HELP - Orientation Feedback Meeting with Manager tomorrow!

[Guest455883]

please help - i have a meeting with my manager tomorrow about the status of my orientation and i'm freaking out!

the background story is that i accepted a good position (in my preferred unit - psychiatry, and close to home) right after graduating. it's a 7-month-long new graduate orientation. i was a few months pregnant when i started, worked for four months, then after my baby arrived i took a 6-month maternity leave. now i'm back on the unit with a total of twelve weeks to finish orientation. about me, i'm in my late 30s and entering nursing as a second career after working as a clinical research analyst in psychiatry in a hospital/university setting for many years. i have a diagnosis of adhd but don't take any medication for it currently.

at first the orientation seemed to go well, but then a number of factors came into play that has made it really difficult. first, my pregnancy. i wasn't at all prepared for the physical demands of the role and just getting through each day was a challenge. also, i don't know if i suffered from "pregnancy brain" or overstimulation and exacerbation of adhd or what, but i couldn't retain any information and worst of all made repeated medication errors. these were all caught because i asked my preceptor to check my meds each day due to my concern over missing details. second, my preceptor. i could write a book, but will simply say that she may be the most horrible bully i have met since grade school. she single handedly creates a toxic environment amongst the entire staff. she is, however, an excellent nurse who undergoes a major personality switch whenever senior staff enter the room. i found her constant gossiping and unkind remarks (eg "f*** it's like you never even went to nursing school.") tremendously distracting. and finally, there were personal factors of my own that made the adjustment really hard. my program offered very little clinical experience, so not only was i orienting the unit itself, but also to hospital foundations in general. i'm used to being in a leadership role, autonomous, and very confident in the workplace. i have had to (and still do!) grit my teeth and let my past experience go in order to move forward. but it is very hard.

returning from maternity leave, i have been given a new preceptor because the other one has gone on an extended holiday. i work with an entirely different team and feel significantly more relaxed. however. i'm now starting to feel distractingly self-conscious because it seems most other new staff were hired on after only a couple of months of orientation, but it seems i will have to work out the duration. i can't decide whether this is a bad thing. it's certainly embarrassing, but i can get past the embarassment. what's happening now is it seems my new preceptor (who is excellent, approachable, and professional) is bored out of her mind. and she wants to be busy, so she's constantly distracting me by asking if i have questions or interrupting the flow of my work to interject some helpful tip or comment about how she does things. i'm by no means perfect. but i think i'm about 95% ready to be a novice nurse out on the floor on my own. at this point, being precepted is only making me nervous and frustrated. my preceptor's input is usually along the lines of "this is how i set up my day", "this is how i organize admission paperwork", "this is the colour pen i like to use"...all things that several preceptors have already reviewed with me, and all of them have a different personal preference. i think at this point i'm being held back from developing my own practice.

my current preceptor met with my manager today and my turn is tomorrow. it's a weird position...i'm told to ask questions, people seem to want me to ask questions, but when i do i appear to need more orientation. and truth be told, i don't actually have that many questions, i just answer to break the boredom. i would just like to be able to work more autonomously, and feel almost as though right now the fact that i'm working under close supervision is contributing to my errors, if that makes any sense.

i'm not making excuses, please understand. i'm just trying to fully describe the situation in order to create a clear picture for the manager. it's very important to me that i don't go into my feedback meeting with a whiny attitude. please help me think of an approach and develop some talking points for my meeting.

thank you in advance - i'm a longtime lurker and it has been tremendously helpful to come here and learn about others' experiences.

[HouTx, BSN, MSN, EdD]

Make sure you focus on objective information rather than vague feelings or emotions.

When you are provided with critical feedback, ask questions to make sure you clearly understand how your performance is being measured - what criteria is being used? What examples of your performance are being cited? Get the details so that you will understand any performance gaps and how to fix them. If you are told you are 'not ready' to assume independent work, ask for specific examples. Then find out what 'success' would look like so you know the goal you must achieve.

If you are asked to provide feedback - provide objective information. Don't use vague labels or assign labels like "bully". Instead, cite examples of behavior and 'own' your reaction.... "I don't know how to respond when Sue uses profanity" "My self-confidence just disappeared when Sue makes general remarks about how incompetent I am"

DON'T use your ADHD as an excuse. It will just remind your manager that he/she is likely to have ongoing problems with you. Your patients deserve the same level of care, right? So you may have to always work harder to achieve the same results as your peers who do not have ADHD... that is just the way it is.

Bottom line - You are going to have a long and productive nursing career. You will look back on this someday as a learning experience. It is not the end of the world, no matter what happens.

[NotReady4PrimeTime, RN]

Well, a couple of things jump out at me. First of all, having taken a mat leave halfway through your new grad orientation has, in many ways, put you back almost to Square One. It's very difficult to integrate a lot of new concepts and routines and retain it all after a 6 month break. So the fact that your employer is holding you to the full 12 weeks remaining in your orientation isn't necessarily a slam on you but an acknowledgement that you're relearning a lot of things. Of the other new hires on this unit who weren't held to the full 7 month orientation, how many have taken a 6 month leave for any reason while on orientation? Probably just you. There are usually many changes in a health care workplace in 6 months and some of the things you learned before and may remember well may no longer be the practice. Heck, I've been off 7 weeks with an injury and will be going back in 2 days... and I'm worried about what's changed and what adjustments I'll be having to make.

Second, your nursing program was short on clinical experience so you're learning more than just the unit-specific stuff. Transitioning from a job where you knew exactly what you were doing and being left alone to do it is difficult, and being autonomous in a nursing job comes only with time. If you have the chance you should read a summary of Patricia Benner's From Novice to Expert; it very clearly describes the phases of development nurses go through as they progress in their careers. Wanting to be autonomous and being in a state where you're ABLE to be autonomous don't necessarily coincide - and it's nobody's fault.

There are good nurses and there are good preceptors, but being a good nurse doesn't automatically confer good preceptor skills. If you find that your preceptor is hovering too much and distracting you, there's no reason why you can't explain that to her. When she starts making suggestions on how to organize your time, thank her for the suggestion and tell her you're still working out what will fit your personal style best but will need to try a few different ways of doing things before you find it. Good preceptors recognize this and don't try to push their way on others. Be frank with her. Tell her that you need to be allowed to do things on your own, with her close by if you need her but not on top of you all the time. Being in the spotlight almost always makes people jittery and prone to mistakes they wouldn't make if no one was watching, that's normal. Promise to ask for her help when you need it, to ask her questions when you have them and then follow through so she sees she can trust you.

As for your meeting with the manager, be honest as you have here. You don't have to actually say, "I have ADHD" and go into great detail about how you compensate for it. You can simply say that you feel ready to be given some room to grow and that you work better with fewer distractions. Make a list of the things you've learned and the things you still struggle with so that s/he can see that you're assessing your practice and your learning needs. This is where your promise to ask for help and to ask questions when you need to comes in. Suggest that rather than you and your preceptor sharing responsibility for x number of patients maybe you could be given half the load on your own with your preceptor availalbe to help if needed. See if that resonates. But most important of all, don't go in there with the preconceived notion that you're going to be hung out to dry. It's in everyone's best interests that you are supported appropriately for the rest of your orientation so that you can get out there and do your job when the time comes. Best of luck.

[Guest455883]

Thank you so much for your replies, I sincerely appreciate it. You both really helped clarify my talking points and boost my confidence.

I didn't expect the meeting to go as it did. As you can see from the length of my original post, I had quite a number of issues and concerns going in. My manager was short and to the point: "Your work is excellent. I have no concerns in any area except the accuracy of your med pours. Work on that. We'll talk again once you've completed the full orientation. Goodbye."

While I can't disagree with her perspective, I feel a bit strange that she didn't request any feedback about my experience. Also, I feel certain that my original preceptor may have been less than fair and honest in her assessment of my work and tried at one point to convey this, but the manager was not at all interested in hearing it. (I haven't had an error (there were 3 before btw) since I started with the new preceptor, perhaps the fact that she doesn't yammer vulgarities at top volume in the med room has something to do with it.)

With the tone set for our meeting, I didn't even raise any other issue. Moving forward, I'll speak directly to my current preceptor about hovering less. I've been taking a full patient load since before mat leave, so she really does seem to be at a loss for something to do.

Thanks again.

[peds_mike]

Get used to the bullying. It will probably never stop. We were always told in nursing school that nursing is one of those professions that is known for "eating its young." I found that, going through my orientation with a seasoned veteran, could be challenging, but I never backed down and stood up for myself. However, my preceptor was always professional, which sounds like your preceptor was not.

Glad to hear that, overall, your meeting went well. During your med admin times, place yourself in a "No Distraction Zone." Focus on the task at hand, and don't let others pull you from that. We use this principle at our hospital, and believe me, it works.