Should i just "hang in there"?

[sr919]

Well this is my first post, so here is my situation: I am an ADN graduate from last year(05/10), and I'll start taking BSN classes in January of next year. I was finally lucky enough to get a job this past january (55 miles away from home), which I am very thankful for, but it just hasn't turned out to be what I expected.

I was hired as the first and only new grad in an ICU dept in a long term Acute care hospital, but I only received 6 weeks of "orientation" which consisted of being paired up with 12 different nurses, with most of them completely unwilling to provide me with any support because they don't agree with new grads starting off in ICU. My first week every nurse refused to take me as a preceptee, so the manager had to intervene, and I think everyone resents me for going to him & letting him know the way I was being treated, but I had no other choice.

I've been given very hard patient assignments, but ive managed to be able to take care of these really sick patients on vents with multiple vasopressors, insulin drips, and numerous other meds, but I still feel that no one is willing to accept me. The only nurse that helped me is leaving, because she says that she cant handle the people we work with because there is absolutely no team work.

I've talked to my manager, but he keeps telling me that I shouldn't worry because im doing a good job, and that I should just "hang in there", but im afraid that im pretty much having to learn everything on my own. Im considering putting in my 2 week notice, but im afraid of not finding a job elsewhere because of the current job market and because im no longer considered a new grad. I really LOVE what I do, but the stress is taking a toll on me, I cant do this on my own, its not safe for me or my patients(even thought I triple check every thing I do)...Should I continue to "hang in there????

[SweetheartRN]

If I were you I would be lining up another job asap. As you do this ask questions about length of orientation and number of preceptors, how the staff utlizes teamwork in that department etc...

Until then unfortunately I have to agree with your boss and say "Hang in there", just until you find something else....

Do you have the option of transferring to another floor in your hospital? If you find sooner rather than later that you absolutely can't take it anymore, before you put in your notice, explain to your manager the situation again and ask her if you can be transferred to another department.

I hate to say this but they will probably never hire another new grad in the ICU after you but make sure you let it be known that it is b/c the staff do not create an inviting atmosphere conducive to learning whatsoever and that fault does not lie with you...obviously because you've done so well thus far despite their lack of assistance.

[Blue2011]

I would keep working and start looking for another job. Thats what I'm doing. Don't quit until you have a job!

[NoviceRN10]

I don't understand why anyone wouldn't want to precept? It means that there is a team of two taking care of their patients and they have help! Well, at least that's how my preceptorship was. My preceptor loved sitting on her butt while I ran around doing everything! She happily answered my questions, but I totally took a load off her for 5 wks. I would not give up this job until you have another one. Plaster a smile on your face, keep learning and don't let anyone get you down.

[sr919]

Thank U sweetheartRN and Blue2011 for ur replies.

I've been applying to other hospitals and I've even contacted past recruiters that I previously met. I am considering transferring to Tele, but since we are an LTACH the patient ratio is 1:9, and im honestly afraid to jump into that, because alot of those are the same vent patients that we transfer once they're of drips, but still require constant monitoring.

Plus our regular floor has a very bad nurse turnover rate, with constant complaints of team nursing not being effective.

What really upsets me is that I really Love what I do, and I know that If i would have gotten into a more supportive environment, I would be a much stronger nurse by now. I took ACLS, critical care, dysrhythmia, and lots of self study courses all on my own time & money just to be successful.

[sr919]

Yes noviceRN i totally agree with you. I actually did most of the care for 1 patient my 2nd week, but thats because I was paired up with a per diem nurse that was one of the most helpful ones I had, and she actually requested me to work with her, but because she's per diem, I didnt have an opportunity to work with her again

[NotReady4PrimeTime, RN]

I can explain why people don't want to preceptor. It's a huge added responsibility for the nurse to start off. The nurse in the preceptor role is still ultimately responsible for the safety and wellbeing of all the patients assigned to her and her orientee. S/he is responsible for ensuring that all the legalities of nursing are met for each patient, that the charting is up-to-date, accurate and appropriate for each patient and that all orders are dealt with promptly and accurately for each patient, the same as s/he would be without an orientee, but with the added components of supervising and teaching someone else. Let's face it, nobody graduates from nursing school ready to function independently and will all the necessary skills, especially these days. So preceptors actually have an INcreased workload. Add in the documentation that goes along with evaluating someone else's performance, formal and informal meetings with the nurse educator and management, the wide variety of learning and teaching styles and a myriad of other factors, and it's not hard to see why some people don't want to take it on. The preceptor is expected to prepare the orientee for independent function on that particular unit in a given amount of time and to ensure they have all the necessary skills and knowledge to do it safely. Where I work there's an added factor- that of management's reluctance to hear anything negative about the people they've hired, even when the nurse is clearly not coping with the workload or the workplace. This is leading to an ever-dwindling supply of nurses with enough experience to provide a decent orientation to new staff- no one wants to keep doing something that puts them at cross-purposes with the people they report to and causes their coworkers to distrust their judgment.

Another dimension is the personality of the preceptor. A person can be a superlative nurse but a terrible preceptor. It takes a lot of patience and restraint to sit back and watch someone else fumble their way through something when the person doing the watching could have completed it in no time flat. It's hard to observe without seeming to be hovering. And it's even harder to be diplomatic every minute of the day. I don't think anyone should be forced to preceptor someone else. I also don't think that any new nurse (either new grad or new-to-the-specialty) should ever have more than 2 or at most 3 preceptors during their orientation. It's too difficult to ensure that all the "buddies" (they aren't really preceptors when there are several of them, now are they?) are on the same page, that they know where the orientee is in the process, what they're good at and what they need help with, and if it's "only one shift" then why bother getting too involved?

Preceptoring isn't as simple as it seems on the surface. I hope this helps you all understand how it is for the people who do it for you.

[~Mi Vida Loca~RN, ASN, RN]

Have you tried to talk to the nurses themselves? I know it's not ideal as a new grad but maybe pull them aside and be very respectful but say something along the lines of

"I understand you don't feel new grads should work in the ICU and I will admit, I was nervous myself to start in such a critical area, but this was where I was offered a job after trying to find one for a long time, it is a commute and a hard job, but it's a job and I have to be able to support myself. If maybe you could tell me what you need from me and if you are willing to give ma chance, maybe we can make this work. I really want to learn and be good at what I do but I can't do it without any guidance. I am sorry you were put in such a bad position but maybe we can find a way to make this work."

I am not generally a fan of butt kissing and stuff, and I am not saying it's appropriate how they are treating you, but the situation is what it is, and trying this might work. They might respect you for coming to them about it in a polite manner, they might step back and understand that this isn't your "fault" and they might grow a new respect for you and be willing to work for you. At least if anything you know you tried all you could. There was a situation once where I had to do something like this years ago. It worked. After that we got along great and ended up becoming friends. Their problem wasn't with me, but I was more so the one it got taken out of, when I called her out on it she stepped back and realized she was handling it wrong. It's worth a shot.

[goldollarRN]

People fear what is foreign and what they do not understand..it could be the case where they dont understand how a new grad obtained your position and/or they fear that a new grad is unable to be successful at your position..either way, i get the impression from your posts that you have tried to view the situation from their point of view and thats all you can do...I would mos. def. feel the same way as you if I was in your position but I would also try to hang in there...only you know when enough is enough and if it gets to that point then I would begin seeking employment elsewhere...hope this hepls