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I'm Worried

Specializes in med-surg, psych, ER, school nurse-CRNP.

Hi all...

I have recently started a new job as an NP, my first real one as an NP, not to be confused with that last disaster during which I was a student.

I love, love, LOVE this job. However, I am not too certain that it loves me back. I work for a cardiology practice, and the biggest part of my job is supposed to be stress tests, followed by helping with the consults and just basic "whatever I can to to make it easier on the docs". I lack about 2 1/2 weeks before I complete my 90 days. Prior to this, my only cardiology experience was a clinical rotation with my personal cardiologist.

Here's the problem. I work with two docs. The one I posted about in "He Wouldn't Let Me Go" has left. One doc is the Director of Cardiology for the hospital. I can not get a bead on him. There are days that I think he likes me fine, and days where I think he thinks I'm the village idiot. He prefers to do his own consults, which is fine by me, I just put a note in the chart if I arrive before him, so that admin knows someone from the practice has been by. He also has said that I am not quite ready to stress by myself yet, and I am unsure why. He's a great guy to work for, but I guess I'm intimidated. He will ask me questions at times about the cases we have, and I feel like a total dummy for not getting them right. He likes to teach, and I am thankful for that, and he has the patience of Job.

The other doc is great as well. I am more than free to do the consults for him, dictate, write orders, the whole nine. I can not stress for him alone yet, either, because the head guy has not said OK.

I know I'm new, and maybe I am paranoid. No one has said boo to me about doing anything wrong, which I'm not used to, after that last fiasco. I really want to stay here, and everyone says I am doing fine, or I'd know about it. The OM says that the head guy told her when they decided to hire me that he knew it would be about 6 months to get me up to speed. I just don't feel like I'm helping or earning my keep, and I want to.

So, what to do? Besides Ativan? I have toyed with the notion that I should just ask one day if I can run a stress and him watch, to prove I can do it. Is that too forward? I am so not comfortable with making the call on meds on new patients yet, but I can usually order the correct tests, something that I was not able to do when I started, so there IS improvement. I guess I just want some reassurance that I'm OK, just a case of the new-job heebie-jeebies. DH said that I was so used to being yelled at and micromanaged that I didn't know how to act now that I was not. Maybe he has a point.

Thanks in advance, all.

XB9S

Specializes in Advanced Practice, surgery.

Firstly congratulations on your new job, it's always difficult settling in. I've been NP for over 5 years now and I sometimes still find it difficult to know what my bosses think of me so don't worry too much.

How about asking for a 1:1 to discuss your progress and what they want from you and what you want from the job, that way you can set objectives and maybe come up with a plan that will suit your needs and the needs of the practice. You may well find they are just letting you settle in slowly and not wanting to push you too hard to quickly

I'm sorry but what is "stress?"

Having worked in post-open heart surgery units, coronary care units, and telemetry units with several cardiologists.......he hasn't yelled at you even once?!!???!!! That is SOME cardiologist--count yourself lucky-they just are cautious.

otessa

AngelfireRN, MSN, RN, APRN

Specializes in med-surg, psych, ER, school nurse-CRNP.

A stress is a cardiac stress test, either on a treadmill or with meds. They use it to assess the effects of stress on the heart, to see whether or not ischemia is present. If it is, or if the patient has chest pain during, then we consider a cath.

AngelfireRN, MSN, RN, APRN

Specializes in med-surg, psych, ER, school nurse-CRNP.

Sharrie,

I just spoke with the OM, who says that no news is good news, that they are letting me learn at my pace, and that everything is fine. She said that the doc told her he knew I'd need "at LEAST 6 months" before I was ready to solo. I guess that means I'm OK. I just have to get past the worry.

A stress is a cardiac stress test, either on a treadmill or with meds. They use it to assess the effects of stress on the heart, to see whether or not ischemia is present. If it is, or if the patient has chest pain during, then we consider a cath.

LOL, tht's the stress yo u meant. I thought it was going to be something I had never heard about.

Cherybaby

Specializes in Derm/Wound Care/OP Surgery/LTC.

Keep up that worry and you will be on the receiving end of one of your own exams! :)

You're probably doing just fine. If you weren't, someone would have said something to you by now. They are giving you that six month learning curve! Take advantage of it by giving yourself a break. Be a sponge and absorb everything for now. Don't be too hard on yourself.

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education.

Being given 6 months to get up to speed is a blessing! It's said it takes about a year to learn one's job completely, so 6 months is a good start. By then you should know alot about what to do, and how to do it, even though you might not feel really confident yet. I think it's a good idea to ask for regular feedback (positive and negative) too. Do you have a collaborative agreement with one of the doctors? In my state, (it's required to prescribe), that means there has to be some sort of meeting regularly, with the APN presenting 5% of her charts. That sort of thing takes care of the feedback.

GadgetRN71, ASN, RN

Specializes in Operating Room.

Sharrie,

I just spoke with the OM, who says that no news is good news, that they are letting me learn at my pace, and that everything is fine. She said that the doc told her he knew I'd need "at LEAST 6 months" before I was ready to solo. I guess that means I'm OK. I just have to get past the worry.

I'm like that..I think sometimes, we are harder on ourselves than anyone else could possibly be.

AngelfireRN, MSN, RN, APRN

Specializes in med-surg, psych, ER, school nurse-CRNP.

Having worked in post-open heart surgery units, coronary care units, and telemetry units with several cardiologists.......he hasn't yelled at you even once?!!???!!! That is SOME cardiologist--count yourself lucky-they just are cautious.

otessa

Oh, he's yelled, not AT me per se, but TO me about things other docs or people have done. Gets rather humorous, really.

ghillbert, MSN, NP

Specializes in CTICU.

I'd probably still ask the head doc if he would mind sitting down with me for a few minutes to discuss how he thinks it's going. The fact that you're almost at 3 months is a good reason.

angelfire, congratulations on your NP job!!! :up:

i bet you are doing just great, and that they are thankful to have you! i'm like you; i assume i'm probably messing things up if i don't get any feedback. i do best with regular assessments of my performance, so i know where i stand...if not, i think they're going to fire me any second. um, can we say paranoid?

ooohh the socratic method makes me nervous, too. i have been known to give some really ridiculous answers because of nerves.

i definitely think a one-on-one meeting would help you worry less! maybe it could happen this friday! that way you can send away those thoughts before the weekend...

are y'all doing GXTs, stress echoes, and treadmill/adenosine/dobutamine mibi's?

so, do you mean the doc doesn't want you to be the only one supervising the patient on the treadmill (yet)? is that how it will eventually work? you will go in the stress room with the patient and the tech?

are they learnin' you about helping to interpret the echo & nuclear pix? i guess the doc would have to sign off on those...right?

i hope what the office manager said put your mind at ease a bit.

i'm betting that they like you (they really do)!!! :heartbeat

AngelfireRN, MSN, RN, APRN

Specializes in med-surg, psych, ER, school nurse-CRNP.

Free, yes, those are the tests we are doing. I will never be expected to dictate or interpret the nucs, just monitor the test, and know when to inject (we use sestamibi/technetium) and what to stop for. I am LOADS more comfortable now than I was starting out, so maybe soon I'll get the high sign.

Thanks!

PostOpPrincess, BSN, RN

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Are you giving off vibes that you're not confident in your skills? If so, be aware and try and stop it. Learn your stuff.

And I mean LEARN it like THEM.

Respect will come when trust is established.

Nccity2002, MSN, RN

Specializes in Trauma/Critical Care.

Hi Angelfire,

I totally agree with Sherry:

" How about asking for a 1:1 to discuss your progress and what they want from you and what you want from the job, that way you can set objectives and maybe come up with a plan that will suit your needs and the needs of the practice. You may well find they are just letting you settle in slowly and not wanting to push you too hard to quickly ".

Go directly to the source. You mentioned this particular MD was heard saying that you were not ready to perform a stress test by yourself...well, I'd say go for it!! Ask if he would let you be present when he perform one. That way he will see that you are willing to learn and grow, and it will allow you to become more comfortable with this particular MD.

XB9S

Specializes in Advanced Practice, surgery.

I am LOADS more comfortable now than I was starting out, so maybe soon I'll get the high sign.

Thanks!

Anglefire it sounds like you have a very supportive practice and doctors to work with, I've been a NP for over 5 years now and I still get times when I just need a little confirmation that I'm doing OK from my supervising doctor so it sounds like perfectly normal anxiety. I am always surprised when I get my appraisal because I get such positive feedback and I always expect something different. The poster who said we are much harder on ourselves than others are.

Your going to do just fine, take the time they are giving you to settle in, I think 6 months sounds about right to do just that.

ShayRN

Specializes in Corrections, Cardiac, Hospice.

You took a beating the last job. Cut yourself some slack and relax. BELIEVE me, I worked 6 years on a cardiac unit. Those doctors have NO PROBLEM communicating their displeasure. If you were messing up, you would know it without a doubt.

Oh, he's yelled, not AT me per se, but TO me about things other docs or people have done. Gets rather humorous, really.

At least he finds you as a confidant about OTHERS and not you, whew!

otessa

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