New Grad Wk6 ICU, defeated.

[NewbieRNbsn]

I'm in the medical ICU level 1 and have been there six weeks. There are four of us new grads on the unit.
 

From the very first shift I was in a room giving meds and hanging lines by myself. I felt uncomfortable, but my preceptor assured me if I needed her she was outside. Day two we are given the most critical patient on the floor. Again I am hanging and scanning pressors alone, pushing bicarb alone, his family went DNR but we were trying to keep him going until they showed up. He was on CRRT, all the pressers, the bicarb.. basically the works. He passed by shift change and I cried for several days. I felt completely overwhelmed and honestly, unsafe. The next work day I requested a new preceptor. I have two. One of them I get 80% of the time the other is just once a week here and there. I've asked my main preceptor for the past two weeks if I am behind on anything or where I need to step up. I was told last week she needed another week with me to know for sure. This week was the beginning of week 6. I still haven't finished my classes for ECG as they will be coming up the next week.  and I haven't had my main preceptor since asking her how I was doing.

Yesterday I was with my preceptor I don't have often, not the main one. My patient went into afib RVR. I didn't quite know what that meant or even the next step. I later looked it up myself,

Earlier that morning I missed the alarm going off that she went into a different rhythm. During rounds I missed the alarm going off showing a drop in O2. So I know those were on me. 100% shouldn't be missing alarms. When it happened the second time, I was on the other side of the residents and taking notes on the next steps for the patient. the preceptor came over to me to have me look at the monitor. I went in to check on patient and she was asleep. I stirred her and she woke up. her o2 shot back up to 95.
 

This all happened by 1000. at the time, I was glad this happened during orientation and not by myself. I feel like it's better to make these mistakes now and learn from them.

By 1300 I'm called into the managers office with the educator and my part time preceptor. I had no idea what was going on. Aside from missing those two alarms.

My manager began with, "you're behind where you should be for week 6. How do you feel it's been going?” I told her that some days are better than others, my confidence varies by the day. She said she has some concerns... and that I missed the alarms. I acknowledged that. She said there is a rumor you're afraid of codes. This is something I told my preceptor (not afraid, nervous) because I haven't done them yet. It is the fear of something so serious and not having any experience in it. They took it as me being incapable of doing it. I told her during stressful situations I do get nervous and had been told that's normal. I went on to say I just want to be confident in doing things. She said competence and confidence are not the same. She then said we cannot have you freezing. I was so clueless where this was coming from. My preceptor just sat there with her arms crossed not saying much.

She then went on to say I should be taking patients by myself, calling the doctors, doing rounds, going into the rooms alone, etc. I was super confused because I had been doing all of those things. She said she needs me to step it up and I have a week to do it. Basically two more shifts. She wanted to see independence from me and not to rely on my preceptor. I'm halfway through orientation.

My preceptor that day was basically gone most of the day. I was asking questions with my pod mate. I later figured out she was telling on me for not acting in the moment or calling the doctor during the afib RVR (freezing up) and For not hearing the alarms. But aside from pointing out the alarms I was clueless! This is a discussion she didn't have with me. Up until that point I have been prompted to call the doctors. Now I'm understanding I just need to do it. At one point I was getting the 1330 meds and supplies. I was heading into the patients room. My preceptor called me over to the pod with her and another nurse. She asked me if I wanted to join in on a family meeting with the other nurse. He mentioned it was the worst of the worse. I hadn't done one yet and said yes! My preceptor said, do you want me to come with you? I said umm sure, if you want to. She brought this up in the meeting with the manager. Stating I should be going into the rooms alone to give meds... it was only then I realized she wasn't asking about going into the family meeting with me! So this is also something she tattled on me for. I had no idea!! I've been going into rooms alone for weeks. I didn't correct her in the meeting bc at this point I felt completely ran over. 

 

I reached out to another cohort on my floor. She started the same time as me. She is still being prompted to call the doctors. She is not being asked to be more independent. She still relies on her preceptors.

 

because I felt this meeting came out of left field with no warning, I feel like I have a target on my back. Maybe because I changed preceptors day three and I raised some eyebrows. I also feel that there's a lot expected out of me that isn't expected from my cohorts, most likely because their preceptor is working with them and not running off with every mistake made. The worst part is not knowing when it's an issue because she isn't talking to me she is tattling.

the manager is upset with me. I cannot talk to anyone about this because I feel like I've been too outspoken so far and it got me into trouble. the next option is showing massive improvement by Monday or go to step down. I don't know what to do. Part of me wants to fight for it, another part of me wants to accept step down, another part of me wants to find a new job! I feel completely defeated. ☹️ 

should I put my head down and let them push me out to step down? Should I quit and find another job?! I just don't know!! 

[FolksBtrippin, BSN, RN]

You're not alone. Starting in the ICU as a new grad is very hard. I want to encourage you to stick it out, because I think you can do this. Don't worry too much about your preceptor tattling. Just step up and take responsibility as best as you can. If she believes you can't do something that you know you can do, prove her wrong by doing it. Take responsibility over and over. Don't wait for your preceptor to tell you what to do, tell her what you need her to do. "I'm going to call the doctor can you please hang xyz while I do that." If she says no, you have an actual problem, but I don't think she will. They need to see you step up, take charge, be the boss. It's a trial by fire. This is painful for most people and you're only halfway through orientation. But you'll be better for it. Don't lie down. If they decide you can't do it after you've tried your hardest then you'll go to step down and come back later, and that's fine (you'll be okay either way.) But don't crumple. You got this. Check back and let us know how you're doing.

[HiddenAngels]

I agree with FBT! One thing to note is, you don't have much time so adopt a kind of take-charge attitude.  Do what's required immediately and delegate only if you absolutely have to.  Prioritize and you should be fine.  Also, that sucks the misinterpretation about the family meeting and the meds, just saying!  But if I were a newbie I probably would have done the same as you and not said anything, whatever (shrug).  Not knowing the Afib/RVR.. Newsflash, there's a lot of things you won't know until you encounter them, that's nursing. Keep your head up and keep smiling! You can do this!