Management demanding perfection from a new grad

[lmd-RN]

This is my first ever job as a RN. My orientation did not go smoothly - I had been handed around to 11 different preceptors, including a float nurse! There was no coordination among my preceptors and conflicting information was routinely given to me. Needless to say, there were many things that should have been covered in my orientation that weren't, but I've managed to piece together enough to get by. Or so I thought.

About 3 weeks into all of this, I was unexpectedly pulled into a meeting with the DON and new floor manager and threatened with termination if I did not show improvement in 30 days! At that point, I had not made any patient care errors and the list of charges against me were vague and unsubstantiated by actual examples ("poor time management," "trouble prioritizing," etc.) To this day, I have not made any patient care errors that I am aware of, handle a patient load independently of up to 9 patients, and get very positive feedback from my patients - but I am frequently pulled into the manager's office and threatened with termination over things that NO other nurse on my floor is reprimanded for. My charts are audited regularly - picked apart and every minor error is held against me. I have now been a practicing nurse for a total of 4 months and I feel broken and beaten.

My co-workers have been tremendously supportive and have rallied behind me to no avail. No one has been able to figure out why I'm being targeted and all have said I am exactly where I should be as far as ability and speed for a new nurse. As the other nurses have stated to me many times - if you look hard enough, you're going to find charting mistakes or omissions made by even the most experienced nurses, and I'm at a point in my career where it should be expected that I will make mistakes! The issue has gone above my DON to a higher level (not my doing - other nurses voiced their concerns about my mistreatment to upper management). Although upper management seemed sympathetic to my plight, it was implied that it is easier to replace a floor nurse than a manager, and without the support of the DON behind me, moving to another area of the hospital would be difficult to arrange.

My health is suffering from the stress of it all to the point that I am having cardiac symptoms (I am the sole support of my daughter and I and most of my family has died. I need this - or another - job to survive!!). My only other option for employment as a new RN is at a psych hospital 45 minutes away, but then I wouldn't get that magical 1 year of med/surg experience that I need to get away from hospital nursing altogether (my career goal has always been to do community nursing: prevention, teaching, and outreach).

So here is my question:

Do I stick it out until I am fired (which appears to be a certain outcome at this point, the question is when it will occur) which will close off all future opportunities with this health system (not just this particular hospital) and make me appear to be a bad nurse, or do I try to get into the psych hospital and forfeit my med/surg training for a clean slate?

It seems that all employers in my area require 1 year of acute care experience, and the psych hospital won't count toward that.

[HouTx, BSN, MSN, EdD]

Gosh, what a mess.

FIRST - get yourself taken care of. If you are having physical problems due to stress, you need to have these evaluated by a physician --- & get the diagnosis/conclusion in writing along with some meds to help with your symptoms. Your daughter won't be in a very good place if her mom collapses.

THEN -- Get all the information you can - what things are you supposed to have accomplished in orientation? This should be in the form of checklists, goals, etc. Get copies of your own orientation paperwork & documentation to determine whether you met the stated expectations. If you have been given any written 'performance improvement' plans, make sure that you are in compliance with them.

THEN - since it seems that the relationship with your immediate sup & DON have irretrievably broken down, make an appointment with HR to discuss your stress-related illness due to a hostile work environment. You will need documentation of the physician's diagnosis. Stress-related health problems due to work is an "injury" is a compensable illness under workers compensation that may entitle you to paid medical leave. Trust me, the HR folks do not want this to happen because it not only costs $, but goes on their workplace injury record for OSHA. So they should take it seriously. At the very least, they should offer you some sort of relief - through transfer or other solution. In my experience, hospital CEOs take a very dim view of any manager (or DON) who allows this type of situation to happen - it tends to be a career-limiter for them.

OPTION - contact an attorney who specializes in employment law for expert advice. There are many who will work on a contingency fee with little or no money up front.

In the meantime, keep good records for yourself of every conversation you have with your supervisor and DON. Don't give them any reason to fault your appearance, behavior, performance or attendance. DON'T discuss this with co-workers any more because you don't really know where loyalties lie and it could come back to bite you. It sounds as though they may be building a case to terminate you "for cause", which would not only mean no severance, but you would be unable to collect unemployment...

Good luck - hopefully you can put this all behind you very soon.

[lmd-RN]

Thank you for replying! My cardiac symptoms are an exacerbation of a pre-existing condition that only appear when I am under extreme stress. The cardiologist doesn't want to treat it at this point because it is intermittent. In his words, if stress is the trigger, then stress reduction is the best treatment until we have no other choice (he is thinking I will be in my senior years before I need medical management). Under the normal stress of life, I am symptom free. That said, it would be difficult, if not impossible, to pin anything on this job.

My orientation paperwork - including all the positive reviews from my preceptors - has mysteriously disappeared. It was turned into the DON and no one has seen it since. My "performance improvement" plan is vague: improve time management, improve critical thinking skills, etc. Since these are difficult to objectively gauge, it is a subjective evaluation by my superiors. I am uncertain how I could prove I have made progress. Of course I need to improve time management and critical thinking - what new grad doesn't?!? The first year of nursing is all about gaining experience and making improvement in all areas.

I think you're right - they are trying to build a case against me and hang me on technicalities. At least I have the comfort of knowing I have not made any patient care errors. The more I think about it, the more sense it makes for me to try to get the psych position while I'm still employed. It's easier to justify leaving one job for another than to explain why I might have a gap in employment. I have a history of employment in the mental health field, so I think my only obstacle would be if there are any current openings - I feel like I'm in a race against the clock. Wish me luck.

[Altra, BSN, RN]

As I precept regularly, your story angers me. It is self-defeating and costly to both the new grad AND to the organization to mismanage orientation programs. In your particular case, I don't see in your posts any evidence that there has even been ANY thought given to what needs to happen to incorporate the new grad into the unit and the organization as a whole.

Definitely pursue the psych position -- you'll be capitalizing on your prior experience. And if at some point you are offered an exit interview, whether in person with some individual or on paper -- use it to communicate factually and dispassionately what has occurred in this job. Emphasize the cost to the organization of a revolving door of new grads.

And good luck to you -- this too shall pass.

[iluvhrts]

I don't have any advice to offer since I myself am in a precepting nightmare at this time. But, I do want to offer you some support and encouragement. I would contact an attorney. There is a section in my state nursing association's newspaper that has "administrative" law attorney's. Take care of yourself. Your daughter needs you! Best of luck in this dismal situation!

[Esme12, ASN, BSN, RN]

lmd-RN said:

Thank you for replying! my cardiac symptoms are an exacerbation of a pre-existing condition that only appear when I am under extreme stress. The cardiologist doesn't want to treat it at this point because it is intermittent. in his words, if stress is the trigger, then stress reduction is the best treatment until we have no other choice (he is thinking I will be in my senior years before I need medical management). Under the normal stress of life, I am symptom free. that said, it would be difficult, if not impossible, to pin anything on this job.

My orientation paperwork - including all the positive reviews from my preceptors - has mysteriously disappeared. It was turned into the don and no one has seen it since. my "performance improvement" plan is vague: improve time management, improve critical thinking skills, etc. since these are difficult to objectively gauge, it is a subjective evaluation by my superiors. I am uncertain how I could prove I have made progress. of course I need to improve time management and critical thinking - what new grad doesn't?!? The first year of nursing is all about gaining experience and making improvement in all areas.

I think you're right - they are trying to build a case against me and hang me on technicalities. at least I have the comfort of knowing I have not made any patient care errors. The more I think about it, the more sense it makes for me to try to get the psych position while I'm still employed. It's easier to justify leaving one job for another than to explain why I might have a gap in employment. I have a history of employment in the mental health field, so I think my only obstacle would be if there are any current openings - I feel like I'm in a race against the clock. wish me luck.

Sad......for whatever reason this don does not want you and has decided to make it her personal journey to take care of you. I have found that this behavior is bore out of jealousy and poor self esteem. One lesson you learned is to ask for copies of all your paper work/evaluations for that "lost" paper work phenomenon.

I would start looking or another job for I think the writing is on the wall but keep in on the down low. In the mean time maybe some brain sheet might be able to helP you stay on point and increas e speed. Don't let this insecure individual get under your skin. :hug:

nursing is hard enough without people like her.

Brain sheets.......here are a few.

5 Pt. Shift.doc

1 patient Float.doc

MTPMedSurg (2).doc

Report Sheet.doc

FinalGraduateShiftReport.doc

DAY SHEET 2 doc.doc

[CrunchRN, ADN, RN]

What they are doing makes no sense. I am sorry you have to go through this.

[whichone'spink, BSN, RN]

Holy crap, wow! I can relate, although thankfully I was taken out of my rotten situation quickly, because I'm just a student at this point. The manager of the ED I was placed in for my practicum sent an email to my instructor in which she accused me of being unsafe in my practice. She said I didn't know what an IV was or how to start it (BS!), how to perform a straight cath, how to measure a NG tube or what a piston syringe was, and that I made patients upset and patients told me to get out of the room (all BS). The biggest lie she told was that my preceptor stopped me from doing patient care half way into my shift, when I continued on until the very end. My preceptor herself did not have any concerns about me, or she would truly have stopped me during my shift. Initially I thought my preceptor was the one who backstabbed me, but now I think it's the manager herself who wanted to get rid of me.

Apply for that psych position now! Get out of that den of vipers, or your physical symptoms will get the best of you. The DON is an evil witch who has it out for you for some reason.

[Been there,done that, ASN, RN]

("poor time management," "trouble prioritizing," is a universal concern/ issue among new grads.

You ticked somebody off during your orientation. Is this a "nurses eating their young" issue?

No one can be sure.. but after 30 years of precepting and being precepted.. I would bet the rent this is the problem.

Document .. starting now.. each and every concern management had in these meetings.Answering every concern.

Your health issues are a moot point.. No facility cares is they stress us out. It goes with the job!!

Pursue the psych position. If you get fired for bs reasons.. you will get unemployment and be able to force answers for your dismissal.

This place is toxic... be glad you learned this early .

Good luck.

[beeker]

I'd start looking for a new position and quit as soon as you find one. This current situation is terrible and no good will come of it. You need a fresh start. Sounds like you are working in a cesspool. Someone doesn't like you, and they poisoned the well. Did you get the job over someones kid or something? Anyway, 9 patients? That is ridiculous, get outta there!

[Zookeeper3]

You could have a meeting and ask for an outline of specific behaviours and skills that require improvement as well as an outline of how progress to improvement will be measured. Additionally, those specific skills need measurable criteria for success. An example of thier vague complaint (your time management is poor), would be that the time spent on your first daily med pass will improve from being one hour late to only 15 minutes late in the next 30 days. or your late clocking out each shift will decrease from two hours to thirty minutes by the end of thirty days.

There is nothing wrong with a follow up meeting, where you ask for clarification of measurable expectations... in WRITING. Generally HR departments require an action plan of improvement to have been set up with new folks, prior to threatening termination.

I wish you the best and hope this helps. Not every place is like this one, but many are, you have to arm yourself with the knowlege of how to beat them at their own game- some back off, others don't.