Novice nurse needs help with action plan

[Lunar]

I would really appreciate some input. This is the first time I'm posting so please forgive me if I'm doing it wrong. I'm a novice nurse, graduated last year and entered a 10 month orientation program at a local hospital. Novices started rotations through med-surg, tele, and then end up in home unit. My home unit is the ER and I have been there about 5 months. I was set to come off orientation and had been put on May's staffing schedule. My last week of orientation I ended up in the hosp so I was told that my orientation would be extended another week to make up for the week I missed. The last shift of that week I ran into the nurse manager and asked if I was good to go to start my own schedule the following week. She informed me that they were extending my orientation (but was not sure for how long) because they were concerned my critical thinking skills were not ready. This conversation happened in the middle of my 12 hour shift AND it was the first it had ever been mentioned to me and it had never been noted in my clinical folder. I put my big girl panties on and finished my shift. Honestly I did have a little cry in private but regained my composure and think that think I did a pretty good job. I called her back on my day off to pick up the conversation and let her know that I loved the ER, felt I had grown tremendously since I had been there, wanted to be a nurse there and would do whatever it takes. She countered with: she needed a timeframe from me on how long I thought it would take to develop my critical thinking skills and I had to write a plan and goals which are due Fri at 0700. I know I need to improve and grow but honestly feel that will come with experience. I am not making excuses for myself but have had issues with the preceptor I have had since getting on days and had been told months ago by the nurse running the orientation program that other novices had issues with this preceptor. I'm a new grad at 47 and my preceptor graduated three years ago and is 23. I hate to talk badly about her, I think she is a great nurse, but honestly don't feel she has what it takes to be a preceptor. That is not the issue I am facing now I am just extremely frustrating. What I am asking for at this point is any guidance with writing this plan. She did not give me anything to go on other than critical thinking skills. I do want to improve upon them but not quite sure how you write a plan for that. Other areas I know I need help on is delegation and confidence. I do believe part of the problem that this is stemming from is that I am the kind of person that wears her heart on her sleeve. I told my preceptor that I was going to be nervous when I came off orientation and started on my own (but I feel that is a normal fear). I just shouldn't have expressed it to her I suppose. And on one occassion last month I had my first BAT and when it was all said and done I complemented my preceptor telling her what a great learning experience it was for me that I don't know I would have known exactly what to do had I been on my own. UGH! Boy did that come back to bite me. Any suggestions for a plan?? I have a 4 week extension. Thanks for any help given. : )

[katkonk, BSN, RN]

Experience has shown me that people will perceive what they are prompted to perceive. If she has campaigned to other people that your critical thinking skills "are not ready" to the nurse manager, then likely that will keep haunting you. You will do 100 things right, then one thing will pop up and they will shake their heads and say....hmmm...see, that is what I was talking about. If there is a personality clash/generational clash, etc. between you and the preceptor, then that will be almost impossible to overcome. And there is a possiblity she is just into the power "thing", and making others look bad elevates her on some level. If you choose to stay and write the plan, etc. then I would suggest that you ask the nurse manager for another preceptor, and perhaps on an opposite shift. Tell the mgr that you want someone to be evaluating you in "the home stretch" that is new and has not worked with you from the time you were a brand new nurse. Tell them you would like the objective assessment of a new, experienced ER nurse. That nurse may have something different to say. Some people are not meant to be a preceptor, and I would question the leadership potential and mentorship ability of a 23 year old. Not to say her assessment skills and judgement are not sound, as a nurse (I am sure they are good, or she would not have been chosen as a preceptor), but mentoring is something different entirely. ER is incredibly demanding and really a tough place to start for a new grad. It can be done, but it is a very hard path. You could also choose to back off the intensity of the ER and opt to go to an ICU or step-down unit, or a chest pain unit that will use your skills that you have learned so far. If you choose to write the plan, get the job description from HR and make a plan to address each part of the job description-give specific examples of what you will do to address each item. And you will need to know what about your "critical thinking skills" is lacking. Is there something in particular? That is a very broad statement. Also, most of all, be honest with yourself. Are you really cut out to be an ER nurse? Are your skills really good enough?? Because people's lives are going to be in your hands, and knowing whether you need to do something and what that something is may make the difference between a poor and a good outcome. Take a step back and look as if you were looking in from the outside....If you are not REALLY an ER nurse... if you would not want YOU to be treating your mother (I know that sounds funny, but it is an effective way to look at the situation) admit it now and change units. I wish you luck, no matter which way the situation goes.

[CaLLaCoDe, BSN, RN]

I think that it is a little tenuous to ask for another preceptor. You might be viewed as weak.

I wonder what precisely the manager and preceptor mean by your not meeting the critical thinking standards of the department. Where are you lacking? Is there a specific incident, which you may or may not be aware of, you or your preceptor can point to where you can make improvements? You also may need to know the specific criteria needed for improvement in order for you to write up a successful plan.

Let us know how it goes please.

I have had work where I showed that I was not happy with my preceptor, for her lack of experience, and I payed a price of losing my job. Be careful. Sometimes one needs to treat a preceptor as one would a nursing instructor, very cautiously and avoid stirring up prejudice by voicing criticism to the manager; who might have chosen this very preceptor to see how you would handle things.

[CranberryMuffin]

Saying that you need a plan to develop your critical thinking skills is way too broad. Could you go back and get further clarification about specific tasks that you need to improve on? Otherwise, it sounds like they are setting you up to fail. If they are unable to suggest specific, concrete goals, then it sounds like their claims are pretty baseless.

[katkonk, BSN, RN]

Wondering, original poster, what eventually happened?

[Lunar]

Hey! Thanks for asking. I finished out the month with two other preceptors that gave me rave reviews and I am now on my own and absolutely loving it! : ) I think back to that initial talk with the manager and I was so devastated because there had been no indication. I went into quite the panic as you could see from my posts here. I don't mind sharing that I shed a tear or two in the privacy on my own home. lol It seemed like the end of the world to me. But I stuck it out and was determined to prove that little &*$(# wrong. lol I'm soooo happy now and love being on my own. I continue to learn everyday and absolutely love it! Thanks again for asking, and again, thanks for all the advice and encouragement and support from everyone. : )