I am a new nurse into the PICU one month into my internship. I have gone between 3 preceptors in this time and have just met my "main" preceptor after about 10 shifts, while everyone else has been with their "main" since the get go. After taking report, she said that she did not like how I jotted the body systems and began making remarks that she did not know that I would be so "unadvanced" at this point in time and that she would have to start me from the beginning. That's fine, because I want to learn and do the way that works for her. By the end of the shift I felt I was getting the hang of things and ended the shift on a positive note. In the morning I jotted the way that she wanted and while charting on the same stable pair from the day prior, I was getting behind and had not finished charting on the first patient. She told me that this is the most stable patients that we have and if I was getting overwhelmed with this that I don't belong in the ICU. When I went to flush the IV, I did not see that it was clamped and she sarcastically asked me where I went to school and if I have ever worked with IVs. I feel that at this point in time I felt overwhelmed because she was breathing down my neck. When I administered the meds through NG tube, it backed up and some of it spilled on the sheets. I re-sent for another from pharmacy, but she made a big deal out that because the sheets had just been changed and I was scared of her seeing it before coming in the room because of the fit she had made over the IV a few minutes prior that I was literally shaking. I understand the ICU is a no-nonsense kind of place, but 1 shift into meeting her I am beginning to believe that I am incompetent. When I went home that night, I cried, because I feel that I made a mistake going into the ICU as a new grad, that I'm not going to ever get better, not last and that they will fire me and wind up homeless. I don't really know what to do. I had never felt like this with my other preceptors. I feel like I am giving 100% and that I will never be able to live up to her standards. I am not trying to put her down, she is an amazing nurse loved by everyone on the unit, which is why I feel so poorly about myself at this point in time. I feel as if I am dreading going back to work and even worse.. this hospital comes with a 2 year contract.
I'm also gonna go against the grain and suggest maybe speaking with your preceptor before you go running to the manager and asking for a new preceptor? I feel that will put a target on you, especially if the preceptor is very well loved. Maybe just discuss with her that you are feeling a little nervous, but that you are working hard and really respect her knowledge and expertise and can't wait to learn as much as possible from her, etc. If you can endear her to you, and make her feel as though you do respect her knowledge, this may help her from being so critical possibly?
I'm a (very) seasoned RN, and even I sometimes forget to unclamp the the stupid clamp before pushing a med. It's not a big deal, you just then unclamp the stupid clamp and push the med.
Right now, you are new enough where equipment is still "scary." Lines are scary, tubes are scary, monitors are scary, alarms are scary, machines are scary, and the patients are scary.
If your preceptor is scary, this can make for a very unpleasant learning experience. You are doubting yourself now, and this will snowball into even more doubt, fear, and anxiety, and the cycle repeats.
You are not stupid, but you will need to find a way to pump up your confidence and relax in this challenging learning situation. My suggestion is to make a habit of going the gym or yoga before work. Get the mind cleared, and the energy, blood, and endorphines flowing. Not kidding here. Take care of yourself first.
@Guttercat Awesome advise. Based on the way you wrote your response, I think you'd be great preceptor... wish you were mine when I was in school.
To the OP @bent1993 Firstly, I am really sorry to hear you are having such a difficult time. I had a preceptor who was as dramatic as yours sounds to be, except I suspect my preceptor was a bit more vicious as she used to fail students on a personal bias. I empathize with you because I used to feel the same way you are feeling right now. You know that phrase "fake it 'till you make it" I'm not sure how helpful or healthy that is, but that's what I did. I realized more than anything that she was a bully, but not all nurses are bullies. So, I pretended like her behaviour didn't affect me and after a while she calmed down a little. Also, I practiced in my off time and documented everything really, really well. The better I got the more annoyed she became, but she couldn't sabotage my placement because I documented every conversation, every skill we practiced together and her reactions in a very rational way. I figured, I was just going to do whatever I had to, to finish the program.
Lean on your peers. Meet up for chats and maybe to share your frustrations r/t your experience.
Whatever you do, do not cower to your preceptor. Hold your head up high. Just because you are student does not mean you do not deserve some respect.
Well school doesn't really prepare you to operate as if you have been a working nurse for several years. Skills take some time to learn. You really learn by doing and making mistakes. Just make sure that you don't make too many and very serious ones. When I first started out as a new nurse, there were so many new nurses that were mean to me and I ended up speaking up for myself and telling them that there was no reason to treat me in such a disrespectful manner. I don't know any way for you to approach this except for dead on. The more you let them abuse you, the more they will. You do need to improve in your work though and that should help them back off somewhat. I will add that I ended up surpassing my difficulties and being great at what I do. You will become confident over time. On another note, the area you are starting out in is challenging and although these nurses aren't being nice, they are being straight-up with you in the seriousness of the position. Some nurses eat their young. They tried to digest me but when they swallowed me, I disturbed their stomach so much that they ended up throwing up.
I am SO sorry you've been made to feel like that. As a new nurse you already start figuring out (if you have 2 brain cells in your head) that everything you THOUGHT you knew in school either doesn't make sense in the real world or has to be re-worked as you figure out "the big picture". I'm not in PICU, but I'm an ICU nurse and, as a traveler, I get that attitude way more often than you'd thing (and I have 8 years-9 total-ICU experience!). That being said, as a new nurse, you'd be the weird one if you didn't have a point where you went home, or didn't even wait until you got home, and cried because you felt inadequate. You have even more of this feeling since you went into such a special unit right out of school! My cousin got all As in school and was sick to his stomach every day for 3-4 months before even crossing the hospital threshold so do NOT beat yourself up for feeling like you have a lot to learn, because you DO! :)
That aside, I detest nurses like that and I had one say the same thing to me when I moved to ICU 8 years ago after being a floor nurse (and charge nurse there, about half the time). It's like being a parent: you don't know exactly how much your words can cut and stay with someone until it's too late. Or you don't care who you hurt because you're a boob. Anyway, you did the right thing by trying to conform to how she wanted you to do things and I STILL do that when I'm on orientation at each new place because it makes MY life easier and I may learn something. That's exactly what they mean when they say nurses "eat their young" and it needs to stop. I can tell you verbatim what that nurse said to me nearly a decade ago because I admired her so much (I'd worked with her in codes, etc prior to making the move to ICU) and wanted so badly to get her approval.
I love having students even though it happens way less as a traveler, but every now and then I get lucky. I always say that I'd rather have them ask something ALWAYS rather than think they know it all or are too afraid to ask and kill someone. There must be few worse feelings than harming an innocent patient because you put your fear/ego first. I also tell them that they may end up not doing everything the way that I do it, but I'm there to give them guidance and a baseline. From there, you should feel free to incorporate or not incorporate those things into your practice. The second you think your way is the ONLY way, get out. Quickly. Do not let that nurse poison you even though she may be a god awful misery to work with. I had to work with that tactless/mean nurse (who is an amazing technical nurse with immense knowledge) for the next 6 years so it can be done. I'd much rather have a kind nurse who cares about other people who has a different but efficient way of doing things than someone who thinks their way is the only way and is tactless and rude. I wish more nurses would lift each other up while providing constructive criticism rather than belittle and demean.
OMG! That was way longer than I intended, but this subject irritates me to no end. If you want to, we can't really talk shop cause I remember so little of my peds stuff, but I can be there for you to yak at or vent to! Good luck to you and I hope things get better for you! Sometimes the hardest eggs to crack end up becoming some of your favorite people! xo
I remember being in your shoes not too long ago (I've been a PICU nurse for almost 4 years now. Started out as a new grad as well). I had numerous preceptors before I ended up with my main one. It took a lot of trial and error before I clicked with my main one and to get to the level of being safe on my own. I remember feeling overwhelmed all the time and being a nervous wreck, constantly scared that I'm going to get fired or that I'll hurt a patient really bad or that I'll do something wrong in my preceptor's eyes. There's plenty of good advice here so I won't go on and on. If I could go back in time I'd tell myself to be less nervous, because I'm smarter than I think I am and I'm only hurting my chances by being a nervous mess. I'd say don't be scared about getting fired, because it's not in your or the hospital's interest to fire you. They've already invested a lot of time and money by hiring you and paying you for 10+ shifts. They want you to succeed. I'm constantly amazed that I've made it this far in my unit. I'm a charge nurse now, precepting other new nurses occasionally. Try to get organized and find what works for you. Reflect on your shift. I'm not trying to be mean or be judgy or anything but why do you think you were behind on the most stable patients on the unit even though you've had them the night before? Ask yourself questions and try to reflect what could've gone better. We all make mistakes. Much bigger ones than you made. For example, I think I pushed heparin instead of running it on the pump (most of it was still sitting in the tubing thank GOD). I remember my preceptor yelling NOOOOOO very vividly lol. Did I get fired? I did not. Will I ever push heparin ever again? NOPE NOPE NOPE
Hello, I'm not sure if you are still having this problem.. I hope by this time you've found an encouraging and supportive preceptor and learning lots!!
I just want to encourage you by saying that you went through nursing school... you passed the NCLEX... you got hired for this position--- I think you are more than competent.
I've been in your shoes, where I felt like everything I was doing was wrong and the more I thought/felt that, the worse I did and the more anxious I felt. In nursing school they always told me, have CONFIDENCE. Even if you don't know what you're doing, act like you do.
I always say that I'd rather have them ask something ALWAYS rather than think they know it all or are too afraid to ask and kill someone. There must be few worse feelings than harming an innocent patient because you put your fear/ego first. I also tell them that they may end up not doing everything the way that I do it, but I'm there to give them guidance and a baseline. From there, you should feel free to incorporate or not incorporate those things into your practice. The second you think your way is the ONLY way, get out. Quickly. Do not let that nurse poison you even though she may be a god awful misery to work with. I had to work with that tactless/mean nurse (who is an amazing technical nurse with immense knowledge) for the next 6 years so it can be done. I'd much rather have a kind nurse who cares about other people who has a different but efficient way of doing things than someone who thinks their way is the only way and is tactless and rude. I wish more nurses would lift each other up while providing constructive criticism rather than belittle and demean.
NurseStorm, BSN, RN
153 Posts
I'm also gonna go against the grain and suggest maybe speaking with your preceptor before you go running to the manager and asking for a new preceptor? I feel that will put a target on you, especially if the preceptor is very well loved. Maybe just discuss with her that you are feeling a little nervous, but that you are working hard and really respect her knowledge and expertise and can't wait to learn as much as possible from her, etc. If you can endear her to you, and make her feel as though you do respect her knowledge, this may help her from being so critical possibly?