New RN Grad Need Guidance Please :()

beekee · Oct 20, 2018

In your next meeting with your manager, ask if you can transfer to a lower acuity floor (med surg). If no, be prepared to resign. I'd start applying now, as it's always easier to get a job when you have a job.

You seem overly focused on "tasks" and "administering medications on time." It also doesn't sound like you are really hearing where you are failing. I get the feeling that you keep doing the same thing, despite guidance otherwise.

I can't really evaluate whether your preceptors' treatment has been justified, but if you had three preceptors and two felt you weren't up to it, well, it sounds like this just isn't where you should be right now. However, it doesn't mean it won't be right later, after some experience elsewhere first.

Good luck. Keep us posted.

NewICUNurse93 · Oct 20, 2018

Ok I'll bite.. what exactly do you mean? The patients are acute but I had orders/daily plan of care that has to followed along with assessments every 4hrs and meds give or take every 3 plus labs which can be any time frame.. are you saying I shouldn't be task orientied? And more? Please clarify to help me out.. also should I ask for a night position? I don't want medsurg I worked as a tech before hand I really just want ICU

EDNURSE20, BSN · Oct 20, 2018

Right so first you are being way to defensive.

When I first started as a nurse I got some bad feedback. Mainly about not being a team player and my documentation. It was heart breaking. I totally cried when I was meeting with my boss, and I'm not normally a crier at all. I felt like I was doing a good job, and suddenly I felt I was a bad nurse who no one wanted to work with.

It was really hard time, and I really had to go over and above to prove to people I'm good at my job and can be a team player. But I learnt from it. I took the Feedback on board. I was more aware of what I was doing wrong, which meant I could change what I was doing. And I learnt to ask for help.

Instead of being angry and thinking I knew it all, I ask staff what can I do? I need help with this. Admitting you were wrong and putting in the effort is what's got me to where I am today. Reputation fixed. Enjoying my job more than ever. Full of confidence.

So while you are still there, ask for help. Talk to your boss and preceptor. Know what your weakness are. There's no need to be denfensive here. They've been talking to you early on and given you a chance to improve. Thinking that you doing well, or that this preceptor is bad, Or that just because your 'cool' with someone that you will automatically get a good mark ect is not going to end well.

Take the chance to prove yourself. It's hard for all new nurses, no matter where you work. We all have things we need to work on. Don't take it personally. And if you don't feel like it's a good fit, reach out to that person and see if you can move else where. But expect it to be any easier if you move.

EDNURSE20, BSN · Oct 20, 2018

are you saying I shouldn't be task orientied? And more? Please clarify to help me out..

no. Never task focus. It's always person centred care where ever you work. You have to see the pt as a whole and not just focus on your tasks.

Also med surg isn't that bad.

Also people are trying to help. You can't keep being defensive.

beekee · Oct 20, 2018

I'm not there, so I'm only really guessing. Yes, you seem too task oriented. For every medication, you need to know why it's been ordered, what to watch for and it's desired effect. On time is nice, but I'd rather see you think through why you are giving a med.

So, for a common medication like lasix...what are the labs? Did you check the BUN, liver enzymes and electrolytes? What's the blood pressure? If it's running low, do you want to lower it more? What does your assessment tell you? Is the patient fluid overloaded or are they euvolemic or even dry? Is it appropriate to give?

After you give it, what was their urine output? We had a new grad not notice that the patient did not void for an entire shift after getting IV lasix. What's the fluid status post administration? And adverse reactions to the medications?

Nights are not necessarily easier. Less staff around, so if you run into a problem, you better be pretty confident in your skills to address them. When you are meeting with your manager, it can't hurt to try at this point. You really have nothing to lose.

JKL33 · Oct 20, 2018

I'll give you this much: 8 weeks is a BS expectation for a new-grad trauma ICU orientation. I think it is complete crap to not give regular verbal feedback during orientation and maintain a written progress record. It makes me crazy to hear of experiences where orientees are not given appropriate feedback and then are ambushed with it when it's too late to do anything about it. I'm guessing there's a decent chance a couple of these people do suck, completely separate from the success or lack of success on the part of any particular new grad.

I'm also pretty sure all of that is irrelevant as far as you moving forward. Go to your current manager and calmly/professionally ask whether there is still a realistic a chance for you to complete the orientation and how you can get to that point. If they don't give you a very reassuring answer, consider asking whether it would be appropriate for you to request assistance in finding another unit/floor that may be a better fit. If they agree to help you with this, take the new position. If they say they can't or won't,thank them for this learning experience and (be prepared to) tender your resignation.

Also NewICUNurse, I'm sure this has been very stressful, but now that you have it off your chest it would be best to take a deep breath and bring things down about 10 notches if at all possible. :) You asked for suggestions - my best guess is your communication style is in play here and also possibly difficulty focusing on what's important/big picture. Regardless of outcome, you're going to have to privately take an introspective inventory of what has happened here. For now, stay calm and professional so that you have the best chance of moving forward.

Sorry to hear of your experience.

allnurses Guide · Oct 20, 2018

Two things that are very common with new grads:

1) They often do not do well going right into ICU.

2) They often "do not know what they do not know"

There's nothing wrong with doing something a bit less acute like Med Surge

for a while, and then trying ICU again. Nothing at all. You sound young.

You have nothing but time to learn.

You also sound very confident. Maybe a little bit too much so.

Again, it sounds like you have a lot to learn. Your preceptors are

likely not giving you low marks because they don't like you, or

are trying to give you a hard time. You aren't asking questions.

You basically said yourself, you are trying to figure stuff out on

your own. You can't find your preceptor? Ask someone else.

Good luck. You'll be okay.

LovingLife123 · Oct 20, 2018

When they say you aren't assessing well, what does that mean? Are you missing things, or just not putting together what you are assessing into the big picture? Are you not taking action on your assessments?

It's common for new grads to be task oriented. It can be hard to get them out if that mindset. It also takes time. 8 weeks is not a very long orientation. 12-16 in a level one trauma icu is more ideal.

I agree that instead of getting defensive, you need to really listen and take to heart what you are being told and work on those things. I would want to know what exactly is going wrong with my assessments and what can I do to improve. I would be calling my preceptor in after my initial assessment and see if they agree with my assessment.

Do not worry about whether or not you should be getting out "on time" with your charting. It surprised me that only 6 weeks in, you are getting out on time. You should be having days that you feel like you are drowning and the last thing on your mind is charting. That leads me to believe you are missing things on assessments. Or you are seeing things, but not acting on them.

Have you had any of the sicker trauma patients yet? What kind of trauma patients have you been getting?

AnnieOaklyRN, BSN, RN, EMT-P · Oct 20, 2018

I honestly didn't read your whole post, as it is longer then my attention span. My thinking is talk to your manager about extending your orientation and just having 1-2 preceptors, NOT 5!! The problem with having numerous preceptors is that you never get anywhere with your learning because you are always starting over, or starting beyond where you were with the last preceptor. Just my 2 cents!

Annie

Triddin · Oct 20, 2018

I'm not there, so I'm only really guessing. Yes, you seem too task oriented. For every medication, you need to know why it's been ordered, what to watch for and it's desired effect. On time is nice, but I'd rather see you think through why you are giving a med.
So, for a common medication like lasix...what are the labs? Did you check the BUN, liver enzymes and electrolytes? What's the blood pressure? If it's running low, do you want to lower it more? What does your assessment tell you? Is the patient fluid overloaded or are they euvolemic or even dry? Is it appropriate to give?
After you give it, what was their urine output? We had a new grad not notice that the patient did not void for an entire shift after getting IV lasix. What's the fluid status post administration? And adverse reactions to the medications?
Nights are not necessarily easier. Less staff around, so if you run into a problem, you better be pretty confident in your skills to address them. When you are meeting with your manager, it can't hurt to try at this point. You really have nothing to lose.

I agree with this. Again, with only what you've said, we are guessing at what's going on. However, I know when I'm learning a new task, I'm initially focussed on the mechanics of how to do things and my critical thinking isn't there because I haven't had time to develop it. However, you can bet I'm asking questions to make sure I don't miss anything.

However, to be like that in ICU for everything is dangerous because you don't know what you don't know. You need to be able to evaluate of orders are still relevant for your patients, what's happening based off your assessment and labs.

New grads arents allowed in ICU where I am and as someone who transferred from med surg to ICU, there is value in having time to learn how to be a nurse, do skills and start thinking critically without the added pressure of having a patient who could die who is on extra machines. It's just an additional burden on top of an already steep learning curve..

I would say nights are equally busy in ICU but you have less staff to support you. i agree asking if you can step down to a lower acuity unit may prevent you from being fired and will give you a second chance at staying at the hospital you really enjoy.

NewICUNurse93 · Oct 20, 2018

I felt like whenever I asked questions they'd write it down and use it against me in our weekly meetings like he ask for clarification about this and he's done it once before etc so I kinda got to a point I'd ask something they spend 30mins talking about it and I'll get super behind and they said why was I behind on meds/task or documentation plus he didn't understand blank blank task and asked for clarification after being told once before... like something it's not that I don't understand it that I want to have my preceptor reaffirm what I knew just to ensure since I'd only done it once before