we often see threads with the title "fired for no reason," or "new grad harassed and fired" or something to that effect. and i always feel at least a little sympathy for the individual involved, if only because i can clearly see by reading between the lines of their self-justifying post that there was a reason for their termination, even if they just don't get it. (there are always a few posts every year from a new grad who is convinced that the reason she's not getting along with her co-workers is that she's just so beautiful they're all jealous, that crowds of mean people are following her around, that she's so wonderful she's going to rock the er or icu or nicu or or and no one sees her wonderfulness clearly, or that some mean, tired, old nurse who ought to retire and get out of the way is targeting her for no good reason.)
i worked with a new grad who was recently terminated for, as she puts it, totally bogus reasons. evidently seeing mine as a sympathetic ear, she went on and on and on about how unfair it was that management expected her to get her act together and actually understand what was going on with her patients. "i've got the time management thing down pat," she said. "i don't know what else they want. they're just picking on me for no good reason." i liked sal, i really did. she was interesting and entertaining and really, really nice. she was also smart, hard-working (when she was at work) and well-educated. but she didn't study outside of work, and really didn't understand what was going on with her patients. i participated in several meetings with her in which it was pointed out that it's not enough to do the tasks, you have to understand why you're doing them. it's not enough to draw the labs. you have to understand what the results mean and then address them. for instance, if the inr is 9, it might explain the nosebleed, the cherry red urine and the fact that the hemoglobin is now 6. giving the coumadin at 6pm as scheduled is not a good thing, even if you gave it right on time and were able to explain to the patient that "it's a blood thinner." i could go on and on.
i got a call from sal today, complaining that she knows she's blackballed for no good reason because she just can't get another job. she wanted me to give her a reference. did she just not get it?
all you new grads out there who are convinced that you're being picked on for no reason, that your more experienced colleagues are just out to get you, and that you're being unfairly targeting, harassed, or picked on, hear this: it may be something you're doing (or not doing) and all those "mean people" are trying to explain it to you so you catch on, learn your job and succeed. we all tried over and over with sal, and she still doesn't get it. are you guilty of the same thing? if your preceptor says you lack critical thinking skills, do you take it to heart, think about it and learn from it? or are you convinced that the entire issue is that she's jealous of your extreme good looks? if your charge nurse charges you with a deficit in your time management skills do you spend time figuring out where you could speed things up a bit? or do you dismiss her as a tired old dog who can't learn a new trick and ought to retire anyway? are you taking to heart and benefitting from any negative feedback you're getting, however poorly given it is? or are you obsessing about how "mean" that nurse was to you and totally overlooking the message?
i wish sal would have "gotten it." she would have been delightful to work with if she had. but right now she's focused on badmouthing her preceptors and the charge nurse, and she still doesn't understand what she did wrong. don't make the same mistakes.
New grad here. Thank you, Ruby, for your post. I'll keep it in mind as I start my first job.
Everyone has a unique interpretation of Ruby's post. Here's mine: I don't think it's about new grad versus veteran, young versus old, or even about nursing. It's about Sal's lack of insight.
Sal will have the same problem wherever she goes, whether she's an accountant or a nurse or a teacher. She'll always have this problem in her relationships, too. It will always be someone else's fault. Until she takes responsibility for her behavior and her actions, until she sees that she is not the center of the universe, until she sees that she is a bit player on the world stage, she'll always believe that everyone else is the problem. Haven't we all worked with Sal somewhere? As one poster noted, you've got to open your mind to learn.
Now, if you don't mind, I've had my license for seven hours. I've got to go celebrate.
:ancong!:
Sal will have the same problem wherever she goes Yes she will because unfortunately wherever she goes, there she'll be! If someone continually finds themself having the same problems wherever they are maybe THEY'RE the problem.
If you're task oriented you focus on the jobs that need to be done (do the obs, give the meds, wash the patient) but don't think about why these need to be done.
So, for example, I'll sometimes find stable stroke patients having neuro obs a week after admission (GCS unchanged since presentation), because nobody thought about why this patient needed neuro obs and if that's still necessary. Or a patient has been on BD obs so the non-critical thinking nurse doesn't (or doesn't consistently) put together a change in condition with increased monitoring.
Obviously this is a fairly basic example, and for the most part most of us employ at least some critical thinking in our day-to-day practice, and as our knowledge, expereince and awareness of all the factors that interact with our patient's condition increases, we think more intelligently about what needs to be checked, changed and followed up. As you say, erik, it doesn't seem extraordinatry. If you're doing it.
For those nurses who don't seem to be able to think critically, the concept is invisible. It's not a process of elimination, perhaps because the connections between BP and meds (or reasons why an APPT might have dropped) aren't there.
OK. So, if I am "thinking critically" , the person has gotten better at this point as evidenced by the consistent scores. People not realizeing the pt. is better and doesnt need GCS anymore just read the orders and do it.
Actually, related to another thread I just posted in..............I would see the scores remaining the same and first thing that would come to mind is "are people really doing these or just copying the assessment from the shift before?" I would go see if I agree with it. If I do, then see about getting rid of GCS for that pt.
Am I way off or what?
Told ya, I am task oreinted. But I dont mind it. There arent meds not given that shouldve been or folleys not inserted when you take over for me. lol
A lot of people use the expression "critical thinking" to mean any mental process. that makes it hard to pin down as a concept.
Nurses need to be able to assess a situation -- to put a bunch of observable facts together and understand how they all fit together -- identify problems -- and then go through a process of sound reasoning to develop a plan. Unfortunately, not everyone has those intellectual skills. Some people see a lab value and all they see is a number: they can't see a relationship between that number and the other facts of the situation. Some people may see a problem, but can't figure out what might be causing it ... or can't think through the possible interventions and choose a reasonable one. They only see the concrete thing in front of them and can only see it in isolation. Those people really don't have what it takes to be a nurse -- unless they can improve those skills.
So, would I be out of line saying the critical thinking that we as nurses are supposed to exhibit.......is............a little like..........detective work. Put together the clues, solve the problem thats going on.
I love your first line though, about how the term critical thinking may be a little overused. I do feel that way. People call things critical thinking and I say to myself "so, you figured out the IV bag is leaking from the wet floor, SO WHAT".
With my first example - failing to check the BP before giving the antihypertensive is only a symptom of her bigger problem that exacerbated an existing issue. She should have been checking the BP regularly throughout the shift, as we already knew she had a potentially dangerouly low BP at 12:20. She didn't put together A (a drug with known antihypertensive sude effects), B (an already low BP) and C (a situation that warrants more frequent monitoring). She then compounded the error by not thinking "I'm giving an antihypertensive drug to this patient - what's her BP? Is she clinically stable? Should I assess her before giving this?"
In the neuro obs example, it's a combination of length of time and stability of observations. If a stroke patient had the same GCS for 24/24 I wouldn't cease the observations because there's still a danger of extension or of bleeding into an infarct, but at a week that's significantly reduced. You're doing the observations to pick up a deterioration in condition as early as possible, in order to investigate and - if possible - intervene. If the GCS suddenly drops then maybe they need more aggressive anticoagulation, or neurosurgical review, or inatropic support (if they're inadequately perfused and hypotensive)... You wouldn't necessarily know that if you don't work with stroke patients, but all the nurses on my ward ought to.
I hope that's made sense - it's been a long hot day without sleep and a busy night...
And I agree that the tasks need to be done. The difference is that the tasks should be a means to an end (like improved patient condition and outcomes, reduced pain, reduction in wound severity) rather than ends in themselves.
With my first example - failing to check the BP before giving the antihypertensive is only a symptom of her bigger problem that exacerbated an existing issue. She should have been checking the BP regularly throughout the shift, as we already knew she had a potentially dangerouly low BP at 12:20. She didn't put together A (a drug with known antihypertensive sude effects), B (an already low BP) and C (a situation that warrants more frequent monitoring). She then compounded the error by not thinking "I'm giving an antihypertensive drug to this patient - what's her BP? Is she clinically stable? Should I assess her before giving this?"
In the neuro obs example, it's a combination of length of time and stability of observations. If a stroke patient had the same GCS for 24/24 I wouldn't cease the observations because there's still a danger of extension or of bleeding into an infarct, but at a week that's significantly reduced. You're doing the observations to pick up a deterioration in condition as early as possible, in order to investigate and - if possible - intervene. If the GCS suddenly drops then maybe they need more aggressive anticoagulation, or neurosurgical review, or inatropic support (if they're inadequately perfused and hypotensive)... You wouldn't necessarily know that if you don't work with stroke patients, but all the nurses on my ward ought to.
I hope that's made sense - it's been a long hot day without sleep and a busy night...
And I agree that the tasks need to be done. The difference is that the tasks should be a means to an end (like improved patient condition and outcomes, reduced pain, reduction in wound severity) rather than ends in themselves.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i disagree. if a nurse can make it thru nursing school and pass nclex then who is to say that nurse is in the wrong profession? perhaps on the wrong floor! that ding-bat of a nurse might do better in clinic work? or somewhere?
i think sal would have done better to start out in med surg or perhaps a clinic. she had wonderful time management skills, but the icu hi-tech seemed to fly right over her head. she's smart, but she just wasn't applying herself. so maybe she wasn't quite ready to actually be a nurse.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
excellent post from a new nurse who "get's it."
the op was expressing her opinion and observations concerning a specific type of new grad. we all know there are poor preceptors, unsupportive environments, and so on. but from what the op told us, this was not the situation in the specific case she spoke of. i think she was trying to stimulate introspection, self-examination, and a sense of accountability among new grads.
i feel that posters who have responded defensively have missed the point entirely.
precisely my point! thanks for restating it so succinctly!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
new grad here. thank you, ruby, for your post. i'll keep it in mind as i start my first job.
everyone has a unique interpretation of ruby's post. here's mine: i don't think it's about new grad versus veteran, young versus old, or even about nursing. it's about sal's lack of insight.
sal will have the same problem wherever she goes, whether she's an accountant or a nurse or a teacher. she'll always have this problem in her relationships, too. it will always be someone else's fault. until she takes responsibility for her behavior and her actions, until she sees that she is not the center of the universe, until she sees that she is a bit player on the world stage, she'll always believe that everyone else is the problem. haven't we all worked with sal somewhere? as one poster noted, you've got to open your mind to learn.
now, if you don't mind, i've had my license for seven hours. i've got to go celebrate.
congratulations on your new license! and thanks for stopping to post before running off to celebrate.
That ding-bat of a nurse might do better in clinic work?
Whoa there Faerie...I work in a clinic. Does that make me a dingbat? Check my profile! Just saying...
At any rate a person who is unteachable is going to be unteachable no matter what setting they are in. Med/Surg and clinic work may not be glamorous but sometimes it can be downright scary and you have to be able to apply what you have learned in those situations. This sounds like a person who cannot do this and unfortunately that is not something easily learned. Just because a person can pass a standardized test does not necessarily mean they can function in the real world.
Ruby Vee, I agree with you for the most part. But, I have seen certain people targeted for really stupid reasons. In one case, it WAS because the nurse in question was cute, with a bubbly personality and there was a clique of ol' nasties that zeroed in on this kid the first day she started. They were vocal in the fact that they hated her because she got along with people. If a doc liked working with her, it was because she was "flirting" with him. This new grad was on the ball too, asked questions when she needed to, cared passionately etc. They didn't end up firing this girl though, she quit. There were those of us that encouraged her, because you don't like to see the good ones leave, but the clique's behavior of her was truly brutal.
I've seen experienced nurses fired for no reason as well...usually something trumped up by management so they don't have to pay them what they're worth.
Like I said, I think in 97% of the cases, the new grad is contributing somewhat to the negative responses. But, there are cases where the workplace is so toxic that this hazing of newbies is tolerated and encouraged.
, the person has gotten better at this point as evidenced by the consistent scores. People not realizeing the pt. is better and doesnt need GCS anymore just read the orders and do it. 
truern
2,016 Posts
:ancong!:
Sal will have the same problem wherever she goes Yes she will because unfortunately wherever she goes, there she'll be! If someone continually finds themself having the same problems wherever they are maybe THEY'RE the problem.