New RN who may lose her Med Surg job

[Epona]

Hi all. My preceptor has told me that I am weak in hands-on skills. I graduated with my BSN and was in the top of my class. I had no previous nursing skills before I got my RN. I was not able to do my externship because of an emergency that came up the summer before I graduated.

They have told me on my crazy busy med surg unit that I am very smart and have a great theory base, BUT, my clinical hands-on skills are lacking. They have suggested I practice on the "dumbies" in the hospital lab and "play" with the machines. They have told me that if my skills are not up to par in two weeks (when orientation is over), there is a chance they could let me go. This is very discouraging. :uhoh21: I have worked REALLY HARD for this.

What do you suggest?? Is there a book I can use as a quick reference?? I am employed there, full time, passed the drug test and all, been working fine, etc.... do you think they will just let me go?? My RN manager likes me and has told me I am smart. My preceptor thinks the same, but has noticed my frustration when I try to do the hands on. I am just lacking here. What do you think?? Can they just boot me out?? I asked if it came to that if could put me on another unit where it is not as busy, but I am not sure if they would do that OR just let me go. Oh my..... what do you suggest to help me?? I was a top student and now I may lose my job. HELP!!!!

[RedhairedNurse, BSN, RN]

I would also like to know what specifically you're lacking in? IVs, foleys? Do you ask for help a lot when performing these skills or do you try yourself first? When I first started, I would always do these things myself with very little assistance, that is, if I was confident in doing so.

[Rabid Response]

The book you want is "Perry and Potter Clinical Nursing Skills and Techniques." But it is not enough for you to read a book, no matter how good a book it is. You should take the advice you got and head to your skills lab (lucky you to have an in-hospital skills lab) WITH the book and practice the interventions at which you are weakest over and over and over again until you don't have to think about each of the steps. Let go of the fact that you were tops in your class academically. So was I, and it means NOTHING once you get to the real world.

I don't think that anyone expects you to be perfect at this point. You only need to show your preceptor and your manager that you have taken their criticism seriously and worked to make a change. They need to see that you are capable of improving. Feel grateful that you received this critique two weeks into your preceptorship, when it was still possible to put things right.

Don't waste time and energy wringing your hands! Get yourself to the skills lab!

[BackfromRetirement]

Machine operation kept me tense for a long time. Different pumps, ivacs, morphine drips, multiple programming....ugh! IV sticks on dummies isnt the same as working on an elderly patient with little to no veins. Female urethras are not always located in the obvious places. The different glucometers require different amounts of blood. Yes, there ARE times when you stick a long-time diabetics finger and no blood appears! It is so easy for older seasoned nurses to forget how clumsy and inept we felt at first. You preceptor should be more patient and understanding. You must learn to walk before you can run.

[Pepper The Cat, BSN, RN]

Let it be known that you want practice with anything.

If you hear that a nurse has to do a cathertization, ask if you can do it with her help. On my unit, if we know that someone is looking to learn knew skills we'll do all we can to help her out.

Yes - "play" with the equipment. Its the only way to get to know it. Take an IV pump that is not in use and try it out. What does this button do? What about this one?

If you don't want to try the procedure, at least ask if you can watch. You'll at least learn something that way.

[evolvingrn, BSN, RN]

You can do it!! practice, practice and its also important to display confidence...even if you don't feel it :) . Good luck.

[Calixan]

Wow, I can't believe you keep pointing out the fact that you were in the top of your class. I am still a nursing student that will be graduating next month and I'm one of the top students too but that doesn't mean jack. All that means is I some how did well on the test, possibly by studying some words that was taught, eh?! I go to clinicals and feel dumb, the nurse is talking to me and I have to ask what she is talking about. Clinicals to me are the most important but our instructors think otherwise. They say your first year of nursing is when you will learn hands on. But I feel as a student graduating in less than a month, I need to have done something in nursing school. I have never done an assessment, inserted a foley, started a successful IV, charted, changed a dressing and much more. So that being said, no books can help you, you need to practice. Forget the "I'm top of my class" crap. None of that matters.

~Sorry to be so harsh~

Good Luck!

[PetiteOpRN]

We recently had two new grads that were let go at the end of orientation. I know one of them graduated with academic honors. They were let go because they refused to learn. They came in with the belief that they already knew it all. They would blow off the preceptor when the preceptor was trying to impart vital information. It wasn't so much lack of skills, it was the belief that as GNs (or newly minted RNs) they were already experts. That attitude in incompatible with growth.

I don't know if that is even remotely related to your situation.

Before your next shift, eat a large slice of humble pie and ask specifically where you are lacking. Even if you disagree with her technique or methods, do things her way, at least for the next two weeks. After you practice the skill, ask your preceptor to reevaluate you. Then try, try again.

If you are dedicated, competent, and teachable, I can't imagine your efforts will be for naught.

[iiliana]

I agree with others here. Just practice practice practice practice! It's very important to be proficient with hand-on nursing skills because it is direct patient care. That is much more important than simply knowing all the theories. Put theory with reality. Good luck!

[bearscrubs75]

Hi there. I worked on a general medical floor for almost three years. It was/is considered the most demanding, busiest, exhausting floor in our hospital. Many of our newly minted med-surg RNs were fired or they transferred because they weren't the right fit. Med-surg nursing is physically difficult and arduous. Did you ever consider that you might be better off working on a peds or cardiac unit? Telemetry requires a more... academic approach to nursing than med-surg because you need to know how to read strips, what the different rhythms mean, the anatomy of the heart, cardiac drugs, etc. Perhaps, you're not a kinesthetic person (???) Tele patients are usually more oriented, less acute, and less hands-on than medical patients. Though you still need to know how to place a foley, start an IV, saline lock, etc., cardiac is somewhat less hands-on skills intensive than med-surg. I love telemetry and hope to be a cardiac RN when I graduate. Don't beat yourself up: if it doesn't work, find another unit that fits your skills :)

[LouisVRN, RN]

Ask for specifics of your preceptor and nurse manager. By hands on skills do they mean you do not know how to operate the equipment? IV pumps, BP cuffs, Accucheck machines etc. Or do they mean that your "hands-on" skills are lacking? You can't insert an IV, foley, wound care, etc. If the issue is with equipment, talk to the nurse educator, I'm sure they will be able to give you specifics on what you need to know for your unit. If its with hands on patient care, find out where you can go to get more practice if its not on your unit. IV sticks - outpatient procedures or ED, Foleys maybe L&D, ortho, ICU, ED, wound care follow the wound nurse. Make the effort to find out what opportunities are available to you to get more experience, everyone seems, including you, seems to agree your education is there, a book will not help you gain the confidence and experience they say you are lacking.

And yes, imho, if they are saying you have a chance of being let go because of this they mean it. Take the opportunity to rectify the situation.

[caliotter3]

Obtain a short list of specific tasks from your preceptor. Then, whenever that task comes up on the unit, you be the nurse who does it, with your preceptor watching, until you start to get these tasks marked off your "to do" list. Keep on doing this until you are told that you are up to par. You have to show interest and a willingness to do what it takes. Tell them you want a list of specifics, and tell them you want to do those tasks until you are proficient and have made the standards. Be proactive, and not by finding a book to look at. Or you won't have a job.

[oramar]

I am disappointed in them but not in you. Hands on skills come slowly to some. Everyone knows that. Even though some will not be as good as others most will get it well enough to function. Shame on them for not being more supportive. If they wanted an experienced nurse why didn't they hire one? Best of luck to you, I would take every opportunity to practice.