New grad feeling incapable or incompetent?

[ICURN5305]

Hello!

I am writing this for all the new nurses (especially the ones that recently started in an ICU) that feel overwhelmed, incompetent, and like it may never work out. I desperately searched for these posts when I was a new graduate.. hoping to relate to someone who has gone through the same thing. I feel obligated to provide other nurses the comfort I needed years ago. (I will make separate posts for nursing student advice, how to pick your first job, etc.)

I was in your exact position when I started a few years ago. I always maintained a great GPA at a (difficult) nursing school, so I assumed my first job in a MICU would be a smooth transition. That could not have been farther from the truth. I could tell you the first 6 months of my nursing career caused me anxiety, depression, and lack of self confidence. I wish I could go back in time and tell myself a few things that I will tell you.

1. Stand up for yourself- relentlessly and without guilt. If you are not getting what you need out of orientation, you need to ask as soon as possible for a change in preceptors. My advice- ensure you have ONLY one or two preceptors during the first two months of your orientation so that you are not "starting from scratch" everyday with a new preceptor. You need someone that knows your strengths and weaknesses so they can help you improve constantly.

I had a a new preceptor every 1-5 shifts. I asked ONCE to have a more steady preceptor, but by then, it was too late. I was too behind. I felt it was my fault, not theirs. I didn't want to cause problems. Looking back, I would follow the advice I'm giving you during my first three weeks.

2. You ARE intelligent BUT you will feel you lack common sense for the first few months (especially if you were not a nurses aid first- I wasn't either.. I survived!). Small tasks like quickly making beds, doing baths, untangling masses of cords/wires will make you feel overwhelmed. Especially with a preceptor/other staff watching. This is NORMAL. You will learn with repetition and time when you're on your own.

3. You probably will feel bullied at some point during your new career, especially if you are having a hard time adapting to your new environment. There are nasty nurses out there that love to watch new people fail- probably because they feel they are a part of an exclusive group of people that could do this job. You MUST remember it is NOT JUST YOU. I can guarantee that many other staff (new and old) feel the same way, but never speak up. If possible, ask other staff that you can trust if you have questions or need help. Also important- Try to put yourself in their shoes. They have not been a new Nurse in years! They probably forget what they did and did not know at that point in their career. Remind them that you are asking for help because you are inexperienced and want to ensure the safety of the patients!:)

4. You are NOT a failure if you require a transfer to another unit to get basic experience first. I would have read this advice 3 years ago and scoffed. It's true! There was no way a 4 month ICU orientation was going to prep me for what I didn't know ESPECIALLY with an awful group of preceptors and orientation process. Swallow your pride and seek out a position on a step down unit or telemetry floor. I did the same. I worked on a step down for a year, and I returned to an ICU. I learned basic skills with moderately sick patients. I could not have learned these skills with crashing patients every day. I am now regarded as a respected nurse, and I absolutely love my job in the ICU.

It is crazy to think that I almost quit this profession. Hang in there!!! It's rough in the beginning. You can do this!

good luck! :)

[Ruby Vee, BSN]

I agree with much of this post, but disagree with the part about asking for different preceptors. Our unit gets so much turnover that there ARE no different preceptors. Anyone who has a pulse and has renewed their one-year license at least once is precepting, so the only way to get you a new preceptor is to take one from someone else. Additionally, our manager views asking for a new preceptor as a failure to get along with the established staff, and that is reflected in your formal evaluation. I'm not sure that she's wrong.

Most established preceptors will look ahead at the daily sheets and see if they're assigned to an orientee they haven't worked with before. Then they'll seek out the preceptor who has worked with that orientee the most, or most recently and ask what they need to know. What are the orientee's strengths and weaknesses, what do they need to work on? Have they had admissions and transfers or are they ready (or not ready) to work on that? Every unit has that pain in the rear patient that the new orientee gets stuck with shift after shift. Has that orientee worked with that patient to the extent that they need a break, or do they need exposure to that patient? If you see preceptors talking about an orientee, chances are they're not just gossiping -- they're trying to figure out how best to meet the orientee's learning needs.

Most preceptors mean well, but not all of them are gifted nurses, gifted teachers or even able to explain things that they've been doing without thinking about for the last decade or so. You may learn visually, but the preceptor learns a different way and thus tries to teach that way. At the beginning, you have so much to learn that you can learn from just about anyone. If your preceptor cannot explain to you why you're using THIS dressing as opposed the THAT dressing, they may be able to teach you how to interpret rhythms or labs, or how to clean up a river of poop. If you cannot make heads or tails of your preceptor's explanations about checking temporary pacer settings, for example, it's OK to quietly slip into another nurse's room and ask if they can explain it. Or to study the hospital's procedure for pacer checks and then ask specific questions of your preceptor, someone else's preceptor, the charge, the educator or the intern. Interns are a great resource because they love to find someone who knows less than they do about something, and most of them will teach you. Many attendings will teach you, too, if you get to know them first and don't ask for too much of their time. (And about interns -- if you can teach THEM something -- pacer checks, for example, or how the art line set-up works, you'll consolidate that knowledge in your own head.)

Remember that you'll have to study at home, at lunch, on your own time. It's expected of you. All of us study at home when we change jobs, change specialties, change employers. Some of us study at home because we're preceptors and want to be able to explain things to you at a level you'll understand, or because the hospital is getting some new equipment and we don't want to be caught out if it lands in our room. Every new grad I've seen who announced that he wasn't studying at home because he's done with school now didn't last long in the ICU and many didn't last long in nursing.

We all felt stupid at our first job -- there's a lot to learn and nursing school couldn't possibly prepare us for all of it. Preceptors go out of their way to try to cut you some slack, so please try to cut them some.