New nurse not up to speed Scared they are going to fire me

[Nurse Beth, MSN]

Hi Nurse Beth,

I graduated in May 2019 with my BSN. I passed my NCLEX-RN on my first try in November with 75 questions. I did not take my NCLEX-RN right away due to moving, having some personal issues with family going on, and have extreme test anxiety.

I thought that I was going to be able to start in the bigger hospitals around where I moved to but they would not hire me due to not being a graduate at the main school in the area, not being employed for eight months, being a new graduate, and at the biggest hospital, it was because I didn't apply to their nurse residency program before I graduated. I ended up getting a lot of job offer for community hospitals that were about 45min -1hr away. I chose one that was about an hour away and similar to a size that worked at when I was a C.N.A.

I started my job at the beginning of March on a general medical-surgical unit at the hospital. I knew this was going to be challenging and that some days were going to be better than others as that is the beauty of nursing. I really wanted to work in the hospital setting and start out on med surgical unit which I am.

My preceptor is a fairly nice person but does not really explain how I can fix the issues I am having. Also, I feel that she is talking about me behind my back on how I am not catching on to things (I have been trying to ignore this and not let it bother me). Additionally, I feel that she really likes to take over certain situations. For example, when I am giving a report at the end of the shift she likes to interject what she has to say instead of letting me finish and then talking. She has done this multiple times when we are in patient rooms as well.

She has also said that I am having trouble with organization, getting a rhythm down with the day to day, talking with the doctors, and trouble with IV therapy. Do you have any tips to help me fix these issues? I am so scared they are going to fire me because I am not up to speed on where I should be and that I am too slow or that I don't have the knowledge/ critical thinking that I should have gained through school. I have had a long road getting my RN and I really want to keep this job. Any help would be greatly appreciated!!

Dear Not Up to Speed,

This is a critical time for you, and your orientation is key to your success. You have been in orientation for only a few weeks. IV skills, talking to providers, time management... if you had mastered all of these skills, there would be no need for orientation. This is a completely normal stage of development for a graduate RN.

Please lower your expectations to make them more realistic.

Your preceptor sounds like she is a fixer, not a teacher. Let me give you some thoughts and language to speak up and ask for what you need, because I'm concerned you're not getting it.

Report

Giving report is a complex skill because you have to include essential information and exclude non-essential information in a brief and succinct manner. It calls for you to interpret data, prioritize the importance of that data, and hand over important aspects of care. Basically you prepare for handoff report all day long.

Talk to your preceptor. First ask for permission/time. "I'd like to talk with you about my report skills. Is this a good time?" Go in the break room, if able, or an empty pt room.

"I'd like your feedback on how I give report"

Listen carefully and repeat back what she tells you. Consider taking notes to show your willingness to learn.

"So let me repeat back so I'm sure I caught what you said. I need to include any outstanding lab work and include the names of all the consults. Did I get that right?"

You can also ask what method she recommends for giving handoff report. What brain does she use, does she use SBAR ? Follow a systems approach? After you get her feedback, propose that she let you give report independently on 1-2 pts following her recommendations. Ask her if she would give you feedback or add information after you've finished. Giving report without being interrupted a few times will help your flow.

Strategy

The more you can get measurable goals from your preceptor the better. Build from simple to complex

Early goals:

• Passes meds within time frame
• Completes assessments
• Recognizes abnormal labs and vital signs
• Performs simple procedures (insert foley, starts IVs, passes NGT)

Later goals:

• Differentiates between urgent and non-urgent changes in condition
• Gives report independently
• Demonstrates sense of urgency when appropriate
• Manages admission and discharge
• Performs complex procedures:
• Manages CBI patient
• Manages heparin drip titration

These are just examples, not all-inclusive performance goals.

Talking behind your back should be addressed, either by talking to her directly or talking to your educator or manager. Your preceptor should be your champion.

If she talks over you in front of a patient, or corrects you in public, speak to her as soon as possible, using the "I feel ________ when you _______" tool. For example, "I feel embarrassed/shamed when you pointed out my mistake in the pt's room.

You can follow this with an ask. "Moving forward, can you call me aside outside of the pt's room?"

I hope this helps you. I'm rooting for you!

Best wishes,

Nurse Beth

Start your job search today!

[BabyCatchr, ADN, ASN, RN]

I would also add that you may want to consider asking for a different preceptor. When I was a new RN, this helped tremendously! Not all preceptors are professional or meant to teach. A hospital with a good education system should be willing to find you a match and help you feel more comfortable.