lordizzy626

Well so far I have been on the dayshift with one preceptor. She has been an ICU nurse for 25 years and she is a real "shoot from the hip" kind of nurse. She is tough and she expects certain things, but I have done well with her. I actually feel like I am getting somewhere. My managers and her have been talking and she really doesn't have any complaints about me. Nor do I have any complaints about her. It has been good. Word on the street is that if I can keep on doing what I am doing, I will be off orientation in a week or so, and working. So much to learn... So much to learn.

Everyone, I appreciate all of the feedback everyone has given. This has been a very difficult situation for me because the nursing world is unlike any other professional career track I have been in pursuit of. I will be starting to document my interactions with my preceptor more as well as making it a point to not "complain", but rather, try to focus on the bigger problem and fix it. I'll start back in that unit soon and see what I can make happen!

So the meeting was today. My preceptor legitimately threw me under the bus. She literally lied about events that never occurred. When I denied that it even happened and that wasn't how the situation transpired, it seemed to fall on deaf ears and they tended to side with my preceptor. If she would throw me under the bus like that I can only imagine what else she has been saying. I opted for them to extend my orientation for 30 days, and they agreed. However, the new preceptor they gave me was one of the people I rotated with before, and he is a brilliant nurse, but does not play well with others. This is why he has had two other orientees and and they pulled him out of the position to precept because of his communication skills. However, they decide to offer him to me as a preceptor when they know he has a track record like that. Seems like a half-orificed option. I really feel like they are trying to get rid of me. I mean, somewhere down the line someone has made up their mind about me and they won't settle for anything less than me being gone from that unit and since I haven't given them a good reason to get rid of me, they want to collectively pick up on small things to build a case. I think I'm done with this facility. It does not seem like it is going to work at all.

@ wooh, I would embrace the chance to orient with one person, and only one person. Don't get me wrong, there was some consistency on nights with my current preceptor, but maybe I have been missing out on the bigger picture, which would help guide my thinking, care, and prioritization... The problem is, I don't know how to fix it. I think that is why I have been progressing so slow as well. On top of some inconsistency from the beginning, I'm having trouble pulling it all together... Uggg

I think what frustrates me the most is that I do not know what I need to do to improve. I'm doing what I can to manage my time more efficiently, and I'm taking any advice I can and trying to use it. I have asked for concrete examples of how to improve what they want me to improve on, and I have yet to get solid answers. I have previously stated that I could be at home studying more for the job, other than that, I am positive that the rest takes practice. I will say that my learning curve has not been it's usual steep angle, and maybe that is my problem. Maybe I'm supposed to be able to provide myself with in depth answers from minimal explanation and potentially know what I need to fix and come up all my own solutions to fix it. I am going to try to get some concrete answers and expectations by the time 8:00 rolls around tomorrow morning. I am also going to try to find out their exact concerns, and how I can address them. That is probably something I should have been doing the whole time. That is something else I could have done better.

icuRNmaggie, I haven't been with my preceptor in two weeks because for one week she was on orientation at a PRN job that she took, and this past week I worked one shift and was told to take the next night off so they could get with my clinical director and decide whether or not the unit would be a good fit for me still. I have been off work for about a week now.

You know, 3 patient's seems to be the norm for a lot of units I have heard of. Only a few local units I hear normally keep a 2:1 ratio. It doesn't change the fact that I was getting my orifice kicked that night. haha. I started off on nights barely being able to keep up with one, then barely keeping up with two, then taking two comfortably..... After taking the two comfortably, they decided to throw 3 on me,and that was where my latest evaluation came from. Unfortunately for me, 3 patient's seems to be the norm in that unit as of late.

It is more or less a throw away shift to shift for personal reminder. It will have things like, "turn patient", "check vitals" "glucose check". Your charting will cover all these things, it is just a basic reminder. That night I had 3 patients. Being pretty new, 3 patient's is a lot of work. It is really hard to stay caught up on checking off that "task list". I mean, I have had experienced nurses tell me that with 3 patients it is hard to keep up on that task list. I can keep up with it when I have two patient's, but being tripled doesn't make it as easy to keep up on. I agree with him that it needs to be done, but it seemed like a very minor ordeal to be caught up on in the grand scheme of things. Minor to me.. Then again, I'm a new nurse and I don't know what is major and what is minor. lol. Some stuff I have done in the past they critique me and say, "you could have or should have done it this way instead." You know what, I agree with them and I try to improve.

icuRNmaggie, I forgot to answer your questions about the amount of preceptors that I have had. By my count so far, I have had a total of 10 preceptors. Not because of personality issues, but because of scheduling and my original preceptor being ill.

Horseshoe, I really don't know what to think. Part of me believes I belong in critical care, but after my orientation in critical care, I am not so sure. I have to really consider my own personality and traits, and see if it meshes well with the type of care and detail associated with CCU's in general. I am leaning towards this orientation time being a fluke, but then again, there is that doubt in me that wonders if I belong there. I didn't know anything going in, I know a little bit now, (still not near as much as these seasoned pro nurses), but my only expectation is to try and avoid making the same mistakes twice and learn something new every day.

I understand that I am expected to know the vent modes, settings, waveforms and pressures. I can look at vent settings and tell you if a patient is riding the vent and needs to be taken down on sedation (if that is the case) or if the PEEP is still appropriate, if the FI02 is still appropriate depending on ABG results, tidal volumes etc... I can take that information and paint a picture of my patient's situation now. These things I learned from other nurses. It's like me teaching you the inner workings of your shifter and your steering wheel on your car when you first start driving. That information MAY be helpful in the future, but for me to make you a successful driver, I need to teach you how to drive and not teach you the internal workings of interacting mechanical parts. It is hard to build anything on a foundation that you do not have.

I did have a lack of confidence at first, but then I slowly started getting more sure of my actions. I mean, I think there is a difference between being confident and being cautious. So far, I can recall one account where being cautious interfered with me making the best decision for my patient. Overall, I feel like it will all come in good time, but not in the time frame they expect it.

It is hard to really pinpoint. I mean, I graduated nursing school with a friend of mine and he started in the same ICU at the same time as me. The only difference between his orientation and mine was that he had the same preceptor all through his day orientation, and had the same preceptor all through the night orientation. He just got off orientation. My clinical manager just enrolled a group of us into some Critical Care Consortium classes. The are supposed to happen sometime this month. From what I understand, time management is always an issue. Even for experienced nurses. I am able to handle two patients by myself pretty confidently. This past week is the first time they tripled me and I still managed to get everything done, I just didn't sit down. One of the critiques I got from that shift was that my task list was not caught up. The patient's were getting all their care (Fingersticks, turning, tube feeding checks, temps) and by the looks of their vitals they were remaining as stable as possible. The "task list" is pretty much an excel spread sheet that you check off as you go. So, the work was getting done, but the task list wasn't being checked off. Something that I told him I would work on, but I didn't feel like it was as big of a deal as he was making it. I never have a negative attitude towards anyone there. I'm always respectful and I take criticism without taking it personally. Maybe it is just a scenario where that particular unit is not a good fit... :/. I will take accountability and say that i could have been studying about disease processes and protocols on my own time at home more. Aside from that, I have tried to soak up all the knowledge I can when I go into a shift. I get paid 100% of my check, so I put in 100%.

Well I don't mind ICU, I just mind the precepting and how things have went down so far. I''m open to other types of nursing, but not rehab... I did clinical rotations in rehab and I KNOW I would not be a good fit for that type of unit. We'll see.... If nothing good comes of this meeting (and I really don't have high hopes) I'll be back on the job market. Unfortunately, I'll still have 6 months of experience and looking for a new job already.... :/ I know that doesn't look good..

I remember once I came in to orient and just ended up taking over another nurses two patient's so she could go orient to the Rotoprone bed. My preceptor was also busy that night orienting other people to CRRT. So, I ended up doing my thing alone and didn't really see her. So yeah, it has been ongoing... I don't feel supported there at all. I mean, I've gotten more help from other nurses on the unit then I have my own preceptor. Toward the middle of our orientation my preceptor would try teaching me stuff that was way outside the scope of my practice.. I mean, the inner workings of the ventilator. I know I have to understand the vent to an extend, but the crap we were going over was not necessary info because we have Respiratory therapists for that. We would waste tons of time doing stuff like that and at the end of my shift she would tell me I have time management issues, and I wasn't learning jack about my actual job. I made a comment to my TM about that once and said that I felt like we were wasting time with her sending me on wild goose chases for information and that maybe it would be better if she would back off that and start teaching me pertinent material. I guess she might have taken that to heart and just became detached... I think that is when it all started to get worse.... Now I'm behind on orientation, and I'm at risk of being terminated. I mean, I'll take some responsibility in this. I could have been studying more at home and asking other nurses more questions and getting feedback from them. My preceptor can't do everything for me.