Left OR for the ED...and I'm failing. Help!

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    Specializes in Tele, ICU, Staff Development, Freelance Writer. Has 30 years experience.

Hello Nurse Beth,
Thank you so much for taking my question. I have been a nurse in the OR for almost 7 years. I had become burnt out and decided to change departments to the ED, as I have always been interested in the emergency room.

I have been in orientation for 10 weeks now.  I changed preceptors from my night shift preceptor to a day shift preceptor as I was planning on moving to the day shift.   My day shift preceptor became very frustrated with me very early on. She has been an RN for 9 months at this time. Almost every question I asked she would answer with a question back to me, saying, "what do you think". She has taken all complaints to my nursing manager regarding everything that bothers her about me, including that I am asking the same questions over and over and that there is a "disconnect" in my brain. She has made me anxious to ask questions.

I have not made any medication errors or caused any injury to the patients at this time and I also feel fairly comfortable in my zone.

The final situation was when we needed to place an OG tube in a patient. I placed one OG tube weeks ago with a different nurse. He was quick and I was under the understanding that the 60 mark was standard placement. It was a misunderstanding and I proceeded with the procedure. She corrected me and showed me how to measure, than went straight to my manager and reported my error.
He switched my preceptor and told me this is my last chance.
I am so confused and I feel like a failure. I have started many other jobs and have never had this experience. Is this normal, or am I in the wrong department?

Thank you for your time.

Dear Confused,

I'm sorry you're having a difficult time. OR and ED are worlds apart. Overnight you've gone from predictable routine and structure to adrenaline-fueled chaos.  

Is this normal?

Unfortunately, some aspects of this scenario are common. New nurses precepting experienced nurses. Fault finding preceptors. Impatient preceptors who lack teaching skills. Poor communication.

Am I in the wrong department?

I don't know. OR and ED nursing skills are very different. The transition is challenging, and it could be too soon to know if you're going to be successful. There really is an "ED type". Read "Are You Cut Out to be an ED Nurse?"

Having an impatient and unhelpful preceptor does not mean there are no performance concerns. You may not have been given meaningful feedback. Saying there's a "disconnect in your brain" is not constructive criticism but could indicate a lack of expected progress.  Likewise, saying you "ask the same questions over and over"  and responding with "What do you think?" could be code for "Come to me with a solution, not a question, and we'll discuss it".

Missing Piece

You can't be expected to go from zero feedback in 10 weeks to "it's your last chance". If that's the case, this is very wrong.

Your manager saying, "This is your last chance,"  implies there's been time/chances given and some history prior to the (rather bogus) OG measurement event.

What was the feedback from your first (night) preceptor?

Does your facility do 30/60/90-day check-ins? Have you been given a performance improvement plan (PIP)? You deserve to be given attainable, measurable performance goals.

Read When You Receive a Warning at Work

Reflect on your experience. Not making any medication errors and not injuring any patients are good, but I'm sure you want more than good.

At this point, what are you wanting to do? It may come down to if you really love the ED and how badly you want this. If you still want this to work out, focus on your performance and partner with your Educator/manager/preceptors on performance goals. Keep in close contact with them to keep them accountable for mutually agreed upon goals.

Very best wishes on your decision,

Nurse Beth