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New RN Grad Need Guidance Please :()

First Year   (3,841 Views 33 Comments)
by NewICUNurse93 NewICUNurse93 (New Member) New Member

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DextersDisciple has 5 years experience.

3,372 Visitors; 220 Posts

Okay a few things that stood out to me:

-preceptor not giving you real-time feedback and as a result feeling blindsided when your called into the mngers office

I absolutely hate that and understand your frustration. In an effort to do your best To fix this- ask your preceptor to give you feedback when they see something that need to work on/do differently. If they don't, at least you know you tried on your end.

-task oriented is expected but not necessarily correct

I agree that new nurses are very task oriented. The critical thinking comes with time and lots Of it. I still need to Focus more on critical thinking skills and a little less on tasks. But again this is expected from a new nurse and will change over time.

-8 week orientation is BS

most I've seen, including my own, are 12 weeks. You should not feel so confident and getting out on time within 5/6 weeks in an ICU as a new grad. I know I was still scared crapless of being on my own after 12 weeks.

-humility and respect are key as a new nurse

Over Confidence in a new grad can quite frankly really worry preceptors. They WANT You to ask *appropriate questions (ie things you have already tried looking up first Or can be easily Looked up, not asking the same questions Over and over). They don't expect you to know it all and it is NOT good if you feel competent this early.

Lots of sage advice throughout the thread that I hope you take. It sounds like your

Unit Orientation may be flawed but you also need to work on improving on you. If they still aren't satisfied then at least you know you tried your best. Good luck with everything and keep us posted!

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2 Followers; 5,683 Visitors; 952 Posts

I read your post twice and couldn't find any real specifics about what you are doing wrong. 2/5 is a failing grade. I think it is very odd that one of your preceptors gave you a 4/5 at first, then dropped you to a 1.5/5 without saying a word about it. What was the big change?

Were there any negative pt outcomes due to your inadequate assessments?

From my perspective, there is probably an element of new grad harassment, possibly bullying, and some type of interpersonal conflict at play here.

Keep an open mind, and there will always be more to learn, but I doubt this problem is entirely on you.

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241 Visitors; 6 Posts

Thank you I really felt this post was a balanced reply. And I've been super open and honest about wanting to be a team player and loving critic it just whenever I'm not doing something exactly how my current preceptor likes she writes it down and just bashes me when it's like I should be allowed to made simple mistakes here and there while on orientation it's not like I killed someone... she told me she gave a whole bottle versed once to a patient and almost killed them on her orientation 10 years ago... like I haven't done anything close to that most of my mistakes are charting descriptions/admitting patients that super critical those are my weak points and I've told them that but it seems like the expectation is to be perfect coming off 8 weeks

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241 Visitors; 6 Posts

I will admit there was one day was not so go good was definitely a humbling day having two patients with no report from previous nurse one was bleeding out (new adm.) and the other is trying to actively extubate himself.. I was probably all over the place since my preceptor was the first one 1-4 weeks and he was like you got em let me know if you need help... but that was weeks ago and my really bad day (I felt overwhelmed by it and owned up to it later) that I was like woah I need to really learn from this.. otherwise I feel like I've been doing really well with Assessment, careplans, communicating with our team, helping neighbors, meds, and labs... I'm weak on admitting patients an hour and half before my shift ends (it freaks me out but not because I have to stay late but because I don't look like an employee running the clock) like it's soo much and I need help in that area but it seems they believe I should be making vast improvements when they said my first 4 weeks won't count because we have no idea where you actually are.. now 2 weeks later I'm being told by my preceptor you aren't ever doing stuff right.. yet my assessments/orders/meds/prodcedures are on time and I'm always asking questions and open to criticism, even though I've barely at all been praised for what I am doing right

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2 Followers; 5,683 Visitors; 952 Posts

It is probably too much to expect that most new grads would be successful in this type of very acute situation.

Hopefully you can move on to a lower acuity position.

There is a lot of cattiness and passive aggression in nursing.

The preceptor was failing you, but never said a word. Passive aggression.

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2,113 Visitors; 94 Posts

As a fairly new grad (8 months in) I am working in PCU, I had 12 weeks of unit orientation, I couldn't imagine doing 8 weeks. I also was always asking questions about things I was unfamiliar with. I didn't just ask my preceptor, I would ask my co-workers as well. I would ask about certain tasks I performed only once, or just to ensure my train of thought was correct re. certain things. I sometimes didn't sit down until 1am to start charting. Other times it was before midnight. Sometimes meds are late, but not so much, and hour maybe. But that was because I had to focus on other aspects of care that required my attention. There are some things that are higher on the totem pole, and I learned quickly that charting is not one of them. I hope things look up for you and there is a chance for you to transfer to a lower acuity unit.

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1 Follower; 11,065 Visitors; 449 Posts

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.

This is very good advice.

I would only add, what another poster has already stated: Be prepared to resign, and seek another position.

You are not an outlier.

Your experience is common.

Good luck.

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Ruby Vee has 40 years experience as a BSN.

11 Followers; 64 Articles; 169,011 Visitors; 13,793 Posts

Hello everyone!

My orientation has been weird, I've had 5 preceptors during 6 weeks. 4 weeks were with just one preceptor and this guy gave me high marks on my weekly evaluation. 1st week 4/5 in all categories..2nd week 4/5... so he doesn't fill in my 3rd week or 4th week until I start my 5th week told me "I'll sign it when I get a chance etc" I figured no problem, I've been doing good we were cool its just a checklist, patient care 1st right?..

I come in my 5th week and I get called into my managers office to evaluate my performance, so I come in there and find out my 3rd and 4th week we're both 1.5/5!!! Like where did this come from? I haven't killed anyone, meds in time, labs on time, never leave late for charting, my charting is decent (charting is difficult when balancing patient care depending on the level of acuity for the day especially as a new grad most of my questions were about charting/policy) so basically we have an hour and half long meeting talking about mistakes I've made (what the ****?!!)...

I'm clueless that I was even making all these mistakes because my preceptor never said a word to me. Then I have to read a sheet of paper basically saying if I don't improve/show signs of improvement by the end of orientation I'll be terminated.....I was mind blown about the whole thing, and to be honest which is typical to say as a new grad but I felt I was doing really well considering I was by myself most of weeks 2-3-4, meaning unable to find my preceptor at all and directing patient care, but I made mistakes here and there I didn't always have a resource (preceptor) always available but I try to figure **** out myself or ask someone else..

So I mention this to my manager that these evaluations are a surprise to me because he hasn't said a word to me, and I feel like I've been caring for patients without him even around to ask questions.. so long story short my manager probably thinks I'm an idiot after that meeting.. we swap my preceptor out with someone else. Guess who? The woman who made a new grad who went through orientation with me quit on her second day during lunch and just never came back (btw she precepted there).... But I buckle down work twice as hard, because I felt I had to change my managers mind after that crap.

So I start my 5th week had two preceptors the woman who made someone cry/quit and another girl. The other girl really liked me even went by the manager office to put in a good word for me because she knew of my situation and we have a busy good day, so we got along great. The woman who made a new grad quit was decent to me but really surprised me when she rated me so low on my 5th evaluation 2.8/5 I had her for 2/3 days for my 5th week so she got my weekly evaluation over the over girl.

Fast forward she gives me 2/5 for my 6th week.. says I don't assess my patients correctly told me to check the monitor and check residuals before completing my initial head to toe Assessment (what the..**** is she talking about??) anyways we had a almost two hour conversation where I had to defend myself and my right to work there even after all my tasks and meds were completed on time that day she in her own way tells me that maybe this isn't the right place for me at the end of conversation. To which I just thank her for her opinion but say I'm completely committed to proving I'm a good fit and I want all the feedback I can get..blah blah was probably what she thought when I said that but it's true I'd really like to be given more direction to do well it is a morning position I'd even do nights if I had too. Supposedly nights are a "different beast" but I've heard it calm and they aren't as clicky as the morning crew ( only a few come to mind)

!

Replacing preceptors isn't uncommon when a new grad is struggling. Perhaps the new grad can learn more from a preceptor with a different style. Or, perhaps the new preceptor is to assess the new grad to determine whether she is having the same problems that the original preceptor noticed. Replacing one preceptor with two (or even several) is also common. Your schedule was no doubt worked out in advance on the assumption that you'd be with your original preceptor. Rather than switching your schedule after it's already been published, or changing the preceptor's schedule, it may take two or more preceptors to cover the days you're working.

I find it problematic that you just assumed that you were "doing well" and went about your business without your preceptor. That's one of the scariest things I've ever heard! If you couldn't find your preceptor, you should have been asking someone else for help. It's OK to try to figure things out on your own -- hopefully you're looking up policies and procedures, medication doses and side effects rather than just winging it -- but it is not OK to function on your own without a preceptor. That reflects overconfidence that is truly a frightening thing, especially in a new grad.

As an experienced preceptor, I am wondering whether your preceptor actually failed to ever discuss your mistakes with you or whether he did it in such a low key manner that you failed to comprehend the negative feedback. I've seen more than one new grad be counseled over and over about the same fundamental mistakes -- and even sign an improvement plan -- but later insist that "no one ever told me it was a problem." Again, that's where replacement preceptors come in.

And here's another thought: there is no way you should be "clueless about all of the mistakes because the preceptor never said a word to me." You should be learning from your mistakes, even without the preceptor saying anything to you. Now some of those mistakes you might not be realizing that you're making -- but surely you've realized that you forgot to listen to heart sounds when you're documenting your assessment. You must have gotten a clue that you turned the stopcock the wrong way when drawing blood by the mess that you made. You should be noticing things that you've forgotten, or that didn't work well, and correcting them yourself, not blithely assuming that if no one took you to task for it, you were doing OK.

Your characterization of one of your preceptors as "the one that made the girl cry and quit" speaks volumes to how much you respect her knowledge, experience and feedback. Or don't respect her. Since you weren't present during the incident in question (you weren't, were you?) you don't know anything about what really happened. All you know is the gossip, and you seem to be assuming that it's completely factual. Gossip rarely is. It is entirely possible that the other orientee made an egregious error, that she made a big error and quit because she couldn't handle negative feedback, that she mistakenly took correction for "bullying" or any one of a hundred other scenarios that the preceptor handled correctly. You apparently entered into the precepting arrangement with her expecting her to "cut you some slack" regarding all of your previous mistakes without being willing to extend her the courtesy.

The negative feedback that you do remember (or admit to remembering) you discount as "what the **** is she talking about?". This makes me think that you're so convinced that you're doing well that you don't pay attention to the feedback you're getting. And that you are disrespectful to preceptors.

At this point, I think the best way to save your job is to ask to go to a less acute area. Then transfer with a good attitude, determination to internalize negative feedback and use it to improve your practice, and improved communication skills. I know this isn't what you wanted to hear. I'm sorry. I wish you luck.

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DowntheRiver has 5 years experience and works as a Registered Nurse.

13,480 Visitors; 839 Posts

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.

Couldn't have said it better myself. I second this advice. Find out where you stand and go from there.

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Have Nurse has 25 years experience and works as a A.D.O.N..

15 Articles; 7,721 Visitors; 713 Posts

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.

I agree.

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Kallie3006 has 6 years experience as a ADN and works as a Jack of all trades, master of none.

5,013 Visitors; 359 Posts

I don't understand the expectations that the unit is expecting from a new grad RN on an ICU unit with only an 8 wk orientation. That's 24 shifts, you are supposed to be competent and ready to care for critically ill patient's solo in 24 shifts? If your account of the preceptor experience is true, I also don't agree with not giving feedback after each shift. How are you supposed to learn from the mistakes made, or make the improvement needed to be successful, with out guidance?

When checking monitors and feeding residuals you are also completing an assessment on your patient at that time, and one that could easily transition to your head to toe.

I would be cautious when speaking of your co-workers and preceptors, as the way you worded it in your original post, comes across to me as disrespectful, although I could be reading it different than your intent to come across.

Transitioning from student to nurse is not an easy task, questions need to be asked without fear of recourse, clarification is a normal part of the learning process, and communication between orientee, preceptor and manager needs to be open.

I would much rather have an orientee ask me the same question 5 times, then have that same orientee decide that they were going to figure it out on their own. I also do not agree with the preceptor telling you that you have got this and then becoming MIA.

Do you feel as if the orientation that you have received has been sufficient enough for you to be able to take those same patients safely on your own? This is also something that you need to think about, if you are not getting the feedback that you need to grow from a new nurse to a competent nurse, or if you feel like your preceptors have not been teaching you and in fact left you to "fend for yourself", will you be willing to risk the patient's lives and your license for the sake of wanting to stay in the ICU, if you are not able to salvage or extend the last weeks of your orientation?

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