New grad need help, afraid I’m failing

[LMSNew]

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.

[Anonymous666]

Hey, you’re brand new. It’s gonna take a while for you to figure out time management so you can prepare a decent report for the next shift. Also, every nurse is different. Some nurses aren’t even listening to you when you give your best report performance of your life worthy of an academy award! Some nurses want to know the length of pubic hair that the patient grew over night. Some just don’t want any surprises—“patient’s satting 98 on room air,” and they walk in on someone gasping and struggling to breathe.

It’s hard with that many patients, especially when you’re running all night. Some nights you’ll run all night, and your report to the oncoming shift will be given in pieces as you’re answering phones and taking orders, getting lab results, paging doctors, and your report will suck. Everyone knows what that is like, and anyone who complains on you for that sh1t can get their best-nurse-in-the-world reward at the end of the month-a crappy paycheck and a bad back.

Giving a decent report is a very important part of nursing. It’s basically showing you know your patients. I know how hard that is with 6 of them and you spent most of the night keeping one of them alive and another from trying to escape their restraints and barely even saw one of them. You’re expected to know each of them at any moment during your shift, as impossible as that can be at times.

Learn a good system for your notes on each patient so you can whip it out of your pocket at a moment’s notice and rattle off the important stuff about each patient. Update it during your shift. Experiment with different systems, learn other people’s methods, take a little from everyone and create your own that works for you.

Think about it this way. If one of your patients ever codes and you come running into the room with a code in process, the doc is gonna be looking at you and she’s gonna wanna know what’s going on. She’s gonna want report. If you can’t remember off the top of your head, whip out your cheat your sheet (your “brain”) and rattle off the highlights.

Take care of your patients. Follow the rules as best you can. Cover your ***. Give the best reports you can. Leave your patients clean, happy, and alive for the oncoming shift, and no one will be able say anything to you. If your supervisor has a problem with how you give report, ask if you can give HER report as a practice and see if she’ll tell you where you’re going wrong.

At the end of the day, when you’re running and just wanna go hide somewhere and cry, just tell yourself these two truths of nursing (regardless of delegating/prioritizing)

You can only do what one person can do

You can only do one thing at a time

[DTWriter]

3 hours ago, Anonymous666 said:

If your supervisor has a problem with how you give report, ask if you can give HER report as a practice and see if she’ll tell you where you’re going wrong.

^This. This is something nurse managers/supervisors should spend time doing with each new employee, and even routinely with old employees to keep up the quality of reports.

If the ANM refuses to do even that, then that unit is seriously a sinking ship.

[myoglobin, ASN, BSN, MSN]

This is why nurses need strong unions. Any time my manager as an issue with me my standard reply is "I don't discuss potential discipline without my union representative being present". At a union facility with a contract one of the things that must be demonstrated is that other nurses are being disciplined equally for the same offense. Also, this illustrates why if you are going to work bedside there is no substitute for California nurse to patient ratio laws. In California you would not have more than four patients on a medical/surgical unit (with tele). Their systemic failure (six patients in an assignment) can't be done by anyone safely let alone a new grad. Blaming system wide issues on individuals is not just bad practice it is immoral.

[LPN Retired, LPN]

Aww, come on . patients complaining you were too quiet?? What do they want you to do? Come into their rooms doing a war dance? I've been a patient before, I never had any complaints about the nurses being too quiet. I like the quiet. Be quiet, get out and leave me alone so I can sleep and get some rest. I think the person who told you this is grabbingvat straws to try and make you think they are complaining, that's most ridiculous thing i've ever heard.

[nursex23, BSN, RN]

On 1/23/2020 at 12:20 PM, LMSNew said:

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.

This sounds like complete BS. Especially if she actually used the word "all." I think I would have even stopped her and told her that I find it hard to believe that all, meaning every single one of the patients were complaining because their nurse was "too quiet." And what does that even mean? If they're in the hospital, I doubt they ALL want a nurse be in their room and engage in conversation. Or do they mean that your patients would ask you a question and you wouldn't answer? What does that mean "too quiet?" It really sounds like she likes giving you a hard time.

As far as report goes, I also find it hard to believe that not a single nurse has told you something during report. When I worked inpatient, we had a kardex for each patient which really facilitated report and then of course, always ask the oncoming nurse if they have any questions.

I agree with the previous poster that said find a new job. You're so close to that one year mark you should just put your resume out there and see what happens. At a new place, you won't be considered a new grad anymore and probably won't have a target on you back.

Good luck

[gonzo1, ASN, RN]

I've been a nurse for almost 20 years. Med/surg/tele/ER/psych/ICU. The complaints you have been given are BS complaints and are signs of a toxic work environment and a manager that has no business managing a unit.

If they can not give you specifics that you can address and fix then it isn't legit.

"If it's not documented, it didn't happen." Right, works both ways.

When I first went to ICU I was told that I was giving report wrong. I was given specifics, I still haven't fixed it 5 years later (my bad) but I was told what to fix. I have fixed most of it.

Also last week I had 2 patients that were bad off and I had to have another nurse show me how to do some things, including changing out a chest tube container. This help was given kindly and without condemnation. This is the way (says the Madolarian).

I have lot's of friends who didn't make one year on the job. They never had a problem going somewhere else. Everyone in nursing knows how the game is played.

I have a friend that was told he was the slowest, dumbest nurse ever. He has been a nurse 18 years now and had his NP for about 5.

Get going and get out. There's a place out there for you that will welcome and nurture you.

[2017_PEDSRN, ASN, RN]

My biggest issue as a new nurse was report. However, they are not giving you room for improvement by complaining and telling you how bad of a job you're doing. Look for a new job soon!

[LMSNew]

On 1/26/2020 at 12:34 AM, DTWriter said:

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.

Thank you so much for the response. I am on a contract that will be 5k to break. I don’t have a desire to stay after this experience and the fact that telemetry just doesn’t interest me. I would prefer ICU or Psych for different reasons. I find 6 patients with 1 PCA a lot of times to stretch me way too thin.

[LMSNew]

On 1/26/2020 at 12:20 PM, Sour Lemon said:

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.

If you don’t mind me asking. How did this end for you in those 2 instances and how have you combated this going foward? You can pm me if you want. Thanks in advance. ?

[LMSNew]

On 1/26/2020 at 9:50 PM, myoglobin said:

This is why nurses need strong unions. Any time my manager as an issue with me my standard reply is "I don't discuss potential discipline without my union representative being present". At a union facility with a contract one of the things that must be demonstrated is that other nurses are being disciplined equally for the same offense. Also, this illustrates why if you are going to work bedside there is no substitute for California nurse to patient ratio laws. In California you would not have more than four patients on a medical/surgical unit (with tele). Their systemic failure (six patients in an assignment) can't be done by anyone safely let alone a new grad. Blaming system wide issues on individuals is not just bad practice it is immoral.

In response to the ratio, that’s the thing. Because nurses have been making it work, you will be told it’s acceptable, but you’re stretched so thin. I went to listen to a patients lungs and was told that was the first time someone did that. Mind you the patient had been there for over 5 days which made me realize how some are getting by.

[Sour Lemon]

5 hours ago, LMSNew said:

If you don’t mind me asking. How did this end for you in those 2 instances and how have you combated this going foward? You can pm me if you want. Thanks in advance. ?

One was a documentation issue. Pain reassessment. I had been "warned" before and was called to a second, more threatening meeting with some higher up person. After the first warning, I tried to improve, although I wasn't aware that I was having a problem to start out with. During the second meeting, I demanded to know exact details as I had NO CLUE what I was doing incorrectly. Some technical person had to get involved and pull e-charts so that we could figure out what the problem was. Once I knew what it was, it was corrected.

Another time, as a relatively new graduate, I was called in to talk about my poor time management skills. After some vague discussion and no specific issues, I requested that the nurse manager follow me around for a shift and point out ways I could be more organized and do a better job. I never heard anything about poor time management again and got along great with the manager until I eventually moved on.

And, once I was called in and told that a patient wrote a complaint letter about me. In fact, most of the night shift staff on my unit were called in and probed for details about things supposedly contained in that letter. I pretty much refused to speak until I was given a copy of the letter to review for myself. I told my manager that I could not respond to a complaint if I didn't know what the actual complaint was.

After a very polite "argument", I was given the letter to read right there in her office. It actually said nothing bad about me, at all, although it did mention me by name. It named me and two other nurses as "nice" and "good", but said that sometimes we took a little too long to answer the call light. It had been presented to me as some sort of major issue, which was not the case at all.

That's all I can think of right now. I'm a direct and cooperative person for the most part, and any issues I have usually don't make it to the manager's office.

[myoglobin, ASN, BSN, MSN]

I really think that in most cases when a new nurse experiences these sort of "vague" issues it usually comes down to one of the more experienced nurses who holds "sway" with a "clique" and doesn't like them for one reason or another. It could be as petty as "if they fill our always empty roster with new nurses my ability to work 20 hours overtime per week might be threatened". This is exactly what my significant other experienced in the Methodist CVICU when she started as the "seventh new grad in two years to fail to complete her orientation". One of the unit nurses actually told her semi humorously "don't you know I just put in a new pool and cannot afford my overtime to be threatened". Her life went on to become a living hell over the next six months and she was basically "terminated" on Christmas Eve. She was not able to return to her old unit (Abdominal trauma a medical surgical unit) even though she was universally liked there. Afterwards she confessed that the experience was so negative that she wished she would have died in a car crash almost daily on her way to work. The circumstances will of course differ, but this is the sort of thing meant by a poster above who said that this is probably a "toxic" environment. I would say find a place where first and foremost that the people are "nice" even if the pay is a bit less. This is especially important as a new grad. Also, it of course helps to work at a hospital with a strong union where allegations must be backed up with facts and due process (better still if you are a California RN).