I am a new grad and can't wait to get out of orientation!

BSN16 · Mar 10, 2017

Reminds me of the time i asked a nurse who was still on orientation how they were like it and they replied "Nothing a don't think i can handle"

When i came back that night the patient was coding and the nurse was like a deer in headlights. Just some perspective :smokin:

Ruby Vee, BSN · Mar 10, 2017

Hi,
I am a new grad and it's my third week on a busy tele floor. Here is the thing. I feel as though I don't need a preceptor anymore and feel I am ready to be on my own. Every day when I come to work I think things would have been easier for me if I could organize my day without anybody telling me what we need to do next or do it my preceptor's way. I feel confident talking to doctors and monitoring my patients. I have caught things before the patient deteriorated badly.
But now I have a question. Am I being too confident? Am I missing something? I feel as though all new grads should feel overwhelmed and need preceptor's help. I just don't want to be one of those new grads who felt too confident and made a huge mistake because they thought they were ready too early and didn't need help.

The scariest new grad is the one who already thinks she knows everything. You don't know what you don't know. That terrifies me!

Meriwhen, ASN, BSN, MSN, RN · Mar 11, 2017

Hi,
I am a new grad and it's my third week on a busy tele floor. Here is the thing. I feel as though I don't need a preceptor anymore and feel I am ready to be on my own. Every day when I come to work I think things would have been easier for me if I could organize my day without anybody telling me what we need to do next or do it my preceptor's way. I feel confident talking to doctors and monitoring my patients. I have caught things before the patient deteriorated badly.
But now I have a question. Am I being too confident? Am I missing something? I feel as though all new grads should feel overwhelmed and need preceptor's help. I just don't want to be one of those new grads who felt too confident and made a huge mistake because they thought they were ready too early and didn't need help.

You know nothing, New Grad Snow.

Seriously, you may think things are going great and you don't need the preceptor because you know the answer to all the questions you hear. Not every new grad has to feel so overwhelmed the they cling tightly to their preceptor's hand the entire time. And yes, there's nothing wrong with asking a preceptor to step back a little if she's being too overbearing.

But you haven't even begun to see and learn everything that you need to about Tele. You've only just begun your education on the floor and there's a lot of learning ahead of you. You're going to find that a lot of what you see isn't how the textbook said it would be.

And it takes a long time to truly master the fundamental skills of nursing...and I don't just mean reading ECGs and inserting IVs. I mean prioritization, delegation, care planning (yes, care plans do live on after nursing school), time management, medications, and the other fun skills you really can't master while you're in nursing school or even a couple of weeks into orientation. These are the skills that every single new grad, regardless of speciality, needs to learn if they don't want to drown.

You are, in fact, operating with a huge safety net under you right now, and you shouldn't rush to leave it. I think you will find your first bad shift off of orientation to be a rather humbling experience. And it's probably at that point when you'll say to yourself, "I now know what all those nurses on the forum meant."

You are far from ready to fly solo. Don't let your overconfidence tell you otherwise.

DNTcode · Mar 11, 2017

Hi, been there, felt same way. And yes, on one side I have to admit preceptors get into way... and sometimes they unfortunately aren't smarter, they might be wrong as well. I recall my first job and my preceptor who could not stand I was bit smarter, so she would constantly try to give me hard time. Once I had patient on whom the lab just draw blood, and it was hard stick. I was to apply some cream on the back. And few other meds. So while the phlebotomist is drawing blood and my preceptor is trying to stress me and pressure me: fast, fast... we need to pass the meds, I am scanning it all, giving patient nicotine patch on the other arm, so I do not interrupt the phlebotomist. My preceptor yelled at me, that I need to put that cream on now... And I just refused - I told her, I am going to wait after phlebotomist will be done. Then I will turn the patient and apply the freakin lotion. Phlebotomist gave her evil eye as well and she got red. And finally cut it out. Other time preceptor wanted me to give whole bottle of Bumex pharmacy sent to us for the patient. I told her nope, its is prescribed for only half dose. Nope, give it all. Nope it is only half dose. And I showed her. She was ok with it then. Sometimes I felt they just used me, as I was doing everything, did not need them around, and they just chat with their friends as I was pretty much on my own.

Yet on the other side... you do not know everything. You been there only three weeks. You did not see many many scenarios. And it is nice to have someone whom you can go to, and who is there to help you! What you gonna do, if your patient starts coding? Where you gonna call if there is something really messed up in computer program with patient and things does not work as they should. Did you see all procedures? Can you perform them all or assist to MD all by yourself?

So far, you lets say you had about 40 - 60 patients... I guarantee you, you did not see a lot of things. What if they will prescribe epoetin? What labs should you check before you give lasix? Would you give that potassium to patient whos K is 3.0 and he is end stage renal disease? What if you will need to start amio? How you will do it? Heparin drip? Not always you have everything served and written in front of you, sometimes you can't rely that pharmacy will send you appropriate tubing, or that MD picked correct protocol for heparin etc... you will know this with time. They want you to take 300 lbs patient to CT can you do that? 300 lbs patient wants to use a wheelchair...

What IV you need to have for CT etc...

Would you know, when you need to get MD to transfer your patient to ICU?

Where you gonna call, or how you gonna get everything ready if computer system crashes, secretary does not show up at work. What if your patient has Alzheimer and walks out... what you need to do, and what paperwork you will have to fill and whom you call. What you gonna do when your patient falls. You might know a lot. But can you really be self sufficient?

I know you may ask someone around... but you might really end up being on your own as it could be bad, bad day and no one would have a time to help you.

Use the preceptor and orientation time to your fullest. You will see there will happen something unforeseen and you will be happy you have a help and support around. Use it,appreciate your preceptor, even though she is driving you crazy. Even you think you might be able to do it better. After all she is also only human. As you are. As she might make mistake - so you can. But you will always need help and support! There always will be that patient who will make your day living hell, and who can ease it up? - is the buddy on the floor. It might very well be your preceptor.

Creamsoda, ASN, RN · Mar 11, 2017

you are way to over confident. WAY to over confident. 3 weeks in? yikes. your scary sorry to say. take a step back and try to see what your preceptor is trying to teach you. seek out learning opportunities while you still have the time and support. your going to kill someone if you keep up your attitude. in general nursing school does not prepare you to be a real functioning nurse whether you believe that or not. right now you dont know what you dont know which is why you feel so great. your in the honeymoon, ignorance is bliss phase. You have the back up to help you "feel" secure. soon there will be no one monitoring your every step. that is when you could fail big time. Kind of like taking off your training wheels. you will stumble. make the most of the time you do have precepting. your on a busy tele floor. you mean to tell me you feel confident in you assesment skills, your base knowledge? you will get eaten alive with you attitude.

ChryssyD · Mar 11, 2017

You have gotten great advice so far. All I can add is to tell you what my mom (a nurse) told me when I graduated nursing school: Congratulations. Now you're ready to learn how to be a nurse.

P.S. And really do enjoy the full orientation; it's most likely the only time you'll get one. Give yourself time to breathe and soak it all in. Plenty of time to fly solo later.

NurseLife88, ADN, RN · Mar 11, 2017

I'm a newbie nurse too and although I am somewhat confident in my skills I also know how easy it is to make a mistake. I also realize that school is nothing like the real world at all and confidence doesnt equate to ability or clinical skill. I think its great to be confident but even greater to have the guidance and have the safety net of a preceptor to help teach you the ropes so to say. I am mandated 12 week orientation at my new job and couldn't be more thrilled that I'm allowed that much time to really get a feel for the floor. Take advantage of the opportunity as others have said, I know I will! Keep up the confidence but keep on learning too. Ask for a bit more challenging patients so you get loads of different experience. You seem to be positive and confident after only three weeks so imagine how you will feel after 12!

kataraang, BSN · Mar 11, 2017

Thank you all for replies! There are many things I still don't know, but I can ask just about any nurse on the floor if I have a quick question. Sometimes seasoned nurses ask questions which I overhear and know the answer to. So everybody has questions (young or old), but this doesn't mean everybody needs a preceptor. But I am definitely going to take your advice and stay on orientation for 12 allowed weeks.

I just finished orientation about a month ago. I can kind of relate to your post, and I think I can see the part of you that isn't being cocky. I get it, I was itching to go off orientation too. I think what it really was, was not me thinking that I knew everything. I think it was more about me and my preceptor having different ways of prioritizing tasks. Doing her way, I felt more behind. I also was always self conscious to have someone over my shoulder. However, I still ask questions every day. I ask fellow nurses, the techs, doctors, anyone. Something as silly as, "I've never done an enema". I am frequently on Google searching vocabulary unknown. I didn't know what a volvulus was so I looked it up.

I'm glad that you're so excited about starting your career! Just stay humble and keep asking questions :)

ThePrincessBride, MSN, RN, NP · Mar 11, 2017

I couldn't wait to get off orientation not because I thought I knew everything (ten months out and I am just scratching the surface), but because I had a hovering, backstabbing witch for a preceptor.

That being said, if you feel your learning style isn't compatible with your preceptor's teaching style, you could always request a different one (though that could potentially backfire). But at three weeks in, you are just getting started and you have a lot to learn. Towards the end of your orientation, she will probably back off and if she hasn't, either it is something you are doing or it's her.

Ben_Dover · Mar 11, 2017

Points to ponder....

If your preceptor thinks you can be on your own, he/she would have

1. Done it by now!

2. "Precepting" a newly grad., an overly confident new grad., is not easy. Actually, "precepting" at all is not easy, cause whatever mistake you make, becomes their own.

3. Listen to the members here, they are saying the "same exact message": "You Don't Know What You Don't Know." These members have been here, I bet yah, even before you were born. They based whatever they're telling you on their years and years of experience.

4.

Wrong. EVERYONE needs a preceptor. You will probably have better insight as to why when you are a nurse on your own. Your over-confidence is a bit worrisome. I do wish you well.

I do agree with SmilingBlueEyes here.

5. Having confidence is good, you might be smart, book smart that is. However, real world experience versus what you've learned straight out of the Nursing Book is completely different.

6. Do yourself a favor, let your preceptor decide. But please do let us know what she thinks of you, by Friday, March 17, 2017. Will you do that?

And/Or, will you let us know once you have a full load, (you are kind'a on your own but fortunately, you're still in orientation) and when or if you get this kind of an assignment:

Since you mentioned you mainly have been admitting/discharging patients, but now, the unit's lacking a CNA and since you are so short staffed, your preceptor had to take a patient or two. So your first newly admitted pt. requires running a total of 40 MEQs of K via IV and 3 gms of Mg via IV, and it so happened that the only IV you have working gets infiltrated and your EKG tech calls you to tell you that "Oh your pt. just had an 8 beats of VTACH.

While your second pt. who was admitted for GI Bleed with critical H&H values, well, this pt. only requires a total of 3 units of blood and added some IV Lasix in between bags. Of course, you know that your vitals need to be taken, sounds easy right?; And to make things safer, your hospital's policy, when hanging blood, is for you to be with the pt., what they really mean is that they want you "to stay with the pt." the first 15 minutes after hanging the bag. I'm sure you can handle that.

But wait, it gets even better, your third patient, yes, your third patient, who happens to be severely confused, uncooperative, combative, and a big time fall-risk secondary to ETOH withdrawal and guess what this pt's bed is full of feces and urine and the bed has not been changed since your first assessment (remember, you lack aides, as a matter of fact, the whole hospital lacks assistance and your manager tells you, "Sorry, they can't send us a sitter").

Lastly, your 4th patient, is a potential candidate to go into sepsis and you have the orders ,"thus the power", (very strong word) to prevent this patient to go into full blown septic shock. But fortunately there's an order to transfer this pt. to ICU. But unfortunately, the manager tells you that the ICU is full and can't really take any transfers since the ER's sending most of their critical ones to the unit. By the way, don't forget, the drunk patient's family member who has been asking you to clean the pt's bed and has been complaining to your manager (who happens to be also busy being a manager to a busy floor) that you are not doing anything for this patient. So here you are, as you approach this family member to explain things, your phone rang, "again", a call from your EKG tech "again", and "again" saying your first patient just had another runs of VTACH, this time only "30 beats", that's just a piece of cake. Wait up, did you ever start a new IV on this patient yet?

This type of assignments do happen and you are blessed to still have such a light load at this time and still be on orientation.

The bottom line is, show kindness and respect to your preceptor and you will earn it, they know what they are doing.

CRC12 · Mar 11, 2017

I got lots of good advice and heard things that could happen I could not imagine. Thank you for helping me figure this whole preceptor thing out. I truly want to be a good nurse, the one who is vigilant and takes good care of my patients. I just need to have a talk with my preceptor and ask her to let me do simple things myself so I can learn, instead of doing it all for me and treat me like a child.

Wuzzie · Mar 11, 2017

I liked your previous wording about taking on more challenges better than "treating you like a child". I don't think these words will garner the response you hope for.