Honest Question

[RNikkiF]

I have an honest question that I'm afraid may get some raised eyebrows, however, I'm going to ask anyway.

Why is it that SOME (not all) nurses seem to freak out over anything that may not go quite as planned. ?

I recently started a new position at a free-standing acute rehab facility. Yesterday (Thursday Jan. 23) was my second day on the floor orienting. I had two patients. One of them told me that prior to admission she had scheduled an appointment to have her supra-pubic catheter changed. She had scheduled her appointment for Monday Jan. 27. She was asking if transportation would be arranged or if she needed to cancel the appointment. I consulted my preceptor who was very busy with five patients. My preceptor said she needed to finish what she was doing and then we would handle it together, but in the meantime, could I get an order from the doctor?

I asked the doctor for an order. She said she would write it when she got to that patient. After I asked for the order, I went back to work with my patients. I had a very involved dressing change on one patient and staple removal on my other. I also had charting to do in a system that I am obviously still learning. My preceptor had said she would catch up with me, so I assumed she would.

Charting took me a while, and I got very wrapped up in what I needed to do and did not realize that end of shift was quickly approaching (we are on 8 hr shifts and I normally work 12s). I also didn't realize the doctor had left. The appointment honestly slipped my mind.

My preceptor finished and was reviewing my charting. There were some minor problems I needed to correct, but the system is quirky and it would take passed end of shift to fix. My preceptor asked me about the appointment (remember she said she'd walk me through it). I told her that it had slipped my mind and I would check the chart for the order. She then started a bit of a rant about how "That's something that has to be taken care of no matter what". And was basically repeating the same thing over and over. Meanwhile, since I'm standing there listening to her say this stuff, I couldn't go get the chart. She's still going on about it, acting like I had failed to address a serious symptom or something.

I checked the chart (finally) and the doctor had not written an order. My last facility wouldn't have considered this a major issue, since there was still time to make arrangements and the next day shift would have made arrangements for it. YES, I realize that I should have done it, however, it was only my second day at a facility that is brand new to me and my preceptor said we would do it together, which didn't happen. Anyway, the preceptor told me to call the doctor and get a T.O. I went to do that when the HUC (they call them CSCs there) said the MD was on her way in anyway and not to bother calling, she'd be there in a couple of minutes.

The doctor arrived. When I approached her, she said "I didn't forget, someone else had the chart. That's why I came back". So I give the order to the CSC and she says that she needs phone number and address ... Actually she said "I can't do anything with this! I need phone number and address! This means nothing to me!...(she already had medical facility and department... I'd think she could handle finding the other info). At this point, my preceptor announces that I need to fix the charting and that she is leaving (but not before she took one more chance to chastise me)... So I go back to the patient's room, it is now 30 min after I'm supposed to be gone, I still have charting to fix and I'm 10 minutes late picking my daughter up from school!! The patient gave me a phone number but no address and was giving me a hard time about "Why can't you just look it up??"... GRR...

I know this is a lot of info, but why on earth do some nurses FREAK out about stuff like this that there is still time to fix???? I know I should have done it, I have no routine in place yet and I'm at a BRAND NEW TO ME facility on my SECOND DAY! I could see someone being stressed about it if it were a Friday and everyone was getting ready to leave, but there was STILL more than enough time to fix it.

I see people freak about this stuff all the time. Honestly, it takes a lot for me to freak out over anything not medically related, but so many people do this... and it is IRRITATING!!! WHY do they do this??

[SL2014]

Why are you freaking out about them freaking out?

Yes, it was your responsibility to get the appointment order. You can't hold the doctor's hand, I've had a tons of doctors leave before doing something that I asked them to do... it happens. All you can do is try harder next time. Your preceptor won't be your preceptor forever, so just learn what you can and let her freak out.

As far as being behind on your charting and late to pick your daughter up- this will not be the only time. Nursing ends when your work is done, not when your shift is over. It sucks, but its a fact of nursing life.

[Wile E Coyote, ASN, RN]

I'll comment on just this one point...as a preceptor myself, I don't leave until my preceptee leaves, and outside of special circumstances, their performance reflects mine.

[canoehead, BSN, RN]

Everyone involved seems to be wound a bit tight. If the doc left you can get a verbal order. The doc was coming back to write the order, but you can't read her mind. If the secretary can't use a phone book, that doesn't reflect on you. Your preceptor doesn't seem very tolerant of normal issues, like taking a bit more time as a new person. As a new employee you can plan on getting out 30min late by times because of finishing up or someone wanting to have a word with you. Can you extend your babysitter's hours?

[dudette10, MSN, RN]

Not speaking to the OP's specific situation, but in general...

People freak out in nursing because of dysfunctional coping mechanisms in a high stress job. Some people never learn it. There is a nurse I work with who is highly experienced and knowledgeable, and I would trust my life with her, but she gets stressed out very easily. One day, she had a very heavy patient that needed incontinence care with no CNA to be found. I offered to help. This was the first time I was ever able to observe her directly and for an extended period of time. She was stressed and flustered, which led to inefficient clustering of care. The basic care took us twice as long as it might have otherwise due to inefficiency.

It took me awhile to become efficient in my own practice and to prevent that uncomfortable flow of adrenaline when something happens that messes up my plans. But now that I have learned it, I'm a better nurse for it!

As for the unit secretary, some of them need all the i's dotted and t's crossed before you hand them a piece of paper. It is frustrating. I had a patient going to a different facility from where they came, so the face sheet was incorrect. I pointed out that when asking the US to call for an ambulance and gave the name of the facility, which is one that a lot of our patients come from. She required me to get the address, and I said that she could google it. She threw a fit, so I went to HER computer, googled it, and pointed to the address. Even now, I'm shaking my head that I had to do that.

All this is to say that you'll always run into things like this--as you probably already know--but don't take it personally because it ISN'T personal. It's the expression of ineffective coping mechanisms and lack of adaptability.

[Gabby-RN]

It honestly does not sound like this facility has a good preceptor program or the preceptor isn't very good. On your second day the preceptor should be working with you, not having their own assignment that is so busy they do not have time to help you. You don't know know how the facility works, how would you have known that the doctor needed their hand held. How would you have know the secretary needs the address and phone number (she may have been taking advantage of your newness here). Your preceptor never should have left for the day with you still there. Your work is her work. You might also want to discuss with her more timely charting reviews or a different method of reviewing your work, the way she is doing it by having you go back and fix everything at the end of the shift seems ineffective-especially if she isn't going to stay to ensure you fixed it correctly. Nobody likes someone watching over their every move but at least for the first week it seems like it would be beneficial for the two of you to be doing everything together. If things don't improve soon, you may want to consider asking for a different preceptor. The facility wants you to succeed and catch on quickly and should be very willing to set you up with someone that will help you do that. Good luck.

[sandyfeet]

I think the preceptor was upset because a delay would reflect badly on her as your preceptor. Even though it is weird that she left while you were still working, remember that the mistakes you make in preceptorship are generally the "forgivable" ones and are your hints as to what is important in your new job. It sounds like staff have well-defined roles they don't work outside of at your new job. Hope your next shift is a better one!

[CWONgal]

One thing that wasn't mentioned is the "passing the buck mentality". A lot of nurses get frustrated and rightfully so when things are forgotten and someone else ends up becoming responsible. Don't get in the habit of always thinking there is time...it's not uncommon to find out your patient is getting discharged or transferred earlier than planned.

[ArtClassRN, ADN, RN]

I have an honest question that I'm afraid may get some raised eyebrows, however, I'm going to ask anyway.

Why is it that SOME (not all) nurses seem to freak out over anything that may not go quite as planned. ?

Because that is what these individuals do. I don't know why, but they probably freak out over everything in their lives. I have one coworker who always rushes in a few minutes late, then spends the rest of the shift perseverating on "How far behind" she is. Cripes.

It used to bother me, but I learned to not give any emotional fuel to their fire.

If they continue to badger me with freakoutishness, on rare occasions I will say, "Look, EVERY DAY cannot be a tragedy. Let's just deal with this." As toxic as these personalities can be, I force myself to provide the same amount of assistance and teamwork in helping them take care of their patients that I would provide to my best friend. Truth be told, I often have to provide more. But I do it.