I think I made a bad choice.

[rant]

I'm a RPN student, just entering pre-grad. I've been assigned to a step-down ICU (acute respiratory), and I've been having some serious personal identity and self-doubt issues since the commencement of this placement.

I've never been in such an acute setting. And I thought it was what I wanted. I thought I would be up to the task.

But the reality is -- I'm not.

Not only are all of my patients dying or coming close to it, I screw up on the most basic of things (like, ugh, leaving a side-rail down and leaving the room), and it seems as though these screw ups keep happening.

I'm so terrified of doing something wrong that I have to ask clarification from my preceptor all the time, and I can see she is getting annoyed with my constant need for affirmation of the most basic of directives. The nurses keep asking me if I've ever had a placement in a hospital before, which should give you a pretty good understanding of just how idiotic I am.

One of my patients has severe hypoxia and shortness of breath secondary to pulmonary fibrosis and dementia. She was satting at 92% on room air during my shift yesterday. I wrote this down on the vitals flow sheet, and left it because I had read in the physician's orders (or so I thought) that she was to be kept between 88% - 92%. Today we got onto the floor, and she was drowsy, completely out of it, and deteriorating quickly. She was on 2L of 02 via nasal prongs, and satting at 96%. My preceptor was very shocked while we were assessing her, and said that it was because I hadn't informed her that the patient was satting "so low" yesterday, and that was why the patient was deteriorating now. I was ready to throw myself out of the window when I heard that -- it made me want to die, to know that it had been my actions that created this downward shift in her condition.

Also, my preceptor doesn't like how I perform patient care -- she implies that I am slowing her down. Today I changed two patients who had become incontinent of stool and had leaked all over their bedsheets. I had changed them earlier in the shift, and when my preceptor saw what I'd done, she got very angry and told me that, in an acute setting, there was no time for that to be done twice. If I'd already changed them, and the amount of excrement was livable, I was to leave them sitting in it because there were more important things to be done.

This is just a small incidence of the philosphy I have been exposed to on this unit.

I feel this isn't what nursing means to me.

And I feel like it's time to drop out, get an $8 an hour job, and turn my back on this wretchedness once and for all.

I guess I'm just not smart enough to be a nurse.

[SecuredFloorNurse]

I think you just need some experience and confidence. It will all come to you, it's still new though. Give it time and keep trying!

What the heck is your preceptor talking about "was the amount of excrement livable"? I don't think it's ever okay to leave someone in their own urine or feces! Even if it's a small amount, it's still enough to add to skin breakdown. That's my main gripe about your post. Makes me mad to think a preceptor thinks it's okay.

[RN4Little1s]

By the tone you use to talk about your precepter, I think you realize how she is not helping you to become a good nurse. She is not being patient or kind. And it sounds like she is trying to expose you to "harsh realities" of the ICU by telling you to leave a patient in their poop... but that is just showing the type of nurse that she has become. And you don't want to be like that anyway!

You are a STU-DENT - you are supposed to need affirmation for basic things. Once you have become competent with the basics in school, you will then learn more complicated tasks pertaining to the field you choose when you orient there.

So maybe ICU isn't for you... That's okay! The beauty of nursing is that there are so many options. And I will ignore your last 2 sentences because I think you know that is just silly.

[twinmommy+2, ADN, BSN, MSN]

Perhaps you need a new preceptor? No it is not ok to leave someone in feces. If that means cleaning them up more often then so be it. And we don't have time but we need to make time to do it cause its just our luck we get patients that have diarrhea and it sucks.

But what now of the patient who was sating low yesterday? Why is she not checking on her patients? You are the student and she is the one responsible for that patient, not you.

Keep at it and don't take things personally. Easier said than done. I know.

[BradleyRN]

My preceptor was very shocked while we were assessing her, and said that it was because I hadn't informed her that the patient was satting "so low" yesterday, and that was why the patient was deteriorating now.

Nothing going on with that pt is your fault. If you are satting at 92% on room air, then that is acceptable, unless otherwise defined. Anything under 90% would need to be addressed. If she is satting 96% on 2L/ nasal cannula, then that is great. In any case, it is your preceptors responsibility to know what her pt's sats are. (Also, the "acceptable values" could vary from place to place.)

Pts should never be left in feces. That is ludicrous for her to teach you differently.

Get a new preceptor. She is steering you in the wrong direction, and perhaps even getting a thrill out of blaming you for things that arent even your fault.

Search this site for O2 sats or something like that, and see what others have to say. Research your patients, and learn the pathophysiology behind their diseases. Dont be fooled by this preceptor, and when you learn the truth, call her out and find out what the hell she thinks she is doing blaming you. You will find out whose opinions you can rely on and whose you cant. And this woman falls into the "cant" category.:)

[silentRN]

everything comes with time.

[FireStarterRN, BSN, RN]

If the physician wrote an order to keep the patient between 88%-92%, that means that the patient is a CO2 retainer. The symptoms you describe of the patient becoming drowsy on 96% might very well mean CO2 intoxication. Some patients MUST not have Sats over 92% because they depend on lower levels of O2 saturation to stimulate their respiratory drive.

As others said, the preceptor sounds like she's trying to pass the buck. Some people use precepting as an opportunity to slack off.

[lpnflorida]

Do not be down on yourself. You are in the learning process. I am proud that you take the time to clean up your patient's when needed. Nursing is not all glory and just keeping our hands clean.

It is not your fault your patient is drowsy as explained by others. You have one lazy preceptor who may be one of those who never gets her hands dirty/ nor accepts accountability. Sadly there are schools today who are teaching young nursing students all about delegation which they interpret as " they are above doing the menial". Do not be one of these. There are times to delegate and their are times to bite the bullet. It is about discerning when to pass off onto someone else such as a CNA versus need to do it at the time by you.

As to leaving a bed rail in the down position. We have all done it. Looking at details such as that will come, just like without thinking making sure the call light is within reach. The bed table,water, Kleenex etc is in reach. Watch the experienced nurses as they are assessing their patient's they automatically without thinking do these little things before leaving a room. Why is it done? Keeps a patient off the call light, when they are able to reach the things they need. Those menial things, are not the most important things for you to concentrate on at this time though.

Can you get a new preceptor? I would. This one you have will lead you down the wrong path to gaining confidence and new skills.

[Blee O'Myacin, BSN, RN]

As a student, you should not be doing any of these things independently. I agree with FireStarter that your patient was probably too drowsy b/c the sats were too high @ 96%. But as a student, you should not have been blamed for a educational piece that should be provided by your preceptor. You really can't appreciate how badly a CO2 retainer does with too much oxygen until you experience it -- classroom lectures just doesn't do it justice.

Don't beat yourself up. When you are about to leave a patient's room, take 10 seconds and look at the patient. Is the rail up? Are they covered? Is the equipment located in a safe and proper place? Are all the leads and wires where they should be? Then run off to do the 80 other things on your list.

Good luck. (And talk to your manager about a more hands-on preceptor if possible.)

Blee

[chenoaspirit, ASN, RN]

Well, I dont like your preceptor! I had one just like her, she almost destroyed me. I cried everyday and thought I was so "stupid" because she made me feel that way. Dont let yours do the same thing to you. Once I got thru it and went on to the next preceptor, thats when I saw and was shown that I was actually a GOOD nursing student. You keep your chin up and dont let your preceptor destroy your determination or confidence.

And btw, the first thing I thought when I read your post was that patient was retaining CO2 from too much oxygen...which is NOT your fault. Is there any way you can look again at that chart to see that order for sats 88-92%. If so, I would take it and show that preceptor. Shame on her for making you feel like that is your fault, shame on her!

[Vtachy1]

If you can, get a new preceptor. What about the evening and night shift?? Was the patient without any nursing care for evenings and nights? Obviously the 92% was not out of the doctor's orders range in the evening and night shift nurse's opinions either. , this nurse preceptor is just a rip!

[leslie :-D]

dang, i hope the nurse had enough sense to remove the nasal cannula...

96% is just too high for this pt.

but even at 92%, you as a student, would not know to understand the implications of a set range (88-92), and that pt was trending upwards.

most important, you definitely need a new preceptor.

one who will support and encourage you.

please, take care of that immediately.

your mental health depends on it.:icon_hug:

leslie