I think I might lose my job, please help

stevierae · Apr 25, 2005

I am a new grad working in OB. I have been precepted for 7 weeks now. During the past week, I have made several errors. I gave a rhogam without charting it on the mar, I did a PKU without filling out the form first, and then ended up putting the blood on the wrong part of the form, and then gave the wrong medication to a pt. I graduated as an honor student, but now that I'm working, i am so nervous all the time, and I feel like a complete idiot. My precepted experience has been rocky, I've been with several different preceptors, I was sent home for low census at least a couple times (this is a very rural hospital), plus we had several days where I was thrown in to work postpartum on my own because we got slammed with labors. In addition, i was expected to train to labor and to postpartum at the same time which I finally objected to a couple weeks ago, because I felt overwhelmed. My preceptor who I was with during these occurences is very distracted because she is going through some severe personal problems at home, and was only precepting me because there were two nursing students on the unit, and my regular preceptor was home sick. We were not working "closely" at all, I was pretty much doing all the work myself, with her just backing me up from the nurse's station when I had questions. I should have had her check over me more.
I am very worried that I am going to lose my dream job. I love perinatal nursing more than anything, and it was a miracle that I got this job in the first place.
I'm off today, and my boss would only talk to me for about three minutes this morning on the phone about this. She put me off until wednesday to resume talking. She was understandably angry this morning when we spoke.
Can anyone please reply and tell me any words of wisdom at all? I know I'm new and all, but I feel like I'm just an awful nurse, even though I care a lot, and get along well with patients and other staff.

Oh, lvandehey(((((((((((((HUGS)))))))))))))))

I am so sorry you are going through this. It sounds like you are sort of falling through the cracks in regards to a good preceptorship. I do not think that you are an awful nurse; just an inexperienced and overwhelmed new graduate nurse. It's all about experience, and gaining the confidence and critical thinking skills needed for independent decision making. It takes at least a year of working full time to stop feeling like a new grad and gain considerable confidence, in my opinion--and even then, you'll often wonder if decisions you make are what the "more experienced" nurses would make. Heck, I can remember feeling like that sometimes after 5 years or more, and so did many of my colleagues (there were always much older nurses around us, and we assumed they were so much better at critical thinking and independent decision making--not necessarily true----and now WE'RE the much older ones, LOL!) It does get better. I promise you, it really does. In 2 years, you will be the one precepting new grads, with confidence and empathy, because YOU'VE been there, and remember how YOU felt.

I would ensure that your nurse manager be made aware of ALL the problems that you are experiencing within your preceptorship. If you are union, bring a union rep with you, just so you can have a witness as to what is being said. I would ask the nurse manager if you can have a preceptor who isn't distracted by personal problems and who loves to teach and give one-on-one, side-by-side assistance and feedback, and who is there with you when you sign out meds, so that you can double check the dosage or the protocols with her. You deserve weekly feedback and progress reports as to how you are doing, their expectations, and how you can improve.

Generally, any nurse can be let go, even without cause--simply because someone doesn't like her, or the earrings she wears, or is jealous because she is pretty or got flowers delivered at work-- before an orientation is over---is your orientation period over? How long was the preceptorship supposed to last? Can you go to human resources or even nursing administration and talk the situation over with them, and ask for some guidance? It sounds like this unit does not have a very sophisticated preceptorship program in place. It is absolutely unfair to you that you were put in situations before you were ready to handle them on your own simply because the unit was slammed with labor patients and they were understaffed.

Occasionally, when I was a new grad, I would ask to come in and work extra hours--occasionally I even did it without pay---just so I could gain the experience I needed more quickly, and to make up for those "slow" days that were not conducive to my learning experience. I don't think you should have to do it without pay, however--you should be able to do it to log hours and learning experiences that you SHOULD have gotten when you were sent home early because of a low census. They can't expect you to gain experience when you aren't there!

I am keeping you in my thoughts and prayers. Just remember, when a door closes, a window always opens. I truly believe this, and have experienced this myself--there may just be a much better opportunity waiting out there for you.

kitty=^..^=cat · Apr 25, 2005

Your orientation experience sounds very much like my first job right out of school -- my first preceptor resigned after my first week with her, my second preceptor was in a bad car accident after only my third or fourth day with her, I have little memory of #3, #4 and #5... Like you, I made errors.

Make an appointment with your manager and just be honest with her about your feelings. Let her know that you want to improve and what you need for the rest of your orientation. If she isn't open to discussing this with you in a professional way, you might think twice about whether or not this is really a "dream job".

=^..^=

Dixielee, BSN, RN · Apr 25, 2005

I feel really bad for you. The sad thing is we hear your story over and over and over with new graduates. When are managers going to realize that you can not scrimp on adequate orientation. So many hospitals are not providing any or only scant orientation for new grads in the "interest" of saving money. Where is the savings if you lose staff, patients, etc. in the mean time.

This is also one of the reasons I think all new grads should have a year of med surg floor experience before moving into a specialty. I know there are new grads who have done quite well in specialties, but the opposite is so often true. While med surg is NO piece of cake....it is more like the patients that the new grad is probably comfortble with. Most programs are heavy on med surg and just do a minimal exposure to the specialties.

A specialty like OB entails multiple specialties within it, i.e. labor, post partum and nursery, as well as extensive education of the new mother. Med surg has a wide variety of experiences, and will provide the groundwork for a solid future.

Now to address the original posters concerns. I do hope you can sit down with your manager and have a heart to heart. You manager has to know that the orientation has been spotty at best, but she may not be able to do anything about it. The whole idea of preceptorship and orientation is to offer an experience WITH supervision so you can get your feet wet. They have failed at this. You probably needed to ask for help, but I know that is hard to do sometimes when you are trying to keep your head above water and you want to make a good impression.

When you have your sit down with the mangaer, try to remain composed. That may not be easy to do, I know you are stressed and upset. Do not attack her or the program directly, but you do need to let her know that you are not getting the support you need. You will have to choose your words carefully. Sometimes nurse managers and others may have a lot of history together that you may not be privy to, so you don't want to step on too many toes. Concentrate on what you need, and the fact that you haven't gotten it, without making personal attacks.

You are in a tough situation as are many new grads. Nursing is not easy. I also know from a "preceptor" viewpoint that many hospitals will assign a new grad to a "preceptor" who has a full patient load and really doesn't have time to help someone else along the way. It is a lose/lose situation if management does not value their employees enough to adequately support them.

Good luck. I realize my post is not much help, but a rant against the system, but it may be some consolation that you are not in this alone. It is a common and very serious problem that must be addressed if we are to have a safe and well educated work force for the future.

camay1221_RN · Apr 25, 2005

I have the utmost sympathy for you!!

Please, please, please, sit down with your manager and discuss your preceptorship with her! Seven weeks is not nearly enough time to learn everything there is to learn in L&D, postpartum and nursery. And don't forget antepartum if you care for that pt population also.

The hospital I work for has six months of precepted orientation for all new grads in our L&D. And that's just L&D! We don't do LDRP.

Please let us know how things work out for you! I will keep fingers crossed and say a prayer for you!

hollyster · Apr 26, 2005

I have been precepted for 7 weeks now. , but now that I'm working, i am so nervous all the time, and I feel like a complete idiot. My precepted experience has been rocky, I've been with several different preceptors, I was sent home for low census at least a couple times (this is a very rural hospital), plus we had several days where I was thrown in to work postpartum on my own because we got slammed with labors. In addition, i was expected to train to labor and to postpartum at the same time which I finally objected to a couple weeks ago, because I felt overwhelmed. My preceptor who I was with during these occurences is very distracted because she is going through some severe personal problems at home, and was only precepting me because there were two nursing students on the unit, and my regular preceptor was home sick. .

Plan for your meeting with your nurse manager but also prepare for the worst. It does not sound like he/she is doing her job properly. After you talk to your NM. Speak to the head of HR. Write down all that happened during your orientation and ask that a copy be put in your employee file(make sure you keep a copy for yourself.) If the L&D is that poorly run transfer to a different department. Learn the basics in a sane environment and then specialise. Good Luck

SmilingBluEyes · Apr 26, 2005

wow Stevie Ray and the others covered it for me. Please make sure you are getting what you need in the way of preceptorship and training as a new nurse. YOU ARE NOT A HORRIBLE NURSE! You made mistakes and obviously have a conscience about it. Please, don't let these setbacks stop you from realizing your dream of being an OB nurse; do what you can to correct the situation and move on. WE ALL ARE HUMAN and we ALL err. Please, forgive yourself, and do what you can to rectify things. And remember, we were ALL new at one time, and all equally-unsure of our abilities, skill and performance. HUGE HUGS my friend

---another L/D nurse who remembers what it was like back then....

BandEmom · Apr 27, 2005

I talked with my boss today, and I recieved a written warning about the med error, which is probably the norm for this sort of thing. She read me the riot act about it being a jcaho standard that we take the whole MAR to the bedside, etc.

She asked what she could do to help me, and I was at a total loss. I have not recieved any positive feedback, except that my narrative documentation is very good. So, I have a job, but I feel like I'm one more screw up from the door. The things I feel I've done well with, that I pointed out to her, she says she has not been able to observe. So basically, I've only had negative feedback. Everyone there has been there for 10-22 years, and I feel like I did when I started at a new high school at the end of my junior year. :crying2:

My co workers are very nice though, and do support me, it's just hard trying to fit into a close-knit group.

Thanks for the kind responses from you all.

mydesygn · Apr 27, 2005

I talked with my boss today, and I recieved a written warning about the med error, which is probably the norm for this sort of thing. She read me the riot act about it being a jcaho standard that we take the whole MAR to the bedside, etc.
She asked what she could do to help me, and I was at a total loss. I have not recieved any positive feedback, except that my narrative documentation is very good. So, I have a job, but I feel like I'm one more screw up from the door. The things I feel I've done well with, that I pointed out to her, she says she has not been able to observe. So basically, I've only had negative feedback. Everyone there has been there for 10-22 years, and I feel like I did when I started at a new high school at the end of my junior year.
My co workers are very nice though, and do support me, it's just hard trying to fit into a close-knit group.
Thanks for the kind responses from you all.

I can't tell you how sorry I am to hear of your experience. Unfortunately, it does take time to gain comfort and skills. My best suggestion at this point would be to ask (1) to extend your orientation time (2) instead of taking a patient assignment, spend the next 2 weeks with a preceptor and follow her without taking any patients, in a way this will force them to staff as if you were not there. Often what happens with orientees is the tendency to give the preceptor more patients or difficult patients because she has an orientee with her. This, however, is the worst possible way for you to learn. (3) look at the nurses on your unit for someone who has been open and willing to help and teach you - request this person as a preceptor. There is a tendency to always assign the most experienced person as a preceptor, these people are not necessarilly the best person to teach. You are owed a good preceptor -- demand one if you have to. You should work her schedule. (4) and my personal suggestion - keep notes on your conversations with your manager, your experiences with your preceptor, the types of patients you were assigned and the time you spent without observation or proper orientation. If, god forbid, this should ever go to the BON or Peer Review, you need to show that you did not get proper orientation to procedures and that you made good effort to get the help you need.

If all else fails, I would consider possibly working in postpartum or nursery for a year and allow yourself the time to build up your organizational skills and confidence. Like many others, I don't always recommend going into high stress specialties like L&D, ER, or ICU right out of nursing school.

And most of all, don't lose faith in yourself or allow others to make you. You are learning and you will be a good nurse, but nursing school doesn't teach you how to be a nurse only time and experience will. Try not to be discouraged and keep making good effort to be diligent and careful, there is not one nurse anywhere who has never made a mistake or several for that matter and blame, shame and criticism only lead to more not less.

zaggar · Apr 27, 2005

>>Can anyone please reply and tell me any words of wisdom at all?

It took courage for you to get where you are today. Don't lose your courage now. Be strong.

I'll pray for you.

NancyJo · Apr 27, 2005

Hang in there, like all who have replied you do become much more comfortable as you gain experience. We are seeing similar problems here also. Often the new staff is scheduled for 6 weeks orientation, but after a week or two they are still paired with a preceptor but basicall given an assignment of their own of 4-5 pt.'s. Because of staffing they are pretty much on their own. Not really orientation at all, but they call it that, so that they aren't counted in staffing and we get to keep an extra nurse and not get pulled. Not fair to the person trying to learn. One of our new grads recently was reamed by doc because she didn't call a stat lab result to him when it came back. She was in tears, had faxed the result to the doc immediately, but it is well known to those of us who are there that he always wants them called. Had she had proper orientation she would have known also. It's not just the new grads either. Last fall I had just started precepting an lpn of 25 years. She had been working in a assisted living facilty in another state for the past twelve years, and decided to move back home and come back to us on med-surg. Things had changed alot. She had never worked on a computer system like ours, the workload has increased tremendously since the good ole days when we worked together before and our roles and responsibilities have also increased in many ways. She was doing fine by the end of the first week, but was in no way ready to go solo. Totally overwhelmed. I stated this to my boss, and to the charge nurse on Friday of the first week. Was off the weekend, came back on MOnday and lo and behold she had been given an assignment of 8 pt.'s and was ready to quit. I questioned why she was thrown into this so soon and was told she 's been a nurse for 25 years and she worked before.(remember it's been 12 years) So I was basically told not to worry. Over the next two months, she made several mistakes, had pretty much every Rn who covered her mad and complaining about her "incompetence". They then decided to put her back in orientation, and said that she had poor training and orientation. Talk about blowing a gasket, I was quick to remind them that it wasn't my poor precepting but the lack of time I had before they cut her loose. She was quick to back me up too. She now is doing fine, not having the errors, and only a few remain who complain, but as we know some people just aren't ever happy. She just needed to build up her confidence and get a little more time on the floor. It will come to you. Continue to talk with your manager and ask questions of those around you. Have them check things that you are not sure or comfortable with. If they act bothered, know that they will get over it, but remember also how it made you feel, because you will someday be in the same position precepting a new grad or coworker. Good Luck!!:)

ivypetals · Apr 28, 2005

sorry to hear about your situation. i too get very nervous when i'm not given clear direction or instruction...i'm a new grad and heres what i've done...don't do it untill you know its right! maybe this isn't "real world" but so far i'm a safe nurse. i triple check my meds and have been so thankful in doing so! but things happen. hang in there and if you can't get help where you are then search for a facility that will give you the hands on training you need.....best of luck to you.

i am a new grad working in ob. i have been precepted for 7 weeks now. during the past week, i have made several errors. i gave a rhogam without charting it on the mar, i did a pku without filling out the form first, and then ended up putting the blood on the wrong part of the form, and then gave the wrong medication to a pt. i graduated as an honor student, but now that i'm working, i am so nervous all the time, and i feel like a complete idiot. my precepted experience has been rocky, i've been with several different preceptors, i was sent home for low census at least a couple times (this is a very rural hospital), plus we had several days where i was thrown in to work postpartum on my own because we got slammed with labors. in addition, i was expected to train to labor and to postpartum at the same time which i finally objected to a couple weeks ago, because i felt overwhelmed. my preceptor who i was with during these occurences is very distracted because she is going through some severe personal problems at home, and was only precepting me because there were two nursing students on the unit, and my regular preceptor was home sick. we were not working "closely" at all, i was pretty much doing all the work myself, with her just backing me up from the nurse's station when i had questions. i should have had her check over me more.
i am very worried that i am going to lose my dream job. i love perinatal nursing more than anything, and it was a miracle that i got this job in the first place.
i'm off today, and my boss would only talk to me for about three minutes this morning on the phone about this. she put me off until wednesday to resume talking. she was understandably angry this morning when we spoke.
can anyone please reply and tell me any words of wisdom at all? i know i'm new and all, but i feel like i'm just an awful nurse, even though i care a lot, and get along well with patients and other staff.