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New grad need help, afraid I’m failing

Nurses   (1,040 Views | 26 Replies)
by LMSNew LMSNew (New) New

53 Profile Views; 10 Posts

I work on a busy telemetry unit. I’ve been at it for 9 months. We usually have 6 patients and the acuity is very high. 
 

 The the thing is when I first got off of orientation, my ANM approached me about 3 weeks out and said that all the patients were complaining about me. She didn’t really go into specifics, she just said that they were ALL complaining and said I was too quiet. I got a good letter written about me about a week later by a patient.

 

A month later she said all the nurses were complaining about me giving report. I asked what were the complaints she said “ you don’t know your patients”. I said in what ways and showed her the reason they came, the hx, what was done, needed to be done, IV sites, radiology, mentation, ect... I was 5 months in at this point, 2 nd month on my own.

 

About a month or so later I was pulled aside and told I was doing really bad. All the nurses  were complaining about report still.I brushed it off.

 

Very recently a patient was desatting and I got an order that I thought could be given later. She scolded me ( which is not a problem) but then proceeded to say “ you’re not getting it, this is why everyone is complaining and you are doing very bad”.

 

I go home and look up skills and try to study things I encountered on the shift to learn. Many times we get 6 patients with 1 PCA and no secretary so it’s hard to take it all in at times. 
 

I have made my share of mistakes but imo they were small and mostly due to issues understanding the EMR more than anything. 
 

My question is how can I improve? Although work was very hard I never minded. Now I’m always anxous as of late and it’s really affecting me. Any advice is appreciated. Thanks in advance.

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10 Posts; 53 Profile Views

Oh in regard to the desatting patient I did get orders to increase her from cannula to venti and she was saying well. The other order was a diuretic.

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scribblz has 13 years experience as a BSN, CNA, LPN and specializes in Med Surg, Tele, Geriatrics, home infusion.

54 Posts; 1,585 Profile Views

Hi LMS,

Based on everything you've said it sounds like you are doing as well as you should be for your first year in nursing. What it sounds like is a communication problem. All the feedback you mentioned came from the same person, and seemed pretty generalized.

What is the culture like on your floor? Every nurse for themself? High turnover? Do you have a mentor or someone you trust that can provide you with feedback on how you're doing?

I suspect that your ANM may be actually trapping you to keep you. People who work hard and keep their head down are not that easy to find. I personally would be pretty put out to always have heavy assignments, minimal ancillary support and instead of a thank you get "you are doing so badly at this". Her paper trail of criticism of you could make it difficult to transfer to a different unit.

I would start lining up alternative references ie. Charge nurse or nurse educator who is willing to vouch for your clinical skills and work ethic. I would be very careful with your interactions with this ANM, you might want to establish a paper trail of how she speaks to you. IE. She pulls you into her office to criticize you, try to remain calm and ask what you should have done differently in XYZ situation rather than defending what you did. In the example you gave applying oxygen and stabilizing a patient's O2 sats prior to grabbing the diuretic is perfectly sound nursing judgement. If she wants to explain otherwise invite her to. Document time, day and specifics of everything she says in case you need it down the road.

Don't stop doing your best and look for a way out of this unit is my advice! You're almost at your one year, and then you can go almost anywhere.

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10 Posts; 53 Profile Views

23 minutes ago, scribblz said:

Hi LMS,

Based on everything you've said it sounds like you are doing as well as you should be for your first year in nursing. What it sounds like is a communication problem. All the feedback you mentioned came from the same person, and seemed pretty generalized.

What is the culture like on your floor? Every nurse for themself? High turnover? Do you have a mentor or someone you trust that can provide you with feedback on how you're doing?

I suspect that your ANM may be actually trapping you to keep you. People who work hard and keep their head down are not that easy to find. I personally would be pretty put out to always have heavy assignments, minimal ancillary support and instead of a thank you get "you are doing so badly at this". Her paper trail of criticism of you could make it difficult to transfer to a different unit.

I would start lining up alternative references ie. Charge nurse or nurse educator who is willing to vouch for your clinical skills and work ethic. I would be very careful with your interactions with this ANM, you might want to establish a paper trail of how she speaks to you. IE. She pulls you into her office to criticize you, try to remain calm and ask what you should have done differently in XYZ situation rather than defending what you did. In the example you gave applying oxygen and stabilizing a patient's O2 sats prior to grabbing the diuretic is perfectly sound nursing judgement. If she wants to explain otherwise invite her to. Document time, day and specifics of everything she says in case you need it down the road.

Don't stop doing your best and look for a way out of this unit is my advice! You're almost at your one year, and then you can go almost anywhere.

Thank you. I am planning to leave. I actually enjoyed work to a degree but now I get about feeling, especially when I work nights that she’s there.

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Been there,done that has 33 years experience as a ASN, RN.

4 Followers; 6,256 Posts; 69,759 Profile Views

Management cannot make generalizations as to your lack of performance. At this time, you should be given a specific plan as to what is needed to improve.

It sounds like a toxic environment. Your fellow nurses should be continuing to teach you. For now, when you give report... ASK..is there anything else you need to know?

 Now.. I am not beating you up on this... but... desaturation is a priority.  You must carry out all orders you received. Sounds like the patient desatted due to fluid overload.  What did the chest x-ray show? The diuretic was a treatment for the desaturation.  Critical thinking skills are learned.  You deserve that chance to learn.

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10 Posts; 53 Profile Views

16 minutes ago, Been there,done that said:

Management cannot make generalizations as to your lack of performance. At this time, you should be given a specific plan as to what is needed to improve.

It sounds like a toxic environment. Your fellow nurses should be continuing to teach you. For now, when you give report... ASK..is there anything else you need to know?

 Now.. I am not beating you up on this... but... desaturation is a priority.  You must carry out all orders you received. Sounds like the patient desatted due to fluid overload.  What did the chest x-ray show? The diuretic was a treatment for the desaturation.  Critical thinking skills are learned.  You deserve that chance to learn.

Cxray showed scarring. Legs were a bit swollen. In the end the doc still kept the patient on fluids.

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TriciaJ has 39 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

12 Followers; 3,472 Posts; 35,928 Profile Views

I don't know the motive, but I do think your ANM is gaslighting you.  EVERYONE is complaining but no one has specifics.  Sounds like BS to me.  I once had a manager who liked to tell people that SEVERAL PEOPLE complained about you.  One nurse canvassed her coworkers to find out what she did wrong and then was chastized for that.

I think you're smart to ask in report if there is anything more they need from you.  If there are coworkers you trust, ask them if there is any feedback they'd like to give you.  Next time you have a slime session I mean encounter with your ANM ask for specifics (sounds like you already are) and tell her you are receptive to feedback and if anyone has a problem with something you did or didn't do, they can feel comfortable addressing you directly.

I don't know who will give you your eval, but if it's your ANM and it's full of the vague negative BS she gives you now, you will likely have the opportunity to respond to it in writing.  Don't be afraid to sit and write a thesis in her presence.  Write how you look up information on your own time, how you seek feedback and act on it, etc etc and that this eval is unhelpful because it contains nothing specific that you can learn from.

I think you're on the right track as a new grad.  You're developing your skills and your assertiveness.  And staying receptive to LEGITIMATE feedback.  Hang in there.

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Been there,done that has 33 years experience as a ASN, RN.

4 Followers; 6,256 Posts; 69,759 Profile Views

4 hours ago, LMSNew said:

Cxray showed scarring. Legs were a bit swollen. In the end the doc still kept the patient on fluids.

Good you reviewed the xray  report. That is awesome.  It is the curse of the nurse.. that  we have to tell doctors  what to do. But we do. Why would one doctor say give  a diuretic.. and another .. say continue fluids?  Hard to do at your stage.. MAKE the docs talk to each other.

 

 

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mmc51264 has 8 years experience as a ADN, BSN, MSN, RN and specializes in orthopedic; Informatics, diabetes.

2,773 Posts; 39,157 Profile Views

AS far as giving report, someone should be able to help you. We have an old Kardex that we used to have in every chart box (before EPIC). Maybe there is something that the nurses that are complaining about could share. We have several different "brain" sheets that nurses use. I have my own. 

I am sorry that instead of helping you give better report, they want to complain about it. 

It sounds like that people are not trying to help you get better. Instead of saying you aren't doing something right, they should be giving you concrete examples of how you can improve. 

I hope you can find some help. 

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282 Posts; 71,632 Profile Views

3 months until that beautiful one year mark...so, at this point, you can say "about a year" when you interview for other positions.

OP, do you plan to stay within your hospital's system or go to another one?

Are you under contract to stay with this unit for a certain amount of time?

Well, if you plan to stay on this unit for a bit longer, be careful not to hint that your one year anniversary is coming to anyone in that hospital...and, if you are currently working full time, you may want to consider going part-time or per diem, so they have fewer chances to find "problems" with you.

Though, honestly, do you sense something is going to hit the fan sometime in the future?

Usually, not always, but usually, when a member starts posting about similar problems on the job, that same member is later posting about getting terminated or being forced to resign.

Now, I am not saying that will happen to you, but if you are getting that sixth sense feeling...again, remember that, at this point, you can say "about a year" when you interview for other positions.

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319 Posts; 1,217 Profile Views

Why not put some "feelers" out there and apply to other positions outside of this hospital/hospital group now?  I know you're not quite at a year, but what's the worst thing that can happen?  You'll either get no bites or you might actually land an interview elsewhere with your current experience.  All you'll be doing is losing some time brushing up your resume and applying.  Besides, it usually takes places months to hire anyway and by the time you get another job, it might already be past one year experience.

Certainly, if your current place of employment helps you learn rather than just criticizing, that would be better and ideal.

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Sour Lemon has 9 years experience.

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You're being put in an impossible situation by these vague complaints. This has happened to me twice. Both times, I expressed a desire to respond, but an inability to respond without knowing exactly what I was responding to.

Be diplomatic about it, but force her to give you details. If I were told that a specific person had an issue with my report, I would also request a meeting with that person and the nurse manager to "sort things out".

The message your sending should always be that you want to improve, but that you need very specific feedback. And like some others have suggested, start looking for a way out of there.

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