nursing_potato

Hi! I'm 3 years and a half into my ICU nursing career. I would just like to know if anyone has any experience working for Memorial Hermann, or at least Memorial Hermann Memorial City Hospital in Houston? I've been wanting to search growing opportunities compared to the current hospital I'm at right now. My current hospital has a bad reputation and a pretty bad management so I would love to find a good place at least to start in Houston. I have tried Houston Methodist but I heard they are picky and don't really give you a chance unless you know someone who works there.

Hi! It's me again. I should've done this sooner, but I finally spoke up to my clinical supervisor. I thought they would take my preceptor's word against mine, but they actually listened to me. It took me so long, a month, to admit and realize that what I've been having was the so-called "nurses eating their young," with my night preceptor. I just spilled everything out two days ago when my mom kept coaxing me to tell my clinical supervisor about how my preceptor's been treating me for the past weeks I've been with them and I couldn't stop the tears from coming out because I had a really bad night. My mindset at the time got really worse to the point where I made really bad mistakes even though I didn't even want to come to work because of my preceptor. After my shift, I didn't even want to go home and stayed in my car instead. My clinical supervisor and director finally realized what was wrong and took me off from work for the next night to get some rest. Their plan for me now is to go with another night preceptor who can give me a more positive attitude and mindset than my last one with about a month of orientation. Honestly, when I heard that, I felt like all the weight was taken off my shoulders. Supposedly, my new preceptor just accepted me right away because they noticed how I was being treated at night (other nurses have seen it too and one even offered me their number if I needed someone to talk to). I have made a long message about the experience I've been having since the start with my preceptor and sent it to my clinical supervisor. If you have read it, you would've felt sentimental too (my friend even told me they almost cried when they read it). I am now trying to do some self-care and go back with a better mindset than before to work with my new preceptor next week because they gave me a few days off to recuperate my health. My advice is, please please please don't wait until the last minute to say something like I did. I was already in my last week of orientation and I have been holding on to my feelings while being ignorant in which I thought my preceptor was there to guide me with good intentions, only for them to basically go against me instead from the start.

I think.. my preceptor is really setting me up for failure. I just had my meeting and I literally broke down to cry because I felt so betrayed by my own preceptor. They told them some issues I’ve had that NEVER happened or felt exaggerated and I wanted to defend myself but every time I do, my clinical sup/director takes it as an excuse. An example would be not going to codes if one happened during my shift, but I LITERALLY helped with one when I did CPR to a patient. Another one was I said something about not wanting to be a renal nurse because I didn’t want to sit down all the time and my preceptor proceeds to tell her CLIQUE (or basically other coworkers) and twisted it saying I didn’t want to do CRRT because all they do is sit when I never said anything about it. I feel like my preceptor wants them (clinical sup/director) to be in their favor of not wanting me to be an ICU nurse in their unit. The only question they gave me was if I was ready to be on my own, and I told them ofc you wouldn’t be because you’re never truly ready but my director told me there’s a difference between that and wants me to sit on it and tell them my final answer once I’m through my orientation. I broke down right in front of them too but that was because I just felt so betrayed by my preceptor and them telling lies about my progress…

Thank you so much for sharing your experience with me! I have about a week left of orientation and my clinical supervisor will talk to us on Monday about my progress. I have been doing better than I did last time since I got used to starting my day by making to-do lists (what are the labs due, q1 neuro checks, etc.), assessing my patient, etc. But even after all of that, my preceptor thinks I should be in another unit which I don't understand because I've been showing so much improvement based on the re-evaluation that they gave me to check on my progress based on "titrating drips," "giving PRN meds," "prioritization" etc. In the end, I feel like they personally don't like me because I can hear them gossiping about me to other nurses. They tell me I should ask them questions, but even when I do, it's not enough for them. And when I want to ask questions, sometimes they're not even present like that time when we got floated to another floor and they went downstairs to help out to the ICU because we got overloaded, but most of the time, they talk to their friends so I was left by myself and asking another nurse who was with me from the ICU to ask questions. Other times, whenever I ask questions, they look at me with an attitude as if I was dumb even though they themselves have told me "there's no such thing as stupid questions." (because of this, I've been asking other nurses instead). When they tell me to look up certain stuff on my own time and even when I do, they expect me to know about it fully even though I wrote them down as I was researching about it as I am getting tired since I have work the next day. I feel as if I am looked down upon and they still discourage me and criticize me more than give words of positivity especially when I did something good and yet, everything I do is still isn't good enough for them. The recent patients that I've had were both one of the very sick ones in the unit and my preceptor decided to leave me all on my own to see how I did. I did like 90% of the care without them being there and asking other nurses for help or questions because I know I can't rely on my preceptor forever. Whenever I chart, I feel rushed because they keep telling me they don't want to leave after a certain time so I have been keeping up with my charting while also doing care on my own especially if the patient is on many drips and I constantly check if it needs to be changed. At this point, I feel that they complain about what I did wrong more (the littlest things) than telling me what I did well when I have been trying my best since I got my orientation extended. They eye more on what I did badly than what I did good on, and even when I met almost every criteria on the progress chart they gave me, it's like my preceptor wants me to get held back. I also feel like they have favoritism because the person they have preceptored before is just on the floor talking to them as if they are besties (and I know that person had an incident when they were on their own for 3 weeks and they didn't do ANY care for the other patient besides giving meds while the other patient was getting worse, they had to prone the patient in change of shift too). In the end, it's not even the unit itself. It's how my preceptor teaches me even though I had told them during my 2nd week I didn't want to change because I know they are knowledgeable and can help me, but I guess now they've been doing less of that. It's like they want me to regret that I didn't change preceptors... (I even remember when certain nurses looked at me when I told them who's the preceptor I had for the night shift as if I was in trouble). Honestly, I'm scared for what they're going to tell me during the meeting... Sorry for the grammar mistakes this may have! My brain is all in shambles and I'm trying not to get depressed but I don't know what to do anymore.

It was actually mainly time management and prioritization in the ICU from what my preceptor has told me. Not so much on meds and other stuff, ofc it’s important to know, but I can always check in with my charge and other nurses just in case. It’s because I fall behind on stuff that are due and I’m slowly building it up because my preceptor told me I was improving. Plus, putting in orders ourselves because that’s how we do it in my facility. Other than that, I get what you mean but I’m not giving up!

They have extended my orientation for another 3 weeks so I'm working to prove myself to show that I can do it! My preceptor has told me I was showing improvement with them the last 2 days so it's just a matter of getting used to the shift in the night because the morning shift I had was comparably way different. My main priority is time management and listing what I should do to prepare for the day because I was so behind in the first week I started. My preceptor even admitted they were mean to me to get it together and I try to keep a positive attitude and work my way through it even if I know they don't like me. I am not giving up! The only reason why I didn't change my night preceptor despite their attitude is because I know they can teach me a lot since they are knowledgeable. I actually don't want to get out of the unit because I have loved it there since the day I started and like learning a lot. It's just learning how to manage my time and get through the day.

I will do my best! They have already extended my orientation for another 3 weeks so I'm going to try to learn what I can before then and prove that I can do it! Thank you so much for your words of encouragement! I'll keep them in mind! ?

SORRY! LONG POST! I graduated back in 2021 December of last year and didn't get to practice my license after passing the NCLEX until July 2022 because of family travel. I applied for the level 2 trauma center (soon to be 1) in the ICU and have had a blast working there and learning a lot. For the past 3 months, they put me on the morning shift first to get the hang of things and I struggled at first because I was still learning the ropes until I got comfortable talking to the doctors and the patients. However, I was supposed to meet with my clinical supervisor with my preceptor to check on my progress and what to improve on etc. every 2 weeks except they never met up with me at all to do that. There became an issue where I had to be with another preceptor midway because the preceptor I was with initially wasn't the right one for me to precept with so they switched me around October. The problem was that they did it too late because it was brought to their attention that I wasn't receiving the best learning experience and felt that I was behind on where I should be even though I was barely one month in at the time. They basically waited 2 months after to switch me with another preceptor who I was only with for 4 weeks (They already met up with me to discuss why and apologized for the late switch up and it was sudden because I already got comfortable with my first preceptor). The second preceptor I would say went pretty well even though I still have a lot to learn because I know each preceptor teaches differently so I had to accommodate to what they taught me and apply it. I have mostly been doing all the charting, giving report, talking to patients and all that on my own at that point, but also of course, still asking my preceptor questions regarding care, medications, how to do certain skills etc. and they would be with me to check on and help what I needed to do just in case in the room. I was even getting the hang of it too so I felt I was more or less ready for night shift. Also, keep in mind, we still never met up with our supervisor to discuss my progress. Finally, I get switched to nights which I originally applied for, and gave me another preceptor to follow, so cut to November of this week and I have about 2-3 weeks left of orientation, then all of a sudden my preceptor says I don't have what it takes to be ready in the ICU. Not gonna lie that it hurt and discouraged me. My first week, this week, being oriented into nights left a bad impression on my preceptor because I got very sick both vented young trauma patients that requires a lot of handling and constant monitoring which I didn't really get to experience before because most of the patients I've had where either very sick but manageable and the other that's sick but stable critical. I didn't even get to finish charting until 8 in the morning which never happened to me before because I used to leave much earlier than that. My night preceptor is very nit picky on what I have to do, even going over my charting and basically what I was taught before was completely different with them, and expects me to already have what it takes to be a nurse with more knowledge and critical thinking in the field. Of course, I am still learning how to critical think and I know it's going to take me awhile but they told me that critical thinking should already be learned by 2-3 weeks into orientation which I don't understand because I'm still a new grad in the ICU. They wanted me to already know and keep in mind how to prioritize and I was basically left scrambling because sometimes they will tell me to do something but then an unexpected event will happen to the other patient so I can't really do what they expect me to do most of the time. They gave me more negative feedback than supportive and encouraging ones because they were very straightforward with me and they're questioning whether I felt I was ready to be on my own. I told them I wasn't of course because you'll really never feel ready but they wanted me to be a safe nurse and from what I've shown so far with my two days with them wasn't good enough. Plus, both patients had very extensive history and I couldn't even check notes of that on my computer because I was busy to the point where I didn't even get any break on my part to give a good report so they've been doing it for me instead. We were supposed to go over it on my first day, but we never got the chance to because we were too busy taking care of the patients. The only time I felt they complimented me was that I was doing a little better than the first day. Honestly, I'm trying hard not to cry but it's no use because I feel like I'm going backwards again. I have been really trying my best for the past 2 days but I feel like I'm intimidated with my night preceptor because their expectations for me were pretty high up so I've been trying to meet their criteria of what I should be doing but it just doesn't seem to satisfy them. I have always felt like ICU has been my calling since the start because I've been so into it since the first day and I've learned so much, but I'm so discouraged because of what happened and I don't know what to do anymore. I know for sure that we'll be having a meeting before I'm going to be on my own and I'm scared whether they'll think I'm not good enough in their unit and send me somewhere else and knowing who's going to discuss that with us, especially when I was switched mid-way, my chances of staying are low, either that or I get an extended orientation. I'm really sorry this is a long vent but I've been so disappointed in myself, feeling that I wasn't good enough, and I have work tonight with the same patients and I need at least an encouragement, advice, or something to get me through the day. Thank you if you have reached this far.

This is super late but I took my test today and I walked out of there feeling like I failed. Low in behold, I did the PVT trick when I got to my car and after getting the email, I got the "bad popup." I have some slight positivity that I p***ed and it could be a mistake.. but a high chance that I failed. I also studied only using UWorld and Mark Klimek for the past month. I was planning on using Archer if I really did find out that I failed when I get the quick results, but I noticed that you took all of them so now I don't know anymore.. How did you do? And if you are, how are you studying? I feel like my test-taking strategies are bad even though I listened to Mark Klimek.

Ah that's very helpful thank you! Also, I do show my work but I'm more of a visual learner than explaining how I did it all in text if that makes sense? Thank you for confirming that my answers were correct! ?

Thank you for responding! I don't know how to explain how I did it.. however, I did dimensional analysis for those 3 questions and got: 1. 10 mL/hr 2. 30 mL/hr 3. 7.5 mL/hr

I thought I could edit but I guess I couldn't... anyway, I think I figured it out! My brother who's also in the program with me said to exclude the bolus information because it throws you off so I got the answer for all of them. I'm just not sure if it's right though. What I did was just take the continuous infusion and the supply that it gave me and worked it out from there.

Hello! I would like some help regarding these dosage calculations if you all don't mind showing me how to do it? 1. A patient with cirrhosis is admitted for variceal bleeding. The gastroenterologist ordered ocreotide acetate 50 IV mcg bolus then start a continuous infusion of 25 mcg/hr. The pharmacy send a premixed bag of ocreotide acetate 600 mcg in 250 ml of sterile solution of dextrose 5%. What is the continuous IV infusion rate of the medication using an IV pump? _______ml/hr. Round to the whole number. 2. A patient had runs of wide QRS tachycardia with a pulse rate of 170/min. The ER doctor ordered procainamide 20 mg IVP STAT and a conitnuous infusion of 2 mg/min. The supply on hand is procainamide 1 g/250 ml D5W. Calculate the flow rate of the continuous infusion of procainamide with use of infusion pump. _____ml/hr. 3. Patient is on septic shock with BP of 68/32 despite infusion of 2 liters of lactated ringers IV infusion. The nurse is getting ready to start norepinephrine bitartrate at 4 mcg/min. The pharmacy sends a bag of norepinephrine 8 mg in 250 ml of D5W. Calculate the flow rate the nurse has to set up the infusion pump __ml/h.Round the answer to the nearest first decimal place. The bolus and continuous flow rate made me confused and I've been trying to solve it for the past hour or so.

I agree with Mjohnson27 above! Don't give up now! There are people out there in your shoes who have failed the NCLEX many times and passed in the end. My advice to you is find out what you need to improve on according to your CPR and what needs to change like figure out what material you're going to use to practice and what didn't work for you. The whole 3 months I've been studying using the Saunders NCLEX book online that was provided to us from my school that gives different content topics to focus on with questions in multiple choice or SATs. I always make sure to read the rationales it gives me even if I get them correct and whenever I don't understand something, I search it up online and take note of it. What I'm doing may not work for you, so it's better to ask around. Good luck and again, don't give up! The hardest thing you've finished was nursing school itself.

But according to what you’re saying, I’ll just go with passing the NCLEX before applying to the bridge program.