New grad, want to quit

[nursing926222]

Hello fellow nurses.

I need help. I graduated with my BSN, November 2015. I passed my NCLEX 4 weeks later and obtained an ER position in a adult/pediatric ER and started in the ER 3 weeks ago. I received no formal "emergency" orientation/training prior to starting, except a couple days of learning hospital policy/procedures. I have had a total of 8 shifts in the emergency room and I want to resign. The orientation is a total of 3 months long, and I am 3 weeks in. My preceptor does very little to no training and I have little to no supervision. I had a patient in A Fib and the doctor ordered a Cardizem bolus/drip. My preceptor told me to administer the medication alone. I told her absolutely not. I made her get up and help me. I have been in a few codes, one of which was a completely disorganized disaster. I had a patient last shift who required between 12-15 medications to be administered and I asked my preceptor to observe me to ensure I didn't make a mistake (some IV push, some required pumps, some po and a couple injections). As a BRAND NEW NURSE, I was asking things such as, do you have any tips as to which order the IV meds should be administered, should I wait in between certain medications before administering meds, etc. My preceptor told me that this is my 8th shift and I will be on my own in 2 months and need to "figure it out." So, I did what anyone with common sense and good clinical judgement would do, I called pharmacy and in addition... I went to my charge nurse and told him my preceptor was unavailable and to please assist/observe me. My preceptor does not observe me 80% of the time, but I attest that I have never done anything or administered anything I wasn't confident or comfortable doing... meaning, I wasn't sure of the contraindications, expected outcomes, side effects, labs to check, vitals to check, etc. I feel that this is a very unsafe environment for me to be in and I do not want to put my patients and my license in jeopardy. I think that asking for a new preceptor will only make things worse for me. I have spoken with my preceptor and get a very casual attitude as to "its ok to make mistakes, that is how you learn." I understand we are all human, but the goal in any type of patient care is to take EVERY precaution necessary to avoid making a potential mistake. I basically do all of the patient care/medication administration/discharges for all of the patients. She helps me get IVs and blood draws and that is it (if I am too busy to do it alone). Is it me? I don't need someone holding my hand, but I do need someone who is watching what I am doing and teaching me along the way. Not sitting at the nurses station. This is an emergency room!!!! My thought process was to contact my ER manager/director and approach it with a "me" thing, in an effort not to burn any bridges. More or less, just say that my understanding and expectations of my training and orientation were x and I do not feel that my training has reflected that. Give a couple scenarios and wait for their response. If they say this is how they do it, part ways? I do not want this to ruin my future job opportunities, but I also do not feel safe working here. Any advice would be greatly appreciated. These are just a few things, there have been plenty of other situations that I have shared with other nursing friends from other facilities and they are shocked. I really don't know what to do. I have been receiving compliments from coworkers and charge nurse that I am doing really well and told me they are usually pulling new grads in the office by now to tell them what they are doing wrong and trying to determine if they are a good fit, and I have not had that happen yet. I know it can be overwhelming starting as a new grad in an ER with zero medical experience besides nursing school, but need advice. Thank you.

[Rose_Queen, BSN, MSN, RN]

Welcome to AN! Does you facility provide any sort of classroom education as part of your orientation? Why are you reluctant to request another preceptor? If the current preceptor isn't doing the job, then you need another preceptor. An inadequately oriented nurse can be a hazard to safe patient care. You need to advocate both for patients and for yourself to get an adequate orientation.

[l.a.m.b, ADN, RN]

UR nursing judgement is correct in that u should be taught correctly the first time every time. It is ok to ask that u be assigned to someone else because that preceptor u have seems too lax in her teaching. That can create a dangerous situation for u and the pts. If this request causes issues, then move on to another hospital. If it comes up as to why u moved on u explain. As a manager I would be grateful that u recognize potential danger than risk hurting an innocent pt

[LadyFree28, BSN, LPN, RN]

Welcome to AN! Does you facility provide any sort of classroom education as part of your orientation? Why are you reluctant to request another preceptor? If the current preceptor isn't doing the job, then you need another preceptor. An inadequately oriented nurse can be a hazard to safe patient care. You need to advocate both for patients and for yourself to get an adequate orientation.

This.

I had a really good preceptor and unit that was committed to making sure I would get adequate orientation; I did not have a nurse educator for the unit until 8 months into my orientation.

One of the things that I do before I do any procedure is to look up the policy and procedure before proceeding; is it possible you can try to to that, then stay in communication with your preceptor before proceeding at least in the meantime before switching preceptors, especially if there are none available? If I had a question, I also got to know the various departments in order to be knowledgable about labs, testing, etc, to be more prepared; I also was very assertive toward staff and sought out anyone that could help as well-and I still do; I have been in the ED for a year and still ask questions and use every resource available.

Also, look into self study methods as well-Sheehy's is a good resource, as well as the ENA manual; I self-studied before I started the position and studied each chance I could because there was no educator and because I wanted and felt the need to figure out how to map out my approach in practicing in the ED.

Advocate and be proactive in your new position; it will be a steep learning curve, however, be prepared to advocate so you can be comfortable in your practice.

Best wishes.

[nursing926222]

Thank you for your response. I am so appreciative of you taking the time to do so. Yes , they do. I asked my manager about the ED education he told me it is a waste of time and they have determined that people backtrack. 2-3 days a week of classroom/sims and 1 day every other week in the actual ER. So, his answer to me was this is the most effective training (hands on in ER). This ER is very "clicky" and I think it would do me more harm to stay with another preceptor (staff will let me sink for "complaining" about their friend), than quit? I think the ER in general is too Lax. I have talked with a couple other nurses I met during orientation (one an experienced CVICU nurse and another new nurse on step down) and they are all thinking of resigning. The entire hospital is understaffed. I think they don't want me to do the ED training because they just need a body to take more patients, sooner than later.

[nursing926222]

Thank you. These girls are all very young and the most senior nurse in my ER has 6 years of experience (charge nurse). The rest are 1-3 years. I feel like its a high school click, by asking for a new preceptor I think these girls will let me sink and will be reluctant to help me and as a new nurse, that is not a situation I plan on being in. I was afraid that by resigning, no one would look to hire me and I did not want to "bash" my previous employer, but you have an excellent point. I think the hiring manager, they would respect me for leaving and recognizing it isn't a safe environment.

[nursing926222]

That is really good advice. I am trying to determine if I should try and stick this out or not. I definitely would only consider doing so if I was offered a new preceptor and did not have any negative repercussion from it. Thank you for the advice. Highly appreciative.

[Hollybobs]

This.

I had a really good preceptor and unit that was committed to making sure I would get adequate orientation; I did not have a nurse educator for the unit until 8 months into my orientation.

One of the things that I do before I do any procedure is to look up the policy and procedure before proceeding; is it possible you can try to to that, then stay in communication with your preceptor before proceeding at least in the meantime before switching preceptors, especially if there are none available? If I had a question, I also got to know the various departments in order to be knowledgable about labs, testing, etc, to be more prepared; I also was very assertive toward staff and sought out anyone that could help as well-and I still do; I have been in the ED for a year and still ask questions and use every resource available.

Also, look into self study methods as well-Sheehy's is a good resource, as well as the ENA manual; I self-studied before I started the position and studied each chance I could because there was no educator and because I wanted and felt the need to figure out how to map out my approach in practicing in the ED.

Advocate and be proactive in your new position; it will be a steep learning curve, however, be prepared to advocate so you can be comfortable in your practice.

Best wishes.

Yes, if you have a poor preceptor then it forces you to look to your own resources and unfortunately put a lot more extra time and effort in than you should have to. I used to make myself go over my shift each night/ on days off and record all the new learning points and look the stuff up I didn't know. I then didn't have to ask a reluctant mentor very often and I wasn't irritating other staff members as I only had to ask things once. I would have liked one of the those enthusiastic preceptors who loved teaching and had some patience but it wasn't to be!

I can see why you are concerned about the repercussions of requesting a new preceptor but you don't have a good one currently. And those cliquey staff are not going to be very pleasant to you if you come off orientation sub-standard. Some of those high-school types will leave as well, and some probably don't even like each other. You might rock the boat a little but it resolves itself over time. It is up to you if you want to try to make the best of it, there is no guarantee somewhere else will be an improvement although, of course, it might be. If it's somewhere where you feel you could learn a lot, then maybe it could be worth it. You are in a much stronger position after a few months off orientation and know your job well, it's just navigating that initial time. Good luck.

[OscarTheOwl]

What is your preceptor doing while you're taking all these responsibilities alone? If your charge nurse is friends with the preceptor then she probably knows you're getting a sub par orientation. I would speak with the unit manager and let him/her know what's going on and see if there's anything they can do to help.

I would not feel comfortable learning all there is to know about ER by myself.

Good for you for using the resources you have.

[SmilingBluEyes]

OP two pieces of advice:

First I found your post incredibly hard to follow as it lacked paragraphs.

Second: please use to quote feature when responding to individual posters so we know to whom you are talking.

You received some good advice. I wish you the best. Sorry for your difficult times.

[dream'n, BSN, RN]

Ask for a new preceptor, even if it makes waves. You are already willing to quit, so what do you have to lose? Also, you are the only one that knows exactly how bad this situation is; if you feel you absolutely need to leave, then do so. Remember you need no one's approval. Do what is right for you.

[kama1990RN, BSN, RN]

I feel like this is why most places require some experience before being placed into critical care positions. The hospitals that I have experienced that did not require a year, offered an intense, 3 month training course. You are justifiably worried. It is your license on the line. You worked hard for that license. I would personally apply for a position in med surg and get some experience there. That way you will develop a familiarity with medications and procedures in a not so extreme environment. Or, request a different preceptor. The one you have has a flawed theory on learning and should probably not be in charge of orienting new hires. Best of luck.