New RN who may lose her Med Surg job

tewdles, RN · Jun 28, 2010

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!!!!

My guess is that OP knows what specific skills are in question. Most hospitals have an orientation skills checklist which must be completed to satisfaction. At the risk of sounding harsh I will comment that apparently you skated out of the clinical requirements for your BSN and your school graduated you anyway and NOW you are scared.

You must come to grips with the reality that a good fundamental nursing theory knowledge base is important but is only a part of what it takes to be a competent and safe nurse. New grad nurses MUST be able to provide basic nursing skills. YOU must now jump through some hoops to demonstrate that not only are you smart...but you are also motivated enough to complete the clinical requirements of your BSN. If you need to know how to do a procedure and want a quick reference....use your employers procedure manual. Do not rest on the knowledge that you are "smart" but some things got in the way of your "externship"...YOU are responsible to replace that externship with other clinical exposure. If you are not properly motivated you will lose your job....as a manager I would certainly cut you loose if you did not show adequate progress in basic skill requirements during orientation.

As you said, you work on a crazy/busy med surg floor. Surely you understand that there is a limit to how long a person may stay in "orientation" mode. You must pick up your pace of "learning" and demonstrate to your employer that you are serious about getting your skills in line with the minimum expectations for your employment.

If you are not able to master the necessary skills to stay in this job you will have to consider another avenue...perhaps another place to start your nursing career besides a skill intensive busy med/surg floor.

As a young nurse I worked in a regional hospital which hired nurses from 3 primary educators...one was a BSN program, one was an ADN program, and the other was a diploma program that was on its last legs. The diploma graduates had thousands of hours of clinical exposure prior to graduation, theory not so much. The ADN program had almost 1800 clinical hours required for graduation. The BSN graduates had fewer than 1000 clinical hours required (about 800). There was no mystery as to which GNs did better clinically, which ones required more support, and which ones would likely pursue non bedside career choices. As a manager of a PICU, I knew that if I hired the new GN from the ADN program s/he would likely require normal to minimal supervision during orientation and would become quickly comfortable with the advanced skills in the PICU. I knew that the BSN would be more hesitant and require more time with the preceptor. I knew that most of the diploma grads would not likely be a good fit because they were often not academically driven enough to maintain the ongoing education necessary in that environment. Of course these are generalities and there were exceptions in all levels of education, but, by and large this was my experience over a long period of time managing a busy PICU.

You have gotten some good advice...but now it is really all up to you. You cannot fix this by reading a book. You must perform the skills and demonstrate that you are capable of becoming a functional and valuable member of the units nursing team. You must get over your anxiety about DOING, guessing that you have a bit. As you said, you are smart...so start connecting the dots between your theory and your practicum...that is what it means to be a nurse.

DayDreamin ER CRNP · Jun 28, 2010

Ok, stop for a minute and think about what you just said. They are telling you that you are lacking in "HANDS ON" clinical skills. Then you ask if there is a book you can read to learn. Hands on skill is only obtained by hands on experience. How are you going to improve with a book?
Are they giving you any specific skill you are lacking in? Do you need practice in IV, dressing changes, etc? How long of an orientation did they give you?

I totally agree. No book or video in the world will help you with any hands on skills. You need to practice and build muscle memory. Words can't translate to a realistic situation where veins roll and blow.

A person wanting to learn how to play tennis can read all the books in the world but will never win a match. Putting a racquet in her hand and training will make her a better player. It is all about getting a feel and perfecting a skill.

I would ask your manager which skills you are specifically weak on and take those and practice on the dummies like they suggest. Ask someone to go with you if you have to and walk you through step by step until you perfect that task. Take advantage of every learning opportunity on your unit. Everyone has a style or technique that works for her. Ask different nurses if they have the time and are willing to show you and help you learn. It does sound a little bit like you are also lacking in self confidence. You have a choice here - either give up or put your big girl panties on and do what you have to do to be successful.

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Simply Complicated · Jun 28, 2010

I would start looking for another job and resign.I'm sorry to tell you but in their eyes you always be the black sheep.Do yourself a favor and find a better learning envinronment.Skills take time...The more you do it the more it becomes easier.I'm a home health nurse,I just started my job and I never did finger sticks during my nursing school days and I have been practicing on myself,my boyfriend,the first couple of times I couldnt figure it out how to correctly drop a sample of blood on a strip and and I used to get an error message on my machine.It was driving me insane since soon I was to start my work and was expected to check pt's blood sugar,but eventually I learned how to correctly apply the blood to the strip and when the time came to finger stick my first patient I did it the first time.But even though I learned the correct method I still sometimes make mistakes and cant get a blood sugar check on a pt,it happens to everyone one.So please find yourself a more tolerant envinronment.

I have to disagree. As a new nurse, I think it's important to take what they say to heart and work on improving those skills. Some places may always look down on her, but that doesn't mean all will. She doesn't say how long of an orientation she has had. Is she at the end of a 6 month orientation, and is stil struggling? They could have very valid concerns, and without knowing the whole story, it is a bit premature to automatically jump to "you should find a new place and quit"

If after doing the work they ask, improving her skills, and she they have unrealistic expectations, then yes she should look for a new job. But how is one to ever learn and improve if they just get a new job everytime the one they have says they are somehow lacking? That won't solve the problem, only delay it for a while.

RNKel, ASN, RN · Jun 28, 2010

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!

WOW... you're graduating in a month and haven't done those things????? :eek:

Ozzybear · Jun 28, 2010

WOW... you're graduating in a month and haven't done those things?????

I was thinking the same thing! Yikes!

SunSurfRN · Jun 28, 2010

I was thinking the same thing! Yikes!

Some hospitals won't allow students to do these sorts of things...believe it or not.

Calixan · Jun 28, 2010

Yeah, unfortunately. Last semester we started clinicals late, we always leave early, and when I am at the hospital, there are no meds to be passed or anything to do really. So our clinical instructor lets us leave after 3 hours. I personally disagree with us leaving early all the time because I don't know squat! At least I feel that way sometimes. But it keeps getting stressed to us that we will learn once we start working. It's a shame really but fortunately for me, I work as a nurse extern and have done foleys and in and out caths at work. Never done it at clinicals for school so technically I have not been checked off on it yet. I feel bad for the students who have no medical experience at all. They are the ones who will really suffer.

DeLana_RN, BSN, RN · Jun 28, 2010

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.

Totally agree. It sounds that this is not a supportive environment at all. And the fact that they even mentioned that they might have to let you go is a very red flag (often, they will just do it without any warning; but if they give a warning... I would expect it).

Skills require practice and repetition, lots and lots of it. Two weeks under this kind of pressure... I don't know. And the skills lab can only teach you so much (with a meatus as big as a quarter, anyone can start a Foley However, I don't want to sound too negative and "all is lost". Perhaps they really just want to see you take the initiative to improve your skills. You could tell your preceptor, "Why don't you chart the assessments on our patients today (I assume you share them?) while I start every IV, do every Foley, change every dressing on the Unit today?" Then it's up to her.

I wish you the best (trust me, I understand completely. I'm also a nurse who has always taken longer to learn the "hands on" part of nursing. But guess what - with time, understanding and a supportive environment I eventually have mastered the particular skill).

DeLana

Charmander · Jun 28, 2010

Also... when you go to the simlab, take a list of those skills that you need to work on- (Pump management, IV insertion, foleys, assessments... what ever... ), the policy and procedure for that skill, and work with a preceptor or one of the educators. Go thru each skill with the p&p, practice several times, get feedback from the preceptor, hints, tips... do it until you're comfortable. Document everything. Excel spreadsheet with checks for how many times you have reviewed this.... and have the preceptor initial and provide written feedback. Be very proactive in your education.... these skills are an individual responsibility...

May sound excessive, but if they are thinking of letting you go, this shows them how much you really want this job (especially since this will most likely be off the clock). You've been told what to work on, so get started right away. Also shows you take feedback and apply it to your practice. They will probably take a copy and stick it in your file. Who knows... you may be helping to develop a new-grad development program???

Good luck-

FLmomof5 · Jun 28, 2010

WOW! I would be scared to death to get a job if I graduated from that school!!!!

I graduate in Aug. I have done IVs, SQs, IMs, blood draws, PICC line dressing changes, dressing changes on level 4 decubitus ulcer, foley, straight cath, hooking up 12 lead EKGs, read EKG strips (my current clinical is on a tele floor), med pass (including taking the necessary meds out of the pixis system after the RN logged in), admit, document, discharge, assessments....etc...and of course, clean ups from code browns and daily bed baths, linen changes...

How any program can be accredited without extensive clinical experience is beyond me!

Up2nogood RN, RN · Jun 28, 2010

Yeah, unfortunately. Last semester we started clinicals late, we always leave early, and when I am at the hospital, there are no meds to be passed or anything to do really. So our clinical instructor lets us leave after 3 hours. I personally disagree with us leaving early all the time because I don't know squat! At least I feel that way sometimes. But it keeps getting stressed to us that we will learn once we start working. It's a shame really but fortunately for me, I work as a nurse extern and have done foleys and in and out caths at work. Never done it at clinicals for school so technically I have not been checked off on it yet. I feel bad for the students who have no medical experience at all. They are the ones who will really suffer.

Someone really needs to step up and report this to someone or something. Heads would roll if I was attending this school. You're PAYING for your clinical time and getting a half a##Ed education!

Up2nogood RN, RN · Jun 28, 2010

I would start looking for another job and resign.I'm sorry to tell you but in their eyes you always be the black sheep.Do yourself a favor and find a better learning envinronment.Skills take time...The more you do it the more it becomes easier.I'm a home health nurse,I just started my job and I never did finger sticks during my nursing school days and I have been practicing on myself,my boyfriend,the first couple of times I couldnt figure it out how to correctly drop a sample of blood on a strip and and I used to get an error message on my machine.It was driving me insane since soon I was to start my work and was expected to check pt's blood sugar,but eventually I learned how to correctly apply the blood to the strip and when the time came to finger stick my first patient I did it the first time.But even though I learned the correct method I still sometimes make mistakes and cant get a blood sugar check on a pt,it happens to everyone one.So please find yourself a more tolerant envinronment.

I totally disagree. As you well know jobs aren't growing on trees out there. It doesn't sound like the OP works in an intolerant environment, it sounds like they're trying to help her be a proficient nurse not to just give up.

To the OP, it sounds like you just need to work a little harder since you missed some valuable clinical time. Find out the specific skills your lacking in and practice, practice, practice. Just like riding a bike.