Question on new grad preceptorship experience

VICEDRN, BSN, RN · Nov 1, 2012

Honestly, I hear a lot of escuses but what it boils down to is you were "frustrated" and "flustered" by taking your own patient assignment of acutely ill patients when you are at the end of orientation. In my experience, many people have more than one preceptor (and personally its what I prefer for myself). It is also normal for education department to ask you to demonstrate that you can fly on your own shortly before you come off of orientation. I think it is common to feel slower than everyone around you and that you require more support from other nurses than they require from you. It is not normal to feel that someone should be hovering over you while you care for the acutely ill in the ER as that it what we do.

I believe that you would feel flustered and frustrated by an independent assignment regardless of the care area as this is specific to you. Your experiences are outside of the norm for new grad ER RNs and it sounds like maybe a less acute area would make sense to you. Since I don't know you, I will simply tell you that I don't think anyone here knows the answer to this problem but you. Can you handle the assignment without feeling flustered and frustrated or would your anxiety be less in a less acute area?

Barnstormin' PMHNP · Nov 2, 2012

I completely understand your feelings, I have been in the ICU for 6 months and I am a 2012 grad as well. It's hard for experienced nurses to remember how frightened and stressful it is to be a new nurse, knowing that you hold peoples lives in your hands and fearing that you will miss something crucial due to inexperience and end up causing harm. I get the shudders every day at work but I am slowly learning to stay calm and try to think my way through a problem before going for help. Sometimes I figure it out, other times I go get help. The nurses in my unit are pretty dang amazing at helping out with any question. Sure, some can be a bit abrasive and they certainly like to see how far I can go on my own while they sit back and make it look like a breeze. You were justified in feeling upset, they should have let you know that they were letting you fly solo, I know I would have been better off knowing that little tidbit instead of feeling ignored and abandoned. Just because you feel flustered doesn't mean you can't handle the ER. I still get flustered and frustrated but I am learning that I can step back and take that 5-10 seconds to think hard and prioritize according to my knowledge base, and then I move along. I don't think there is any cure except experience and time :up:

bubblejet50 · Nov 2, 2012

How were your clinicals set up in school? I was taking 4 patients complete cares on a step down unit/tele by myself. I think this helped me feel better on the job. I also worked as an lpn in LTC which makes you feel stressed and use your critical thinking skills. In my experiences in the er during school rotations is that if it is a true emergency then the others nurses all help out. I think that by the end of a 16 week orientation that you should have the knowledge to assess and treat the "normals" of the er, example...chest pain, fever, broken bones, dehydration, and etoh abuse. If something unusual were to come in like a rhythm strip you did not know or an illness like possible meningitis I think that it would be appropriate to come up with an action plan and ask another nurse for their opinion on your plan. I never received 16weeks orientation anywhere. I got 3days in LTC and saw everything from gas pains to an AMI to a gi bleed. My current job I got 40hrs orientation. You just need to be more confident. :) it does take time and experience but maybe what you see as your dept turning their backs on you is really them supporting you in flying solo. That day will come and maybe they felt you were relying too much on the seasoned staff and giving you the chance to build your confidence

One1, BSN, RN · Nov 2, 2012

Having multiple preceptors during your orientation is pretty common from what I see. You had a nice long orientation, MUCH longer than I had, that should hopefully prepare you enough to take on a full, or almost full, load of stable patients and to do ok with support with unstable patients. In my orientation, there was never a "heads-up" that I was going to take on patient care by myself. Depending on the craziness of the day and the staffing level I had many preceptors who would take on their own patients while I took care of mine, with support as needed or not. If you are at the end of your orientation, you should examine what exactly you felt flustered about: did you take on a load that was too much for you, were your patients too sick to have that many, was it normal new grad flutters or do you maybe want to look into a less high-acuity, stressful area of nursing? What help did you ask for that you did not get? I don't know the details, so I can't make a call. However, NOW, while you are still in orientation but almost done, is in my opinion the perfect time to "test drive" you to see if you might need more orientation time or in what areas you need the most work in.

Anna Flaxis, BSN, RN · Nov 3, 2012

Nursing is trial by fire. You would be experiencing this no matter what unit you were on. I'm just amazed you got sixteen weeks' orientation! That is simply astounding!

Patient safety first? Don't get me started!

Altra, BSN, RN · Nov 3, 2012

Orientation for new grads has been 16 weeks in 2 of the 3 emergency departments where I have worked. That time frame is also, I believe, recommended by the ENA (will try to find a link ...).

sserrn, BSN · Nov 3, 2012

You are correct, Altra, about the ENA's recommendation. Mine was only 12 weeks, which is the standard length of orientation in my area (pediatric ERs are usually longer here, 16-18 wks). Wish mine had lasted 16 weeks!

Anna Flaxis, BSN, RN · Nov 3, 2012

The only new grad programs in my area are in the ICU, and those are six month preceptorships where at the end of the six months, you must apply for an open position on the unit. In the ED, new grads are rarely hired and receive the same orientation as experienced RNs. Mine was closer to 16 shifts than 16 weeks! As a new grad RN on a PCU, I had 10 shifts of orientation.

Lali1118RN · Nov 3, 2012

Help!!! I interviewed yesterday for icu fellowship and the interview last 15-20 min. I was interviewed by 2 nurses manager from icu. They were extremely nice, but they only asked me 3 questions, and asked me to ask them questions. I asked them about 7 questions, and I asked for a tour they were really happy that I asked for it. They showed me everything and introduced me to the staff. My concern is that in the end she told me to email her next week and ask about the process. She also told me to put on the email things we discuss do she knows who I'm. Is it a bad sign. She said to email her so she can tell the DON about me. I asked how many openings she said 6 and is interviewing 20 people. I'm really anxious about it. This is a dream opportunity. I'm a new-grad no experience. Thank u!!!

sandyfeet · Nov 3, 2012

I'm also a new grad in the ER, coming up on about 5 months in (including an 8 week orientation). My hospital had a progressive orientation, where towards the end you started taking 2 patients on your own and at your preceptor's discretion could take up to 3 or 4. My preceptor said to me once "You seem to do better when I'm not around" because I kept relying on her to make little judgement calls, and once I was forced to do it on my own I got to practice and learn. What kind of help were you looking for? Was it "I'm drowning in tasks and falling behind" help or "I don't know what to do in this situation" help? Because I've found that there is always someone available to bounce ideas off of, but there is not always help with catching up. And that is the reality of the ER, when you have to prioritize with your ABCs and delegate to techs/aides. It's ok for some patients to wait (this was really hard for me to learn). The more you struggle on your own, the more you will figure out shortcuts and what works for you to in order to save time.

I also felt like the staff of the ER were cold at one point. What helped me to put it in perspective is viewing the ER as a whole. It's not just me and the doctor processing a patient. It's the Triage RN and the Radio RN waiting for an open room. It's Radiology trying to fit my patient in their schedule. The RN I'm trying to delegate a task to has their own patients. It's the tech who has to fit a 12 lead EKG in between making a cast and my request to put a LOL on an air mattress. When I prioritize poorly and fall behind, it can affect a lot of different people. What turned the tides (besides better prioritization) was offering help to other RNs. I can pop a line in your patient, or medicate someone else's patient without falling behind in my work. And then your co-workers will start to see you as a team player instead of someone who always needs helping out.

So to answer your question, I think it's a normal part of orientation to feel like you are feeling. There were some pretty hard days at the beginning. I complained a lot to my fiancee. Luckily he stuck around and I stuck it out in the ER. I can't say right now I feel like a total rock star in the ER or anything like that, but I can see where I am progressing and improving, and that gives me hope.

ecerrn · Nov 4, 2012

My first impression is that they are trying to get you out of the nest and flying on your own. It is very difficult thing to be a new grad - do you have any experience in health care hands on? You should be, at the end of orientation, handling your own assignment with little to no help from the preceptor. You may consider stepping down to a less hectic area until you have the basic nursing skills down, then consider adding to that experience. If you are nervous and worried about pt safety why? You would be surprised to know how we can watch you without your knowledge.....they are well aware of what you are doing at all times. Get in there...jump in and run your assignment as if you are on your own. Drive your own day. Show independence now, or apply for a transfer...the patients safety is in your hands...or it will be shortly. You have to prove you can do it. Prove it. Good luck too.