Med/Surg is Kicking my Butt

Nurses General Nursing

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I've been an LPN in LTC for a little more than a year. Left to go to a hospital. I'm on a rural med/surg unit where we get a little of everyone and do a little of everything. Tele, peds, and the ubiquitous old folks with the ubiquitous old folks exacerbations of various comorbidities. I'm entering week 4 on the floor. I come from a BIIIIG city and have been told more than once that this a a big part of the problem - including by my NM, who comes from the same city and had a lot of the same problems when she started up here.

After working a few days with my first preceptor I posted an "I Love Nurses!" thread. My NM changes my preceptor. Come to find out the she said I am unsafe and overconfident. No examples, just a "feeling," and she doesn't want to be responsible for me.

I am assigned random preceptor for the next few days. Five preceptors in two weeks. Preceptor two is a great fit. I'm happy. Preceptor Three not so great. I was syaing all day, "I'm not doing well," and all day she's telling me, "It's all good."

Next day I'm back to Preceptor Two. She's off with me. I ask what';s wrong, she tells me she has been told by Two that she has to take this "very seriously" and she's cold. Blows me off for break and lunch. By the end of the day she is yelling at me in the nurses' station. This goes on for a week. She is treating me so badly that I at one point end up sobbing in a vacant room. All of the other nurses are reporting her behavior to the charge and NM. I tell my charge, who agrees, that I need a new precptor. She agrees. Turns out Two has told the NM I'm unsafe. She had to remind me to use a wipe on a port once and once to wash my hands before I got a chance to. She has no examples other than these. She "feels" that I'm overconfident and unsafe.

I get a new preceptor (four). I really like her although she is the most anal nurse with whom I've ever worked. Preceptor Three, who poisoned Two against me, was charge this weekend. She gives us incredibly high acuity patients, even mentions that she shouldn't have given them to us together, and gives the same ones to us ystdy. I am LOUSY with IV's. Of course, these guys all have multiple meds and solutions running, and one had an MI while there (on nights) and is getting her orders changed every 10 minutes. Four ALSO has a second orientee for a total of six patients. One patient can't be left alone on the commode and I spent over two hours of my day ystdy watching to see that she pooped.

I got off of my 7 - 3 shift at 1745.

So my job IS in jeopardy, according to my NM, because 2 have said that I'm unsafe, and even without examples their "feelings" count. I have to make this work.

Help!

Please. And thank you.

Yeah, we've talked about this already. The big pieces of advice are to keep my mouth shut, don't kibbitz around (her words, meaning kid around or be at all relaxed or joking), and keep my mouth shut. And did I mention keep my mouth shut? She got the exact same thing - cocky, know-it-all - and it took her two years to lose the reputation. But meanwhile, she's already told me my situation is "tenuous" because she has to consider what they've said. Even though they have nothing to back it up.

Pffft.

I find that rather strange advice--- especially if the nurses are already suspicious of you being "big city" and all that. Keeping your mouth shut and not showing humor, etc., could come across as cocky.

I wonder about this NM. Maybe SHE is the one who's threatened by you, not the staff. Given how she messed with your preceptors, it's something to consider.

It's certainly that I'm from a big city, and also that these folks are quiet and reserved and I'm outgoing and, frankly, probably well-suited to the ED in nature.

I think I'm supposed to be freaked out about every pill I give because, you know, this is MED/SURG ACUTE CARE and IT IS VERY IMPORTANT and it is not LTC where everyone is stable. (And where they got that idea, I don't know.) I can eyeball an old fart going downhill at a thousand paces. And a sleeping old one with decent VS isn't going to get me nuts.

I dunno. I really wonder if I should be a nurse. I'm having a heck of a time getting along with people even when I think I am.

And not ALL of them think I'm cocky. TWO said I'm unsafe. The others are defending me, at least, as a human being if not a nurse.

I wonder about this NM. Maybe SHE is the one who's threatened by you, not the staff. Given how she messed with your preceptors, it's something to consider.

I think she just doesn't want grief.

I dunno. I really wonder if I should be a nurse. I'm having a heck of a time getting along with people even when I think I am.

Stop that!

nill illigitimi carborundum

I think she just doesn't want grief.

Then she should resign as manager. "Grief" is part of the job description...

Thanks. I just need to survive another month of orientation. And I think Four doesn't think that I'm unsafe, just maybe semi-competent. And that is partially true - I really can't get the hang of IV's. Clumsy with them.

I'm just down, though. I was fired from my first job because someone died (not on my shift) and the other nurse on with me was the DON's DIL. My last job I heard the same crap. "It's nothing specific, you should just be safer." WTH?

Specializes in Rodeo Nursing (Neuro).
It's certainly that I'm from a big city, and also that these folks are quiet and reserved and I'm outgoing and, frankly, probably well-suited to the ED in nature.

I think I'm supposed to be freaked out about every pill I give because, you know, this is MED/SURG ACUTE CARE and IT IS VERY IMPORTANT and it is not LTC where everyone is stable. (And where they got that idea, I don't know.) I can eyeball an old fart going downhill at a thousand paces. And a sleeping old one with decent VS isn't going to get me nuts.

I dunno. I really wonder if I should be a nurse. I'm having a heck of a time getting along with people even when I think I am.

And not ALL of them think I'm cocky. TWO said I'm unsafe. The others are defending me, at least, as a human being if not a nurse.

With all due respect and all the best wishes in the world, are you sure you're taking the right attitude? I'm worried maybe you have a little bit of a chip on your shoulder and others may be picking up on it. I say this while freely admitting I went into orientation at the opposite extreme. I was scared, that is, my sympathetic nervous system had lowered my GI motility--and that made me inefficient and even unsafe. Only the Grace of God (and my own incredible brilliance at choosing to orient with people who'd known me for years and wanted me to succeed) got me through it to become the more-or-less marginally adequate nurse I am today. Even so, I recommend a strong dose of humility to anyone orienting to a nursing unit. Maybe you really can eyeball an old fart going downhill at a thousand paces, but is that really the best nursing practice? Gut instinct is important, and you need to be able to trust yours, but others are going to need to see that it's reliable before they trust it as well. Part of orientation is just what it says it is--orienting you to your environment. But another, equally important part, is proving yourself, and that's as it should be.

Of course you're right not to be freaked out, but I'd hate to think you were taking anything you do lightly, because IT IS VERY IMPORTANT.

Mike, I hear you. But I don't know that I so much have a chip on my shoulder as that I am reacting to their thinking that because I am not shaking that I DON'T think that it is all very important.

And of course I have to prove myself. I'm expecting that. I don't mind that. But Two has told actual lies about me. I knocked a pill out of a med cup and she claims I went to pick it up off of the floor and give it to the patient! Say what? I did no such thing. I did pick it up, and I then said that we needed to call the pharmacy to get a replacement. I also knew which pill I had knocked out - I banged out a similar cocktail every morning mutiple times for over a year - and was told that we replace them all since we're not pharmacists. Now, that's fine, but I came out of LTC where every nickel was a major expenditure and we would NOT have wasted every pill in that cup. I am learning that what was standard practice where I was is considered bad practice here. But that doesn't mean that you need to flat out LIE about what happened.

And yes, there's a better method of evaluation than "eyeballing." But if a patient is laughing and eating and evacuating and voiding and has stable VS and is being considered for d/c am I permitted to relax?

I don't mean to sound as if I am not hearing you, because I am.

What I AM waiting for is the attack - not the chip, as feeling very vulnerable. And I am right to feel that way.

I dunno. I'm just really discouraged.

Specializes in Rodeo Nursing (Neuro).
Mike, I hear you. But I don't know that I so much have a chip on my shoulder as that I am reacting to their thinking that because I am not shaking that I DON'T think that it is all very important.

And of course I have to prove myself. I'm expecting that. I don't mind that. But Two has told actual lies about me. I knocked a pill out of a med cup and she claims I went to pick it up off of the floor and give it to the patient! Say what? I did no such thing. I did pick it up, and I then said that we needed to call the pharmacy to get a replacement. I also knew which pill I had knocked out - I banged out a similar cocktail every morning mutiple times for over a year - and was told that we replace them all since we're not pharmacists. Now, that's fine, but I came out of LTC where every nickel was a major expenditure and we would NOT have wasted every pill in that cup. I am learning that what was standard practice where I was is considered bad practice here. But that doesn't mean that you need to flat out LIE about what happened.

And yes, there's a better method of evaluation than "eyeballing." But if a patient is laughing and eating and evacuating and voiding and has stable VS and is being considered for d/c am I permitted to relax?

I don't mean to sound as if I am not hearing you, because I am.

What I AM waiting for is the attack - not the chip, as feeling very vulnerable. And I am right to feel that way.

I dunno. I'm just really discouraged.

I hear you, too. What I hope didn't get lost in my "what if's" is that I'm pulling for you, as I'm sure many others are, too.

I've spent exactly 8 hours precepting. I was working in stepdown with two patients. One of them got a Prevacid at 2200. The other got a Prevacid at 0600. That was it for sched meds the whole 12 hrs. One was almost certainly going to the floor, if not home, next morning; I think the other got to hang out in stepdown another day or so, but both were pretty stable. So, at 2300 they gave me an orientee to help with my staggering workload, and also because her intended preceptor was already precepting someone else.

I asked my orientee if she'd had in pts in orientation, yet. She hadn't, so I gave her my "easy" one (the other had purportedly gotten aggressive with the dayshift nurse, so I didn't want to give him to a newbie.) I followed her through her initial assessment, looked over her note, and was very impressed how competent she seemed. She was, like me, a middle-aged new RN, but already way ahead of where I'd been as a GN.

Later, we were having a smoke and she remarked that it was a boring night. Well, yes it was, but I still thank God for boring nights. She casually mentioned that after 18 yrs as an LPN taking care of 50-60 pts in LTC, stepdown seemed pretty easy.

After several minutes of reviewing everything I'd said so far and hoping that none of it came across as condescending, I assured her that it was usually anything but dull, even for far better nurses than me. I didn't take offense at her "boring" or "easy" comments, because even though I was (and am) new enough to nursing to take it very seriously, I'm old enough at life and experienced enough in other ways to know what she meant. I can well imagine I might have decided she was cocky if I had been young and earnest, and I get a vague impression some of my earnest young colleagues do find her cocky. She isn't. She's confident in her abilities as a nurse, as she has every right to be. She's kind of a brash personality type, too, but I like being on a unit with some colorful personalities, and Lord knows we have some. In fact, I think I'm starting to be one.

Well, I'm just rambling, now. Main point is, don't let 'em get you down, but try not to let 'em get your goat, either.

I hear you, too. What I hope didn't get lost in my "what if's" is that I'm pulling for you, as I'm sure many others are, too.

Thanks, Mike. It didn't.

:)

Specializes in Trauma ICU,ER,ACLS/BLS instructor.
Bull. Demand documentation. Just because some nurse gets the vapors is not cause for termination.

gets the vapors? I have not heard that in years,,,,lmao:lol2::lol2::lol2:

My only advice is to take a deep breathe. Next shift ,ask for a few moments with whoever is precepting you. Explain how u feel and ask their advice on what u need to do to gain everyone confidence. People r brutal,sometimes ya have ta kiss a bit of butt to calm the indians. I am not good at this either,but it sometimes works. New people r always unger the glass scope. Small places are huge on "city people" invading their space. I just moved to a small rural area after being a city girl all my life. It is worse then peton place at times,,,lol. Good luck and do not give in. Smile pretty,,,,keep all evil thoughts in ur head and do ur thing!

You've gotten good advice on how to handle this situation. I would just add that you should be documenting everything that is happening during your orientation, since you are concerned about being terminated. Keep a journal of all situations that your preceptors may misinterpret, such as the dropped medication. At least you will have documentation if your NM tries to take action against you. Also, I would ask the NM if she could try to limit the number of preceptors that you have.

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