"You've got 4 days to improve or else..." ... advice?

Long Term Care Columnist / Guide · Mar 10, 2012

Welcome to Allnurses, Cherry! :hug: I hope you'll find what you are looking for here. We're a darn good support group and we're glad you joined us. :yeah:

I'm not an ER nurse so I'm afraid I can't answer your questions very well, but someone should be along here pretty shortly who can. In the meantime, feel free to look around the site and post in other threads as well so we can get to know you better. Big (((((HUGS))))) to you......sounds like a pretty rocky introduction to nursing, but you'll get the hang of it. Trust me. :)

nurse2033, MSN, RN · Mar 10, 2012

Your story is pretty common unfortunately. Once there is blood in the water, the sharks start circling. This is a common management error. Once they hear a whiff of a problem they start digging and scratching until they find more dirt to justify their doubts. You can overcome this but it requires a positive mental attitude and you must focus on the areas they are looking to improve. Time management is hard for everyone, especially when pressed. I would be more forthcoming in communication with your preceptor and ask for time management advice in specific situations. Make sure you are clear on what they are looking for and do everything you can to show them you are working on it, and improving. Good luck.

vega · Mar 10, 2012

First, I'm sorry that this is happening to you. Four days is such an arbitrary and insufficient amount of time to show marked progress, especially considering the stress and pressure that their ultimatum puts on you. I don't say this to be discouraging, but with no specific improvement plan in place, it seems like an unrealistic goal. On our unit, for example, new and experienced nurses go through a formal improvement process whenever there is a performance issue. Typically, the initial improvement plan is 6 weeks, at which time a reevaluation takes place; in the meanwhile, there is often some kind of education/coaching that occurs off-unit as well.

Considering hospital and unit politics, it is possible that you aren't a good personality fit for the unit, and you're being targeting as a result. It's not fair, but let's face it, it happens. If that's the case, nothing you do will likely satisfy them. Please don't let it discourage you from staying in your speciality - just find a greener pasture and move on.

If you are truly behind your peers in the learning process, then in your shoes, I would seek out feedback from experienced nurses who seem to be doing the job well and enjoy offering advice and their list of lessons learned the hard way. Ask them how they manage their shift, deliver safe care, and prioritize when things get crazy. If you have a good relationship with the colleague that's being pressured to end her orientation early, ask similar questions. During your orientation, did you shadow anyone on your unit? Would the unit manager allow you to come in on your own time and shadow the "top performer" for a half a shift? Are you thinking about what might happen before you go into each room so that you can anticipate and make less trips in and out? This sounds so simple, but I wasted so much time as a new nurse running to get things that I forgot.

In the hospitals that I've experienced to date (I'm going on year 4 as a nurse, so I'm still a little green around the edges), understaffing and high turnover rates are more common than not. Three months isn't a very long time for a new grad to learn the ropes. I definitely felt more comfortable in my role as a new nurse after a few months, but it took a lot longer to get rid of the butterflies in my stomach before my shift started, or that feeling that I would never be good at nursing. Sooner or later, those feelings faded and I was able to recognize that I had become a resource to my unit. It takes time to become efficient, but it also takes time to develop professional confidence in an environment where learning occurs each and every day on the job.

Good luck, no matter what the outcome!

JR816, BSN, RN · Mar 10, 2012

Good luck to you in this 4 day battle. In my opinion, getting hired on as a new grad in the ED means you had a certain quality about you that made you stand above the other applicants. Try and relax and let that be your strongpoint.

I started working in the ED 2 years ago and also had a difficult time adjusting. It was hard for me to stay organized because I was used to working off of a paper patient report that was organized and easy to follow. It seemed like I just couldn't keep my patients straight. Maybe you should try writing mini reports on your patients to keep things straight. You would be able to anticipate the orders before you even walk in the room.

That helped me. Hope it helps you!

mrvlegov · Mar 10, 2012

I had similar situation when I first graduated. I have a few things to tell you. First, if they don't think you're ready to be an ER nurse you may want to consider a) if they don't want you there you aren't going to be happy there b) they might be right, you might not even realize how much you have to learn until you work on a med/surg floor for awhile and realize all the things you learned before you go to the ER.

When I graduated they told me "2 years in med/surg" I didn't want to, but I have worked the ER for 5 years and surgery dept and am so glad I did the 2 years in med/surg. Nurses can be caddy and its frustrating. Especially when you are new, worried about hurting someone, doing everything right, making people like you etc. It might be ok if you accept the fact that you should work somewhere else in the hospital first. Maybe you could take a float position, and ask to float to the ER too. I did that for awhile and learned so much!

A few things to work on in the 4 days though:

a) always jump in and offer to help or ask what needs to be done. If you have down time, don't socialize, you can make friends later just focus on being a hard worker. Stock things, wipe things down, read policies, ask questions.

b) Try not to butt heads with anyone. Play it cool and try to stay under the radar. You will have to do this for awhile as a new grad until you gain enough experience. If you want to challenge someone or disagree word it as a question not as a challenge.

c) Be direct. Don't be embarrassed to ask for feedback or admit you don't know something. At the end of the day ask your preceptor if there was any suggestions for something you could have done differently. Tell her you heard you are scattered (are you scattered?) ask her for ideas to help you manage time better and watch other nurses and see how they do things. Nurses tend to think you aren't a good fit or aren't progressing if you act like you think you know a lot, it scares them. If you are up front and say "I have a hard time managing my time, or I got flustered when talking to the doctor not the phone, do you have ideas for helping me get through that learning curve?" they realize that you recognize your own limitations, aren't making excuses and it makes them trust you more.

D) always ask for help, if you need help.

e) as far as the feedback about jumping in on critical patients. You can always jump in and help roll, start a second IV etc. even if you aren't comfortable taking the patient or people are too busy to ask questions.

Again, don't feel like a failure if you can't go in the ER right away. ITs hard, when you're new and its ok to recognize that maybe you need to start out elsewhere.

Hope that helps!

Gold_SJ · Mar 10, 2012

I have to say four days with such pressure seems somewhat unkind to me. However I agree with prior posters, ED is hard. When I did my rotation through that specialty as a student there were so many things I still had to learn, I lacked at times initiative as I didn't relate procedures needed to illnesses. Eg. Abdo pain needing an MSU, pregnancy test, bloods. So didn't jump straight in and start it up so to experienced nurses it made me seem like an air head who needed prompting. So my preceptor had me sit down and write out all the illnesses I could think of and all the procedures they could possibly require and ones imperative to the condition. It was amazing, it just cemented it in my brain, from such a simple exercise, I went from needing prompting to being able to go right in and be really really helpful. I know this might seem a rather irrelevant example.

My point however is sometimes it's just something small that can make a major difference. Ask your preceptor what she feels you need to improve on the most? Is it being assertive? (like on the phone), time management? Do you need to write out lists to assist you or use ISOBAR when on the phone when you clarify and feedback information to ensure it's right.

With such a small time limit too I can only advise you to be optimistic at work, even if feeling the opposite, be helpful, smile ask to help and ask for feedback and try to apply it. Show them you're a good diligent worker who wants to be there. Complaining or showing you're unhappy (You may or may not. I have no idea) may be seen as a weakness or that you're not ready to some, so sometimes it's better to keep that to yourself and vent later to a person close to you (not about clients obviously).

Like other posters in my postgrad I started in med/surg, it was the best foundation I could ever have received for time management and working a busy ward. I then moved into paediatrics and have never looked back I love my work. I do feel I wouldn't be as good at my job now if I hadn't started in the med/surg ward. However that doesn't mean you can't stay in emergency nor that you should go to med/surg but I do think if in four days you were sent to one (or another ward), to embrace it and then just stick your foot right back into that ED specialty as if that's your dream don't let anything stop you just work on being better and better and before you know it I'm sure you'll be there.

Sending you good thoughts and prayers!

Pinkmegan · Mar 10, 2012

Hi

I am in England but situations are very similar. It seems to me that you are in a 'hostile environment' and one where only the brave can succeed!

If you are sure that this is where you really want to work then all you can do is give it your best shot, keep your head down and carry on!

If, however, comments that are being made about your work are incorrect, or simply lies, you need to think, very hard, about whether you want to be part of this environment. There is always the risk that if you do manage to crack it and 'fit in' you will, in the future, feel obliged to treat new staff in a similar way. I'm sure you won't as you are obviously not that type of person but, in any job, 'fitting in' makes daily life far easier, especially in high pressured environments.

I say this from bitter experience. I had been working fine, for 4 years, with good reviews. I then moved to another environment where the staff were a clique and newcomers were not welcomed! I did my best but it was never good enough, even though my work was as good, if not better, than the rest! I knew I should leave but stuck it out for 8 months, big mistake!! The lies continued and got worse and worse! In the end I had to leave to save my sanity!!

I'm now in a job I enjoy where I'm appreciated & treated like the professional that I am.

Don't risk you health & well-being, there are other posts out there where the same will happen for you.

Whatever you decide, good luck for the future!!

Megan

diligent-trooper · Mar 10, 2012

You need to resign now and get another position. You definitely were given a job with no support, and with expectations that no one with your experience level could achieve. You were set-up to fail from the start. I am sorry this happened..and good luck to you!

Esme12, ASN, BSN, RN · Mar 10, 2012

I had similar situation when I first graduated. I have a few things to tell you. First, if they don't think you're ready to be an ER nurse you may want to consider a) if they don't want you there you aren't going to be happy there b) they might be right, you might not even realize how much you have to learn until you work on a med/surg floor for awhile and realize all the things you learned before you go to the ER.
When I graduated they told me "2 years in med/surg" I didn't want to, but I have worked the ER for 5 years and surgery dept and am so glad I did the 2 years in med/surg. Nurses can be caddy and its frustrating. Especially when you are new, worried about hurting someone, doing everything right, making people like you etc. It might be ok if you accept the fact that you should work somewhere else in the hospital first. Maybe you could take a float position, and ask to float to the ER too. I did that for awhile and learned so much!
A few things to work on in the 4 days though:

a) always jump in and offer to help or ask what needs to be done. If you have down time, don't socialize, you can make friends later just focus on being a hard worker. Stock things, wipe things down, read policies, ask questions.

b) Try not to butt heads with anyone. Play it cool and try to stay under the radar. You will have to do this for awhile as a new grad until you gain enough experience. If you want to challenge someone or disagree word it as a question not as a challenge.

c) Be direct. Don't be embarrassed to ask for feedback or admit you don't know something. At the end of the day ask your preceptor if there was any suggestions for something you could have done differently. Tell her you heard you are scattered (are you scattered?) ask her for ideas to help you manage time better and watch other nurses and see how they do things.

D) Nurses tend to think you aren't a good fit or aren't progressing if you act like you think you know a lot, it scares them. If you are up front and say "I have a hard time managing my time, or I got flustered when talking to the doctor not the phone, do you have ideas for helping me get through that learning curve?" they realize that you recognize your own limitations, aren't making excuses and it makes them trust you more.
E) always ask for help, if you need help.

F) as far as the feedback about jumping in on critical patients. You can always jump in and help roll, start a second IV etc. even if you aren't comfortable taking the patient or people are too busy to ask questions.
Again, don't feel like a failure if you can't go in the ER right away. IT IS hard, when you're new and its ok to recognize that maybe you need to start out elsewhere.
Hope that helps!

This is excellent advice. I couldn't have done better myself. :yeah:

I changed it a little separating one section into two. One BIG issue is to forget you were ever an EMT. The functions of a nurse are completely different and it is nails on a chalkboard for an ED nurse to hear about EMT escapades. The ED is not all about jumping in on critical patients it's about keeping it moving and dealing with all the little stuff to treat em and street em or get them admitted.

The ED can be a tough place to break into and learn how to recognize what is needed and when. Some ED's are more nurturing than others. Their reputation as "The Top" ED doesn't mean it's an ok place to work. I am afraid they have made their decision already to give you 4 days when you have 6 weeks left doesn't bode well, I am sad to say. But don't give up and even if you don't have a good fit here doesn't mean you aren't fit for emergency medicine....it means you don't fit well there. I have to say I find it strange that you have spent all this time and JUST NOW saw the educator....what has she been doing????

:hug: I know this is a tough time for you and I hope it gets better. Don't let them get you down. Go up to your preceptor and tell her that you want to succeed and what do you specifically need to change over the next 4 days to change their minds.....Good luck.

Sending prayers your way!

Esme12, ASN, BSN, RN · Mar 10, 2012

check out the stickies .....and here.....

new grad er links....

Amanda.RN · Mar 10, 2012

I can't get the "quote" function to work for some reason, so I've copied and pasted below:

Your story is pretty common unfortunately. Once there is blood in the water, the sharks start circling. This is a common management error. Once they hear a whiff of a problem they start digging and scratching until they find more dirt to justify their doubts. You can overcome this but it requires a positive mental attitude and you must focus on the areas they are looking to improve. Time management is hard for everyone, especially when pressed. I would be more forthcoming in communication with your preceptor and ask for time management advice in specific situations. Make sure you are clear on what they are looking for and do everything you can to show them you are working on it, and improving. Good luck.

I disagree with the lines 2-4 ("Once there is blood in the water, the sharks start circling. This is a common management error. Once they hear a whiff of a problem they start digging and scratching until they find more dirt to justify their doubts."), and I'll tell you why -- When we (I am a supervisor) are notified or become aware of a new employee who is struggling, it is our responsibility to determine what improvements are needed and provide feedback to foster growth. Our ultimate goal is to help each employee excel in their position; not just because we care (we do!), but also because it’s VERY expensive to train new staff and we want to avoid having to train yet another person.

This isn’t “digging and scratching” to “find more dirt”, but rather, an attempt to evaluate where improvements are needed so pertinent and appropriate feedback can be given. The probationary period (sounds like yours is 20 weeks) is the time when we determine whether or not you will be a good fit and live up to the expectations we have for you. If you received any written documentation during the meeting you had, it’s probably called a “Trial Period Memo” (or at least that’s what it’s called in the facility in which I work). This means that they have outlined where you need improvement and they expect you to make immediate and sustained improvements (which is likely why they provided you with a deadline of 4 working days).

I understand that your med error was caught prior to administration and another nurse caught the error(s) in the telephone orders you took, but what if these errors hadn’t been caught? From a liability standpoint, your employer may be concerned that these errors won’t be caught once you’re off orientation, which could cause patient harm. I do agree with nurse2033 in that it’s important to maintain a positive attitude, work hard on making the improvements they’re requesting, and work closely with your preceptor/request feedback often. Other very important qualities would be making yourself very approachable and open to feedback, and avoid “butting heads” (as you called it) with the other staff. Not only are you evaluated based on your patient care and nursing skills, but also on your teamwork and attitude, which is why approachability and being a team player are so important.

Your comment “challenge accepted” indicates that you’re going into this defensively with your boxing gloves on – your co-workers/preceptor and management will be watching your attitude and comments closely, so avoid being defensive and/or making snide remarks about having been talked to about your performance. Esme12 also gave fantastic advice by saying “forget you were ever an EMT” – others may view you mentioning this as you thinking you “know it all”. Not only can this be annoying to hear over and over again, but it can also be cause for concern that you won’t ask questions as needed, which is a safety concern. I hope you find this advice and insight helpful. You’ve received great advice in the other posts above, as well. I wish you all the best, and I hope things work out for you. Good luck!