New to ED from med surge. Fouling the ball a bit

[BarkattheMoon]

I need some advise perspective.
I have 5 yrs exp and have developed relatively varied exp. nursing home 1yr hospital psych unit 1 yr 3 yrs meds surge in a big fast paced hard metropolitan hospital. I just started as a “transition RN” to ED Level 1 trauma in the same hospital (not a resident position).It’s been my dream to get here and it was hard since they rarely take transition RNs in my city. It’s very competitive. Anyhow I know how to work hard and prioritize pretty well on med surge/ tele I could do 5 patients that were all acute. I did this very well with no issues and good Evals. And I also learned a ton on psych and did very well. Now I’m nearing the end of my three month ED preceptorship. They gave me And another new hire some more shifts because the felt I needed to be better at critical care and faster.

I haven’t made any major mistakes and overall my preceptors (I’ve had a lot) say I’m improving. Within a week I’ve had one preceptor day I’m doing good but the other one of my main preceptors has had issues with me. She said I need to go faster (I truly feel I’m doing okay at my speed but I Take the advice and I can improve) . I made the mistake of mentioning a few times my old med surge unit was similarly busy/ fast but Added that obviously the ED is way more unpredictable and critical. I know I shouldn’t do this but I guess it’s my ego; I want to feel people value where I come from. But in reality nobody wants to hear about med surge and they always seem to put shade on it.... I’ve been told “forget what I learned there” and that causes me internal strife LOL.

I want to not fail. I’m scared and stressed. I’ve been so good and efficient on other jobs. What the hells my problem? I’m trying not to have a chip on my shoulder. I was one of the fastest on my last unit. and I like the speed of the ED etc.
The other day this preceptor didn’t follow me at all and let me work alone all day. I was consistently busy and I thought I got people in and out but she said it was not up to par. I thought I was ? I’m not sure tho. I watch others and they seem sorta like they’re moving at my pace ? I kept up with all the meds, charting, ambulances and triage coming in. I did my best getting the discharges out.. Last comment; she came down on me for a big concern ; I sent up two patients at the same time who needed a bunch of IV bags. One of them I didn’t yet give vanco to and I let her know I didn’t .... I also told the receiving nurse When I wheeled him up face to face and handed her the bag. My preceptor waited till the end of shift and then called me out on it with the charge present. She said “we aren’t going to write you up but we need to know that you know this was a mistake. I replied I’ll never do it again and yes I know it was a bad move “ She said “you told me you were going to give it” but I didn’t and I even mentioned to her I told the receiving RN about “he needs it”.

im trying so hard to stay positive. I even got counseling just to help me in this transitional time in my career. I feel that my preceptor wants me to fail and she’s setting the cards in motion. I’ve never been in the position of not making the cut.....

please help! Any advice welcomed (almost that is)

[Nunya, BSN]

First of all, you're on orientation. You'll get faster and smarter. You weren't one of the fastest people on med-surg at the beginning either. Secondly, if your preceptor doesn't bother you all day and let's you do your own thing you must be doing OK. Bring that up next time they say anything. Thirdly, if you're still on orientation they're still responsible for you and your actions, so if you do something they don't like then it's also their responsibility. I wouldn't hesitate to bring that up next time you hear about something you did wrong but only hear about it in front of your supervisor. And fourth, when you're asked to evaluate your orientation mention that you should only have ONE preceptor, two at the very most and then only under extenuating circumstances. What kind of idiots run your education program and think it's OK to give someone several preceptors?!? You're doing fine, but I would definitely start a paper trail on this preceptor, and while you're at it do it for the others also.

Edit: and that paper trail will help when you pull it out if your supervisor decides to counsel you. And HR will be interested in seeing it also.

[canoehead, BSN, RN]

I think you are fine. You aren't supposed to go fast when you're orienting!! slow down and absorb as much information as you can. This is the time to read the policies before acting, and ask questions.

The Vanco- you took it with you and handed it to the RN letting her know it was still needed. There was probably a reason why you didn't just hang it- another antibiotic running? It's nice to send people up with a bow, but in reality we need to be a team. Don't worry about it.

[LibraNurse27, BSN, RN]

I don't see why the antibiotic thing is a problem. I work in step-down and ER transfers me pts w/ meds waiting to be hung all the time. Of course I'd love them to arrive with no meds due, but as you said some pts have multiple IV meds and all of them couldn't be hung at the same time. I especially don't like to hang more than one antibiotic at once. If pt has a reaction you won't know which one caused it. Also, most patients don't have ten IVs! Did your preceptor say why that was a problem?