Is This Normal? (Long Post)

[NewTexasRN]

So this is my situation. I'm a new graduate who just graduated from nursing school and I recently started working at a new hospital 5 weeks ago. The supervisor of the floor was supposed to be my preceptor but she was too busy to precept me so after a week or so she asked a floor nurse instead to become my preceptor. The first issue here is that no one explained my background to my new preceptor. She thought I was a LVP or LVN. She asked if wanted three patients and I said yes not realizing that I wasn't ready to care for so many patients. Things got kind of crazy because this nurse expected me to be on top of my game. She was very tough on me. I made a few mistakes in the process and she came down really hard on me.

First let me say that this floor is an extremely fast paced floor cardiac/ tele floor. In the process no one explained to me how to become a nurse. One of the most important aspect of becoming a nurse is learning how to carry out the doctor's order. On the unit, it is very very very important to check your patient's chart at least every hour. No explained that to me. There was a point where I missed a doctor's order. My preceptor came down really hard on me for missing the order. I had four days off after that incident and I basically spent the entire time having anxiety and feeling sick to my stomach. My preceptor basically told me that a good nurse carry out doctor's order and bad nurses are the ones who carelessly missed the doctor's order.

The following week when I returned to work I was a nervous reck. I diligently carried out the doctor's order and did my job to the best of my ability. My preceptor came back to me later on and actually apologized because no one told her that I was a new graduate.

The other issue I'm having is that I'm responsible for taking care of patients on a tele floor and I haven't taken an ACLS class yet which is down right scary for me. I vaguely remember what I learned about rhythm strips in nursing school. For example, what if my patient is having a 3rd degree AV block. I wouldn't even know how to recognize that. I mean I have a preceptor and I basically ask her questions when I don't understand something, but some days it really feels overwhelming and there is still a million things I don't understand. Then, I have be worrying about killing a patient and losing my license. I have had such bad anxiety that I'm actually thinking about leaving the profession in a year.

I mean I love the aspect taking care of patients and feeling as if I have made a difference in someone else's life, but at what cost? I worry about getting sued all the time and all kinds of legal implications. I mean I wished that someone had told me about this in nursing school.

Anyway, my issue is that last day that I was at work I just got really frustrated. The unit secretary was off the unit several times and I was told to answer the phone. It was so stressful because no one explained to me how to answer the phones and how transfer new phone calls. Then one of my patients was going up to the cath lab for a procedure. He was originally scheduled for a stress test and they switched the procedure to a cardiac cath. So while I'm trying be the unit secretary, I'm trying to grab the consent form and before you know it, the cat lab nurses are on the unit with the stretcher to take the pt down. The pt just came out of the shower and I guess he accidentally pulled out his IV. My preceptor rushes in the room and started raising her voice. She said "This is not acceptable!" In front of the patient and the supervisior from the cath lab. At that point I was just really upset. I mean I know that I'm new, but I'm not a child. I don't think it's appropriate to talk to someone like that. I didn't say anything to my preceptor because it just wasn't the right time, but I'm really started to regret the fact that I went into nursing and I'm seriously thinking about leaving after one year. Basically I feel as if I'm an assistant to my preceptor. As I'm answering call lights and trying to what they tell me to do.

I mean there are times when my preceptor has 6 pt's and I take 2 of her pt's. Even with four patients the amount of things you are responsible for is ridiculous. How do you survive in a profession that grinds you down for the constant mental and physical stress for 13-14 hours?

So here's the thing. I'm deeply upset about my orientation and what's been going on. I'm thinking about setting up a meeting with my manager to explain how I feel and what has been going on. I really can't work like this.

My question is for nurses in the nursing field. What do you think I should do and is my orientation experience normal for a new graduate?

[Orange Tree]

I'm a new graduate in Texas too, and the same thing happened to me. I was also sick about it ...and I tried very hard to appease my preceptor before I realized that it just wasn't going to happen.

When I talked to my nursing directer, I left out most of the details and focused on the fact that I was not progressing as well as I thought I could be. I did mention that I felt my preceptor was often too busy to teach me, that our communication styles were very different and that I felt she became easily frustrated with all of my "new graduate" questions and needs. I was very nervous about "complaining" to the director, but I also felt that I had nothing to lose at that point.

Since asking for what I need and being assigned a new preceptor, things are much better and I am learning a LOT more. Now I am quite sure that what I went through with the first preceptor was NOT normal.

[HollyHobby]

Your experience is not typical, and it sounds like your unit is pretty disorganized at least when it comes to orienting new grads.

Even when I was an experienced nurse orienting to a new unit, I was given a few days of simply shadowing my preceptor. This allowed me to learn how the unit runs, who the people are, where everything is, and what the protocols are. After that, I was given a couple of patients of my own, but with my preceptor close by to make sure I was getting the hang of it. Then I would take a full assignment, but again with the preceptor to back me up (at that point she didn't take any of her own patients; her job was to shadow me.) When I was comfortable with that, I'd be given my own assignment, but another nurse would be assigned as a "resource" for me so I had someone to go to with questions. Even as an experienced nurse, it is very difficult to learn the ropes on a new unit; I can't imagine how stressed out you must feel!

It sounds like you're being thrown to the wolves. I would definitely raise my concerns to my manager, if I were you.

As for ACLS, don't worry about not having it right off the bat. As a rule of thumb, it's better to wait until you've been a nurse for about 6 months so you have a feel for what's going on before you get ACLS certified. At this point, all you need to know is BLS and when it's time to call a code. In a code situation, you will not be left alone: there will be about 10 people in your patient's room.

You'll definitely need to learn your EKG rhythms, but if I was your preceptor I would certainly not expect you, as a new grad, to know them right off the bat. This is the kind of thing you can do a little self-study on at home; if I was your preceptor I would take the time to teach you the rhythms too.

Maybe your manager could give you the option of orienting on nights for a little while. At night, there are fewer procedures, doctors, and orders to deal with so you get more time to actually orient before you're thrown into the action.

[shoegalRN, RN]

Your orientation sounds like what I went through in the ICU.

I, too, had a preceptor that I couldnt please no matter waht. She would often leave me alone with two critically ill sick pts who were circling the drain, then would throw me under the bus if I didnt come to her and ask the "right" questions, although, I was asking questions all the time.

She would berate me in front of my co-workers and then get mad when I would ask her to help me turn a pt, after she berated me about following the turn schedule. If I followed the turn schedule and asked for her help turning, she would get upset because it was taking away from her "break time" gossiping with the other RN's in the breakroom.

I was a new grad and had never worked with titrating drips before. I had an incident when at pt was on Cardene and that was the first time I ever worked with that drip. The pt was vomiting and her HR shot up. I was waiting for her to finish vomiting before titrating the drip up to see if her HR would return to baseline. My preceptor comes rushing in the room titrating the drip although the pt was actively vomiting. Then she "goes off" on me for not titrating the drip. She constantly would do this, and then come back and apologize later on.

It just became too much. I went to the DON and asked to be transferred to the ER. I couldnt take anymore. I was sick on my days off, vomiting before I came to work, I absolutely hated going to work. I didnt like my coworkers and I didnt fit in there. I explained everything to the DON and asked to leave because it was not a good fit and the ER was a better fit for me and it is.

I would go to the manager and explain everything you have done here. Also tell the manager that you dont think your preceptor's teaching style and your learning style is compatibe. Give concrete examples and then ask for another preceptor. You might be a target after this, depending on how "cliquish" your unit is.

Good luck!