New Nurse, what did I get myself into...

MrsICURN14 · Sep 21, 2014

I feel ya, OP! I'm a new ICU nurse and I had my hand slapped for basically not reacting quickly enough in a critical situation. I feel like a lot of managers and preceptors expect us to come out of school with the critical thinking skills to just jump in and be a full fledged functioning nurse who knows what to do in any given situation.

That's just not the case. We learn basic critical thinking skills in school, but none of our patient scenarios are like real life. They're always text book simple situations with a text book answer.

I have felt so beat down lately. I'm doing my best to shake it off and keep on going, and just be thankful for the handful of nurses who don't expect that I came out of the womb as an experienced nurse, and who remember what it's like to be brand new.

Hugs

Esme12, ASN, BSN, RN · Sep 21, 2014

Thank you so much, reading your reply made me feel like I actually had a right to feel lost and overwhelmed... I was beginning to think that maybe I was just being a baby and needed to suck it up and power through it... which I probably should get some thicker skin, but I really think some nurses just shouldn't be preceptors, and if they are doing it just for the extra money then it is not fair at all to the new grads who are scared beyond belief to go out on the floor in the first place.
I just have to keep telling myself that no one is born a nurse, and it takes years to actually learn how to be a nurse.
It will get better, it will get better! HAHA
Thanks again for the kind words, I appreciate them a lot!

You have a right to feel lost....the first year or 2 really suck. NONE of us were born nursing...NONE!

The problem is...very few it any facilities pay preceptors more money and if they do it's like 25 cents. Very few IF ANY send nurses to learn how to precept.

How it mostly goes now...they come in and are assigned to recept they aren't asked they are assigned. Itis sa poor system but those CEO's gotta make sure there is enough money left over for their end of the fiscal year bonus. :rolleyes:

Esme12, ASN, BSN, RN · Sep 21, 2014

I. I'm doing my best to shake it off and keep on going, and just be thankful for the handful of nurses who don't expect that I came out of the womb as an experienced nurse, and who remember what it's like to be brand new. Hugs

All I can hear is the new Taylor Swift song Shake it off...I prefer this version!!

[video=youtube_share;s2YHHIOocxs]

Muser69 · Sep 21, 2014

You have a right to feel lost....the first year or 2 really suck. NONE of us were born nursing...NONE!
The problem is...very few it any facilities pay preceptors more money and if they do it's like 25 cents. Very few IF ANY send nurses to learn how to precept.
How it mostly goes now...they come in and are assigned to recept they aren't asked they are assigned. Itis sa poor system but those CEO's gotta make sure there is enough money left over for their end of the fiscal year bonus.

We get about $2.50 per hour for precepting . It wouldn't matter if it was $10.00 per hour. NO ONE wants to precept. Everyone avoids it like the plague.

designer-mommy, BSN, RN · Sep 24, 2014

We get about $2.50 per hour for precepting . It wouldn't matter if it was $10.00 per hour. NO ONE wants to precept. Everyone avoids it like the plague.

See, and that's sad. New grad RNs already feel incompetent and like a complete burden any time they have to ask a question. To know that the seasoned RNs avoid precepting like the plague makes those new RNs feel even worse. Some may not even want to ask an important question in order to avoid feeling like a fool, which puts patients (and licenses!) at risk. I get it...it's tough to have your own patient load and then have to train someone on top of that. However, I wonder if those nurses who run from and complain about having to precept remember how tough it was when they were new. Or, maybe they just snapped their fingers and instantly became awesome nurses who knew everything? At any rate, it's very, very sad that no one likes to teach anymore. It's just setting new nurses up for failure right from the beginning.

Oh, and OP, I'm sorry you're having a rough time. I am too, so I can relate. My clinical experiences SUCKED big time. I never, ever had even one day of total patient care. Why? Because I, as well as most of my classmates, was unfortunate enough to get paired with nurses who basically avoided precepting like the plague. They didn't want to be bothered with teaching, so they would just blaze through their stuff and if we got a glance at how to halfway do it we were lucky. Oh sure, the first few clinical courses were awesome. Why? Because those same nurses had NO problem letting us bathe their patients and change them when they were incontinent. Of course not LOL After that it was "Get out of my way." Now I'm left feeling like a complete idiot and like I chose the wrong profession. I hate my job, I really do. I work in substance abuse/psych nursing, so maybe it's the wrong specialty for me, but I just hate it. Being new doesn't help at all. However, I have awesome coworkers, so that (plus getting experience) is the only reason I stay. I hope the two of us can find peace in our new careers and be awesome one day! Hang in there!

MrsICURN14 · Sep 24, 2014

See, and that's sad. New grad RNs already feel incompetent and like a complete burden any time they have to ask a question. To know that the seasoned RNs avoid precepting like the plague makes those new RNs feel even worse. Some may not even want to ask an important question in order to avoid feeling like a fool, which puts patients (and licenses!) at risk. I get it...it's tough to have your own patient load and then have to train someone on top of that. However, I wonder if those nurses who run from and complain about having to precept remember how tough it was when they were new. Or, maybe they just snapped their fingers and instantly became awesome nurses who knew everything? At any rate, it's very, very sad that no one likes to teach anymore. It's just setting new nurses up for failure right from the beginning.
Oh, and OP, I'm sorry you're having a rough time. I am too, so I can relate. My clinical experiences SUCKED big time. I never, ever had even one day of total patient care. Why? Because I, as well as most of my classmates, was unfortunate enough to get paired with nurses who basically avoided precepting like the plague. They didn't want to be bothered with teaching, so they would just blaze through their stuff and if we got a glance at how to halfway do it we were lucky. Oh sure, the first few clinical courses were awesome. Why? Because those same nurses had NO problem letting us bathe their patients and change them when they were incontinent. Of course not LOL After that it was "Get out of my way." Now I'm left feeling like a complete idiot and like I chose the wrong profession. I hate my job, I really do. I work in substance abuse/psych nursing, so maybe it's the wrong specialty for me, but I just hate it. Being new doesn't help at all. However, I have awesome coworkers, so that (plus getting experience) is the only reason I stay. I hope the two of us can find peace in our new careers and be awesome one day! Hang in there!

Couldn't agree more. Well said.

kdkout, BSN, RN · Sep 24, 2014

I just have to reply:

For reference's sake - I have been a nurse for 20 years, in hospitals for most of it, and have worked in almost every area. I am also a preceptor who is currently having a very tough experience, again, with a VERY green new grad.

Your preceptor may not know that you have had no hospital orientation on IV pumps, giving meds, etc. Tell her. If the hospital orientation is so crappy that they arent giving this education to you in a separate class OR not giving it to you before you are orienting on the floor, then you are screwed. So, toughen up, ask her questions and figure it out fast. There is no time for babying you, that was school. This is TOTALLY different. You just took a job on a hard floor with really sick patients, and it's make it or break it time. Either this job will make you a good nurse, or it'll make you quit. If you can survive it, you'll be a well-organized nurse with good experience that will lay a foundation for many future nursing options. For now, you just need to suck it up and get experience because this is the boat new grads are in, like it or not.

On that note, it's way too soon to quit. You dont realize it now, but the grass isnt greener somewhere else. Nursing is HARD. The nursing instructors, especially the ones who lecture, often dont work in "real" Nursing Jobs (that's why they are teaching!). They arent "in the trenches." They cant, or wont, tell you the truth - that it's HARD. Yeah, the money is good but you will earn every penny, believe me. You just "drank the koolaid" for 4 years and now you're finding out the truth, and you are in shock. Welcome to nursing.

Before everybody here thinks I'm a complete b*&*h, I can easily recall my first nursing job on a Med-Surg/Cardiac tele floor. I started developing an ulcer and almost vomited before every shift for AT LEAST the first 6 months there. Only after a year did I feel like I may actually be able to "survive" being a nurse, but I still felt pretty dumb (because I was) most of the time. Every job I've had has scared the hell out of me for at least the first year - and it should. Book smarts/school generally teaches you how to think, but the colleges nowadays seem to give VERY little "practical" experience. They are just happy to take your money. The new grads I am teaching (no matter what school) are frequently coming out acting like first year nursing students; I cannot believe how unprepared they are! In my ideal world, nursing students would be required to work as CNAs or Techs (OR do a very thorough internship) so they can actually learn some real world experience without fear of their instructor flunking them. If I ever get a chance to be on our 'peer interview' committee, I'm probably not going to advise hiring the new grads without some really good internship/CNA/Tech experience, either. Right now it seems the new grads who are being hired are the ones who interview the best, not the ones who actually have some experience, common sense, humility and critical thinking ability. For example, I am having to teach what "standard precautions" means, why we are wearing gloves and when, how to give a medication (the 5 Rs- right patient, right med, etc), what an isolette is, etc. I could give SO many examples but wont for fear that former preceptees are reading this. About 10 times a day, I'm thinking in my head, "Really?! Did your college not teach you ANYTHING??!!" But, at least the new grads are asking questions. Its much more scary as a preceptor when the new grad pretends they know everything and dont ask any questions.

You dont know anything, we know you dont, so quit acting like you do - it's terrifying to us because then we dont know what you're thinking and why; we dont want you to kill anybody. A good preceptor asks a lot of questions of you too - to assess your thinking and see if you are getting "why" we are doing things. Tasks are important, but they are only a small part of it - you need to learn how to see the "whole picture" of the patient/the goals eventually. This takes at least a year, in my experience, to be able to do.

I knew my BSN school wasnt preparing me for "real" nursing, which is why I worked as a CNA and then later a Tech. You know what was great about that? My RN coworkers were so helpful- they were so happy to teach me extra stuff, to let me watch them do procedures, etc. You also will get good examples of what kind of RN you DONT want to be at some jobs, and that's helpful too. Maybe some day you'll be a preceptor and you'll be a better one because of the trials you're facing now.

Figure out what kind of learner you are; tell your preceptor how you best learn new things. THis is big. If she wont advocate, then advocate for yourself. Are you visual? Tell her you need certain info written down. Kinesthetic? Auditory? Think about how you best learned in school - what do you need - to hear her explain it first? See it done first? My current preceptee always writes everything down - when I asked, she SAID she was an "auditory" learner, but she's not. She's very visual. I am auditory and talk too much; I needed to "hear" lectures to understand them in school; I read about things later to make them "stick." When I precepted a different kid, I thought by us talking things through together that my preceptee was getting it, but nothing was "sticking." We figured out later that I needed to give feedback, positive and negative, in WRITTEN form for her to look at later - away from the patients - so she could absorb it. That was a helpful thing to learn for us both.

Ask your preceptor for typical meds and typical diagnoses of patients on your unit, and then study that at home. I always find at least one book that pertains to a certain type of nursing and study from it all the time. I'm always learning. For example, if you have a patient with CHF spend time looking at labs, thinking about his jugulars, his crackles, his feet, his pulses - and then go home and read about it. Putting a face with a diagnosis will help you remember it.

My last advice for all new grads is definitely to keep your ego at home. I dont know where it's coming from, but so many of the new grads (especially the young ones) are coming in with way too much ego and undeserved confidence. Why? Do you think that it impresses us?...because it totally doesn't. There's a fine line. At interviews you need to show enough confidence to get the job, but if you get the job, just be humble. We know you dont know anything. Neither do most Residents. Neither did we when we were new. It's not bad, it's a fact. Smile, take deep breaths, advocate for your own needs, and try your best to learn what you can. These weeks will pass. Ask questions (but dont ask every 3 seconds unless you want your preceptor to go crazy). You dont know how much pressure your preceptor is under, you may not know that she is constantly short-staffed and not getting the "lighter load" she was promised so that she'd have adequate time to actually teach you. (That happens to me all the time!)

And yes, I'm well aware of the 'Nurses eat their young' statement. I've been eaten. There's a book called "Nurse to Nurse Hostility: why nurses eat their young," which I own. It was pretty enlightening. I'll paraphrase what I learned from the book and why I personally think nurses eat their young:

The job is stressful as hell and often back-breaking, the public is increasingly entitled, we are like rats in a cage and start taking out our stress on each other, we rarely get to take care of our own needs (ie. breaks, vacations), nurses lack boundaries, too many women=a lot of passive-aggressiveness and cattiness, and management not caring because we are all just replaceable warm bodies with a license. That and the fact that hospitals/healthcare are a business FIRST, so decisions are usually made based on money, first. You want to believe as a RN and as a patient, that people do care and that they are there for altruistic reasons - but never forget that the people at the top are running it as a business first. It's a total conflict of interest, really. Individuals care, they do, but business people need to keep businesses afloat (and they are very removed from us peons at the bottom) so they'll cut corners, short staff us, not give adequate training and make the public think everything is peachy while your hair turns gray and you wonder how it's fair that Vanna makes so much money turning letters. :-)

What does that "it's a business first" mean to you? That means that you'll be promised to care for 4 patients but really get 5 or 6, you'll spend the whole day trying to figure out how to eat something, and you'll spend your off time trying to figure out how to have any semblance of work/life balance and self-care. Despite what they said in school - in order to survive, you may not want to think of it as a career, think of it as a job. Work hard; dont be lazy. Get off the D*&n internet when you're not on break, for crying out loud. Do a good job because YOU want to do a good job. Be the nurse you'd want if you were a patient.

While you're at it, give up being a perfectionist if you are one. I'm one, and it makes nursing SO hard because you have so little control over anything....you rarely have the time to give the care you learned about in school. You always have to figure out how to put out fires, which ones to put out first, which ones can be ignored for now, what you can delegate to whom, etc. That takes time and is a learned art.

I'm often surprised that the families that I do the most for are not thankful for it, and the ones I do the least for are often the most thankful. The public really has no idea what the job is really like. I also am surprised at how much acting we do, usually because the families are right in front of us and we have to be "professional." "Acting" like that decelling baby is OK and we arent nervous because the OB is ignoring us, "Acting" like we arent mad that that Dr just yelled at us for calling him in the middle of the night for that critical lab, "Acting" like we arent mad when we have to call parents to beg them to come & visit their child, or my personal favorite - "Acting" like we arent mad that we are caring for drug-addicted babies and people who fly into this country to have "U.S. citizen" baby, never to pay a dollar to their hospital bills - while I worry about hospital bills & try to figure how to pay for my own child's medical needs. Meryl Streep has nothing on me. (And I clearly need a vacation).

designer-mommy, BSN, RN · Sep 24, 2014

That was an awesome post, kdkout. I think, or at least I hope, that a lot of the "ego" that new grad RNs have is a total front. They put on their poker faces for fear that the seasoned RNs will talk crap behind their backs if they show weakness or lack of knowledge. Like both of us have already stated, that is scary! We need to ask questions! Your post helped me realize that it wasn't only my school that had horrible clinical experiences and there are other new nurses that are as "dumb" as I am. Trust me, I really wanted to have all of that patient care that many nursing students had in their clinicals. I started this job with two other new grad RNs, and I was so jealous when I heard about their preceptorships and how they had months of total patient care. I didn't have that. Some people say that it's our fault for choosing a crappy school. Well, my school is accredited and I heard good things about it, so I thought it was OK. And most nursing students, myself included, don't have the luxury of just switching schools mid program. There are waiting lists, different prereqs, etc. We're stuck.

Anyway, I'm glad to see that you encourage questions even if you might think "Why doesn't s/he know this?!" This is going to sound horrible, but I didn't even get to give insulin during my clinicals. I was terrified to admit that at my new job, because it is SUCH a basic nursing skill. However, I was even more terrified to kill someone, so I swallowed my pride and asked the friendliest/least likely to talk about me RN at my facility about it. She was supposed to go home about 30 minutes prior, but stayed just to give me a crash course. I just wanted a verbal explanation, but she was like, "Hey, let's go practice!" That was awesome, and I was an insulin giving pro by the end of the night. Now she would make an awesome preceptor. We only get two weeks where I work at, so it's not much at all, but still...she'd do great.

kdkout, BSN, RN · Sep 24, 2014

To "designer-mommy:"

Thanks for your reply. I agree that I think it's a "front" for some, but not all. I've had a new grad blatantly blame me for her mistakes and not being able to do some aspects of the job months into it, to the point where even our "Educator" running the evaluation was shocked.

When a new grad continues to have too much ego it eventually puts me in the place of having to "break them down," so to speak. I dont like to do that because it can be very demoralizing. I talk with them directly about it first- but if they continue to act like a know-it-all, then they will be given the worst assignment and left to drown, on purpose, and I will step in only when absolutely necessary. I hate to do that (!) but some people have to learn things the hard way.

As for switching schools or picking the right college - I had NO idea what school was good and what one wasnt. It's hard to really know that - they All want your money - I just went for whatever BSN school I could afford, & I'm glad I did. I was a Child Development major and knew nothing about nursing when I went into it. Nothing except what I saw on TV, which we all know is realistic! ha ha

If students have a choice and are not hampered by marriage/kids, I encourage them to get their BSNs first only because there's a good chance you'll have to get it anyway, so get it over with. I've also noticed that some of our LPN to RNs who have an AA are better at tasks initially, but lack critical thinking skills. It really is different person to person so much of the time.

I've heard instructors say "The BSN students start out worse but they are taught better critical thinking skills, so in the long run they'll be better nurses." I've met dumb BSNs and smart LPNs that should really be RNs, so who knows. We're all individuals and I guess there's no magic "formula" for success that works for everybody. Cant say enough about the value of common sense.

If you were interviewed by someone like me, I would ask you "Why didnt you have any preceptorships? Internships? CNA or tech jobs?" and listen to what you said. Would I consider hiring somebody else who did, instead of you? Probably, but if you gave me the answer that you were 'really scared about not having enough experience and wish you had gotten more,' and I could tell by how you said it that you were being honest, that would say it all.

For example, the kid I'm precepting came from a Christian private college which touts a fantastic 3rd world country experience that I would've killed for when I was in school. Unfortunately, I quickly found out on day #1 together, that this experience helped in NO WAY clinically/practically. It was instead of "real" experience in a First world country. SO, if I were this kid, I would've recognized that my school didnt really prepare me and tried my hardest to get a CNA or tech job while in school. Yes, those jobs suck, but they make you a better nurse.

When a friend of mine interviewed a kid from this same school on his first job, the kid said something like:

"I'm really concerned that I'm not adequately prepared to do this job. My clinical experiences werent great. What can I do to help prepare me to learn what I need to know?"

He said it honestly, and you could tell. That one statement made my friend, the preceptor, feel so much better.

I forgot to mention that all of my preceptees kick my butt when it comes to learning the computerized charting. They pick it up a lot faster than I did and frequently show me a few new things :-)

pcelley · Sep 24, 2014

How awesome that a few other nurses noticed your struggles, advocated for you, and you got a new preceptor! The first thing you need to do is thank your manager, tell her how much you want to do well, and tell her exactly what you feel confident about and what you are struggling with. Maybe you could come in on volunteer time to shadow or get some time on just the tasks that are most challenging to you. Then make sure you talk to your current preceptor and thank her for her introduction to the real world of nursing and let her know how much you admire and respect her. Don't bury your face in your hands and avoid things that make you uncomfortable (be it people or tasks) - reach out and conquer those things with positive attitude, enthusiasm, accountability, humbleness and gratitude.

Welcome to nursing :)

kdkout, BSN, RN · Sep 24, 2014

Also -in defense of preceptors - many times we are not given a choice and are forced to precept. Sometimes we find out at the start of our shift. And, I get a whopping $1.25 more per hour.

NightNurseinTx · Sep 24, 2014

Nurses eat their young...sad but really is true. Most forget what it is like being a brand new nurse. Just stay positive and don't be afraid to speak up for yourself and ask for help...during orientation may be the only time you will get it. Nursing is a seen one do one type learning style so speak up and ask questions during the "see one". Hang in there, you will get more comfortable and it will fall in to place, a lot of it comes with time and practice.