I totally understand the book smart vs street smart. I graduated with straight A's, but struggled my first few years out of school. It took me a while to realize that textbook and tests are not the same as real life. Here are some specifics to try and help. I copied and pasted your situations and bolded my advice to try and help you.
We had a resident.... parkinsons.... baseline shaky and not very verbal.
When mad/irritated, resident became markedly more shakey and yelled out
We had a newer aid that day. Aide came to me and stated that he was having one of these episodes..... I stated to her that he does this sometimes and to just ensure his safety and let him calm down.
Aide wasn't happy and went to other nurses and management.
Honestly I am not sure how I feel about this situation. I honestly thought I WAS using my nursing judgement and didn't believe that it was an emergent thing that I needed to go and assess. Perhaps if it had continued? Again, I don't know how to feel about this situation.
Even though you thought that you assesed the situation and used your nursing judgement, you didn't. With this situation, you can't use your nursing judgement if you don't go and assess the patient yourself. Your aide was obviously fantastic enough to come to you with their concerns (believe me, that doesn't always happen) and it was interpreted as you blowing them off...and you did.
Some of the concerns at the second hospital were as follows "lack of progression in orientation, mis-prioritization of nursing assessments, reminders to assess and document routine cares, lack of asking questions when uncertain...."
While I don't necessarirly say that this is "unfair", I am a much more quite person..... I don't always say outloud what I am thinking/planning/questioning. I believe they took that as me not being safe and asking questions. To my recollection, there were no specific "incidents" at the second hospital that were of concern. It was more an underlying concern.
Then you need to start thinking out loud, whether you're a quiet person or not. No one knows what you're thinking so no one can help you. Maybe what you are thinking is not accurate (and that's perfectly OK!), how are they to know if you don't tell them what you're thinking. I'm a quiet introverted person too, but to think/plan/question out loud when you have the luxury of a preceptor, someone who is dedicated to helping YOU, you need to take advantage of that.
At the first hospital, I did make one major mistake, and to this day, I regret it. I had a patient that was a known difficult straight cath. I was on "transition" at that point, so my preceptor wasn't right next to me. I had the assistance of the nurse aide, but attempted to cath that patient too many times (3-4). I was not aware that there was a policy of how many times that I could try. And even when I had asked for another nurse to come and take over, they stated I was doing fine and declined to attempt to cath the patient.
Yep, same goes for IV sticks, NG insertions, anything. When I worked in infusion, we had a max 2 stick rule. Even if you're the BEST at it, you can still have an off day. Get someone else. Don't be afraid to ask for help, don't be afraid to advocate not only for yourself, but for your patient. BUT, don't give up. Maybe you didn't get this one, but you'll get the next one.
I learned something that day, and honestly I hate foleys now. I avoided them as much as possible. I would NEVER make that mistake again.
Again, DON'T GIVE UP. You'll never learn if you do. You want to be at the bedside, you better believe you'll be inserting foleys and if you refuse, you're going to make yourself look bad. Every nurse has their weakness and that's OK to admit that and then ask for help. I HATED starting IVs before I took the infusion job, guess what, I was one of the best before I left there. I've been gone for 5 years now (switched to school nursing to spend more time with my kids), and I always say I miss starting IVs the most!
Some of the other concerns at the first hospital,
There was a situation where I was dealing with a brace on a resident. I had stepped out of the room and had asked for help (which I believed at that point that I was following the coaching to ask for assistance. There was also the orthotics provider in the room asking me a bunch of questions about the brace. I honestly believed that he would be the expert about the brace and was throughly confused as to why he was asking me all the questions. The patient/family became concerned because they believed I didn't know how to handle the brace (I hadn't dealt with one before, so no I didn't, but i would have learned!)
Doctors aren't the experts, nurses are Never assume that the doctor knows. Different brands of braces can be different and different doctors order different stuff. I'm sure your facial reactions indicated your confusion and that may not have gone over well either. You say you would have learned, but did you show them that you were taking the time to learn? Again, saying "I'm pretty new at this, I don't know your answer, but I'll find out." will go a long way. But if that situation happened the way you describe it, I would have been concerned as well. Put yourself in the patient or family member's shoes, would that situation make you comfortable?
There was another incident with a patient where we recieved a call from central monitoring. I said something about that I was concerned about his head, rather than his heart. It was a neuro floor and his heart rate was increasing or something.... So I believed it was possible that perhaps there was some swelling in the brain or something neuro related. They also stated that the preceptor had to prompt me to go and get vitals and assess the patient. This I completely DISAGREE with. As stated earlier, I was kind of quite. I already knew and was planning on getting into that room asap to assess and get vitals.
OK, 2 issues here....
1. I don't care what specialty unit you're on, you need to take into consideration the whole patient-ALL systems of the patient (neuro-yes, but heart, lungs, GI, whatever as well). Maybe this patient had a heart condition that lead to a stroke, the stroke is the primary reason he's there, but that doesn't mean the heart condition is not a factor. THAT kind of nursing knowledge and assessment skill does not come right away, but it will come with time. You need to learn from that and ask questions. Ask yourself-what did you do miss and what can you change in that situation so that it doesn't get missed again?
2. If central tele calls you, you get up, go in right away and you assess the patient, you don't have time to plan. By you writing that you were planning on getting it leads me to believe you didn't act fast enough to assess your patient. And I don't even mean getting vitals, you know his heart rate already-go LOOK at him yourself. (The delay of physical assessment seems to be a common denominator since it was brought up in the SNF as well).
I hope this helps. Good luck and please don't give up!