New Grad: The First Review

[thenursingnurse]

Hi everyone. I have a BSN and got my first job at one of my clinical sites--I've been there for 6 months now. Our first review was supposed to be at 3 months, but alas, it didn't end up happening until today. I got some feedback that will be very helpful, and some that I'm a bit boggled by. I'm trying not to take any of it personally, but I don't agree with all of their assessment of me and it's leaving me a bit concerned about how they'll see me in the future.

Firstly, they think I'm completing my assessments too quickly. I can definitely see where I can improve my assessment skills, and agree that I may be panic/rushing it a bit first thing in the morning. I have sometimes recently caught myself not checking a GVR because I know I have a medication to give 30 minutes later and I can check it then. This is not good practice, and not a habit I would have thought I would have picked up. I feel like this is more me cutting a corner out of time management panic than anything, but again, I agree I need to work on this. I'm embarrassed that I was called out, but I mostly just wish it had happened sooner. The way my manager spoke to me made it seem like it was this known fact, but no one has approached me thus far. This feels like something I can work on and they will be able to see it.

At the same time, she mentioned me going to the break room and being on my phone too much. This is the part that is concerning to me. Our break room has several computers, and after I've done my physical assessments (I almost always chart those on the COW in the room, but depending on what other chaos is happening in the tiny, tiny rooms at the time, there just isn't always the room) I catch up on some other charting and read through histories, notes, etc. Before I do assessments I start writing out a med list by hand (no way to print this in chronological order), so I can bring any 0700 meds with me, and at this time I'll usually finish that up. I do check my phone during this sometimes, but I'm not sitting back there goofing off. I feel like this is partly me being a bit off guard and comfortable, and part misunderstanding on behalf of the charge who I'm pretty sure gave most of the feedback about me. I think I just need to do my charting from my COW, and not even touch my phone until lunch. I feel stupid that a few glances at my phone has made me look this lazy.

Another thing that was mentioned happened the other day. I got telephone orders to, "type and cross, infuse 2 units of PRBCs, follow up with hematology." I repeated the order back to the doctor, she said yes, so I put the orders into the computer and called for the hematology consult. The ordering doctor showed up about 45 minutes later, before the blood was ready, and asked the charge why there was an order to infuse. My charge kind of gave me a hard time about putting in the incorrect orders, but I still don't really understand how I misunderstood. That quote up there is verbatim. I said it back verbatim. I explained this to her, as well as my manager when we were talking about this, because I'm still a bit confused. In the future I will always clarify if they want to infuse now. The feedback I got during my review was like this was a chronic problem I've been having and this was just the latest example.

People have been great when I need a hand or a more experienced set of eyes. I don't feel like I weigh down the unit or anything, but people are receptive when I ask for a pointer. I feel like I'm pretty good about helping out when admissions come in, and I do everything I can to set up the night shift for success (having the next tube feeding prepared in the room, keeping up with IV/tubing changes that are due, doing my best to complete any orders I'm able to during my shift). She mentioned that I could be more of a team player and offer to help out my coworkers more. This makes me think that multiple people have some issue with me, maybe I've just been oblivious to it. I've done a few PICC dressings, Accuchecks, bladder scans, things like that when people have been swamped. I'm usually the one to answer the pages for cosigns in room X. I answer call lights and fix alarms that aren't mine. I'll take critical lab calls for other patients. I've tried to help with admissions that weren't mine, but I sort of get chased out because they know what they're doing and can do it faster. My time management is much better these days, I feel like I'm helping a fair amount when I'm able to. This one really boggles me. What other things can I be doing to be more of a team player? My manager suggest I answer the call lights and phone if I'm there and it's ringing, but I already do that.

Any one of these things wouldn't be a big deal, but I'm just concerned about how management sees me with them put together. Even if I work hard to prove them wrong, I'm concerned they won't be able to shake this picture they have of me that I don't feel is entirely accurate. I'm partly relieved that my documentation, patient care, and skills seem to be adequate, but the issues brought up just seem like they're going to come bite me in the ass down the line. I'm probably overreacting and just need to sleep on it.

Thankfully, I have 4 days off and a lot of bubble baths in my future.

[Been there,done that, ASN, RN]

You are being micro- managed. Partly because you are newbie, partly because the charge nurse has some sort of issue with you.

Think about this.. how often do you see other nurses on their personal phone? Compare and contrast.

The doctor MAY have said type and screen and hold. What was the patient's hemoglobin level?

Whatever it is, keep your head down.. get your year in. It sounds like you are doing an excellent job. I hope you are not in a toxic environment.

[Ruby Vee, BSN]

If I understand correctly, this is your very first review on your very first job. Surely you didn't start this job with the notion that you were going to be so perfect no one was going to be able to find areas for you to improve?

Completing your assessments too quickly is something I personally would be worried about. At your stage, you want to be thorough. If you're completing your assessments too quickly, odds are you're missing something, and it could very well be something important. First, make sure you know everything that should be included in your assessment, then slow down and do it right the first time. Charting in the room before you move on is a great habit to get into.

As far as your phone -- you don't want the reputation of someone who is "always looking at your phone." Keep it in your locker. Or only look at it when you're on break or in the rest room. My manager's theory on phones is that "We all have them, and everyone knows it. But no one should ever SEE it." It's probably not a bad theory, especially when you're new. Once you've been there long enough to become and to be recognized as competent, it won't be as much of an issue. But for the next year and a half or so, no one should ever see your phone. That one is an easy one to fix -- if no one sees your phone, you won't have the reputation for always looking at it.

About your phone order: Type and cross, infuse two units and follow up with hematology probably did not mean to call in a heme consult. In most places, the providers are responsible for calling in their own consults. What the order probably meant was T & C, infuse 2 units and follow up with a heme-8 lab draw to assess the bump in hemoglobin/hematocrit. Try to avoid verbal and telephone orders as much as possible -- they can get a crusty old bat in trouble, too. I've got the stories to prove it. This may be a chronic problem for you, but more likely it's just something they want you to keep an eye on to prevent it from becoming a chronic problem.

Most new grads are focused in on their own tasks and their own assignments -- I'd be rather worried about one who wasn't. As you gain experience and confidence, assessment and time management skills, you'll be more able to help out your colleagues when the need arises. Again, this may or may not be a problem you in particular are having; it may be just something that gets ticked off on a first review for any new grad. It's probably appropriate, because at your stage you haven't learned enough to be a total team player; the assumption is that it's something you're working on. No one expects you to be perfect -- or even completely competent -- yet.

Did they give you a performance plan or suggest follow up in a few months? If not, you're probably OK. If you're still worried, you might ask for another interim review in three months. Also, it would be could to identify some mentors on the unit and check your progress with them.