Hello, I could use your feedback and advice. Recently I resigned just short of the full term of my orientation in an ICU, though it was the last thing I ever thought I would do. My primary goal since I decided to pursue nursing was to become a good nurse.
Background: This is my second career. My first was successful, but it was time for a change. A former manager called me "the quiet professional." I am not an extrovert and was known to work hard and keep my nose clean. In every workplace I have formed very good friendships with others. Before nursing school, I achieved a lot due to some amount of intelligence and a LOT of hard work. I completed nursing school in one year (accelerated program), top of my class, with commendations from the dean. All of my clinical instructors wrote very good recommendations for me when I applied for jobs. I passed the state boards answering 75 questions. My success up to this point I attribute to a lot of hard work and a wonderful family. During my orientation I did not advertise any of this. I told no one except my preceptor about the number of questions I got on the state boards, and even with her, I made it a point to be modest. Personally, I don't like people who brag and boast, and doing well in school or on a test doesn't mean someone will do well in real life.
Several of us from the same class were hired by one ICU. We had the opportunity to complete our last semester with this unit, which we saw as a head start in orienting to the unit. We each had the same preceptor during this period and during orientation. I discovered during this last semester that many of my fellow-students were ahead of me in terms of responsibilities given. I was uneasy about this and asked my preceptor a couple of times for more responsibility. Her response was that I was a student still and that there was plenty of time to learn.
By the way, I was never late (always very early), never sick, and never rejected the opportunity to do anything. I loved the extra classes offered and did well in them. I looked forward to them.
During this time I also learned that the unit had had a bad reputation due to poor management. Nurses came and left within 6 months. There were a lot of agency nurses to fill the gaps in the schedule. The former manager had been fired because the work environment was so toxic. A new manager was hired shortly before I was hired.
In the last semester of school I noticed a few things about my preceptor:
1. She was very negative about other nurses, doctors, and even patients. She would treat patients she suspected abused drugs or alcohol badly - she would try to avoid giving them pain medicine, she would speak very negatively about them. She was not very compassionate with most patients in general. On three occasions the patients complained about her and requested me to be their nurse.
2. She was very condescending towards me. The longer we were together, the worse it got. I tolerated it because I realized that it was a temporary situation. As long as I was learning what I needed to know, I could put up with her bullying, I could put up with her behavior. She would have particularly bad days when she would disappear for long periods, then reappear in a patient's room, ordering me to do XYZ, as though I had done something wrong, when in fact I was in the process of doing those tasks. Several times patients and patient's families commented on her behavior once she left the room.
3. As time went on, I saw that other orientees were progressing, learning things I that I longed to learn, but wasn't taught. I was given tasks that a PCT would have, and on the rare occasion that my preceptor wanted to teach something to me, her lessons fell short. For example, when learning how to draw a blood sample from an arterial line she said: "turn the thingy up." That evening I went home and watched videos online to figure out how to do it. What she meant was: turn the stopcock off to the flush. On several occasions I asked her nursing questions that she couldn't answer. No harm, I thought. She can still teach me how to do the basics. But she didn't, or perhaps couldn't, do that either. As time went on, I felt more and more behind and that I wouldn't be prepared for 'real life' in the unit.
4. In the fourth week of orientation my preceptor was reprimanded. Her head was not in the preceptor game before this, and after the reprimand, it most definitely was not. For the first couple of shifts after the reprimand, she was almost nice to me. I thought it would be the turning point. Then she became even worse than before.
5. Right after she was reprimanded, she suddenly began to go through the preceptor's evaluations with me. I got good marks and her general remark was that I needed to learn more stuff. Well, yes, I thought. I DO.
6. In the seventh week of orientation, the manager saw a tense exchange between the two of us. I asked my preceptor a question in front of the manager, my preceptor snapped at me, and I replied that I hadn't been shown how to do X. It had gotten to the point that she was very critical with me all the time about everything. I could do nothing right. I was becoming more and more nervous at work. Sometimes I had trouble breathing. A few minutes later I asked the manager to talk to her, thinking I could talk to her alone. The manager called in my preceptor and then asked me how orientation was going. I was kind. I said that I didn't feel I was on the right track. My preceptor then totally torpedoed me. She said she didn't think I had what it takes to be a nurse in ICU. I replied by saying that in my heart I believed I did, but that I wasn't being taught how to do just that.
My preceptor left, I spoke with my manager who said she would find another preceptor. She also offered me the opportunity to transfer to another unit, saying that I could be a good nurse in another unit. I wanted to stay in ICU. Now I realize that was my moment to exit gracefully.
Within a few days I had another preceptor. She didn't seem enthused to have me. In fact, on our second day together she said she thought new grads shouldn't be hired in ICU. She was definitely not on my side. After a few shifts together, in which I learned a great deal - the learning curve was amazing - I discovered that I had been doing about 1/2 the charting I should have been doing. I quickly adapted. I was given full responsibility of two patients (normal load) and even though we had to stay late the first time, I did a good job,
I thought.
I discovered in the following weeks that my first preceptor had a very bad reputation. She was seen as lazy (yes), a gossip (yes), gave very poor patient care (no Q2 turning or oral care, leaving patients who needed consultations in their rooms languishing - experienced this on several occasions), and unkind to patients (yes). I never participated in this talk, just listened. When asked about the change in preceptor, I said that we had decided to mix things up a bit. I made it a point to saying she had taught me a great deal.
I was steadily given more responsibility, feeling overwhelmed sometimes, but happy to finally have the opportunity to learn what I needed to learn. I thought I was making great progress. By the fourth or fifth shift together, preceptor 2 left the unit to make a phone call, leaving me in charge of two patients. One of those patients was on levophed. The levophed ran out shortly before preceptor number 2 came back from her phone call, and then it was my fault that the patient's BP dropped. Somehow I felt this was unfair, but I accepted responsibility for it, had bad dreams about it, and spoke with preceptor number 2 about it. Her reply was that I should have learned all about levophed in school.
Looking back, I see that there was no 'winning' from this point on. Even though I explained that I was behind others because I wasn't taught skills, she was not convinced. Preceptor #2 reported every mistake I made to the manager. I was docked for asking questions, I was docked for being behind the other orientees who started with me, etc.
For two shifts I worked with other nurses, who each said at the end of the shift that they would report what they observed back to the manager. One said she was very surprised at my performance - I had asked a lot of questions, and she thought I needed another 12 week orientation. I was very surprised since I completed all of the documentation and almost all of the tasks (save two) for THREE patients by the end of the shift - no staying late.
The second, and last nurse, I worked with was a true horror. She was a disorganized mess who arrived late and spent the shift talking to colleagues. Three people came up to me during that shift, giving me words of comfort. I realized that this nurse, who I rarely saw during that shift, was talking about me with other nurses. Near the end of the shift, I went to the charge nurse to ask her a question and found the nurse I was supposed to be working with talking to the charge nurse. It was obvious that the two of them, plus one more, were talking about me. A little while later I confronted her and she admitted to talking to the charge nurse about me. It was her duty, she said, to weigh in on my performance. In her opinion I should work in Med-Surg. During that shift I took care of two patients and did all the documentation for them as well, well before the end of the shift. I made one mistake with an infusion pump, which was reported back to the manager.
It was in the middle of the next shift that I asked to speak with my manager to discuss my progress. In my opinion, in three weeks I had picked up more than I had in all the time before. I had certainly made mistakes, they were beginner's mistakes, and no patient was ever hurt. In this conversation the manager said ICU wasn't a good fit. It was pointless to argue, so I decided to conduct myself as professionally as possible and to end on friendly terms. The feedback I was given was that I as a nurse I had excellent assessment skills, documentation skills, was detail oriented, was a good communicator with nurses, doctors, and patients, but I needed to work on prioritization skills and basic skills.
The good news is that physically I feel like a huge burden has been lifted from me. I have been sleeping well (whereas before I couldn't sleep through the night) and my stomach is no longer in knots. Maybe I dodged a bullet, but then again, maybe I simply failed.
If you have made it this far, Experienced Nurse, I would really appreciate YOUR feedback.
Where did I go wrong?
What should I have done differently? I don't want to make the same mistakes.
Now that this has ended, how do I talk about it in future job interviews?
Thank you for your input.
