So I moved for a job 300 miles away from home...this was my first nursing job...I have no prior hospital experience,this was a big change for me but I was also quite excited (it took me nearly 6 months to find a job)...well the position I found was in a private teaching hospital on a telemetry floor...very nice unit,nice people I guess you can say a dream job...I was happy despite being far away from my hometown and my family,friends and a boyfriend..When I was first introduced my preceptor she appeared to be nice and pleasant but also had that look about her that told you "be aware of her she might smile but she looks tough" Well at first she was nice and enouraging,telling me when she first started working on this unit she felt overwhelmed and she didnt know a lots of meds etc..so I thought that she was humble and "cool".Then fast forward to a day when she asked me to give an IM injection in the arm (flu shoot) Ok so I graduated from a ADN program and we didnt get any experience in a flu clinics during our school so I asked her if she could demonstrate an IM injection on a patient just this one time for me (since I never had given an IM injection in the arm before) Mistake number one!! She got upset and was "shocked" that I never gave an IM injection in the arm...then she told me straight up to my face "that I must come from a lousy school" That day she went into manager office and told her that my school didnt prepare me well enough for the real world,strike number one....then she went ahead and told everyone on the floor that I dont know anything...oh and she also asked me "if I like it over here and if I ever though about transferring?" Mind you this was my second week on the floor!!! But despite being discouraged I kept going and showing up every day one hour earlier before my start time....It is worth to mention that my preceptor never discussed our patients with me,never asked my opinion,what was the plan for the day etc,during lunch never spoke about our patients,nothing....I often had a feeling that she "was bothered by questions and I was hesistant to ask questions and I often felt discourage to ask questions or even scared at that point! Well then came strike number two,patient had a low blood pressure and she asked me to take his bloood pressure manually,so I put on a cuff on the patient inflated the cuff but for the life of me I couldnt hear a thing....so anyway since the patient was unstable and she was in the room with me I told her if she could recheck for me since I couldnt hear anything....she did..Later I realized that my stethoscope somehow got turned off,but I guess it was too late cause she run to the manager office and told her that she doubts that I can handle unstable patient,so later that day my manager call me and her to the office for a meeting.....the manager voiced her concern to me with the preceptor backup,the manager told me that according my preceptor I'm not meeting my goals and she is giving me one week to improve (I should have known right there and then I was going to be terminated in the near future)..so I tried my best the following week,yes I did my share of mistakes (nothing major,nothing to do with a patient safety)...all of the sudden (that week) my preceptor started to take interest in me....asking me which patient I think I should go see first,what did I think the plan for the day was for each patient...asking me did I check my labs etc??? I swear to you she never bothered to ask me that before...I guess she got scared after the previous meeting with the manager...So like I was saying that week I made some mistakes but also I caugh a lot of things (like inflitrating IVs,patient pulling out IVs,pressure ulcers) my skills were getting better,I was gaining more and more confidence and started to feel that I can do it....still had some trouble with prioritizing but I think that is expected of a new grad,unfortunately not on this floor..well fastforward to yesterday (sunday)...very busy day,my preceptor was a charge nurse and one of the nurses overslept and she had to take care of her patients so she left me with 'our patients" well I handle my patients quite smoothly,finally felt like a real nurse and went home with a light heart and happy that things finally are coming together for...hah what a dillusionment of my part....today monday my manager calls me home in the morning to come in to see her ( I was suppose work a night shift today with my preceptor)..I have a feeling that something is wrong...so I go with a heavy heart...the human resource person is there,all of the sudden I know I'm getting fired...so the manager tells me that she doesnt think I'm a good fit for this floor,that she spoke with my preceptor friday and she still thinks I have trouble prioritizing...I'm crushed I'm trying to explain that I'm a new nurse and that comes with an experience and that there is always someone there to help...but my manager is set on her mind...she tells me that I should go into med surg first and then maybe after one year reapply if I want (is she ******* kiddding or what??)..I almost burst into tears,yep,signed the termination papers and left...yep so that is my story what do yo think?
I'm so sorry to hear that they fired you. I remember how excited you were about your new job. It seems like they didn't give you time to adjust to being a nurse. It takes a while to transition from nursing school to real world nursing. I still don't have a job but that is what I heard . I wish you the best of luck in finding a new job!
I feel so bad for you Princessa, I know you had an extremely hard time in finding your first job,I'm crossing your fingers something soon will come up! I also hope that my post will somehow help new grads not to make the same mistakes I did--speak up about your orientation,if you think your preceptor is not a good match for you speak up early in the process,dont wait unit the last minute my mistake was keeping my mouth shut and then it was too late,be confident in yourself,take things in your own hands,find another mentor on the unit or as matter of fact anywhere in the hospital to whom you can vent your frustrations,lastly dont let anybody make you feel insecure and like dirt,question your critical thinking (you graduated from nursing school,pass the exam so you have it in you to be a nurse).
:smackingf OMG, Sorry for the long post above, I am working on being shorter and to the point in the things I want to say, but sometimes when I am writing in the moment I don't realize how long the post is until after I have posted it. My apologies again and I hope I didn't annoy anyone with such a long post.
Hey your advice is awsome I read it with pleasure. Thank you for your pearls of wisdom.
I cannot understand the impatience of seasoned nurses with new graduates, I just don't get it. Prioritizing comes with experience. Did they at least allow you to complete your orientation period before showing you the door? Gosh!!!
Let me tell you something based on your explanation, the problem is not you. I'm not trying to dog your preceptor too much, but I feel that she was just way too impatient and premature and should have given you more time before making her final judgment. Prioritizing takes time and is something you still have to work on way after your orientation period. As far as skills go there is nothing wrong with asking for a demonstration.
Don't give up or despair, pick yourself up, brush yourself off and try to move forward.. "This too shall pass". Get out there and start applying for new jobs and as someone pointed out try getting into a hospital with a nurse residency program if you can. Also bear the following in mind:
The first impression a preceptor has of a preceptee can set the stage for how much confidence he/she places in the preceptee during orientation (just my humble opinion).
My biggest advice to you is to be proactive during your next Job orientation and help run your own show, it will demonstrate that you hold yourself accountable for your own learning experience:
1. On your first day of orientation with your preceptor request a meeting if even for 30 minutes so you can tell him or her about your past experiences. For example, I told my preceptor that I have a lot of experience with G-tubes and Traches, but not a lot in other areas. For example, I have done IV starts before and one IM injection (in a NICU) but I still need more opportunity to practice. I am telling you to explain these things in the beginning, so that it doesn't come across as if you just don't know anything at all or that the school you went to was not a good school etc.
2. Let your preceptor know that you may ask for a demonstration of certain skills as a refresher because you may not have done them enough in the past.
3. At some point during your first week of orientation write a list of skills relevant to the job that you feel ok with such as: taking vital signs, blood sugar checks, subQ injections etc. and write another list of skills you would like more opportunity to practice during orientation. Again this will give your preceptor a mental picture of where you are skills wise, so there are no surprises if you ask for a demonstration of a particular skill you are not comfortable with.
4. At the end of each day of orientation summarize what you learned and the next day when you go to work with your preceptor, spend a few minutes going over what she taught you the day before, because that will make him or her realize that you do listen and make note of what he/she is teaching you. It may help the preceptor feel good about his/her preceptingl.
5. Keep a running list of every pt you have seen (identify by pt condition ex. TIA pt) and the skills you had an opportunity to perform, so that if for example your preceptor says you should know how to do X Y Z by now, you can remind him or her that you haven't had certain opportunities as yet. You know what I mean. I know all of what I'm telling you sounds a lot, but I did it and it really wasn't difficult.
Keep the faith, vent and cry off your frustration if you need to, but keep on applying for jobs.
Best Wishes
Nope,this is my 6 week (well really 5th) because the first week I just followed my preceptor,originally they said they would give 6 to 8 weeks (depends how I do) In april I was going to go to EKG classes and I was on a 3 month of probation period,they let me go 2 months before my probation period,and I havent even done anything terribly wrong,all they have is "what if "excuses!!! They said that they are not sure how I would handle a critical patient ok but there are other nurses to help when you call a code!!!
Use the month of April to apply at the Catholic hospital and all the local LTC facilities as well as any other local places where you might get a job before you move home. If you find something, you might consider moving into a rented room or a residence hotel type situation to save some money on a place. I imagine you exhausted the job prospects at home before you took this position so it will at least be worth it to look where you are now for awhile before you go back to square one. Good luck and keep your spirits up.
Yeah the place where I stay is not so bad it is a quite cheap room.Well anyway I might just do what you wrote.I could always apply to another state...Before I came here a hospital in Luisiana wanted to hire me also one in Texas,and a hospital in Aspen was interested in me but I choose this one cause it was close to home. Ideally I would like to find a job at my home state,but this is probably just a wishful thinking you know...
Okay, don't take offense, but here goes. Please bear with me:
I would be shocked too, if a new grad had never been taught IM injections in NS. IM is a route of medication administration that falls well within RN scope of practice. Having said that, it is not your fault if your program did not prepare you for this, and you were correct to speak up that you had no experience with it.
With the unstable patient, your inability to take a blood pressure no matter the reason would have stood out to me as well. Obtaining VS is such a basic nursing task that unlicensed assistive personnel do it as part of their normal job duties. If I were precepting a new nurse and had an unstable patient to deal with, and all I asked of the new nurse was to get a BP and they couldn't even do that for me, I'd have some concerns too.
Difficulty with prioritizing is definitely normal for a new grad, so I wouldn't hold that against you as a single factor. But, combined with other things, it can be part of the bigger picture.
Stating that you think med/surg is harder was a mistake. You're free to think whatever you want, but the things that come out of your mouth do influence what your preceptor and your team mates think of you as a nurse and team mate. There is a reason patients are on telemetry. While many of them are not nearly as physically demanding and don't have as many medications and treatments as your typical med/surg patient, the risk of becoming unstable is real enough that they require continuous cardiac monitoring.
Hiring a new grad with no hospital experience into a tele unit was poor hiring practice, IMO. That is not your fault.
This type of environment is very much sink or swim. If you are not swimming reasonably well after a woefully short and inadequate orientation, then one should not be surprised to be let go. Is it right? No. Is the "sink or swim" approach good for patient safety? No. But it is the reality.
Pick yourself up, dust yourself off, and get back out there and find a job, knowing you gave it your best. But, I suggest you find something more entry level and get some experience under your belt.
I'm really sorry to hear that this has happened to you. I have to tell you, I have been a nurse for 8 years. I started off in a PICU as a new grad and have been a PICU nurse for 8 years now, and a travel nurse for 6 years. Do NOT let the lack of professionalisim and support of some nurses make you feel discouraged ( easier said than done, I know). I consider myself quite fortunate to have had an EXCELLENT preceptor. Make no mistakes, no nurse comes out of the womb knowing how to practice nursing, NO ONE does. It's takes time to learn to adequately, safely, compassionately, competently, and confidently care for our patients. Unfortunately, some nurses have gotten into a very destructive habit of what I call "eating their young" and treating the new nurse very poorly. I have seen it first hand, and have made it a point to encourage the new nurses and remind the other nurse that we were all there before, how quickly some forget. It is OK to say, can we talk about IM sites, the viscosity of the medication, in relation to the site, the length of the needle, The size of the patient, all OK questions, and good to talk about before you go to the patients bedside, so that you feel confident before you walk in the room and most importantly be prepared. Sounds like you needed to switch the correct side of the stethescope on to take that patients BP ( bet you won't forget that again , it would have been a good opportunity for your preceptor to teach the importance of making sure your equipment is working correctly and teach the importance of timeliness and how quickly our patients can decompensate and how important it is to be "on point" because our patients depend on it. My preceptor told me years ago, "i'm gonna make you a great PICU nurse". And that was her attitude, it was positive, and patient. You can be a successful tele nurse! As more experienced nurses, it is our responsibility to ourselves, our patients and new nurses to make sure that you are armed with all the information, resources and support that you need,:clown: so you can learn to be a great critical thinker, and hone in on cues that your patient will give you, as well as protocol and proper practice. It is not professional or appropriate to belitte each other, nor is it supportive. It sounds like that Nurse manager and that preceptor did you a HUGE favor. If you are going to be a successful RN you need the support of your peers, period! One RN ( or any healthcare provider for that matter) cannnot run the whole show, I repeat, it takes a team. It takes people sharing information, sharing skills, sharing resources and teaching. She was not a good teacher for you. Furthermore it speaks VOLUMES about your nurse manager. Not assessing wether or not you all were a proper fit, and ensuring that you were in situations that were conducive to your learning. When I started out in the PICU as a new grad I had 3 months orientation and at the end of my orientation my preceptor said, you're ready, but I was asked if I felt ready to start or if I wanted more orientation time. My preceptor was always by my side encouraging me to critically think and teaching me how to provide patient care and how to get organized. My suggestion to you is to chose another job you want to do, and go for it. Ask A LOT of questions when you get your next interview like, how long is the orientation, what steps does the hospital take to encourage and support my learning, is there a formal orientation program, does it have a module that the preceptor and orientee will follow, and things of that nature. It's VERY important for you to have a strong foundation on which to build your nursing practice on, so you can move forward into the future in a positive way, and deliver the best possible care to your patients. I wish you well in all of your nursing endeavors:clown:
Okay, don't take offense, but here goes. Please bear with me:
I would be shocked too, if a new grad had never been taught IM injections in NS. IM is a route of medication administration that falls well within RN scope of practice. Having said that, it is not your fault if your program did not prepare you for this, and you were correct to speak up that you had no experience with it.
With the unstable patient, your inability to take a blood pressure no matter the reason would have stood out to me as well. Obtaining VS is such a basic nursing task that unlicensed assistive personnel do it as part of their normal job duties. If I were precepting a new nurse and had an unstable patient to deal with, and all I asked of the new nurse was to get a BP and they couldn't even do that for me, I'd have some concerns too.
Difficulty with prioritizing is definitely normal for a new grad, so I wouldn't hold that against you as a single factor. But, combined with other things, it can be part of the bigger picture.
Stating that you think med/surg is harder was a mistake. You're free to think whatever you want, but the things that come out of your mouth do influence what your preceptor and your team mates think of you as a nurse and team mate. There is a reason patients are on telemetry. While many of them are not nearly as physically demanding and don't have as many medications and treatments, the risk of becoming unstable is real enough that they require continuous cardiac monitoring.
Hiring a new grad with no hospital experience into a tele unit was poor hiring practice, IMO. That is not your fault.
This type of environment is very much sink or swim. If you are not swimming reasonably well after a woefully short and inadequate orientation, then one should not be surprised to be let go. Is it right? No. Is it good for patient safety? No. But it is the reality.
Pick yourself up, dust yourself off, and get back out there and find a job, knowing you gave it your best. But, I suggest you find something more entry level and get some experience under your belt.
Best of luck to you!
I think I forgot to mention that I knew how to give an IM injection in the tigh but I never gave one in the arm( I never had an opportunity to give a flu shot in school also our instructors always told us to avoid arms because of nerves). I did tell her that I gave IM injection to babies in the tigh but she brushed it off. Also I know how to take a BP but I didnt realize that my stethscope was turned off,and yes possibly it was a bad choice to hire a new grad into a tele but I still think med-surg is a much harder floor.
Doesn't matter. The deltoid site is so basic, you should have been taught that and checked off on it in a skills lab in NS. Again, it's not your fault that your program apparently neglected to educate you in this, and you were right to speak up.
Had I been your preceptor, I would have simply given the injection myself while demonstrating the correct technique, answering any questions, then expect you to do the next one under supervision, and once demonstrating competency, expect you to do them independently. But, I actually like to teach. I look forward to the day when I am experienced enough to precept.
However, it sounds to me like your particular preceptor did not feel like investing in you in this way. This is the "sink or swim" that I am referring to. They do not want to invest too much time and effort teaching basic nursing skills. As I said, I don't think it's right, but it is very much a reality that you need to be prepared for.
Doesn't matter. The deltoid site is so basic, you should have been taught that and checked off on it in a skills lab in NS. Again, it's not your fault that your program apparently neglected to educate you in this, and you were right to speak up.
Had I been your preceptor, I would have simply given the injection myself while demonstrating the correct technique, answering any questions, then expect you to do the next one under supervision, and once demonstrating competency, expect you to do them independently. But, I actually like to teach. I look forward to the day when I am experienced enough to precept.
However, it sounds to me like your particular preceptor did not feel like investing in you in this way. This is the "sink or swim" that I am referring to. They do not want to invest too much time and effort teaching basic nursing skills. As I said, I don't think it's right, but it is very much a reality that you need to be prepared for.
Yep,that was my impression too,it sounded like she didnt really care enough in investing her time in teaching me.Otherwise she would come in to work with a better attitude,she never smiled when she came to work and greet me with an enthusiasm..she never enouraged me to ask question (an example: we had a pt going into cardiac surgery I was going through a pre-cardiac surgery orders list and I ask her for a clarification about one of the orders (I wasnt sure if the beta blocker should be held) she brushed me off,looked at me like I'm stupid and then said "just follow what is says) I mean come on my first cardiac surgery patient and I cant even ask a question about one of the many orders) When I asked another nurse she was more than happy to explain me everything,as a matter of fact the other nurse approached me herself and asked me what I was writing and I said just notes to myself of what I learned and she said what kind of questions I have and that she would be more than happy to help clarify (and she was suppose to be the meanest nurse on the floor/well that is what my preceptor said about her) Also my preceptor on numerous occasion told me that if I want I can go home early (on low census),one day she took of in the middle of the day cause it was a "slow" day,dont mind the new hire on orientation,then yesterday she told me I dont have to do a night shift if I dont want to.She just didnt seem to care but why talking such trash about me.
PS.I'm not denying my mistakes or lack of experience,I just wish they were more patient with me and understanding,after all I was not claimed to be incopetent and can even apply to the unit in the future (yeah right like I would anyway!!!)
It's OK to say I haven't done this. You do not stop learning after nursing school. Furthermore, you have to learn BASIC foundation nursing skills and learn how to critically think concurrently when going to a floor other that Med/Surg. Whenever you hire a new grad, it's rare to find one who is competent in all off the basic nursing skills. I would EXPECT to demonstrate FIRST and then you demonstrate under my supervision, that is part of teaching.
, it would have been a good opportunity for your preceptor to teach the importance of making sure your equipment is working correctly and teach the importance of timeliness and how quickly our patients can decompensate and how important it is to be "on point" because our patients depend on it. My preceptor told me years ago, "i'm gonna make you a great PICU nurse". And that was her attitude, it was positive, and patient. You can be a successful tele nurse! As more experienced nurses, it is our responsibility to ourselves, our patients and new nurses to make sure that you are armed with all the information, resources and support that you need,
:clown: so you can learn to be a great critical thinker, and hone in on cues that your patient will give you, as well as protocol and proper practice. It is not professional or appropriate to belitte each other, nor is it supportive. It sounds like that Nurse manager and that preceptor did you a HUGE favor. If you are going to be a successful RN you need the support of your peers, period! One RN ( or any healthcare provider for that matter) cannnot run the whole show, I repeat, it takes a team. It takes people sharing information, sharing skills, sharing resources and teaching. She was not a good teacher for you. Furthermore it speaks VOLUMES about your nurse manager. Not assessing wether or not you all were a proper fit, and ensuring that you were in situations that were conducive to your learning. When I started out in the PICU as a new grad I had 3 months orientation and at the end of my orientation my preceptor said, you're ready, but I was asked if I felt ready to start or if I wanted more orientation time. My preceptor was always by my side encouraging me to critically think and teaching me how to provide patient care and how to get organized. My suggestion to you is to chose another job you want to do, and go for it. Ask A LOT of questions when you get your next interview like, how long is the orientation, what steps does the hospital take to encourage and support my learning, is there a formal orientation program, does it have a module that the preceptor and orientee will follow, and things of that nature. It's VERY important for you to have a strong foundation on which to build your nursing practice on, so you can move forward into the future in a positive way, and deliver the best possible care to your patients. I wish you well in all of your nursing endeavors:clown:
Blackheartednurse
1,216 Posts
I feel so bad for you Princessa, I know you had an extremely hard time in finding your first job,I'm crossing your fingers something soon will come up! I also hope that my post will somehow help new grads not to make the same mistakes I did--speak up about your orientation,if you think your preceptor is not a good match for you speak up early in the process,dont wait unit the last minute my mistake was keeping my mouth shut and then it was too late,be confident in yourself,take things in your own hands,find another mentor on the unit or as matter of fact anywhere in the hospital to whom you can vent your frustrations,lastly dont let anybody make you feel insecure and like dirt,question your critical thinking (you graduated from nursing school,pass the exam so you have it in you to be a nurse).