Please help, orientation problems

-MNC_RN- · Jul 16, 2008

I don't think one can tell after 5 weeks.

If you're doing things that are unsafe: problem

If you're not doing the work: problem

Learning slower: not a problem.

The first few weeks of ICU orientation are just getting your feet wet. The next several are for you to start making the connections. About a year after that, you'll start getting proficient.

As for the technical, hand-on skills--you probably are clumsy. But you don't get better skills by not doing them. Hands-on skills need to be hands-on. Keep doing that and eventually you'll get better. If your preceptors are still giving you not-ready-for-ICU feedback in another three weeks, then they might be on to something.

Suggestions:

More shifts, more consistently. Our new ICU nurses work full-time 5 shifts a week. Each shift reinforces what was learned previously. Less than 0.8 and you might not be getting enough shifts to retain information.

Also, look at how many hours you've worked, instead of weeks. I have found that the majority of new ICU nurses need about 300 clinical hours before they're ready to be off orientation, another 80 or so independent but with a strong resource, and another 300 or so independent but with a "mentor" to guide them. That's a long time. Even if you're working full-time five shifts per week, you're only a 200 hours total clinical.

llg, PhD, RN · Jul 16, 2008

It sounds as if your deparment is being fairly reasonable about this. Your preceptor has identified a problem that you acknowledge is one of your weak areas. (Acknowledging the legitimacy of the identified problem is terrific on your part -- and a necessary step in overcoming it. Good for you!)

Your manager is not freaking out about it -- but instead, is offering your a chance to work with a different preceptor who might be able to help you improve before any final decisions are made. That speaks well of your manager.

I'd discuss it with both preceptors (and anyone else who might have valuable input) and ask them for suggestions on how to improve your performance. Thank them for their input and give some of their suggestions a try. If they seem to help, be sure that your preceptor and manager are aware of your progress. Most units will keep an employee in your situation if they see that real progress is being made. If you don't see any real progress in 2 or 3 weeks, then it would probably be best for you to take their advice and transfer before they have to force you to leave. You'll want to leave on good terms with them so that you can return once you have mastered those clinical skills that are now holding you back.

You might want to talk to a few people to check out some of the other options in the meantime -- just so that you won't be rushed into a bad decision should you decide to transfer in a few weeks. It would be best to do your homework and choose your next unit carefully rather than rushing into a unit that would be a terrible fit for you.

Good luck!

Ruby Vee, BSN · Jul 16, 2008

if you're weak on technical skills, i'd say spend some time in med/surg perfecting them. in icu, you need to be able to slam in an iv, ng and foley while assessing the patient and giving a unit of blood and 4 stat meds. learn those skills in the (relatively) lower pressure area of med surg, then when you're confident of your technical skills you'll do great in icu!

good luck!

pupnurse · Jul 17, 2008

Thank you all so much for your advice. I think technical skills are important and I may not be fast enough right now.However, I'm going to try and see what happens with my new preceptor.

NoviceToExpert · Jul 17, 2008

You may not have been a good fit with your preceptor... maybe your new mentor will work out better... I switched preceptors during my critical care unit orientation... worked out great for me...It seems like you easily identify where your weaknesses are... so spend some time gathering the information you need to work more quickly... maybe that is getting your hands on a swan in the supply room (some units have an opened one for teaching), etc. Don't bow out to med/surg if you want critical care... assemble your resources... show how badly you want to excel and stick with the program... our critical care orientations are about six months...go on the manufacturers websites of the equipment you use... edwards.com for swans, central lines... atriummed.com for chest tubes, datascope.com for balloon pumps...The manufacturers have all sorts of online educational in-services... I learned more about some of the equipment than the nurses on the unit... I ended up teaching them different features...Also, your unit likely has manuals on all the technical equipment, or in-service dvds... find them and borrow them... you'll discover a lot of them have never been touched...you will gather a ton of information this way... and you'll be up to speed quickly...

Med-surg isn't going to prepare you for critical care... basic nursing skills, yes... time management, yes... but critical care, not really... our new grads are off orientation more quickly than the experienced nurses coming to the unit from med-surg...

Depends on the person... If you can make it work... you can make it work now... without leaving the unit... go for it!

PiPhi2004 · Jul 19, 2008

if you're weak on technical skills, i'd say spend some time in med/surg perfecting them. in icu, you need to be able to slam in an iv, ng and foley while assessing the patient and giving a unit of blood and 4 stat meds. learn those skills in the (relatively) lower pressure area of med surg, then when you're confident of your technical skills you'll do great in icu!
good luck!

i'd have to disagree. i started as a new grad in icu and this seems to be the biggest thing that preceptors have issues with when it comes to precepting new grads. it will just take some extra time to get used to these skills. for the most part you can get help with tech skills and always take time on slow days to do these skills for other nurses! if someone is doing an art stick, do it for them, put down ngs, foleys, etc for other people. keep a notebook of how to perform these skills so that you can refer back to it. hope this helps!! it is a very hard time for you right now but it will get better! :nurse:

TLCinCICU · Jul 20, 2008

We have a maximum orientation period of 12 weeks for new CICU employees. New grads go into our critical care fellowship (without an assigned unit), which gives them classes and rotates them through the various critical care areas and takes roughly 12 weeks. They get to sample each unit to see what might be their "best fit" and then apply there. So new grad RNs in our ICUs/ER get up to a total of 6 months of orientation before being released for independent bedside care. However, I have seen RNs complete the fellowship and come onto our unit only to be assigned to a preceptor that is a poor match for their temperaments/skill sets. At the end of their orientation period, they're still a little baffled and insecure. So by all means, try a different preceptor. You may luck into one that thoroughly enjoys teaching and will adapt his/her teaching methods to your learning methods. A former ANM told me when I transferred into CICU "It takes about a year to become comfortable with what you're doing. It takes close to two before you are truly a critical care nurse." So don't criticize yourself too much just yet....

gilf7243 · Jul 23, 2008

I have been an RN for two years and an LPN for 12 years prior to that. Since becoming an RN I have worked on ICU step-down. It took me a few months to figure it all out. It will come to you. It just takes longer for some than others. It doesn't make you a bad nurse. I have had to fill in on ICU at times. It still scares me. I am most comfortable on step-down. Try sticking it out. Maybe you new preceptor will not be as subjective of your work. If that doesn't work, maybe step-down would be an option for you until your have more experience and are more comfortable with yourself and your skills. Then you can eventually go back to the ICU. Don't take it personally. ICU is busy and there is alot to learn and you can't expect to experience it all in such a short time. I still continue to learn after 2 years on step-down.

ukstudent · Jul 23, 2008

I thought ICU would be a great place because I have really good patho and critical thinking skills. But I know I'm weak on technical skills.I have always done very well in theory(3.8GPA) but not as well in clinicals. Because I was always hesitant and unsure of myself, I always felt clumsy! But I was hoping these will come with practice and time.

I am not trying to be mean. But I highlighted that part of your post that jumped out to me. The ICU environment is very hands on and very technical. If you never felt comfortable doing hands on care even at the student level after several years of clinical practice then the ICU might be too much of a jump for you at this time.

Work with your new preceptor and please listen to him/her as to where then think you are in relationship to where you should be in your orientation. Take the advice of the other posters and ask if you can help other nurses with the tasks that you are uncomfortable with. Wishing you the best.

pupnurse · Jul 24, 2008

I am not trying to be mean. But I highlighted that part of your post that jumped out to me. The ICU environment is very hands on and very technical. If you never felt comfortable doing hands on care even at the student level after several years of clinical practice then the ICU might be too much of a jump for you at this time.
Work with your new preceptor and please listen to him/her as to where then think you are in relationship to where you should be in your orientation. Take the advice of the other posters and ask if you can help other nurses with the tasks that you are uncomfortable with. Wishing you the best.

Thank you for your response, I agree with you, ICU is a very hands on and technical environment. But technical skills come with time, but it's the critical thinking that's more challenging to learn and I think that's where my strengths are. According to my manager, it's OK to be slow, she said some of the best ICU nurses started of being very slow as far as the technical skills are concerned. Anyway, I'm working very hard, trying to be more organized, and if this preceptor decides I'm not ready, I'm willing to go to the step down unit. But the last few days went very well, and I got some positive feedback from her.

TLCinCICU · Jul 24, 2008

Keep plugging away at it Pup. Skills do take repetition to go from novice to expert. In fact, I work beside a nurse or two who would have benefited from taking things a bit more slowly and grasping rationales behind what they do in addition to the how to do it. If the critical thinking skills are there, the rest eventually falls into place.