could have been a medsurg pt) Once we were done helping our new admit (who eventually turned to a 1:1) after 2 hours. She asked me why I had not passed medications on our other patient, or tipped her urine. I was in the new admit room hanging her drips, IVs, and making sure she lived the entire time! I heard her in the hallway talking to the new nurse who was to take our other (Stable) patient how, it was so many things I didnt do. How she apologized on my behalf. WHAT?! I finished the night out.
I honestly wouldn't take this part personally. I did an independent month-long practicum in the ICU when I was senior. There were several times when I was transferring care of a patient to another nurse and things just weren't up to my preceptor's usual standards. He usually tried to be discreet about his apology to the other nurse but in a tiny ICU, it's easy to overhear what someone is saying.
Also, sometimes preceptors discuss their experiences with other, more seasoned nurses to get feedback from them. (Obviously this isn't what happened with you, but I'm just giving you a head's up that you might see this as a new grad.) I once overheard a preceptor telling the charge nurse what I had told him (which was that I had no idea how to start an IV because our experiences were limited in nursing school). His charge nurse then delegated me the nurse to start all of the IVs for the next week.
Especially as a new grad, it helps to not have a thin skin. Whenever possible, let the unimportant things (like your preceptor apologizing on your behalf to another nurse) slide off your back.
Back to your main point. It seems like there's a disconnect between what you're doing and what your preceptor is expecting you to do. I agree with the suggestion that you should begin to rephrase your questions - instead of asking out-right how to do something, tell her what you think you should do. Maybe with the assistance of your manager or higher-ups, you can find a way to communicate effectively with your preceptor. You could try asking her politely what her expectations of you are. Where should you be at this point in time? What short- and long-term goals should you be progressing towards? (I would come up with some of your own answers and run these by her, and then add her suggestions to the top of the list.) It does seem like she's expecting skills out of you that she hasn't helped you implement, which may not be a solvable issue with this particular preceptor.
If at all possible, I would try to find another preceptor, or be re-assigned to a preceptor that you had positive experiences with before. Just make sure that they're direct, honest and clear about their expectations of you, consistent in their work ethic and are willing to teach. Set some short- and long-term goals ahead of time for things like time management or skills that you're still iffy about, and then share those goals with your preceptor.
Don't worry about crying in front of your manager. I cried in front of my manager twice as a new grad. As long as you're not crying constantly or doing it in a way that jeopardizes your patients (like during shift or in front of your patients) then you're probably fine. Being a new grad is stressful, and some tears are normal for the emotions you're feeling.
Try to stick it out. Try to learn how to do your job effectively and safely. Keep asking questions. If you do those things, they likely won't hold it over your head that you cried as a new grad during a tough ICU orientation.
Although I am in a different field, I too had a similar experience during my student/ orientation phase. I too have a very inquisitive nature and have to understand the "why" so I can understand the whole picture. I am never comfortable "winging it" and being overly confident at the patient's expense... I take my job very seriously and think that every patient deserves excellent care (read: not perfect care) however, I now understand that this type of mentality can be perceived as incompetent...
Sometimes it feels like some kind of initiation or weeding out the weak by these senior professionals, i.e. boot camp. I personally love to teach and welcome questions from other techs and other departments. I can appreciate when someone can explain a not-so-easy task and make it seem simple, as this shows how well someone understands their craft.
My advice for newbie9909 is to weigh your Pros and Cons about your chance to grow professionally on that particular unit. If they are too busy while they are training you and not willing to break it down so that you are comfortable to fly independently it may not be a good fit and may not be worth your time. However, I understand being a starving college student and wanting to be a part of a great institution... if you can stick it out, by all means try. But if not, your morale will undoubtedly deplete before it's time and you will burn out a lot quicker than necessary.
Also try to emphasize your strengths. For example, are you particularly patient or speak with a soft, sweet voice? And try to remember why you became a nurse and develop a mantra to live by at work.
OCNRN63, RN
5,979 Posts
I think your comments were just fine, and you gave helpful, encouraging advice.
Best wishes on your new role. :)