New grad in an ICU residency program considering quitting

[Maria D]

Hey all. I am part of a 6 month residency program at a level 1 trauma center. I am approaching month 5th and was told my orientation was going to be extended which was extremely discouraging. I have also been struggling with my second preceptor. I feel that she has been picking on me and makes frustrating comments about my performance in front of me, other nurses and doctors. She talks to me in a condescending manner and in front of patients. The feedback she gives me every time is very discouraging and makes me feel as if I was stupid and not fit for the environment. I have been trying extremely hard to be better and even read articles and books when I get home to educate myself. I truly want to be able to make it but I have been extremely stressed and I cry every day after work and have developed anxiety from this. Has anyone one had a similar experience or have any thoughts/advice on how to move forward?

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

4 hours ago, Maria D said:

Hey all. I am part of a 6 month residency program at a level 1 trauma center. I am approaching month 5th and was told my orientation was going to be extended which was extremely discouraging. I have also been struggling with my second preceptor. I feel that she has been picking on me and makes frustrating comments about my performance in front of me, other nurses and doctors. She talks to me in a condescending manner and in front of patients. The feedback she gives me every time is very discouraging and makes me feel as if I was stupid and not fit for the environment. I have been trying extremely hard to be better and even read articles and books when I get home to educate myself. I truly want to be able to make it but I have been extremely stressed and I cry every day after work and have developed anxiety from this. Has anyone one had a similar experience or have any thoughts/advice on how to move forward?

Have you thought about talking to your preceptor? Unfortunately in the nursing world you’re gonna come across lots of condescending people don't ever let anyone push you away from your dream.

[yournurse]

5 hours ago, Maria D said:

Hey all. I am part of a 6 month residency program at a level 1 trauma center. I am approaching month 5th and was told my orientation was going to be extended which was extremely discouraging. I have also been struggling with my second preceptor. I feel that she has been picking on me and makes frustrating comments about my performance in front of me, other nurses and doctors. She talks to me in a condescending manner and in front of patients. The feedback she gives me every time is very discouraging and makes me feel as if I was stupid and not fit for the environment. I have been trying extremely hard to be better and even read articles and books when I get home to educate myself. I truly want to be able to make it but I have been extremely stressed and I cry every day after work and have developed anxiety from this. Has anyone one had a similar experience or have any thoughts/advice on how to move forward?

Hi Maria,

I had the same experience when I started the ICU or any nursing floor for that matter. One thing that I can tell you is to welcome these experiences because that is how you’re going to be able to know how to react to situations like these in your life. I hate to tell you think this but this is just the beginning, you’ll learn how to be a better person. I did the same thing you did, I read, took the CCRN as soon as I was able to because some nurses would always put me down. You have to not take these things personally and realize that although it is wrong for them to treat you this way, there must be something going really bad in their lives to treat others this way. I’ve realized that people put people down to make themselves feel better. I coped with it by knowing that I deserve to be in that ICU. Also, I wish I got extension for my orientation, welcome that extension. Don’t ever feel like that is a bad thing. Be open to it because you always learn something new everyday. I hope this helps, 5 months is a long time. Kill it.

[RNperdiem, RN]

That was my first year of nursing. That was the first year for many of us. Nursing school did not prepare us for the reality of nursing in the real world.

I learned how to cope with stressful situations. I learned how to manage the anxiety in a productive way. I accepted that as a new nurse, I would be extra-sensitive to criticism, but that was okay and part of the growth process. I knew that as a new grad I was hired onto a floor that had high turnover for a reason- the unit was undesirable for experienced nurses.

When my year mark was closing in, I plotted my escape and did some looking around at other jobs. If they extended your orientation, it means that they still see potential. Otherwise you would have been let go long ago.

[ruby_jane, BSN, RN]

15 hours ago, Lovethenurse2b25 said:

Have you thought about talking to your preceptor? Unfortunately in the nursing world you’re gonna come across lots of condescending people don't ever let anyone push you away from your dream.

You have described everything about my first preceptorship in the ICU so I have the feels for you.

Document EVERYTHING. Everything the person says and does. Speaking to the preceptor on your own may be disastrous. Speaking to the preceptor with someone else from the agency may be worth it (but it may also put a target on your back because she is a "well-respected competent nurse" and you are a "struggling new nurse."

Is there any chance that you can get another position in the hospital that is not acute care? Step down, telemetry....anything else?

A six-month orientation to ICU sounds like a dream. In reality, six months is not long enough for us to move from task-based nursing to that gestalt nursing required in the ICU. You simply have not seen and done enough - and that is no shame on you. It is what it is.

This site is loaded with posts from people in the exact same situation as you. Head up, do your best, protect yourself.

[Nurse SMS, MSN, RN]

Its hard to tell from your post if you just aren't reacting well to being told how to improve or if it is truly a lateral violence situation.

You don't say how long you have been extended for. Usually once an extension is needed, the writing is on the wall. Perhaps discuss with your manager, without laying blame at the feet of your preceptor, and share your struggles. It may very well be that ICU isn't a good fit, but that in another environment you will do fantastic. Explore your options.

[subee, MSN, CRNA]

Politely speak with the person who criticizes you in public and ask them to take this conversation to a private area where it belongs.That is just so unprofessional and sloppy to do in front of a patient. Maybe her supervisor would appreciate knowing that she speaks like this in front of the patients.

[RNninja]

What I am saying here is just based off of my perception of what you have wrote. Please don't take any of this harshly.

Firstly it sounds like you have a real passion for ICU nursing. You are going home after long stressful days and continuing to educate and better yourself! That is awesome! ICU is a tough gig, A level one trauma ICU is about a rough as you can get. A lot of new grads aren't ready for that yet. I'm not saying you aren't, but most aren't. There are many hospitals that will only hire RNs with experience for those positions.

You said you have been struggling with your second preceptor. Was this a scheduled change from your first preceptor or did they give you another preceptor because it wasn't working out with the first one?

When you said that she is picking on you what do you mean? I ask because this is sometimes a perception that people have when they get criticism. When I started in an OR I had a doctor talk to me about how a patient was prepped for a surgery. After the conversation was over a tech came up to me and said that he shouldn't have spoken to me that way. I didn't understand because he just spoke clearly and concisely on how things should be done properly but she took it that he was being demeaning to me.

You said she spoke condescendingly to you in front of patients. I'm not saying that she didn't because I wasn't there but was she really trying to be mean or was that how you perceived it? What was the situation there? In ICU some mistakes or misshapes can seriously injure or kill a patient. Was she stopping you from doing something detrimental to the patient before it happened?

I have precepted many new RNs and it is a hard thing but sometimes I had to say that maybe the position wasn't for them. When I precepted the one big thing always in the back of my mind is my patients and their safety. What comes of to you as callous and her picking on you may just be because she believes that you are not ready for that type of nursing role yet.

All that being said if this is really what you want keep working for it. But you saying that you are going home extremely stressed and crying every night is no way to live. My suggestion would be to see about getting into another position for a year or two just for you to develop your nursing chops. With your passion for critical care, something like a stepdown or cardiac unit would be a good start. This would give you time to grow as a nurse and really develop your critical thinking skills.

Once again I'm not saying any of this to be mean just trying to give another perspective. I almost quit nursing myself in the first 6 months as an RN. Luckily my charge talked me out of walking that night. Now I couldn't see myself doing anything else.

Remember in nursing there are always other options and sometimes you don't know you really like something until you try it. I started with a passion for cardiac and telemetry and wanting to end up in ED. I did both of those and kinda slid into doing OR circulating and recovery nursing, now I can't imagine doing anything else!

Good luck with what ever you choose!

[BeKindtoanurse]

Maria D,

You can do this! You sound really interested and motivated. Your preceptor needs you to partner with her. Tell her that her feedback is absolutely necessary for your growth and you value it~but could we have a debrief session with just the two of us where you would share you insights with me?

Also make a list of situations or clinical issues that you want to focus on so that she has some direction and realizes how engaged you are in your commitment to work in the ICU. Precepting takes a lot of energy just as this takes a lot of energy for you to have the courage to take on this role. Communicate about what you are uncomfortable with clinically and this will help her to engage with your progress. I am impressed that you study at night. If they are extending your orientation that means that they believe in you but want to give you more time to gain experience. That is a gift not a punishment. Let us know how it’s going we believe in you! It’s not about me but I was a new grad in the OR and it was hard! I would say it was 2 years before I became comfortable but still always had to be on my toes. Best to you!

[Fern Tirado, BSN]

Dear Maria,

I am so sorry that you are going through this. This is an unfair and outdated practice in Nursing. That BS about the "old eat the young" is a thing of the past. It is our responsibility as nurses to promote a healthy work environment, and bullying fellow new nurses is unacceptable. Your preceptor should be ashamed of herself and her behavior reflects poorly upon all of us in this profession.

I can see that many of us have experienced this toxic work environment. In my 10+ years as a nurse, I have learned (the hard way) that working in a floor where your are unsupported (emotionally and educationally) is just simply not worth it... The stress caused by this situations is unhealthy and completely unnecessary... If you have reached the point where you cannot sleep the night before your next shift or you find yourself fantasizing about driving off pass your hospital the morning of your shift... mama, It is time to go...

And let me make one thing clear: leaving does not mean that you are incapable or lack the skills to be an a fantastic ICU nurse. It simply means that you are not in the right environment... And in nursing, having a good team is key.

The worst thing that can possibly happen (other than accidentally killing a patient) is that you get fired, and that is just going to make it harder to land on your feet after you leave... Nursing is one of those environments where *** happens and you need to be/feel supported by your fellow colleagues. You need to feel comfortable to ask stupid questions and seek others opinions without hesitating... If something (minor) went wrong, will your boss have your back? Will he/she see it as an opportunity for you to learn? Or will it be an excuse to fire you/chastise you? If your reality is the latter one... You gotta go..

What do you have to lose? Nothing. To the contrary, you have all everything to gain. There are so many options: step downs, PCU, rehab, ER, NICU, PACU, Med/surg, L&D, Dialysis, home care, etc....

You should feel good about going to work everyday. Your mind should be focused on your patients and not on any other BS.

Best of luck to you,

Fern

[brandy1017, ASN, RN]

I think all the responses so far have something to offer. Take the advice that makes the best sense to you and your situation.

The first year of bedside nursing is usually stressful and difficult for most new grads. But things get better. That doesn't mean you have to stay in a job that is leaving you stressed out, crying and unable to sleep. If this job is not what you thought it would be or what you want at this time it is OK to admit that. Don't stay where you are stressed and miserable to prove something to yourself or your coworkers or manager. Sometimes what we think we want turns out not to be the real deal. Sometimes a "great opportunity" isn't the right fit for you or for this time in your life.

In my experience very few nurses stay bedside for any length of time, even less in the ICU. It is an incredibly stressful work environment even for the experienced nurses.

The fact that they are willing to extend your orientation is actually a good sign that they see your potential and want to give you the best chance to succeed. Some subpar places will simply cut your orientation short to save money and fill a hole when they are short staffed and have a sink or swim attitude.

That said if you feel the ICU isn't for you, speak to your manager. Usually they realize ICU is not everyone's cup of tea and are usually willing to transfer a new grad to a lower acuity job such as med-surge or step-down. Contrary to some people's feeling, that is not an insult, nor does it determine your future. It simply means right now is not the best time for you to work in ICU. I've watched several nurses find their way back into another ICU environment a little later on and thrive, if that was their wish.

My best advice is to use your time at bedside as a paid residency while you feel out and explore what type of nursing makes you happy. Be open to all possibilities, including going back to school for NP after you've gained a year or two experience.

Best wishes for a peaceful, joyful 2020 as you explore the start of your nursing journey!

[headofcurls, BSN, RN]

Hey girl,

I totally understand your frustrating. When I was a new grad everyone one else finished orientation in three months and it took me five! I felt like I should quit and I cried at work twice because I was so confused on what I was doing wrong.

Looking back the root of the issue was that I lacked confidence. The catch 22 was that the longer they wanted to orient me, the less confidence I had! And every time we would meet in the managers office, I would always get a list of things that I was doing wrong. On one of the final meetings, the manager said if I couldn’t make it in a week, I would be terminated. I say this to say, I understand what it’s like to feel like you’re walking on eggshells and to feel like everyone is watching you and that if you make any mistake (which we naturally do when we are nursing/learning) that you’ll be fired. It is A LOT of stress and it messes with your confidence and now instead of focusing on learning, you’re worried and stressed. I understand completely and I also understand what it’s like to just want to jump the gun and quit before you “get terminated”.

Since I’ve been in your situation before, the best advice that I can give you is to not give up. Take the extension, it truly is a blessing. If you’re able to change preceptors, I would do it and just say “she was great but I know precepting is stressful and I wanted to give her a break plus I want to be exposed to how other nurses run their shift” (every nurse runs it differently and another nurses style may sync better with yours). I know when I’m being precepted I need someone that is very organized for others that may be annoying.

Take the extension, the pressure makes you a better nurse. By the time I finished my super long orientation, I was one of the best nurses on the floor. My time management and critical thinking was excellent and my patient care was as well. And I know that was because I was working 10x as hard as my residential cohorts because eyes were always on me to catch me making a mistake and I had a much longer orientation than they did.

good luck!!!