Landed my dream job and now I feel like I'm not cut out for it...help!

Ruby Vee, BSN · Sep 26, 2017

Hey everyone! I graduated in may and landed my dream job in a busy ED. Our orientation is 8 weeks and I should be off of orientation this week but they don't feel that I am ready. I just had a meeting with my educator(who is also our manager) and he informed me that I will have another two weeks of orientation and that I will be switching preceptors.
This is has me very worried for my job security as well as it makes me feel like I'm not cut out for this while nursing thing at all.
My preceptor is a fantastic nurse however I just don't feel that he is the greatest preceptor for me. I have learned a lot from him but there are times where I feel like I'm being set up for failure. There are days when I am able to handle 4-5 patients and not need help, and then there are days where I am just drowning and it seems like I can't do anything right. Sometimes I feel like I'm truly being set up to fail.
For instance a few weeks ago I got an ambulance and was triaging them, hooking them up to tele, starting a line and drawing labs (which he told me to do and then to come back out and report to him when I was finished)...I was in that room not even 10 minutes when he comes flying in and telling me that I need to move faster bc I also got another ambulance (which no one told me until then) and the ems was waiting to give report.
Another example was was last week when he told me to go into my patients room and start a line on them, draw the 10 labs, and give them the 4 iv meds that were ordered. We had just settled another patient who was very critical and he assured me that now would be a good time to go do the tasks for this other pt. It took me awhile to get the line going in that room and even longer to medicated and get the labs into the computer since we don't have a scanner in all of our rooms so I had to individually click off each lab and each med which takes forever. Meanwhile when I was in with that pt our critical pt took a turn and I didn't know it. When I came out I got chewed out for not being around for our critical pt. Which I asked him what he would have done and he said well not what you did. Which confuses and upsets me bc I even asked him if he was sure that I was ok to go do all of that bc I didn't feel comfortable being too far from our other pt.
Its just stuff tiff like this happens all the time. I don't know what to do about it. there was a week where i was with other people when my preceptor was on vacation and they all said that I was doing great.
im just really concerned. My preceptor is good friends with our educator/manager, and the new preceptor that I'm being given seems to be good friends with them as well. I feel like I have no one to talk to about what's going on. We supposedly have a nurse residency program for us new grads but NOTHING has been said to any of us, we have yet to have a meeting, and we have no idea is supposed to be running it. That also makes me mad because I decided to come to this hospital because I did my clinical here, it's supposed to be a great teaching hospital and I wanted to start in a place with a nurse resisdency program and we were told that we would have one.
i just don't know what to do or who to talk to. I will be devastated if I loose this job

You should have a formal list of objectives for you to complete during your orientation AND formal meetings with your preceptors and/or nurse manager/educators for feedback on how you are doing. In other words, you should have a clear idea of what you're doing right and what you're doing wrong. The first person to talk to about your concerns is your preceptor. Your current preceptor. Ask him for feedback -- you may have to get specific if he's not used to giving feedback. "What do you think I'm doing well? Where do you have concerns about my progress? What should I work on next? What specifically can I do to demonstrate that I'm progressing?"

You may be getting the extra two weeks of orientation and the new preceptor because your current preceptor has concerns (or your nurse manager has concerns) about his ability to take you any further. If he's a new preceptor, or a preceptor who is burned out on precepting or who isn't used to working with new grads, perhaps the other preceptor is meant to give you a better orientation. Or if there's something specific that you need to learn that your first preceptor cannot teach you but another one can . . .

I'm good at teaching ECG rhythms, ACLS, drugs and many other things, but I cannot for the life of me explain pacemakers. I can recognize failure to capture, I can adjust the pacer settings to maximize capture, I can do pacemaker checks in my sleep (and probably have) but I just cannot explain it coherently to a new grad. Often I'll arrange for my orientees to spend a day with Anna, who is a whiz at teaching pacers and she'll send her orientees to me for ventricular assist devices or ACLS drugs. This may be what is going on for you to get a new preceptor. (Or the first one is going on vacation, taking some sick leave, picking up another new orientee, taking a class . . . any one of a number of things.)

You may -- or may not -- be in danger of losing your job. I'd urge you to talk to your preceptor to find out what exactly you need to work on. Just talk professionally, about facts. Accept any feedback gracefully, without trying to defend yourself or justify anything. Thank him for the feedback, even if it's negative feedback or delivered poorly. That's the professional thing to do.

As far as talking to someone about all of this . . . if there are other new grads that you've met there or from your class, make a lunch or dinner date with one of them for the purpose of venting about your new jobs. Do it off the unit, away from the hospital and if possible, with someone from another floor. Maybe your best friend isn't a nurse but does understand orientation and new job blues. Don't vent or complain to other nurses with whom you work. If there's no one, check out the "First Year After Nursing Licensure" forum -- plenty of new grads are in your shoes. That's the best place for emotional support. The General Nursing forum is a great place to get feedback and advice, but not so much for emotional support.

Good luck with all of this. It's probably just a bump in the road -- if you handle it with grace and professionalism.

amzyRN · Sep 27, 2017

8 weeks is a short orientation for the ER. I had 10 with the option of extending and I had 4 years experience as a nurse and it was tough to be done at 10 weeks. You should have had very clear guidelines of what was expected of you and also of how your thinking process needed to be in order to pass orientation.

In order to pass, you must be able to prioritize critical tasks and patients appropriately and know why you are doing things. On top of all that the flow of the ED (the time factor and patient movement through the ED) is always considered as well. It sounds like your preceptor may have problems with that, your critical thinking skills and lack of consideration of time and how to get things done.

There is no way you will have the speed of a nurse that has been doing this for a while, but what you must master in your orientation is your priority setting and ability to find help and delegate to get your tasks done in a timely fashion. One of your techs should be helping put your patient on the monitor and getting the vitals and EKG.

You've got to ask for help. Tell your preceptor that you'd like to use them as your tech, while you do all the nursing stuff. That's what my preceptor did for me. During my orientation, my preceptor made sure we were on the same page with what things should go first, what things can wait, and what patients needed more attention. If my priorities weren't in line with hers we discussed this, she also helped me with "flow" expediting disposition and time management-clustering care and delegation.

I'd have a talk with your preceptor if I were you and ask for their honest feedback and what they want to see you do so that you get off orientation. I think it's usually bad to change preceptors and I have seen more bad outcomes than good ones. Good luck and don't be shy about taking control of your orientation.

ivyleaf · Sep 27, 2017

8 wks is short for er. agree with the previous posts. speak up!

JKL33 · Sep 28, 2017

I would go and talk with your manager. As above, you do need to ask for feedback and accept it and work very hard on the recommendations you receive.

8 weeks is not a long enough ED orientation, in my opinion.

I really dislike when the plan is to switch preceptors for a short time, like 2 weeks - sometimes only a few days. It just doesn't work that way - the new one will want to rework some of what you've become accustomed to doing based on the previous preceptor's preferences...etc. Regardless, you need to try to develop a good rapport with your new preceptor ASAP. Generally-speaking, this will involve some serious hustle and serious effort to show ambition for learning and succeeding. I know that's kind of vague, but do your best at every opportunity.

It sounds like you and your preceptor didn't have clear understanding about acceptable timeframes for completing tasks. Make sure you understand exactly what your new preceptor expects. "Quickly" is vague. "You should be able to get that done in the next 10 minutes, then report back to me" is specific. Specifics 1) keep them from getting bent out of shape with you because of their own stress and 2) give you an understanding of where they think you should be, in terms of learning time management.

Keep your preceptor up-to-date on your whereabouts and progress. Any time a task is taking longer than your preceptor's guideline (as mentioned above), call them and tell them. Ask if they want you to continue or is there another more pressing matter now? It's very difficult as a preceptor to send someone off to do something that you (preceptor) think will take 10 minutes, and 30 minutes later you still haven't seen your orientee.

There are some elements of your reported experience that I don't like with regard to the first preceptor and the 8 week orientation and the lack of promised residency, but make no mistake - - you are NOT going to come out ahead by spending one second on complaints of any kind. Fair or not fair I'm just advising you for your sake not to waste your time and challenge your manager's goodwill that way. Don't do it.

Good luck and let us know how it's going.

nightbrightener · Oct 2, 2017

Sometimes there is just a mismatch with preceptors and personalities/teaching styles. Personally the facts the preceptor is telling you are correct, in regards to needing to get things done quickly (just a general fact) but his tone seems lacking at best, especially in regards to his "i wouldn't do what you did". That to me is a red flag because if he can't give you a better answer, he couldn't do any better himself. Personally I would see how the 2 weeks go with the other preceptor, I know a number of our nurses have been given an extension to orientation or another preceptor. Honestly, from an experienced nurse standpoint, sometimes it is just seeing if a new preceptor see's the same "deficiencies" your current preceptor sees. And in my experience the answer will often be no, they are happy with what they see from a new nurse perspective. The fact that other preceptors you have worked with are happy with your progress is encouraging.

And sorry but this needs to be said in my opinion. You are not being set up to fail, you are in the ED, there will be days where you never get caught up, especially early in your work experience. That is normal, find a way to deal/prioritize your tasks. BUT it doesn't mean you are bad at the job, it is just the nature of the beast, and with time you will find the shortcuts/get up to speed. Some ER nurses and floor nurses are just not nurturing types, I personally will happily work with them, but working under them can be taxing.

I am hesitant to say complain to management, that is not how I operate, nor do i think it works, but I would ask for an honest appraisal from them over how they think you are progressing. Generally I see that by the time management advertises, interviews, hires, and trains someone they are more than willing to give them numerous breaks to find their groove before they want to go through the whole process again FWIW.

And for what it is worth hang in there, the issues you're having do get better, and they don't point to a lack of aptitude, just time management and experience. I would just try not to turn it into an adversarial relationship with your current preceptor due to a sense of persecution. just my thoughts

guest52816 · Oct 9, 2017

I agree with the posters who have stated that 8 weeks orientation in a busy ED isn't long enough.

When your orientation was extended by two weeks, were you placed on a Performance Plan? Since you are on extension, you should have received a PP which outlines goals and expectations.

From what you posted, it doesn't seem as though that happened. You might want to ask your NM or educator about that. You need to know goals and expectations.

Best wishes and hugs!

gemmi999 · Oct 10, 2017

I'm sorry you're going through that! It's a tough situation. A couple questions/comments:

1) Does your ER have float RNs? When I'm settling one ambulance and getting everything going, if I get a second run, I either tell them they have to wait or ask a float to triage them. Most EMS staff are really understanding and even help out! They'll clean rooms/get the pt. on the gurney and even start hooking them up while I finish what I'm doing.

2) If I do have a critical pt, for whatever reason, I tell someone that I will be in another room for a bit with another pt. I ask them to keep an eye on the BP/HR/whatever the concern is so they can either intervene or let me know. Did your preceptor notify you that something was changing, or just expect you to be psychic?

Nursing politics can be tough. You just need to know what you're good at and stick with it! My first ER, my preceptorship was going great (per the preceptor) until a new manager came in and suddenly I was transferred to ICU for a month of "critical care experience". After that the manager tried to trick me into staying in the ICU even though that wasn't what I wanted (she oversaw both departments, and ICU was *very* short staffed). I politely showed her my contract and explained I was there for ER and NOT ICU. It made me second guess myself a *lot* because I thought I was doing good in the ER and then to hear at the end I wasn't being fast enough, etc...

I switched to nights and just held on as long as I could. The biggest thing I will say is you need to know yourself and believe in yourself. If I wasn't convinced I was a good ER nurse, I would have let them talk me into switching departments. Don't let them do that to you!

FolksBtrippin, BSN, RN · Oct 10, 2017

Don't look at the extra 2 weeks as a punishment. 8 weeks is not enough. I had 11 weeks in psych with the option to take more. In our hospital, the ED orientation for new grads is 6 months.

nursey3202 · Oct 18, 2017

I agree that 8 weeks is a short orientation - our new grads get 12 weeks, regardless of what unit they start on (Med/surg, ED, ICU, ortho/neuro, Etc) and I have known that to be extended. The other thing that concerns me about your post is how little assistance you are getting - especially with ambulance arrivals. Where are your ER techs? Where is the team work? Maybe I'm spoiled but our ED works together, people pitch in and offer help or are at least available to help if asked. Experienced nurses require less resources freeing up the the ED techs for those who are a little more needy and should be willing to at least get vitals and help get patients settled to speed things along when things get busy. Just because you are a new grad doesn't mean you have to learn to do everything without assistance - that's not the point of an orientation. Team work makes the dream work - for real, especially in nursing. In addition, our nurse to patient ratio is never over 1:4, often it is 1:3. Assess the dream job you think you have - you may be in a challenging ER which can be difficult enough as an experienced RN, much less as a new grad. Don't be too hard on yourself.