Need advice--possibly failing orientation

[Semper_Gumby]

Hi all,

I need some advice. I started on an antepartum/mother-baby postpartum unit a couple months ago. I have previous experience with well babies at a much smaller community hospital, and coming to a much larger teaching hospital with much stricter guidelines has been quite a change. My orientation was a little haphazard--I've rotated between antepartum (which I had no previous exposure to), couplet care (which I had minimal previous exposure to) and well-baby nursery, which is quite different here than at my previous facility. For various reasons, I've had multiple preceptors, resulting in things being a little haphazard.

Things had finally calmed down recently, and I had one preceptor for most of my shifts, who suggested I request to extend my orientation by a week just to get a better handle on things and feel more comfortable--so I did. I thought things were going well and I was getting the hang of how things were done here. My two most recent preceptors both told me I had done well for my shifts with them and one (not my "main" preceptor now) even told me she was surprised I had no med-surg experience because of how well I managed a hyperemesis patient with all-IV meds.

Last week, with my main preceptor, I made a few mistakes. I hung an IV medication and forgot to label it (and when pointed out, I corrected it immediately) with time/date/initials and patient's info. I am rusty with IV's, having not dealt with them since nursing school, and simply forgot. I also had a medication to give PO that I was supposed to split in half, but when I went to give it, I dropped the whole pill in the patient's hand and she pointed out her pill splitter on the cabinet--so I quickly split it and administered the correct dosage. Finally, this facility verifies mom and baby's ID bands with shift assessments, which my old facility did not do, so I've had a hard time breaking old habits and remembering to check them with every shift. On this particular day, I remembered to check the baby's bands but not the mom's. When my preceptor pointed it out, I corrected it immediately. At the end of the day, she told me I'd done well that day overall.

The next shift I worked, I was pulled in to the office to speak with the manager, assistant manager and educator. This is the first time anyone had met with me to review my progress on orientation. I was told I was not pulling things together quickly enough, that I seemed to lack critical thinking skills, and these mistakes were cited. It seems there are also concerns about whether I am able to recognize abnormal findings in both mothers and babies. I was told they were extending my orientation by one week and if I did not show marked improvement, I will no longer be employed. The night before this meeting, I had notified the educator that I had accidentally missed a class I was supposed to be at--I was sick and completely forgot about it and felt terrible when I realized it.

I have spent some time in thought and analyzed why the cited mistakes happened. The med error and the band error both occurred when I got distracted talking to the patients, usually due to a question they had. Since I'm used to being able to go into a patient's room and do what I need while talking with them, I am going to have to make an effort to keep from being distracted (maybe asking them to hold that thought for just a moment while I finish up) until I am experienced enough with this population to not make silly mistakes like that. With the pill I forgot to split, perhaps I could have pulled her pill splitter down from the shelf first thing and had it ready before giving her the med. I have made a series of notecards outlining what I need to do in various situations to ensure I don't inadvertently leave something out.

So I guess I'm wondering where do I go from here? How do I gently ask my preceptor to step back and not automatically take charge if I'm not doing things fast enough for her? She has a very strong personality and I am very laid back so it can be hard for me to assert myself! If, at the end of the week, they decide that they do not want to keep me on, do I request the opportunity to resign? Would it be ok to request transfer to a different position/unit if one is available? Any tips or tricks I can use to keep from making mistakes like the ones cited? At my previous facility, I rarely gave anything but erythromycin ointment, vitamin K, and Hep B vaccines, so there's been a lot to learn! If they do decide to keep me on, should I start looking elsewhere? I would hate to work where I feel I'm constantly under scrutiny and I'm concerned that's how I'd feel after being blindsided by that meeting. I'm so disappointed nothing was mentioned to me at any previous point about these concerns--if I'd known I could have done something to try to change it!

Any advice?

[BSNbeauty, BSN, RN]

It may not be a bad idea to start looking elsewhere. I have been where you were, except is was an ICU unit. Once they made up their minds that I was not a good fit for the unit, and said it was due to my " lack of critical thinking and mistakes" I pretty much had a target on my back. I decided to resign and start fresh somewhere else. Best decision I've ever made.

[quazar]

It may not be a bad idea to start looking elsewhere. I have been where you were, except is was an ICU unit. Once they made up their minds that I was not a good fit for the unit, and said it was due to my " lack of critical thinking and mistakes" I pretty much had a target on my back. I decided to resign and start fresh somewhere else. Best decision I've ever made.

Yep. BTDT. I left. Best decision ever, I was so much happier, no longer nauseated on my drive to and from work, no longer hating my job, no longer stressed out every second, etc. etc.. Sometimes it's just not worth it.

[Semper_Gumby]

Thanks for the replies. I was actually fired this afternoon. Today didn't go well at all despite my efforts to prepare and they pulled me into the office and said they would not wait until Friday and I was sent home. Guess that answers my question of whether to look elsewhere!

Never been fired before so I guess I can check that off the list lol. Still processing it because it happened so fast, and gonna have to figure out my next step from here.

[jenrninmi, MSN, RN]

I'm sorry to hear that. Maybe try going back to a smaller hospital?

[Semper_Gumby]

I'm sorry to hear that. Maybe try going back to a smaller hospital?

Thanks. I think I probably will, though now that I've been in a larger environment, hopefully it'll be an easier adjustment if I end up in one again. I think I'd definitely prefer a smaller one though!

[FuturePN]

Thanks for the replies. I was actually fired this afternoon. Today didn't go well at all despite my efforts to prepare and they pulled me into the office and said they would not wait until Friday and I was sent home. Guess that answers my question of whether to look elsewhere!

Never been fired before so I guess I can check that off the list lol. Still processing it because it happened so fast, and gonna have to figure out my next step from here.

I'm so sorry that happened Hoping many great opportunities come your way. I'm just a newbie out of school, but it sounds to me like you owned your mistakes and were working to find ways to troubleshoot.

[Semper_Gumby]

I'm so sorry that happened Hoping many great opportunities come your way. I'm just a newbie out of school, but it sounds to me like you owned your mistakes and were working to find ways to troubleshoot.

Thanks, FuturePN. I was, indeed, working to correct them--that last day, I had another new (to me) medication that had to be split. I looked it up in the drug book and when it was time to administer, couldn't find whether it was safe to split the pill (it was scored, but my preceptor told me that not all scored medications are safe to split, which I did not realize) so I contacted pharmacy for the answer (found it was safe and administered after that, correctly)...but according to my paperwork, it seems my preceptor made it seem like I had not bothered to look it up and was administering unsafely.

Interestingly, my husband works with someone who used to work on the same unit, and it seems that I am not the first nurse this particular preceptor has gotten fired. Looking back, I feel it's highly possible that she decided for whatever reason that she didn't like me or that I couldn't do the job, and then set out to prove it. I have even wondered if her suggestion that I request extra orientation time was to give her time to gather evidence against me (since none of the complaints about my performance were presented until the extra week). If, indeed, that is the sort of person she is, I will be thankful that I do not have to work with (or opposite shift) of her. Trying to let this roll off my back and consider it lessons learned.

[Calalilynurse]

I'm sorry that happened. It seems like you were very willing to own up to and correct your mistakes. It might have just been a bad unit culture ( i.e. Crazy / multiple preceptors). I know that job must have been a lot different than your experience working in a well baby nurse. Try to get your old job back or a straight mother/baby or postpartum. I once worked at a teaching hospital it was great experience but I hated it. I much prefer my little community peds unit. Other than not having an inhouse doctor 24/7.

[Semper_Gumby]

I'm sorry that happened. It seems like you were very willing to own up to and correct your mistakes. It might have just been a bad unit culture ( i.e. Crazy / multiple preceptors). I know that job must have been a lot different than your experience working in a well baby nurse. Try to get your old job back or a straight mother/baby or postpartum. I once worked at a teaching hospital it was great experience but I hated it. I much prefer my little community peds unit. Other than not having an inhouse doctor 24/7.

Thanks, Calalilynurse. I think you're correct, that it was entirely a matter of unit culture. It definitely requires a mindset switch to go from thinking only of the baby, to thinking of the mother and baby both! I know I was rusty in my adult skills but was trying to get up to speed...guess it just wasn't fast enough! Unfortunately, my old job is about 800 miles away but I am debating whether to try to stick it out here (where my now-former job was literally my only interview in four months of searching) or head to my home state (neighboring state to my first job). I think it would have been an easier transition doing straight mother-baby rather than throwing the antepartum in with it (especially with only a couple weeks orientation in each area). Ah, well. Can't unscramble those eggs!

Now the question is...what changes to make to my resume, if any?! Thinking I should probably leave this one off...

[klone, MSN, RN]

Thanks. I think I probably will, though now that I've been in a larger environment, hopefully it'll be an easier adjustment if I end up in one again. I think I'd definitely prefer a smaller one though!

I'm sorry that happened. I hope you are able to find a better fit at a different facility.

One thing I wanted to comment on - regardless of where you go, and what they do at the new place, ALWAYS ALWAYS ALWAYS check/compare mom's AND baby's bands, EVERY SINGLE TIME. That's "Mom/Baby 101" and I'm sorry your previous facility took such a lackadaisical approach to infant safety, but please don't pick up that bad habit.

Best of luck to you!

[Semper_Gumby]

I'm sorry that happened. I hope you are able to find a better fit at a different facility.

One thing I wanted to comment on - regardless of where you go, and what they do at the new place, ALWAYS ALWAYS ALWAYS check/compare mom's AND baby's bands, EVERY SINGLE TIME. That's "Mom/Baby 101" and I'm sorry your previous facility took such a lackadaisical approach to infant safety, but please don't pick up that bad habit.

Best of luck to you!

Thanks, klone. My old facility did require bands to be matched when babies were returned to mother's room after being out for any reason but did not require verifying with each shift assessment. I take it that is unusual? At any rate, I expect I will remember it now! Despite how it turned out, I learned a lot over the last couple months.