Hi, I've been looking at other post that may have something to do with what I am going through but can't find any.
I worked as a cna on a cardiovascular step down unit for 2 1/2 years and when I graduated from school they offered me a full time night position as a nurse. I thought it was going to be great, b/c I already am familiar with everything on the unit and the night nurses told me they would help turn me into a good nurse. Well when I started I thought I was doing well until my 1st eval from my preceptor, things like doesn't know how to put up TPN,(never did it before in school), doesn't delegate enough to cna's, has difficulty talking to the doctors on the phone, then every eval got worse after that, it seemed like they had the highest expectations of me and kept noting to the nurse educator that I am not thinking of the whole picture when it comes to my patients and I have problems anticipating what the doctor's orders will be. I thought critical thinking came with time, I have given 100% but after 14weeks, yes 14 weeks they decided that the step down unit is not for me, and they called a few med surg unit managers and set up for me to talk with them. I am very disappointed in my self and I feel I have disappointed my coworkers and nurse educator, I feel like I have tryed so hard and I really don't know what went wrong. I had a interview with one manager and it sounded promising but I kept thinking during the interview will it be exactly the same thing but on a different unit, and am I really cut out for hospital work, I guess I am feeling inadequate and don't know how to get my confidence back. Any advice would be appreciated. Thanks.
First I would decide if this unit is where I wanted to be or would I be uncomfortable on this unit after the issues that have been raised before me. (Would I be embarrased/uncomfortable/uneasy or do I give a f&*ck?) What is your desire at this point? What do YOU want to do? Sometimes in life we have to fight for the things we want. If u have a desire to remain on that unit, I would first set up a meeting of the minds with the preceptor and the manager to discuss my weaknesses, and develop a "plan of action" so to speak to improve in the areas which were quoted inadequate. I would also start out by stating my strengths, give concrete examples of things you have learned (both in tasks and critical thinking instances), give an honest critial anaylsis of your performance to date. In this way you are building a case that is in your favor and letting them know that you are eager to improve in weak areas. Also stating your strenghts and what you have learned will give validation that you are worth keeping, worth training and you have learned alot within the last 14 weeks.
Write down a checklist of the areas that need improving and with assistance from your preceptor you guys will "work together" to ensure that you have adequate opportunites for experience. (Being comfortable comes with practice and with practice comes perfection...or damn near it!!) I would create a checklist of things that I need to improve and be very clear about it, in this way you can be sure the goals you have set for yourself are in agreement with your preceptor and manger, you guys are on the same page. I dont know how long you have for oreintation, but obviously if you are going to improve in these areas, you need (an extended) time in which to complete this.
I would not give up, if this is where you want to be. Sometimes I've noticed that alot of issues while training can be self-confidence busters and when it seems like you've failed at one thing, a fear enters in in regards to future opportunites (on other units or wherever). But keep ya head up and your eyes on what you want.
If you would like to move to a different unit, than i would explore those options, it doesnt have to neccesarily be Med surg, ask if there are other units with open positions, maybe try a diffrent workload, unit with different staff- interaction dynamics or different population of patients. If you are intrviewing for other units, perhaps shadow a nurse there for a couple of hours to get a feel for the staff, patient to nurse ratio, and overall climate of the unit, see if you gel. (This is what I did when I was interviewing for positions). Its totally understandable to feel that you are not cut out for hospital work, but dont let them be the judge of that. I dont think you shouldnt question your abilites bc of TPN, talking to docs, critical thinking skills, and delegating to CNA's ... also if you have been a CNA for a number of years, is just comes so naturally to do those tasks and being that you are learning so many new things, CNA work now is like a peice of cake, so you may gravitate to things you really know how to do and feel absolutely comfortable with. Just put these on the checklist of things to improve. DONT GIVE UP!!!
Hey!- to all the posters that are calling the preceptor a "jerk"....." I've precepted in a critical care unit for a number of years, and I am known as a tough preceptor. Some nurses just can't "get it" on our unit. There are a lot of things that come into play- the level of independent action expected of the nurses, the acuity of the patients, familliarity with the meds, rhythms, protocals... Some nurses can't adapt thier care philosophy to the rhythm or this unit. There are a thousand things a nurses may need to learn to work on a high acuity critical care unit. Cardiac stepdown is a bit less intense, but it is still a tough place to orient as a new grad. 6mos for a very focused nurse who spends a lot of thier own time reading up on the things they wish they had been taught in school, 1year for your average new grad with a life that involves something outside of work, and then they have a much better chance of sucess orienting to a specialty floor. It's not "nit-picky" or mean, or unkind to expect any nurse to meet the standards of the unit before they come off orientation. Heaven knows I couldn't have done it without a few mos on a gen. medical floor, followed by 18mos on a tele floor. Does that mean iamanurse13 isn't a good nurse- I have no idea from her post. What I can tell is that the experienced staff don't feel she has the skills to take over the responsibilities of RN on that floor yet. If that is the case- I wouldn't want to work there until my basic skills got some polish. Working a level above you skill set is dangerous for the patients and for the nurses own licence. That is sometimes what precepting means- discovering the new nurse needs more time in a lower acuity area before they make the jump to a specialty unit.
Don't beat yourself up. You are a new nurse....things are not going to click over night. It takes time. In the first year of nursing you are still pulling it together and learning your role and learning the support systems around you. Are you at a teaching hospital? But hold your head up high. So if you have to move to another hospital or clinic...don't give up. Things happen for a reason. Remember the newiest will wear off and your skills will tighten up. ASK ALOT OF QUESTIONS....WHEN YOU ARE UNSURE, IF THEY CAN'T HELP ANSWER QUESTIONS THEN....I WOULD BE LOOKING FOR ANOTHER JOB....THEY KNOW YOU ARE A NEW NURSE....NO NEED TO BEAT YOURSELF UP. Nursing schools are faster pace. Being a CNA going into the role of an RN thats a big step. I wish you the best.
Specializes in Occupational health, Corrections, PACU.
So you didn't know how to hang TPN. I'm sure after you did it once that now you know how.
So what. You don't spring out of nursing school knowing how to do every little thing. I never hung TPN in nursing school, and I had a fairly comprehensive BSN program. Move on, search for another unit or another hospital that you can feel comfortable learning in. Just look at it as one learning experience of many to come. Don't feel ashamed or embarrassed, don't be rude when you leave, but you certainly don't have to be friendly when you go somewhere else and see those people in the lunchroom. Get more experience, grow, learn, and then...guess what? You can go ANYWHERE you want, baby!
Specializes in Certified Med/Surg tele, and other stuff.
I could see if you thought V tach was normal to see on the monitor, lol, but you didn't know how to hang TPN? It takes...what...15 min to show someone how to hang it? Picky...picky. Move on. Believe it or not, Med/surg isn't the scurge of the earth and you aren't being sent to hell to 'only' become a med/surg nurse. Go to another floor, talk to Dr's you don't know and let the nurses there help you as a new grad.
Specializes in Critical Care; Cardiac; Professional Development.
If they thought you were a "bad" nurse they would not be setting up interviews for you on other floors, they'd be showing you the door. Hang in there. :hug:
Hi, I've been looking at other post that may have something to do with what I am going through but can't find any.
I worked as a cna on a cardiovascular step down unit for 2 1/2 years and when I graduated from school they offered me a full time night position as a nurse. I thought it was going to be great, b/c I already am familiar with everything on the unit and the night nurses told me they would help turn me into a good nurse. Well when I started I thought I was doing well until my 1st eval from my preceptor, things like doesn't know how to put up TPN,(never did it before in school), doesn't delegate enough to cna's, has difficulty talking to the doctors on the phone, then every eval got worse after that, it seemed like they had the highest expectations of me and kept noting to the nurse educator that I am not thinking of the whole picture when it comes to my patients and I have problems anticipating what the doctor's orders will be. I thought critical thinking came with time, I have given 100% but after 14weeks, yes 14 weeks they decided that the step down unit is not for me, and they called a few med surg unit managers and set up for me to talk with them. I am very disappointed in my self and I feel I have disappointed my coworkers and nurse educator, I feel like I have tryed so hard and I really don't know what went wrong. I had a interview with one manager and it sounded promising but I kept thinking during the interview will it be exactly the same thing but on a different unit, and am I really cut out for hospital work, I guess I am feeling inadequate and don't know how to get my confidence back. Any advice would be appreciated. Thanks.
Raises hand, that is my same story! so I totally understand I have the issue with the math with the TPN,time mangement,and just not getting the whole picture,and I ask the same questions over and over again. Its hard and confusing but we will get!!! I feel like I have no confedience anymore as well,but we should all put the little bit we have left and put it all together to take it with us to work. Cant tell you when,but I'm hearing that it will get better. Just know YOU ARE NOT ALONE!!! :-)
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creative scholar
1 Article; 19 Posts
My 50 cents:
First I would decide if this unit is where I wanted to be or would I be uncomfortable on this unit after the issues that have been raised before me. (Would I be embarrased/uncomfortable/uneasy or do I give a f&*ck?) What is your desire at this point? What do YOU want to do? Sometimes in life we have to fight for the things we want. If u have a desire to remain on that unit, I would first set up a meeting of the minds with the preceptor and the manager to discuss my weaknesses, and develop a "plan of action" so to speak to improve in the areas which were quoted inadequate. I would also start out by stating my strengths, give concrete examples of things you have learned (both in tasks and critical thinking instances), give an honest critial anaylsis of your performance to date. In this way you are building a case that is in your favor and letting them know that you are eager to improve in weak areas. Also stating your strenghts and what you have learned will give validation that you are worth keeping, worth training and you have learned alot within the last 14 weeks.
Write down a checklist of the areas that need improving and with assistance from your preceptor you guys will "work together" to ensure that you have adequate opportunites for experience. (Being comfortable comes with practice and with practice comes perfection...or damn near it!!) I would create a checklist of things that I need to improve and be very clear about it, in this way you can be sure the goals you have set for yourself are in agreement with your preceptor and manger, you guys are on the same page. I dont know how long you have for oreintation, but obviously if you are going to improve in these areas, you need (an extended) time in which to complete this.
I would not give up, if this is where you want to be. Sometimes I've noticed that alot of issues while training can be self-confidence busters and when it seems like you've failed at one thing, a fear enters in in regards to future opportunites (on other units or wherever). But keep ya head up and your eyes on what you want.
If you would like to move to a different unit, than i would explore those options, it doesnt have to neccesarily be Med surg, ask if there are other units with open positions, maybe try a diffrent workload, unit with different staff- interaction dynamics or different population of patients. If you are intrviewing for other units, perhaps shadow a nurse there for a couple of hours to get a feel for the staff, patient to nurse ratio, and overall climate of the unit, see if you gel. (This is what I did when I was interviewing for positions). Its totally understandable to feel that you are not cut out for hospital work, but dont let them be the judge of that. I dont think you shouldnt question your abilites bc of TPN, talking to docs, critical thinking skills, and delegating to CNA's ... also if you have been a CNA for a number of years, is just comes so naturally to do those tasks and being that you are learning so many new things, CNA work now is like a peice of cake, so you may gravitate to things you really know how to do and feel absolutely comfortable with. Just put these on the checklist of things to improve. DONT GIVE UP!!!
-Creative Scholar-