dann023

*Sorry for the LONG post in advance.. but I really appreciate for any suggestions/advice* I am a new grad, 3rd day on the floor. Today was just a disaster! I don't feel like my preceptor is assessing me accurately and is pushing me too hard and too fast. But he wouldn't listen to my concern, keep saying "you're ok~ you're ok~". I would like to hear more opinion, to see if I am over reacting or I am really okay. I am really concerned for myself and patient safety, and wonder if I should speak up for myself or even involve the educator to have them help me communicate with or change a preceptor. A quick overview of our floor, it's a floor with heavy/unstable patients, mostly on vent & telemetry, lots of wound care need, mainly elderly, we get lots of rapid response team call - nickname "tower of terror". (I work in acute care hospital btw) About me -old grad from May 2011, last clinical adult Med-Surg experience was 2nd semester was in spring 2009. Precept in pediatric, so really unfamiliar with adult med/surg since it's been sooo long. About my preceptor - known for "good nurse, never see him have to stay overtime, he's FAST, efficient". I'm his first preceptee. My first two shifts, I had 2 patients, and the same patients for both days. Both very stable, not many med. First day was mostly observing and gave some med, 2nd day - since we had same patient and both of them were improving, it went smoothly and easy, he had time to show me things and explain. We got everything done on time. Today! Pt #1 - came in for GI bleed, on 2 IV med, pain med round the clock, was NPO/prep for EGD & Colonoscopy. Needed Platelet transfusion before GI procedure. Diabetic - need to check BS & insulin. Activity independent. Pt #2 - Obese, Total care, turn q2h, with a leaking ileostomy, has F/C, couple PO and IV's with a PICC, multiple DTI and a healing stage II ulcer. And discharged at 6:30pm - right before shift change! Pt #3 - Came in for DVT - on heparin drip and warfarin, bilateral foot ulcer require dressing change, couple other DTI. Also diabetic - need to check BS & insulin, Many PO med, some IV. Bedside commode with assist. It was a nightmare!! I was running around like a headless chicken the entire day, besides knowing what time I had meds due, I had no clue when or how do to dressing change, what to do regarding procedure prep, how to give transfusion - I have never done any of these things in school. In the morning, after report, my preceptor literally went "OK - today I want you to tell me what to do - you be the boss". The 1st day, he taught me his routine - get report @ 7 - 7:30, read up chart @ 7:30 - 8.. so I did that. We sat quietly in front of computer no talking just reading up our own chart. Usually he talks me through, but today was just silent! I felt soooo lost. NOT familiar with the new computer system, the med, the Dx, the treatment. He had the look when I try to ask him question after report - "what question could you possibly have? What part of the report don't you understand?" When I tell him my plan - for who to see first, he just said "ok". 80% med I gave today, honestly I don't really know why patient need it, so I tried to look them up, but when I'm in the med room looking up (takes long time) he just went "what are you doing?" as in - "why are you taking so long?". And SO MANY time he end up having to just grab the med for me and tell me "it's for ____". Or it's for ___. I go into patient's room scared that the patient would ask me why he/she's on the med... cuz I am not even sure how it is related to their illnesses! 40% of the time today, because we are SOOO behind, he often go - go chart, go finish charting, "I will give this med for you", "don't get the call light - I got it, go chart!", "I just called the doc, he said ___, ___, are you done charting?" if I'm not charting, I'm giving medication, and it was like he telling me to do everything. Besides this morning, the entire day became the telling me to do 80% of the things - "after you give this med, go to room 14 and do that, and then to room 15 finish that, then you can chart. OK?" "I'm gonna call the doc for ___, you go chart." "I'm gonna help room 14 turn and change the ileostomy - its okay, you stay and finish charting, I don't want you to be distracted." OMG - I hate this! Not that I mind being told what to do, but I'm so anxious the whole day because I feel this is NOT OK. When I'm by myself, I am not going to chart all day, chart become less priority. I won't have someone there do all the things for me, handling all the call light and phone calls just so I can chart!! I mean I finished charting all the medication on time - the assessment, I will do it when I have time. But I really feel my preceptor is controlling my time, when I have some free time, he's CONSTANTLY behind my back and tell me now go to this room and do this, then you can chart. Or don't chart right now - that's not important, do this first! I feel I didn't learn anything really today, I mean yes I got to see dressing change, I saw him did ileostomy change, I saw him did PLT transfusion, etc. But he took over most of everything because we were so behind - he had to do it to speed everything up. I never got to talk to the doctor the past 3 shifts. When I tell him I am scared to talk to the doctor - "oh its ok, you just talk to them.." - (very helpful = =) WORST of all, when I was in med room opening up the eMAR about to do 3 check 5 right on medication, he told me "it's okay, you already know the patient, you don't need to check here with the computer, just go to the patient room and check there, saves time!" - you can tell he really want to rush to get all the things done. It's FREAKING ME OUT that even doing 3 check I'm being rushed. We stayed 40 minutes after work just for me to finish charting. I try to tell him today was too much for me. I need to have 2 patient, and open for new admit. He insist he will let me have 3 patient still, he kept on saying it's ok.. you didn't make mistake today, it's good. I have too high of expectation for myself, blah blah blah ..at the end he said what I think it's the real reason.. "I won't let you go back to 2 patients, because you'll eventually need to care for 4 patient, and today is only 3 STABLE patient. You gonna need to adjust to it" I am so anxious and I want to quit just because I feel so unprepared. I have 6 more shifts only and I am on my own. I do not think I can survive. and feel he's not listening. Am I over thinking? Is this normal? Should I speak up and call the educator to step in? (btw, don't get me wrong, my preceptor is indeed a good nurse, experienced, compassionate, and follow good practice when not rushed) But still.. I am not sure if we are best fit for each other.. what do you guys think? Should I go in next Tuesday (my 4th shift) and try another day with 3 patient? Or Try to get a hold of nurse educator on Monday hoping she can talk to my preceptor or someone before Tuesday. I feel my confidence is really crushed today. Feel like a 1st semester nursing student, even giving PO med I'm being watched. if it continues, I think I will doubt myself more and more.. I need quality preceptorship time, not just focus on quantity...

thank you all sooooo much. Today, I used and modified one of the brain sheet and it helped more! I will definitely try to ask more question - and thank you for reminding me, it's about the patient, not me. I have to admit I was intimidated and often worry more about how other nurse will perceive me instead of think patient first. and I will definitely be doing my homework.. I use to hate careplan so much, but now I wish I have the opportunity do preplan.. ha... anyway, thank you all so much again :) they are great tips/info and thank you for all your encouragements and being supportive!!

I am a old 'new grad' graduated last year May. Recently started on a stepdown med/resp floor. lots of unstable/critical patient. I get 3 weeks of orientation, and I am really struggling right now. one big problem I having trouble is remembering reports and getting a big picture together after receiving reports. I feel after received report, I should be able to retell the report to another nurse right after or give the CNA a brief report but I can't! often I feel I am barely having time to writing down report, and after report is done I still don't really know why the patient is here, what has happened, etc. All I can remember is the not-so-important things such as pt has a PIV at left hand, family was at bedside..uggh! but the big picture - why was the patient first admitted, why is pt still here? what are we treating? what's the plan of care? I can't remember them!!!! I am so frustrated with myself. And after getting report I actually feel MORE anxious & panic. I know I can read up H&P, but I really want to be able to just get a big grasp of patient during report, and use the H&P to fill in more detail information.. not the other way around. I know you can ask the nurse to repeat, but I feel I literally need them to regive the whole report. The inability to put a big picture of my patient together stop me from prioritizing things I need to do for the rest of the day. I am really worried and wonder if I really gone through nursing school at all.. I tried to communicate this problem to preceptor a few time, but she doesn't seem to understand what I mean, I guess no one else had the problem before.. I was mostly an A student in nursing school, I have struggled with report before in school, but never this bad. I could at least give a little bit of the story after getting report. I wonder if it's because I just need to adjust to the clinical more? Even though I graduated last year, my last actual Adult med surg was 3.5 years ago.. Because I did my preceptorship in Pediatric and my last 1.5 year of school we were doing community health and Ped/OB, etc. many terms, dx, medication, treatment are all so new to me. I feel so overwhelmed, and out of place. Any tips/advice?

Thanks for all your reply! I will follow up with a PCP when my new insurance become available. Hoping for the best that I will just get use to the mask.

I will be working in medical pulmonary floor soon. During physical exam, they did a pulmonary function test and found my result was quite low - borderline low. The RT even have me redo it 3 times just to make sure. The doctor told me I should be fine but may have trouble if there's a need to wear N95 mask. I can see his concern, because when I wear a regular mask I normally try to make it looser as I sometimes do get light headed when it's too fit. I've never wore a N95 mask before, and am concerned if I just won't be able to do it if I have to care for a TB patient. If that really is the case, would I have to quit my job? should I mention it to my manager in advance?

thanks for all your reply. It is not my intention to job hop, I understand how it effects the resume. In my previous non-nursing jobs, I always stayed at least a 2 - 3 years. However, I would hate to work in an environment that have poor support for the new grad. and would like to have a back up. The hospital I've accept the offer at does not have a new grad program, and gives provide 2 weeks day shift orientation, and 2 weeks night only. The manager that I interviewed with weren't very respectful and polite. Even the HR was quite rude. I took the position because there were no other options at the time. Of course, if the orientation goes well, environments are supportive, I plan on staying for at least 1 - 2 years and go from there to decide if I want to move to a bigger hospital. anyway, thank you again for your help! :)

I recently accepted an offer as an RN in a hospital, done the physical, turned in documents, etc.. and orientation starts this coming Monday. But just yesterday I found and applied a job opening at a magnet status teaching hospital I really would like to work for. I don't know if I will get an interview, but if I do - 1. do I have to mention in the interview that I am currently orienting for a hospital? 2. worst case scenario - If for whatever reason orientation (4 weeks) didn't work out, I end up leaving the job - can I leave the 1 month experience off the resume? or will HR find out when they do my background check with my SS#?

thank you so much martinml!! I didn't get to see your post in time.. but yours sounded much better than the one I came up with, I'll keep it for the future :) meanwhile, I was offered a position!! But I have 2 questions, I hope you can give me some advice. I was at work when the HR called, so the conversation was short, it was literally “we're offering you a position, I need you to come in next week to go over some paper work and you start on the 27th. Call me on Monday to make an appointment.” It sounded like the HR thought I had already accept the position - though I didn't really get to say anything yet. 1. When I call HR back on Monday, should I ask for a tour first, then schedule with HR? or schedule with the HR first then ask for a tour during the meeting? 2. If I accept the offer, because I’ve been out of school for awhile now –1.3 years – I thought about asking if I could shadow or volunteer to be a CNA on the floor just to familiar myself with the floor & basic patient care before I actually start even just for a shift or two? Is it appropriate to make such request? Should I ask the question to HR or the unit manager? Or should I make the request after the orientation start? This hospital only give 4 weeks of one-on-one then you're on your own. My preceptorship rotation (Spring 2011) was in general Ped, so I really haven’t be on an adult med surg floor for a LONG time now (Fall 2009). I am worried I won't be able to catch up in just 4 weeks.

I was just offered a night shift RN position on Friday on Med-Surg Respiratory floor. When the recruiter called me, because I was at work, so the conversation was really short - it was literally "we're offering you a position, I need you to come in next week to go over some paper work and you start on the 27th. Call me on Monday to make an appointment." I am feeling excited/nervous but also very clueless at the same time with many questions going through my mind... I've worked throughout school but they are just part time position such as office assistant, etc. this is my first "professional job" so I don't really know how do things go about after you got the call say "you go the job!" sorry for the many questions..been thinking about them all weekend! I really appreciate any answers or advices! thank you so much in advance!! 1. I am not sure if I want to take the position yet because she didn't go over the benefit/pay or anything with me yet - yet she made it sound like I already want the job. So what should I say when I call her on Monday? If I make the appointment with her does that mean I am accepting the job? 2. What questions do people ask or talk about during the meeting with the HR? are there some important questions to ask? Things to say/or not to say? 3. If I accept the offer, because I've been out of school for awhile now -1.3 years - I thought about asking if I could shadow or volunteer to be a CNA on the floor just to familiar myself with the floor, basic patient care before I actually start even just for a shift or two? But I don't know who to ask, and is it even appropriate to make such request? Who should I ask? Or should I make the request after the orientation start? This hospital only give 4 weeks of one-on-one then you're on your own. My preceptorship rotation (Spring 2011) was in general Ped, so I really haven't be on an adult med surg floor for a LONG time now (Fall 2009). I am worried I won't be able to catch up in just 4 weeks. =/ 4. In the interview, when they ask do I prefer day or night shift, I said Both would be fine but day would be better. They had several position open, I guess I got the night! I really regretted my answer - I should've just say Day only!! I had night shift during preceptorship, and I remembered how in the first few shift was fine, but what I forgot during the interview was after a month the night schedule was really starting to mess with my body.. I'm tempted to ask if they have any day position open, but don't know if it'll make me sound bad.. Or is it too late since they already offered the night position? or should I just ask after how long I started working can I request to switch to day and hope to stick through with the night shifts?

Just had an interview today! will find out answer by Friday! Meanwhile, I am having trouble writing the thank you letter..because I'm not sure if I really want to work here yet - still thinking. I am not trying to be picky in this job market, but the orientation program made me feel a little unsafe for a new grad. I interviewed with the med-surg & cardiac tele unit. It is a local acute care hospital ~300+ bed. They give you 2 weeks at day shift, and 2 weeks at night shift. Then you're pretty much on your own. Med surg ratio - 1:5, Tele - 1:4 with occasional drip patient. I still want to thank them for their time obviously, but next should say how I believe I will be a great candidate for the job, hope to hear from them soon? what if I decide to decline later, would I be leaving a bad impression by sounding like I want the job but decline it? also, I forgot to ask this during interview, I hope to have a chance to have a tour on the unit if I am offered the position before I make the decision.. is okay to ask this? if yes, when and who should I ask? I had a panel interview with few manager & HR - so I don't know which unit will be hiring yet. Thank you so much for your help in advance!

I need to obtain 2 - 3 letter of recommendation for job interviews/applying for new grad program. Best possible from clinical instructor. My problem is - It's been a year since I graduated! my professor doesn't really remember me especially the one from earlier semesters.. I mean they recognize me, but don't know much about me outside school - I did very well in all my clinical, but was always too intimidated talk to my instructor other than school related question - yes, lesson learned - I should've make myself talk more even though I didn't feel comfortable.. - but it's too late now when I emailed one of my instructor and she was very honest with me and replied "My concern now is that a letter from me might not be as substantial as one from a more recent instructor. It's been 3 years since I had you as a student, and since we haven't been in touch since that time, I'm uncomfortable speaking to your current qualifications. If I wrote you a letter, it would be rather generic. Is there someone else that could better speak to your qualifications? I just want you to have the best opportunity to get a strong letter of recommendation from a more current source. Let me know..." I don't really know what to do. does the letter sounds like she doesn't want to write the letter? I don't know how to reply the email at the moment.. I want the letter (it's better than no letter at all) but I also don't want to sound desperate and pushy (even though I am desperate).. I can try to obtain LOR from different professor, but I am feeling I might get the same response, or even no reply. my most recent instructor (6th semester) already retired so she didn't even reply to my email. We had public health for 5th semester, my clinical instructor almost never saw us, except during community project presentation and occasional post conference. we weren't in hospital setting. so I didn't ask her yet. my 4th sem. pediatric clinical instructor, was from fall 2009.. so it's been 3 years as well. (I think I might have similar response.. I wasn't close with this instructor..)

[color=#333333]*my original question was lost due to website maintenance, this is a re-post - sorry if you have already read it* [color=#333333]as a new grad nurse in ca, job market is tough. well, it's been so long i think i'm considered an old grad now. my ultimate goal is to work in the hospital. but while job hunting, i would like to find some sort of jobs.. at least something to do. i am already applying for volunteering, and even cna positions at the hospital - (no call back so far). at this point, i don't care about pay anymore - i need whatever that will help my resume look good. and gain experience. sooo -- i thought about going back to work in the doctor's office. [color=#333333]i worked as an office assistant throughout nursing school, therefore, my manager is happy to hire me back - but she said it's up to me whether i want to be hired as an rn or medical assistant or office assistant. [color=#333333]i don't want to work under my title as an rn because i'm afraid that it will disqualify me to some new grad. position requirement include "no work experience under the title of an rn".. [color=#333333]and having worked there for so long, i know even if i work under the title of an rn - i really will only be doing office work, except occasional flu shot and start iv (rarely needed). that's it. [color=#333333]another thing is - if i choose to work as a ma/office assistant, and they ask me to do rn-only duties (eg. start iv, flu shot) should i do it? or no? (my manager is very understanding, and i feel comfortable saying no.) would working as office assistant/ma look better or rn but not really working as an rn.. [color=#333333]all in all, i really just want whatever will help my resume look better.. help/suggestions? i am afraid taking this job will hurt me overall in my job hunting for acute hospital position. =/ in the end, should i not even take the job after all? and just keep volunteering? [color=#333333]nurses, hiring managers, recruiters -- is this a bad decision for me to work in a doctor's office? suggestions??