New Job Bummed Out

[SBBFMW]

I am a Second Degree Nurse with a year experience in outpatient peds. I recently started a new job in in a NICU at one of the top Peds hospitals in the nation, well respected, well-liked.. I even heard someone say they would give a limb to work here!! Well I'm here and the other day I had a meeting with my orientation coordinator and preceptor. This is the end of my 3rd week, we met a week or a week and a half ago, to discuss goals and expectations.

My issue has consistently been time management. She was very concerned because I am still having issues with it even though it was a goal to address since out last meeting, and at this meeting she questioned whether I was fit to deal with pts at this acuity. I was crushed! She also stated that I seemed flustered and anxious every time she saw me and said I seemed inattentive to parents. I agree with seeming anxious because I indeed feel overwhelmed since this is completely different from my last job where I basically did vitals and minor lab stuff, but I feel I have had a good relationship with the parents. But it doesn't help that she comes by just as I sit down, while my preceptor is still with the parents chatting.

At the last meeting it was suggested to use a time management worksheet and a few days after the meeting my preceptor suggested coming in a little earlier. I have attempted to use different worksheets to no avail 1) because I am unfamiliar with them since I didn't use them before 2) I often forget about them. I came in early one day it seemed to help some, the other two days the weather was crappy so I only arrived on time.

Over the past few weeks I additionally have been feeling a disconnect between my preceptor and myself, upon our first meeting we never sat down and went over goals and expectations, nor did she ask about my previous experience and what I am comfortable with completing. The first day she told me what care was to be done and asked if I was ok to do it on my own without showing me?!?! I told her I would appreciate if she showed me first.

Since then she constantly asks if I have completed something, knowing that it was never discussed, she has seemed inattentive, walking away sometimes not saying where she is going, or stating she'll be back and is gone for 15+ min. I often have to interrupt her conversations from other coworkers if I need help or assistance or wait because she is nowhere to be found. One day a found her and she was in another pod talking to a group of nurses. I also feel the need to repeated ask her questions because I have gotten inconsistent answers from her.

So before doing something I try to look it up in the policies and procedure manual which is time consuming. She does however asks frequently how she can help me but I feel uncomfortable calling her out on her crap, so I've tried a more gentle approach and told her multiple times that everything is new to me so I need her to thoroughly explain things to me prior to doing it and while doing it. Nothing has changed. I felt uncomfortable going to management because my preceptor has worked here for 6 or more years, she is very well-liked, and I know how horrible it can be to work in an unpleasant hostile environment.

I wanted to mention all of these things to the coordinator, but I knew she was really ****** about me still having issues with time management and felt strongly about wanting to progress me a long in my orientation, that I felt uncomfortable because I feel she already has a negative opinion about me and will negate these issues and say its still my fault. I do agree it is my fault because I have not addressed these issues and I feel I am on the verge of being let go. However I feel my preceptor has a part in it as well.

They don't seem very understanding and I have no idea of what to do. I have been crying my eyes out the past couple of days and I've considered sending her an email stating what has been going on with my preceptor but again I'm not sure if a good idea because of her attitude towards me and because of my preceptors experience and likeability. She said that next week she will pair me with a different preceptor to get a different idea of what my problem is but after that I don't think there is much hope. Any advice?

[Esme12, ASN, BSN, RN]

I moved your post to the NICU forum. I think you will find help here. There is a link to a thread where a brain sheet is located that was posted by an excellent NICU nurse......https://allnurses.com/nicu-nursing-neonatal/nicu-brain-sheet-882031.html

[NicuGal, MSN, RN]

My suggestion is to get used to using a brain sheet, make sure you write down every hour on every patient and what you have to do every hour. Tick it off when you are done. What did you do for your previous job? Time management is crucial. Take the time with the new preceptor to tell her what you need to work on. And you should have talked to the education coordinator about your concerns, that is their job to help you, even if you think she was being mean. It doesn't matter how well Liked your preceptor is, etc she isn't doing her job and I am sure her co-workers know it too. I hope it all works out!

[SBBFMW]

Thank you NICUGAL, my previous job was an outpatient peds clinic so I really didn't need a time management sheet.

I will only be paired with the new preceptor for a week. I believe this will be an evaluation of whether or not I'm "fit" for the position and if they will decide to keep me. If I make it through next week I think she plans on putting me back with the previous preceptor which is why I think I should send her an email about what is going on.

[NicuGal, MSN, RN]

I've been in the biz for almost 30 years and still use a sheet :) and you really need to speak up, if someone is not doing what they are supposed to, and it is affecting you, say something. Not everyone clicks, not everyone is meant to precept.

[Esme12, ASN, BSN, RN]

that link to the other thread has BortazRN sheet..... NICU Brain - Jan 2013.xls (36.5 KB, 1050 views)

[SBBFMW]

Thanks Esme12, I will give it a try!

[llg, PhD, RN]

I agree with the above posts ... but also ...

You need to take a few deep breaths and focus. As someone who has coordinated NICU orientees and preceptors for many years (though not currently) ... I have heard many stories such as yours. So I can imagine what it will sound like when/if you relay it to your coordinator.

1. It sounds "all over the place." On one line you say your preceptor is "constantly questioning you" and on another that she is inattentive. That's confusing. If I am to give this Preceptor some feedback and advice on how to handle the situation better, it's hard for me to know what to tell her based on that input. You sound as if you want her to be at your side all the time -- but only giving you positive strokes and that you can't handle her asking you about the care of the patient. A preceptor's job is to show, explain, etc. but it is also their job to evaluate. So don't be surprised or upset if it she seems to be evaluating you -- because she SHOULD be evaluating your performance every day and that's OK.

2. You have been given some suggestions for improvement and have not been diligent in following them -- i.e. the time management sheet. You need to show that you are following up on the advice given. If you don't, you are giving them evidence that you are a "difficult orientee to work with who is resisting suggestions for improvement." You don't want to do that.

3. As you discuss these issues with the coordinator, be careful about your accusations and how you phrase them. At one point in your original post, you accused your preceptor of (Heaven forbid!) talking to nurses in another pod. There is nothing wrong with that. She is allowed to walk away from your side and talk to other people. Now if she is doing that regularly without telling you where she is going, or when she will be back, that THAT is your issue -- not the fact that she is talking to someone else. The way you phrased it makes it sound like you think she should be at your side every minute -- But wait! -- You don't like her at your side every minute because she stresses you out with her questioning. See what I mean -- "all over the place and not focused."

4. You need to learn to talk to other nurses in your pod when you have a question and your preceptor is not there ... and you need to learn to talk to your coordinator. Not being able to do so implies that you are too fearful to speak up. And speaking up is a necessary skill for a NICU nurse. So don't write a letter to your coordinator -- TALK TO HER -- but it would be OK to write a BRIEF summary of some of your issues with specific examples if that will help you keep the conversation on track.

Good luck to you. I don't think it is too late to salvage the situation ... but you need to focus on achieving specific tasks and making progress and stop letting your emotions keep you all scattered.

[HyperSaurus, RN, BSN]

Brain sheets are your friend--Even just the process of writing out your tasks and schedules do a lot for helping you sort out your day. Not only that, but you can use it to write down relevant assessment data, ect. My unit has an unofficial policy of everyone using the same style sheets so that if you have to suddenly give up your assignment, someone else can look at your brain and know exactly where to go from there.

Also, llg was spot on regarding talking to other staff for questions. You're going to be working with them, get comfortable with them. They don't expect you to know everything and would probably feel better having you just ask instead of muddling your way through. Don't take criticisms personally from your preceptor--this is business, you have a job to learn, you have to have criticism to improve.

That being said, (I'm just off orientation, so feel free to take all this in whatever way you like), I did have one preceptor that I didn't mesh well with--she had a hard time stepping back to let me participate in cares, ect. We came to a semi-mutual decision of me working with different preceptors and moved on.

Do you have any learning resources of your own at home? Any textbooks? I have Merenstein's and Gardner's Handbook of Neonatal Intensive Care. It's great for learning the pathophysiology and the how's and why's of what we do. I highly recommend getting some at-home study resources.

Good luck.