Overwhelmed in Preceptorship

[RowRN_8855]

Hi everyone,

I am very overwhelmed with my ICU preceptorship. I have had a few shifts on the floor so far, but today was my first day taking a patient and doing pretty much all the care/charting myself. I have been doing pediatric and obstetric clinicals for the past year so I am trying to be understanding with myself, but I am very overwhelmed. My nurse has been a nurse for 30 years and is the veteran on the floor; while she has a ton of knowledge, I feel stupid asking her simple questions that I feel like I should know the answer to, but have just been off the floor for so long that I don't remember how to do. I am also struggling with getting everything done while charting everything at the same time. What if I make a mistake or miss something important for my patient, like a lab draw or med administration, because I am so busy? My nurse expects me to be able to keep up with all that demand, but I am just feeling very overwhelmed and running around constantly. Any advice would be appreciated. 

[JKL33]

So just to clarify this is a student rotation, correct (not a new grad position)?

If so, your nurse should be sticking fairly close by (instruction and close follow up, touching base frequently, in-person observation as appropriate, giving guidance, etc). I don't agree with the "throwing in the deep end and letting them swim" approach for new grad nurses in their first job and IMO it is even more unacceptable when working with students. As in negligence-level unacceptable.

 

9 hours ago, RowRN_8855 said:

I feel stupid asking her simple questions that I feel like I should know the answer to, but have just been off the floor for so long that I don't remember how to do.

Now isn't the time for that. If you can't quickly consult a resource of your own in order to remember something, you need to ask. And not feel any particular way about. That is what you need to do, period. I mean this kindly: It doesn't matter how it makes you feel. KWIM? You are there for the patient. So be proactive and pleasantly assertive. NOT self-deprecating.

You need to find a way, rather quickly, to work more closely with your preceptor. This gig here isn't about you doing half the nurse's work so the nurse doesn't have as much to do. This is your last student opportunity to learn with someone who is supposed to be guiding you.

If your nurse really does expect you to keep up with all the demand of taking care of an ICU patient, that is a problem.

Try to work on your rapport with this nurse, pronto. Don't make any assumptions about her. Instead, find out who she really is and how you can work together with her.

At the very least, involve her in what you are doing. Do not approach this as just being afraid and assuming what your nurse wants to see and then going off on your own to try to prove yourself without using the resource with whom you have been paired.

Time to buckle down. Stand up tall, be pleasant, make good eye contact and interact with your preceptor on a professional level.

If you really feel like a fish out of water then you need to tell her pronto.

You can do this. ??

[Hannahbanana, BSN, MSN]

We have all been there, even your preceptor. Try some of these:

"When you were new in ICU, how did it feel?"

"How did you learn to organize your time and make it all fall together?"

"Can you give me a moment before we start to give me some feedback on my priorities for this patient for this morning?"

"Thank you. I really appreciated it when you ..."

8 hours ago, JKL33 said:

Stand up tall, be pleasant, make good eye contact and interact with your preceptor on a professional level.

Yep. Part of your preceptorship is to begin to learn the nursing professional role, which is so much more than how to do the tasks and assessments. Being a team member, asking for/giving help. seeing when somebody else is stressed, seeing unit priorities -- you're not going to be able to do those all now, but it's part of the clinical preceptorship anyway, even if it's not explicitly stated in the syllabus.

 

[NICU Guy, BSN, RN]

On 4/18/2021 at 8:55 AM, JKL33 said:

So just to clarify this is a student rotation, correct (not a new grad position)?

If so, your nurse should be sticking fairly close by (instruction and close follow up, touching base frequently, in-person observation as appropriate, giving guidance, etc). I don't agree with the "throwing in the deep end and letting them swim" approach for new grad nurses in their first job and IMO it is even more unacceptable when working with students. As in negligence-level unacceptable.

 

Now isn't the time for that. If you can't quickly consult a resource of your own in order to remember something, you need to ask. And not feel any particular way about. That is what you need to do, period. I mean this kindly: It doesn't matter how it makes you feel. KWIM? You are there for the patient. So be proactive and pleasantly assertive. NOT self-deprecating.

You need to find a way, rather quickly, to work more closely with your preceptor. This gig here isn't about you doing half the nurse's work so the nurse doesn't have as much to do. This is your last student opportunity to learn with someone who is supposed to be guiding you.

If your nurse really does expect you to keep up with all the demand of taking care of an ICU patient, that is a problem.

Try to work on your rapport with this nurse, pronto. Don't make any assumptions about her. Instead, find out who she really is and how you can work together with her.

At the very least, involve her in what you are doing. Do not approach this as just being afraid and assuming what your nurse wants to see and then going off on your own to try to prove yourself without using the resource with whom you have been paired.

Time to buckle down. Stand up tall, be pleasant, make good eye contact and interact with your preceptor on a professional level.

If you really feel like a fish out of water then you need to tell her pronto.

You can do this. ??

I agree with all of this. Also, just because she has been a nurse for 30 years, does not make her a great teacher. It can be difficult for someone with a large knowledge base to be able to teach their knowledge to someone on the basic level. 

[TriciaJ, RN]

To reiterate JKL, it isn't about how you feel or even how your preceptor feels.  It's about the patient receiving safe, appropriate care.  If you need to ask a thousand questions and be annoying, so be it.

What's the worst that can happen?  Your preceptor doesn't like you?  You get a bad review?  No, the worst is a bad patient outcome.  Of course you know that; I'm not trying to insult you.  But sometimes there are competing priorities and this is not one of those times.

So keep working to organize yourself.  Look up everything you have time to look up.  And level  with your preceptor about what is really happening.  She can't read your mind and might think by your demeanour that you have everything in hand.

Feeling like an idiot when you're new at something is par for the course.  I've changed specialities enough times that I've learned to embrace my stupidity.