New grad with no preceptor

[ER_JEN_RN]

I graduated in May 2009, and worked per diem for a staffing agency doing hospice, LTC, rehab, etc. In Dec 2009 I was hired full time for an ER position. During my last few weeks of school I did a 120 hour capstone (assigned preceptor full time status, no class room hours) in this particular ER and thats a big part of the reason I was hired here.

Now comes my issue...Upon hire I was given a 2 week "orientation" with no assigned preceptor. Who ever was the charge nurse for the day kind of looked over my shoulder and offered minimal direction but thats about it. Its been about 7 months since I started and I was given my FIRST review by my nurse manager just last week! The good news is, I asked her specifically what my strengths and weaknesses were so I had some direction to focus my needed areas of improvement. To my absolute SHOCK, she said "oh youre doing fine. Youre a good nurse!" Now, I dont mean to complain about getting good reviews, but seriously, I only have 7 months under my belt as an ER nurse and wasnt even really precepted. There is NO way that I dont have areas that need to be improved. Seriously, I would expect that even after 15 years in the ER, everyone always has room to improve. So, Im a little disappointed because I feel like Im not being given the direction and support I need to improve my skills and succeed.

The thing is, I dont feel lost or overwhelmed, but just feel that I have so much to learn and no one is really interested in teaching around here. Its great to be considered competant, but seriously, how low are our standards that a new grad with no real training is let loose to "learn as I go".

I have taken the steps to obtain ACLS, PALS, ENPC, NRP and TNCC just to try and get more comfortable in my ER shoes but what else can I do. It seems to me that any training I am going to receive is dependant on me seeking it out in other environments.

Suggestions? Thoughts? Is this normal?

[rshenry]

I would love to be in your shoes. I can't get a job!

[Lovelee82]

Im not in your position but as a student extern I will have to suggest that you ask some of the seasoned nurses on your unit for feedback. I make sure that I ask all the nurses for procedures to learn, observe or try.

[medicrn13]

My first instinct about this position, even with the way the economy is going, would have been to leave.

They set you up for failure there, fortunately for you you thrived. I'm moving to the ICU in August and I will have a 3 MONTH orientation program, with a preceptor the entire time. When I started on Telemetry/Med-Surg I had a 3 MONTH orientation, with a preceptor the entire time.

Never was I left on my own to "work things out for myself..."

I'd start looking somewhere else...my opinion only though.

[ER_JEN_RN]

Thanks for the replys. Rshenry- I know how you feel. I send out literally hundreds of applications after graduation before taking this position. I really didnt want to work here mainly due to it being such an isolated hospital (its an IHS facility) but eventually took it because I couldnt find any other acute care position.

Medicrn13-I would love to leave but I signed a 12 month contract so Im obligated here for at least another 5 months. At this point Im more than half way through so I figure I will suck it up and get my full year of acute care experience in hopes of being able to land another ER position a little easier. I am concerned however, that my transition to another ER will be a failure because they will expect me to be better trained after 1 year and I wonder how on par I will be in comparison to other nurses with the same experience. Hopefully I will be able to hang :-)

Most of all, its amazing how relieved I feel just being able to post this complaint somewhere, so thanks for listening!

[Lunah, MSN, RN]

One word ... YIKES! I agree with medicrn13 -- they certainly didn't set you up for success. That is insane. And yes, another ED will probably expect a minimum level of competence.

My suggestion: Sheehy's Emergency Nursing: Principles and Practice. Read it, learn it, know it, love it. :) It's a fabulous text.

Are they assigning you to high-acuity sections/patients?

[PetiteOpRN]

I work in the OR and had a similar experience when I transferred into neurosurgery (no preceptor, no evaluation, just "you're a good nurse...").

There must be someone in the department who wants you to improve. Maybe it's a coworker, maybe a doctor, maybe a charge nurse. The person I found was the chief of neurosurgery. I pulled him aside as a case was ending (the resident was closing) and told him that I wanted to be an asset to the neurosurgery team and would appreciate his help and guidance. I made a form that basically has two columns (things I did well/areas for improvement). I put it by the door and he filled one out at the end of most cases. After a while, other members of the team added comments too.

[ER_JEN_RN]

Lunah-Thanks so much for the book reference. I will make a point of picking it up ASAP! I dont mean to say I dont meet a minimum level of competence, I just often wonder if I am truly on par with where I should be. Hopefully studying that text will help.

I think one of the only aspects of working here that has made any level of success possible is the "team" nursing approach. We dont have assigned beds or patients. For each patient, there is an assigned RN, however we all pitch in and pick up med orders, assessments, etc as needed. It seldom happens that a patient comes in to our ER and doesnt end up seeing each of our nursing staff at least once during their stay. I think this only works because we arent huge. We have 13 beds, 2 trauma bays, and 1 isolation room. We usually staff 5 or 6 nurses per shift with 1 being dedicated to triage. I have had critical patients, some immediately post code, some on vents waiting to be shipped to another facility, septic and on pressers etc, and do fine as long as I am able to focus solely on them. Fortunately we are staffed well enough that when any RN has a patient that critical, they are a 1:1 until they are sent to the floor or another hospital.

PetiteOP-GREAT idea!!! Im going home tonight and creating something like this to post as well. I think it would be a huge benefit. Although most of our nurses are very friendly, I am sure some will take a snarky approach to things and maybe post some not so nice comments, but as long as I keep an open mind and view these things as constructive, Im sure it will be a great benefit.!

So most of all, I dont want to sound like I am whining because I KNOW how fortunate I am to have a job as a new grad, especially in ED. I just want to be the best nurse possible.

[Lunah, MSN, RN]

You're not whining! Not at all. Just because the economy is rough and we're grateful to be employed still doesn't make it all rainbows and unicorns. All new nurses deserve an orientation! Even seasoned nurses who are new to the ED get an orientation where I work. I'm glad you're doing as well as you are, and you're smart to keep seeking knowledge. We should all do that, all the time. I learn something new each shift!

[cjcsoon2bnp, MSN, RN, NP]

Yipes! I'd be really hesitant about staying an employee for an ER that allows a new grad. to work as a nurse without any form of orientation and when you discuss areas of improvement they respond with "Your doing fine. Your a good nurse." Everyone has room for improvement and the fact that they won't even offer you any sort of advice or formal, supervised orientation makes me think that they aren't the safest place to be working. If I were you, I'd finish my commitment with them and then (quietly) start looking for another hospital with a strong ER orientation program.

!Chris

[kxvc]

Sounds a little scary to me. I'm glad you're doing well. If I were you I would seek opportunities elsewhere. It does not sound like they are committed to providing a safe environment for you or their patients.