New Grad Orientation Doesn't Feel Safe or Supportive

[Camillus_Was_a_Murse, BSN, RN]

Hey y'all. I passed the NCLEX one month ago, and started in a new grad residency position on an ICU shortly thereafter. I chose this unit as my first nursing job after having such a great experience during my clinical rotations as a student. From day one as an orientee on the unit, I feel like I was sold a false bill of goods. I'm not sure if this is due to my expectations of the residency program and preceptors, or if its because I'm too stupid to be a nurse.

I've lurked other similar topics, and I'll preface by saying that I am under no illusion of competency or superiority, nor do I fail to heed relevant criticisms. I have enough humility to recognize that I am new and I know nothing about the real world of nursing, so please take that into account.

So far, I've had nine shifts as an orientee. I'm on my third week of a six month orientation. From my very first shift, my preceptor has thrown me to the wolves. I've essentially been taking independent critical care assignments with zero experience as a nurse, while my preceptor browses the internet for their next vacation and gossips with the other nurses - that is, when they're not berating and belittling me in front of patients. I keep being told to "ask questions", but when I do, I'm then belittled and berated by my preceptor for not knowing something. When I talk to my preceptor about something they've said that I misunderstood, they tell me "sink or swim. This is the ICU." I timed the last negative interaction I had with my preceptor, and they continued to beat a dead horse for fifteen minutes, in front of an aphasic patient, over me not knowing that a different brand of angiocath is proceeded differently than the ones that I have used in the past during nursing school. When my charge nurse saw me crying after this episode, my feelings were dismissed and it was chalked up to me not asking the "right" questions. The fact of the matter is that as a brand new nurse, I don't even know that I don't know something; how can I ask the right questions if I don't know what the right questions are? I am constantly asking questions, and my preceptor often gives curt or belittling responses that have little to no substance as an answer. When they blow their lid, they then accuse me of not communicating or asking for support (despite numerous attempts to do exactly what they're accusing me of not doing). 

I've cried every single shift, and I've considered quitting every day since I've started. As a former instructor and trainer in a different career field, I can confidently say that it is one thing to offer constructive criticism that builds someone up to a competent level, and quite another to beat a dead horse after someone has acknowledged their deficiencies.

Unfortunately, I am not able to be paired with another preceptor due to staffing issues and other orientees having seniority with their preceptors and assignments. Talking to my preceptor has resulted in a lack of empathy and being gas lit. And I can't transfer until after 150 days from date of hire. 

TL;Dr - I don't feel supported in my transition to practice program, and I don't feel safe for patient care after being constantly belittled and berated by my preceptor. Constructive criticism is helpful, but belittling is not.

I've only been on orientation for three weeks, and I don't feel like I can go back to the unit anymore. It has caused me to just hate life altogether and I've had passive SI on more than one occasion since my last interaction with my preceptor. I don't want to be blacklisted by the Uni hospital, because I'd love to get my DNP there someday and I've been told that being blacklisted counts for NP clinicals and not just hiring.

I just feel like I have no options left, because talking to the unit director will just put a target on my back and I'm already miserable as it is. I don't know what to do. Any advice would be appreciated. 

[JKL33]

What you describe is 100% wrong.

It makes me so angry.

I would like to have something helpful to say, but in this sort of scenario where you are backed into a corner like this my personal decision-making would have me immediately considering if I really, truly *must* continue to stay in good graces with such a dysfunctional place.

If the answer is no, resign.

If the answer is yes, you can do all the things (arrange meetings, do your best/try to learn, etc., etc., etc) but still a decent chance things won't improve much and they will make it seem like your fault.

One thing I must encourage you on (please take this as a little pep talk if you will): This is certainly both anxiety-producing and depressing, but don't let yourself start thinking extreme things or entertaining any kind of SI. I promise you, the job is not worth it, the small hope of maintaining a connection with this organization isn't worth it, NOTHING in this scenario is worth thinking of giving up on nursing or especially LIFE. You are a person of value. This organization treating you badly (EXTREMELY POORLY) has nothing to do with you. It's just what they do. Don't give it more value/importance than it's worth.

Take care of yourself!!

[klone, MSN, RN]

I'm so sorry, OP. I think what I would do in your situation (or what I would want you to do if you were a new nurse on my unit) is set up a formal meeting with the unit manager. Are you unionized?

I would approach it like "I feel like my preceptor and I are not communicating effectively. I want this to work, and I want to learn how to be a safe and effective nurse. Can you please help me figure out the best way forward so my preceptor and I can have a functional and fruitful relationship?"

[Been there,done that, ASN, RN]

You have been set up for failure. Quit NOW and leave it off your resume. It's a do over.

Good luck.

[kkbb, MSN, RN]

My heart breaks for you.  This is absolutely not okay.  

As a preceptor to new hires (experienced nurses), it is my job to teach them our policies and procedures, and about our patient population if they are not from a similar specialty.  

As a preceptor to a new grad, we cover the policies, procedures, and patient population, AND I help them find their nursing practice and help guide them as they start out.  Part of it is based on what I see as an experienced nurse, and part is based on what they tell me they need.  And (because I feel like a mama to all the new grads), I keep an eye out on them throughout their first year to make sure they continue to feel supported.

The fact that no other preceptors are available due to staffing issues is a big red flag.  I'm also questioning leaving a new grad to fend for themselves days into orientation.  It takes a while before I trust anyone to be alone with my patients.   

Big hugs.  I agree with Been There Done That (she always has such great advice)...there are better places out there.  The first year is hard, even with the best of support.  ICU is hard (I've heard), even with the best of support.  You have no support there.  No.  Just no.    

[hppygr8ful, ASN, RN, EMT-I]

Camillus_Was_a_Murse said:

I've had passive SI on more than one occasion since my last interaction with my preceptor. 

First and foremost, please seek the help of a mental health professional. Speaking from experience because I did attempt to end my life in 2004. Your employer should have an EMP program if cost is a consideration

[K Kerley, BSN]

OP-First and foremost you are NOT stupid. You are learning. There is a huge difference in not knowing and being stupid. You are just taking your baby steps. Be gentle with yourself where others are not.

Let me give you a little background on myself. I became an RN in 2014 after having been a CNA in nursing homes straight out of high school from 2009 until 2014. My first job as an RN...a critical care unit at a level 2 trauma center that also specialized in cardiac care. I went from doing CNA work to post op day one open heart surgical patients, neuro patients we were draining spinal fluid from, every drip imaginable. All in the same team. Initially I was so excited, but then I met my preceptor and got to know her. Much of what you have described also happened to me. Nights and days were spent hysterically crying when I wasn't at the hospital. Antidepressants were prescribed. I hated life. How could my dream become a nightmare. The final straw for me was 3 months in with a team from hell, on my own, getting my 5th patient on a cardizem drip, another receiving blood, one with 2 triple lumen piccs all of which had infusions running to them if not multiple to each line of the picc. I didn't feel well, couldn't find my preceptor and finally around 3 am took my temp. It was 103. I let my preceptor and team members know and instead of taking me at my word offered a rectal thermometer but instead sent another nurse to check my temp after making me wait 10 minutes to make sure I hadn't had anything hot to drink. It was now 103.2. Before handing over my team to my preceptor she told me to stop on the way home, pick up some Tylenol and beer, take the Tylenol for my fever, the beer to help me sleep and to kill any baby I might be pregnant with. That was my point of no return. The day I decided I was not only done but I would make sure my purpose in nursing would be to make sure no one ever felt how I had if I could help it. 
 

Nursing is hard, but you are stronger. One of the most beautiful things about nursing....there's always going to be a job for you. I was lucky and I was able to transfer within the hospital system, find my calling and trained relentlessly to become not just a preceptor but a clinical coach where I only trained new graduates and guided them through whatever they needed. I even went on to become a mentor for the residency program where once a month I met with a group of new graduates and we just talked. They vented and I listened. Gave advice and most came from the unit that nearly did me in. For a full year and I made myself available outside of that once a month meeting and even after the year was over. 
 

My biggest piece of advice to you is to let go of the idea that you HAVE TO STAY at this place you are at. You don't. I had my future planned out too where I was at. And when I say it crushed my soul to admit to what I thought was defeat by leaving it would be an understatement. I mourned leaving. I convinced myself that I was a failure. That I'd never make it as a nurse. In reality I found something so much better. I found my calling, my purpose, my passion. 
 

Sweet OP, please love yourself enough to know that what you are experiencing is lateral violence at its worst. It's toxic and it has NOTHING to do with you. Do not let your victories of making it this far be overshadowed by people who are miserable excuses for not just nurses but human beings. Not everyone is like them. You BELONG on this earth and you have a purpose. Don't let them take away and ruin what a precious gift to this planet and this profession that you are. I may not know you, but I AM HERE for you. As someone who has overcome this I promise you there will be better days ahead. I KNOW you CAN and you WILL do this. And you'll be a damned good nurse for everything that you are being put through right now because you already know what type of nurse NOT to be. If I can help you in any way, please let me know. I'm not sure how these forums work as I'm not normally on them but I saw your post and knew I had to say something. I'll be thinking of you and leave you with a poem once told to me by my old mentor once I found my place when I was just starting out "To laugh often and much;
 to win the respect of the intelligent people
 and the affection of children;
 
to earn the appreciation of honest critics
 
and endure the betrayal of false friends;
 
to appreciate beauty;
 
to find the best in others; 
 
to leave the world a bit better
 
whether by a healthy child,
a garden patch, 
or a redeemed social condition;
 
to know that one life has breathed easier 
 
because you lived here.
 
This is to have succeeded”-Ralph Waldo Emerson. Remember how strong you are even if you don't feel it ❤️

[mdsRN2005, ASN, BSN, RN]

First of all congrats on graduating nursing school and passing NCLEX!  That is truly an accomplishment, be proud of yourself!  Secondly as others have mentioned, if you are having SI, please get help immediately and do whatever it takes to take care of yourself!  Which in this case very well may mean quitting this job.  I understand your concerns about being blacklisted but there are always other options both for work and clinicals.

As to the situation at your job, that is truly the definition of a toxic work environment. Your preceptor should never be allowed to precept, and "sink or swim" in the ICU could have deadly consequences.  If you do decide to stay you could try approaching the nurse manager from this standpoint (as opposed to "my preceptor is mean to me" which would make you sound whiny).  However be aware that your manager may be in the clique with your preceptor so that may make it worse instead of better.  Alternately, you may consider going to HR to request a transfer. Even though you haven't met the guidelines, you can try explaining that you are not only not being taught anything but also are in a situation that is dangerous yo patient care. This may not work either but you could try.  Finally consider this, even if you do leave, you could write an exit letter to both the manager and HR outlining your concerns for the safety of the patients in this unit.  In a previous workplace similar to this I precepted a new nurse who did this when she left (she complimented me as a preceptor but truthfully exposed lots of other issues including a toxic group of nurses that kept PRNs from picking up on our shift which subsequently left us chronically short staffed).  Surprisingly this letter went further than I expected and did lead to an investigation.  And since she'd already left she couldn't be retaliated against.  Whether you do the same is up to you, but your top priority needs to be getting out of there.  Not only for your mental and emotional wellbeing, but also before this ends badly with a patient care mistake.  I'm sure you are much smarter and more skilled than you give yourself credit for, but you can't be expected to know everything required to independently care for critical patients.  And I'd hate to see a bad outcome as a result.  Don't put yourself in a position to make that kind of a mistake. 
 

Best of wishes and please keep us posted! Most of all please don't let this experience keep you from pursuing nursing as a career!  And don't judge all older nurses based on this, I promise we're not all that bad!  ?

[SnickRN BSN RN CCRN]

The ICU is a different beast but you shouldn't be thrown to the wolves at three weeks in. 

 

First and foremost, skip the Charge (who could be helping and getting that RN off her butt) and go to the educator, the manager then HR. Her/his attitude should not be precepting a student nurse let alone a staff nurse. The ICU is the endpoint for patients, there's no where else to send them. It's not an area to "figure it out" but teamwork.

If you're going home or at work, thinking of hurting yourself,  get out of there and get help. No job is worth that. Despite wanting to do your NP there, nothing is worth your life.

There are millions of possibilities for a nurse from bedside to safety to research. I would suggest, if you want to stay in acute care/hospital, to go to a medical/meg-surg unit and get your feet wet there. I was in a heart care unit for 3 years, getting the basics, understanding the body, then transitioning to the ICU. I understood what I was learning in the ICU so much better with that base underneath me. 

Also, there are thousands of hospitals and NP programs out there. Don't be so dedicated to one facility/ program/university.  Thousands of hospitals are looking for staff and it sounds like they would treat you better than where you are working.  If you can move, maybe it's time to look away from home.  If you can't,  maybe it's time to talk with management. But your sanity and life are more important than this one job. 

I wish you the best in whatever course you take.

[sleepwalker, MSN, NP]

Everyone has given excellent advice.

My 2 cents...talk to your manager and explain the situation and issues and ask for a new preceptor. If they gas-light you or try and white was the situation then give your notice and resign. You've only been there 3 weeks so you can start over somewhere else easily as a new grad. I wouldn't even bother with listing this place/experience on your resume should you choose to resign. 

[londonflo]

Camillus_Was_a_Murse said:

I've had passive SI on more than one occasion since my last interaction with my preceptor

Set up an appointment with your Employee Assistance Program right away. This is a serious response (SI) to an untenable situation. Don't worry about calling in, there are a lot of DNP programs out there. CALL IN! Take care of you! YOU are more valuable to this world than any crappy hospital, rotting inside-preceptor, or the rest of the bunch.

 

[Nurse Beth, MSN]

Camillus_Was_a_Murse said:

I just feel like I have no options left, because talking to the unit director will just put a target on my back and I'm already miserable as it is. I don't know what to do. Any advice would be appreciated. 

This is awful, I'm so sorry. Can you talk to your unit Educator?