Needing some advice before I get fired

Nurses New Nurse

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Hello all! Hoping for some advice!! I am in my 6-7 week of orientation as a new grad on a busy neuro unit in a big hospital in CA. I've had a few different preceptors, one had concerns about me getting the whole picture, another told me I was doing fine and another apparently has concerns about me getting the big picture. I've had a meeting with my manager and they need to see improvement by the end of the week, or, I'm assuming, I'll lose my job. I'm not quite sure where I'm going wrong, what to do about it or how to improve. I havn't made any major errors, no med errors or had any major mishaps. There are times when I am late getting my vitals and assessments done/charted and I stay pretty busy. The RN's on my floor take 3-4 patients and I am taking 3. These meeting with my manager make me nervous so I'm not sure what to say when she asks me what I need to improve. She also asked me a question about a patient's condition and I didn't give the right answer, I didn't think of it but as soon as she told me the answer I knew I knew that, it made sense to me. I really think I would be good at this type of nursing, I just think I am a little slower than most. I'm terrified of losing my job. I think what bothers me the most though is that my preceptors haven't really told me what I'm not getting, only one told me that they had concerns. Instead they tell me I'm doing fine, that I need to be more organized and have better time management but that comes with time. I was also told that I try to do too many things at once, that I need to stay focused on one thing and finish before I start something else. I understand this, that's how errors are made. But at the same time, you have to be able to multi-task in nursing and sometimes you may be in the middle of one thing but have to stop because something more important comes up. My plan tomorrow is to tell my preceptor that what I need is for them to allow me to tell them what I'm doing and in what order and why and then go over with them "the big picture" so they can give me feedback on what's right, what isn't and why. The other thing that bothers me is when I'm asked what I think I need that would be helpful and I tell them that being quized on my patients or having my preceptor watch what I do to tell me ways I can better organize my time and tasks I'm told that I'm no longer in school and shouldn't need to be told. There are some seeminly great people on the unit and I like it, I don't dread going to work. I just don't know what to do. Would love some advice! How far behind am I for being this far along in orientation?

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Specializes in Thoracic Cardiovasc ICU Med-Surg.

I precept a lot on a cardiac surgery step-down floor. By week 6 my orientees should be able to handle a four MAYBE five patient load on days. By that I mean doing the head to toe assessment and charting it correctly, administering all the meds, giving prn pain meds etc.

Only being able to do three patients doesn't sound great frankly. Are you making good use of your time?

I teach the way I do it, which is to do the assessment, chart it, and assess the next patient. Then chart their assessment etc.

One option might be to ask if you can spend a day just shadowing one of the experienced nurses to suck the brains out of her head. LOL-- you get my meaning I hope. Time management is the MOST important skill to surviving out there as a nurse. Because you can be the nicest, smartest new grad, but if your time management sucks, then everything is messed up.

Fortunately that can be taught, and learned. So don't give up hope. On my unit we' d probably just give you a longer orientation. ( it's hard to get fired at my place, you have to really work at it.)

hope this helps.

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Specializes in NICU, PICU, PCVICU and peds oncology.

Wait a minute... she's taking a full load FOR HER FLOOR.

newstudentn09, are you familiar with Patricia Benner's work on the evolution of nurses from novice to expert? I recommend you read a little of her work and make good use of it in your next interview with management. Because you're not supposed to be able to see the "big picture" as not only a novice on that unit but a novice nurse period. http://www.sonoma.edu/users/n/nolan/n312/benner.htm

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I appreciate the responses guys. TCV...I'm supposed to be as independant as possible so I am doing the head to toe, vitals, meds, orders, ADL's, I & O's, and of course charting that and other misc charting, such as education etc. One of my preceptors gave me some great time management ideas....we do bedside rounding so things like checking fluids and pain meds I try to check on during that point. I basically try to do report, look at labs, get meds, do vitals, head to toe, give meds and then chart. I think part of the problem is how long it takes for me to do my assessments and my charting. Thanks for your imput!

Janfrn-thanks for that info...I remember that being briefly mentioned in school and will look into it more. Thanks for the advice because I did not remember that. I was told that I'm good with the patients, have a great attitude and it's obvious that I'm trying and have made improvements...I guess I just wish that while I may not be exactly where they want me to be, I will get there and because I care about my patients and my job and am actively trying to improve, that I'm a keeper. I will do my best and give it my all and hope it works out. Thanks again, I'm very appreciative of your response!

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Other info re: neuro patients....

For CHI, SAH, SDH, EDH, meningitis, suspected Guillan Barre, etc:

Checking for lateral deficits (bicep/tricep/dorsiflexion/plantar flexion), EOMs, nystagumus, pupils,

-knowing what meds may effect LOC and behavior

-mobility

-# people needed to assist

-I & O w/ any indications of DI or SIADH

-behavior and affect

Neuro is SO interesting....I loved it- but you have to really know how to catch the little things before they blow up. A head bleed can be slowly oozing for a couple of days, and then blow... you need to see the subtle changes before he blows. And pupil inequalities are later signs- should have LOC/MS changes, widening pulse pressures, possible vomiting w/o nausea, etc. Pupils 'blowing' means there's already compression on the 3rd cranial nerve- a late sign. (still check them, because cataract patients/other eye surgeries can leave pupil changes that are the new normal for that person.

Hang in there :up:

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Wait a minute... she's taking a full load FOR HER FLOOR.

newstudentn09, are you familiar with Patricia Benner's work on the evolution of nurses from novice to expert? I recommend you read a little of her work and make good use of it in your next interview with management. Because you're not supposed to be able to see the "big picture" as not only a novice on that unit but a novice nurse period. http://www.sonoma.edu/users/n/nolan/n312/benner.htm

Page won't open :crying2:

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Specializes in NICU, PICU, PCVICU and peds oncology.

Try this one then: http://ajcc.aacnjournals.org/content/13/6/448.full

I just tested it and it worked for me.

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