help surviving orientation

[cookielady,rn]

I worked in med/surg for a year and deceided I needed soemthing that invoved more thought process that what I got to do on the floor. I started to a MICU/SICU in late April and none of my precptors explain how anything causes or effects the paitent/disease process. I ask questions all the time and most of the time no one knows the answer. This past week someone offered to help be better understand vents and how to set up the monitor for swans, but then she got busy helping other people. Now one manager is getting on my case for not taking charge when I experienced a patient dropping pressures and having abnormal heart rhythms for the first time (though I immediately got some orders from two physicians and carried them out whle my preceptor started on things that didn't have orders). I've repeatedly asked my precptor to give me scenarios so I can talk out what to do and she doesn't (instead goes around helping the others do anything they need). I'm also getting flack for not identifying a rhythm no one else did and having clutter on my table or in a patient room.

I'm afraid of losing my job, but I don't feel I'm getting enough help to function at a higher level. My coworkers tell me I'm doing well, but I still don't know how to manage emergent situations without help.

Any advice? SHould I apply elsewhere? Help!!!

[oldiebutgoodie, RN]

Hi, Cookielady,

It is an unfortunate fact that there are a lot of prima-donna type nurses in critical care who make lousy preceptors, and who think nobody can do it as well as they can. I have been off orientation about 2 months now, and several of my preceptors were quite unsupportive and critical. I changed preceptors and got 2 that were wonderful (although still a little high maintenance).

It sounds like you are doing fine. I'm not sure what your preceptor wanted you to do when the patient began dropping pressure. Bolus the patient? Start Levophed? I'm guessing you need a doctor's order to do those things. So, you did the right thing. If the patient was crashing, then they need to call a code anyway.

Hang in there.

Oldie but goodie

[cookielady,rn]

thanks. My pt actually had a 17 beat run of vtach and went into a-fib but the qrs looked wide sometimes and no one could really make up their minds what to call the unerlying rhythm. My preceptor started a bolus (no order) while I got pharmacy to get me the amiodarone stat. Another nurse helped put in the order for blood products for me and when the doc came by I started the potassium and mag, all the while looking to my precptor to see what else I should do since I'd not been in a situation like this. My preceptor is nice and at times tells me "good job" but offers no pointers, explainations, rationales, hypotheticals...

I'm so afraid of being fired.

[dorimar, BSN, RN]

I think it is great that you are looking for rationales and the why and how of things. You will find that there are some nurses out there who pretend to know more than they do. Watch the nurses you work with, and don't assume that just because someone acts cocky, that they know it all. Be carefull who you choose as a role model. I know it is discouraging when people don't have the answers, but also remember that you are responsible for your working knowledge base. While i know you don't have time to look things up in the middle of a crisis, maybe you could research these things at home after the fact. Also, most places put the nurses new to ICU, through a critical care course of some type. If your facility does not offer this, i reccommend experiecing your first ICU somewhere else. Good luck to you, and hang in there. I know it can be difficult, as many nurses can be the most unsupportive people. I would also hope that when you are feeling like a strong critical care nurse and others are coming to you for help, that you remember how you were made to feel when you were not comfortable and needed help. So many of us seem to forget that.

[cookielady,rn]

thank you for your response. WE had ECCO from the AACN, but sitting in front of a computer for serveral hours doesn't help me remember things like getting it hands on or hearing it in a real-life story. My preceptors haven't exactly helped me get experiences either and I've asked management if I could go to days for a day or so to get some expereince with procedures...but no. I also don't feel very comfortable that nurses will insist on writing orders they never received for tests, bolus...

[dorimar, BSN, RN]

That is the fine line we do cross sometimes. Rest assured, I don't think there is a nurse out there who would write an order she wasn't sure the doc would sign. I am not condoning this (especially for a new nurse). Those nurses know the docs they are working with, and there is obviously some trust in their working relationship. Sometimes precious time is saved by knowing what should be done, and starting it before the doc calls back. That knowledge comes with experience. An example might be that your patient started peak airway pressuring the vent and then suddenly started dropping his sats with diminished breath sounds on 1 side. Well, you can bet that i would get a stat CXR before i even heard from the doc. I'm not going to wait 15 minutes for the doc to call me back just so I can ask him if i can order it. By that time i can probably already have the results, and be getting the CT set up for when he does call me back.

Try to be patient. This knowledge will come with experience. Critical thinking is aquired. I am sorry you are feeling a lack of support. Some of the best nurses can be lousy teachers. Keep reading. Take your experiences and research them when you get home. keep posting here and reading posts. Try to find a truly strong nurse and watch & listen. Try to be present in the rooms where stuff is happening even if it is not your patient. And keep wanting to know the why.

Good luck!

[cookielady,rn]

I typically looked things up when I had the chance to do so while at work so everyone could know the answer (i.e., sick sinus syndrome).

I took a job at another hospital that seems to think their preceptors like to teach.

[dorimar, BSN, RN]

Good luck to you! I know you will find your comfort level.

[cookielady,rn]

So far so good at Scottsdale. My preceptor actually explained some things to me. Imagine! Hope they keep it coming and see you around, hopefully Dorimar

[begalli]

You are one smart cookie!! :)

I applaud you for recognizing and getting out of a situation that was not good for you. More nurses need to do this!

You are going to make a fine critical care RN.

It will still take a while to really grasp onto things, but don't give up. It sounds like at least you might have some support now.

Be a sponge and take in as much as you can. dorimar's advice is very good especially being present where stuff is happening. Let not only your preceptor but other nurses know that you want to be there so they can let you know when something new or interesting to you comes up.

Good Luck!!

[cookielady,rn]

thank you. I try to make it a point to tell my preceptors to let me know if there's a better way to do something or they prefer something done differnetly to tell me and I won't be offended, I just want to learn to do my job well.

All I need is better concentration to absorb classes (once i get into them) and text books.

Anyone have pointers on how they learned?

[dorimar, BSN, RN]

I'm sure I'll be running in to you! I 'm very glad it's going well.