New grad orient possibly going to get fired...Plz help!

ckh23, BSN, RN · Oct 19, 2011

The ICU can be very challenging for nurses new to critical care, whether they are new grads or experienced. All you can do is your best. Time management is something you will develop with time and experience. I would recommend you ask your preceptor what routine they do when they start the shift and how they use their time management skills. From there, see what works for you and what doesn't. Also you can take your patients from your last shift and write out what you could have done differently to better manage your time. Sometimes seeing these things written out, you can pick up on areas you can improve.

What exactly is the issue with communication? Are you intimidated by them?

I would hold off on looking at other departments for a job because it will most likely send the wrong message if your boss gets wind of it, which he/she will. Instead, if it doesn't work out in the ICU, try to switch to a different department instead of leaving the facility all together. The hospital does have a vested interest in you because they have spent a lot of money on orientation and sending you to class, not to mention all the admin.

If it doesn't work out and working in ICU is really what you want to do, you can go get some more experience, work on your time management, build a good nursing foundation, and then come back and try again.

Good Luck.

oldiebutgoodie, RN · Oct 19, 2011

Is anyone giving you concrete examples of time management and prioritization issues? If not, and they are just picking on you, you might think about transferring to a med-surg floor to get a better handle on nursing, and then go back to the ICU.

ICUs have a certain culture which is sort of unspoken. If you don't "get" the culture, the RNs there will be all over your backside.

Good luck to you!

Oldiebutgoodie

poopprincess · Oct 19, 2011

I would def. ask for specific examples of where they think that you need improvement. Tell them what you think you should do better and see if they agree with your method to improve. In otherwords, get a gameplan and pitch it. Also, asking the preceptors what they do is good advice. The NM's generalized advice doesn't help, so I would say that there is a communication problem. Where did you go wrong in time management? How can you fix it? What are you prioritizing wrong? How can you fix it? These are things that they should be helping you with. i would take their advice, but ask how they handle the situations that they question you on.

If you apply to other departments then it will be hard to explain that ICU is where you want to stay because your actions show otherwise. I would have a meeting, be direct (no beating around the bush) and tell them you aren't ready to leave. Give them 100% for the next few weeks and hopefully they will notice and respect your hard work. If you feel that it isn't going to work then talk to your manager about tranferring within the facility. Trust me, if you leave that hospital then it will be difficult to find another job when this one didn't work. There are numerous threads on this site from people who mistakingly did that. Transferring within the facility is acceptable and ususally the med-surg managers are more than willing to give it a shot. Good luck-I hope that everything works out for you.

gr9153 · Oct 20, 2011

Thank you guys so much for your advice! Means a lot that you cared to give me some really great pointers. This week went well for me I'm happy to say and my confidence has gone up. My preceptors were the nurse leaders too and they both said I did good with minimal assistance from them but like always, I need to be faster just to prepare for other emergencies that might come up. I hope they and the NM see that I am giving it my all and that I have come a long way from only a few weeks ago. While I am sure that there was a certain preceptor who stained my image with some negative reviews, and office politics play a bigger hand than I realize, I've moved past them and am focused in improving my practice. Im finally getting the hang of things and have been communicating more with the NPs and MDs and RTs. My time management is much better and smoother and I've learned how to prioritise and delegate (this one is a life saver and our PCTs are amazing). Thanks so much for your input again, I will def take them in mind and hopefully in the new few weeks I can share some good news with you guys. Thank you so very much!!!!

Good Morning, Gil · Oct 25, 2011

Sorry to hear you're going through this. I am a newer nurse, and am still on orientation as well, just a few weeks left myself. But, here is what I would suggest....Firstly, communicate to them how much you want to be there, and what you can do to improve. Ask them what materials they suggest that you study, maybe they know of some resources.

Secondly, as far as rounds, it really is important for you to be present when the MD's are making their rounds. Why? So that you have an idea what is going on....I know that if I am off the floor transporting my other patient, and I come back, and they already rounded, I feel lost, and I don't usually have time to read the progress notes in b/w everything that's going on. So....if you are just charting or gathering meds together, but are not yet administering them (try not to be interrupted if possible during med pass)...then drop what you're doing, and communicate to them your patient's needs. (I do this all of the time b/c I know it might be hours before I see them again, usually not if the patient is really sick, but you just never know when you'll actually get to highlight things that concern you in person). This also saves you time from having to page them later about an issue that you're aware of now (which helps time mgmt), etc. Time management does just come with time unfortunately. I'm certainly not as efficient as I could be yet either.

Also, I will say..that if it's meant to be, it will be. I would think a supportive manager would rather you transfer to another floor if this one wouldn't work out for you rather than just letting you go completely. If they can't give you more orientation time, and after a few weeks, you don't see it going anywhere, ask them what floor would be more appropriate for you at this time. Best wishes. You may find that whatever floor you transfer to (if that happens) might end up being a better fit. Whatever you do, don't give up. Just keep showing up to work every day being enthusiastic, etc.

livingonadream · Nov 11, 2011

Do your preceptors ever do "what if scenarios" with you or "what would you do"?

Get examples of 2 patients, then how they are doing, their problems. And maybe some critical things you need to see... like dec LOC or hypotension.

And talk through how you would react.

A lot of the time new nurses are so task oriented and not seeing the big picture or priority

whitneylc87 · Feb 11, 2012

Hello, I am a new nurse myself. Graduated last year, and I have been in working in ICU since August. I am now on night shift and out of orientation. ICU is very intimidating. I can say my fellow coworkers are awesome. They are very supportive and try to help, but they definitely like to see what you're made of. I have struggled with time management myself, and I feel that its a struggle for all new nurses and it comes with time and experience. In ICU I tend to see, sometimes time management is a struggle for even the best and most experienced nurse. I love my job, but I do get frustrated as I to am constantly learning and figuring things out. I am here not to tell you what you should do differently because I myself still have much to learn, but I am writing to encourage you to tough it out. All you can do is your best, sometimes think of it as the nurses are finding out what you're made of. Be confident in what you do know 100%, and if you have the slightest doubt on an issue ASK, ASK, ASK!!!! I would not give up if this is what you really want, but only try that much harder. Maybe ask what skills you need to improve on, and I myself asked my preceptor how she would time manage in specific situations or how she would have prioritized in comparison to how I managed my care. I hope that things get better for you and I wish you the best!!!! Stay positive, and no matter what know remember each one of your coworkers have been in your shoes as well, they all started somewhere!!!! P.S.~ Inexperienced we may be, Dumb we are not!!!!

CCRNDiva, BSN, RN · Feb 11, 2012

I don't feel like the length of your orientation is adequate. That is not enough time to develop time management skills while developing critical care knowledge. Our orientation to the unit is 6 months for new grads. We work on time management skills during the first phase ie learning the tasks of nursing like interacting with docs, RT etc, med administration. Then the grad nurse is able to care for increasingly difficult patients.

Starting in the ICU as a new grad is difficult and it isn't for everybody. I started in the unit as a new grad and I serve as a preceptor now. I'm more concerned with the critical thinking skills. I want you to know why you're doing what you're doing and understand the disease process affecting your patients. That's the only way you'll know what complications to look out for. My advice is to read the H&Ps for your patients (pay particular attention to the ED and intensivist reports) and look up the medications you're giving (this will paint the picture). If your facility has Up to Date, use it. It is a very good resource that describes the disease process and treatment plans. Sign up for Medscape; it's free and can be downloaded onto a smartphone. It provides information on drugs, diseases, treatment etc and also allows you to test your knowledge. Never, ever turn down a learning opportunity (that is one of the quickest ways to alienate your colleagues). Pay attention to the nurses, physicians, PAs, NPs, RTs etc who like to teach. Be a sponge.

My final piece of advice: don't be afraid to assess whether this is a good fit for you. Give it your all now but if it doesn't work out, know that it doesn't mean you will not be a good nurse. It just means it wasn't a good fit for you at this time. Good luck!

Merlyn · Feb 11, 2012

We have all been where you are now. Nursing School just teaches you to past the boards. You are now learning to be a nurse. We are all learning every day. I've been an agency nurse for about ten years now. Every day for me is a new experience. The great teacher is time. Time management is only putting the important stuff first. It could be the meds. or the paperwork or other things. But always be flexible. Emergencies prop up every day. Nursing is damn hard. Remember, Rome wasn't burnt in a day. Just do your best.

xtine618 · Feb 21, 2012

I don't feel like the length of your orientation is adequate. That is not enough time to develop time management skills while developing critical care knowledge.

Since this was originally posted a while ago, I was wondering how you are doing? Are you still in the ICU? They gave you a very short orientation in my opinion. When I was a new grad in the ICU, my orientation was 12 weeks on days and 2 weeks on nights and that was only because I had done clinicals there for my last 2 months of nursing school. Otherwise, it probably would have been closer to 16 weeks on days.

If you are still in the ICU and you feel like you continue to struggle with time management or other issues in the ICU, I suggest asking a more seasoned nurse on your unit to be a mentor. Pick someone that was supportive and honest with you, and someone that you respect professionally.