New nurse need advice

Ruby Vee, BSN · Nov 12, 2014

i am on my third week working with my preceptor on the floor, and i am up to two patient out of 6, im not to thrilled about it because i feel so slow and feel like i need to be told how to do everything. although i have come to quickly realize that real world is nothing like what they taught you in nursing school, i still feel like i am way too green. i feel like i am getting reprimanded on everything, the bright side is that i rather it be done now instead of when im off on my own but i hate how im getting yelled at even for not going to lunch at the time i was told to. WHAT CAN I DO TO MAKE IT BETTER? Does any one have advice on what to do to improve my skills everything from prioritizing to time management. i don't know how long her patience will last with me and im not really getting any feedback...
my first week she told me what i could work on and we had open communication, since then i just get talked at instead of to.

People are YELLING at you? Or are they giving you negative feedback.

Are you getting REPRIMANDS in your personnel file? Or are you getting negative feedback.

Guess what -- you're a new grad. You'll screw up and you'll get negative feedback. Get used to recieving it, embracing it and seeking it out. You NEED negative feedback to learn. If people are giving you negative feedback (which is what I'm assuming the "yelling" and "reprimands" actually are), you're getting feedback. You just aren't getting the warm, cuddly, HAPPY feedback you think you should get. Or you thought you would get. Or you're used to getting from your parents.

In the real world of adults and real jobs, you get far more negative feedback than positive. If you're screwing up, you'll hear about it. If you're doing things right, you're just doing your job and since that's what you're supposed to be doing, you won't hear about it. You might hear about it if you do something extraordinarily well, but you're a new grad and the chances of that are rather slim.

Communication is a two way street. If you don't like the way the communication with your preceptor is going, be an adult, sit down and talk with her about it. Bear in mind, however, the preceptor is more likely to be right about most things (including the best time for you to go to lunch) than you are. Good luck.

HouTx, BSN, MSN, EdD · Nov 12, 2014

Pay heed to Ruby Vee's advice - she's very wise.

There are some things you cannot improve unless you actually DO them... rather than watch someone else or read about it. Time management is one of those things. I know it's not a popular stance, but based on my 'plenty-one' years as a clinical educator, I firmly believe that the best approach is to assign the new nurse a full assignment - and the preceptor acts as a 'coach'; readily stepping in when needed, but not until then. It works.

At first, the coach is always right beside the newbie - watching carefully and frequently assisting. As time goes on, the coach gradually steps back - continuing to reassure and validate to help the newbie's confidence grow. By the end of the orientation period, the coach is taking his own assignment.. but remaining available if the newbie needs help. But coaching is not precepting - different set of principles and theory.

It is impossible to be an effective trainer without engaging in corrective feedback. This is one of the most important aspects of role. If the trainer is afraid to provide negative feedback for fear of upsetting the orientee, he cannot do his job.

laKrugRN · Nov 13, 2014

It's okay to feel green, stupid, overwhelmed. School cannot prepare you for what you'll endure. Time is the best teacher in my opinion. My first 2 months as a nurse I was frozen in fear. It gets better. I'm in my 6th month. I am feeling much much better. It'll happen for you too!

jennyx33 · Nov 13, 2014

You are not alone. I am in my third week of precepted and I do feel overwhelmed, incompetent, slow and even stupid. I have been given 5 patients with new admissions. I barely have time to document assessments. I also do it very slowly because I dont want to miss anything, but my preceptor keeps on telling to speed up. She also mentioned I am slow. It makes me wonder if I am in the right field. Everyone keeps on telling me to not give up. I really hope it will get better. Dont give up. We are all going through the same thing. :)

jalow · Nov 13, 2014

I can understand that and appreciate a point of view that is not mine. I do need to learn to be more confident about what i am doing but also reconize i will make mistakes a d its better for me to hear about it now than later. I will remind myself not to take it personally and take the advice to help improve my skills and take the oppurtunity to handle my educational and priceless orientation

jalow · Nov 13, 2014

I appreciate all the comments and just enjoy having a place to share my feelings and thoughts

MissMoo25, BSN, MSN, RN, APRN, NP · Nov 13, 2014

Also more people than less start out slow. Seasoned nurse have their routines, and my preceptors made it very clear to me that it will take time for me to get my own routine and create a system that allows me to get my work done on time and get to lunch on time. I would say keep at it and keep asking questions while also being as self-directed as possible. I am sure it will work out if you focus hard.

LVHI_RN · Nov 14, 2014

Don't worry, you're not alone. I am a fresh RN as well. I know what exactly what that feels like. Three weeks is still very brand new. Don't be too hard on yourself, and don't hold on to the negative feedback you received. Soak it in, learn from it, then brush it off. Or at least try to, I know its hard.

Do you go into work early to prep for your patients? What kind of "brain" sheet do you use? Staying organized can make a HUGE difference in your day. Create a very good brain sheet and tailor it to your unit. The more experience you get, you'll probably figure out ways to make it even better for you.

The more prepared you are, the more confident you'll be. Have a routine and stick to it. Change it up a bit to make it better if you need to. Take LOTS of notes. For the first few months, I kept a notebook at hand always. I wrote down things I should remember (random things... from steps for a blood transfusion to how to print patient labels). If you write it down, there's a better chance you'll remember it.

It'll get better, trust me. I know our confidence as new grads are shot because we have the vets yelling at us and we aren't do as great as we THINK we should be. Trust me, you'll be increasing your patient load. You'll still be stressed and struggling... but every single day you're improving. Eventually you'll be at 4 and be like hey, I'm doing this. Then you'll be at 5 and its a whole new ball game. Everything takes getting used to. You'll get better. Keep positive. Good luck!

icuRNmaggie, BSN, RN · Nov 15, 2014

Several years ago I precepted a new grad who could not stay on task. She was intelligent and gung ho, "let me do it"but utterly disorganized. Frankly she needed to have her add meds adjusted.

In order for her to get the routine down, I made her a checklist or a to do list. Things like:

Check AML.

Report critical values.

assessment 8 - 12 - 4.

FSBS 8 -12 -4.

Daily weight.

Chart check

Read and evaluate care plan

Unit rounds at 0900.

I and O at 1800.

Clear IV pumps.

Empty foley and drains

Chart check.

Computer charges.

Restraint order and q 2 hr documentation.

It may sound juvenile but sometimes new employees a checklist need to keep them on task. They can use it at the end of the shift to make sure that all the tasks have been completed. Eventually it will become engrained. In the beginning, it can be a big help.

AmyRN303, BSN, RN · Nov 15, 2014

Several years ago I precepted a new grad who could not stay on task. She was intelligent and gung ho, "let me do it"but utterly disorganized. Frankly she needed to have her add meds adjusted.
In order for her to get the routine down, I made her a checklist or a to do list. Things like:
Check AML.
Report critical values.
assessment 8 - 12 - 4.
FSBS 8 -12 -4.
Daily weight.
Chart check
Read and evaluate care plan
Unit rounds at 0900.
I and O at 1800.
Clear IV pumps.
Empty foley and drains
Chart check.
Computer charges.
Restraint order and q 2 hr documentation.
It may sound juvenile but sometimes new employees a checklist need to keep them on task. They can use it at the end of the shift to make sure that all the tasks have been completed. Eventually it will become engrained. In the beginning, it can be a big help.

I use a checklist. I'm still orienting, and I'm noticing after 12 weeks, I don't have to write down some of the most common things anymore. It takes time, but a checklist is very helpful. I also welcome any and all feedback, positive or negative. For example, I was mistaken as to how often to calculate I And O on our higher level patients. I'd been calculating it every 4 hours with the assessment, and my preceptor pointed out it should have been every 2. Tell me once, show me once, duly noted and I won't make that same mistake again. Will I make others? Absolutely. Organization and attention to detail is important, and it takes time to get it all together. I feel much better about my routine now than I did the first few weeks. It just takes time.

icuRNmaggie, BSN, RN · Nov 16, 2014

Starting a new job of any kind is stressful. You are being scrutinized by doctors staff and the patients. Along with the what did I get myself into misgivings, being told you need to improve and being afraid of

killing someone, it is no wonder that new grads can be emotional and super sensitive to the remarks of others

Reminds me of Kermit the frog singing it ain't easy being green:)