Stressed New NICU Nurse

[AmandaPanda101]

Hello, everyone! I am looking for advice/encouragement. Sorry! this post is going to be all over the place! 

I started out on a level 2 NICU floor with a 4 month set orientation! I thought I was doing really well until the end of orientation where I met with my learning specialist and manager and they informed me that they wanted to extend my orientation by two weeks. 

Each two weeks I was handed a different preceptor (on my last week they had me switch to days) which I feel like really threw somethings off for me because we obviously do things different depending on the shift. 

Again, I met with my learning specialist and management and they wanted me to orientate for another week, with a different preceptor. Just yesterday, they informed me that I am still not ready- although devastated and now severely anxious I am trying my best to stay positive. 

For these three weeks of orientation, my preceptors were told not to intervene at all and let me take on the team. I was told that I could come to them for questions or concerns. 

I am not blaming them, however, I quickly realized that me asking questions would get comments reporting back to management such as me not knowing certain things this far in orientation. I thought it was always good to ask questions/get clarification? At this point I have had 11-12 different preceptors and it can become overwhelming because all of them do things differently. I've had some relaxed preceptors and others who seem to nitpick at every single thing I do.  

Also them switching my preceptor every week (and also nights to days, back to night) was a struggle. 

On top of that, they gave me a new assignment every new shift of the week for experience, which I am grateful for.....but it was hard and anxiety provoking. 

Also, every preceptor does things differently so its always hard to gage what they want from you.....I have also ran into some bully preceptors but I am too scared to mention that to management since they have been here longer....

Im going in my fourth week and I AM TERRIFIED......I feel grateful that they want to invest time into my development, but I can sense that my manager is getting a little upset by these delays. 

Some feedback that I received and need to work on is time management, critical thinking, and prioritization and then last shift, I was told that I am not responding to alarms fast enough. 

This week I will be working with a charge nurse for two shifts and then one of my old preceptors. I have also asked for a set team so hopefully I will be accommodated and I can prove to them that I can establish a work flow and improve as the week goes on. 

Some positive feedback I've gotten is doing great SBAR's, speaking with providers, charting is perfect, medication, milk administration is perfect,  and safety checks are perfect. 

I agree with some of the feedback that my preceptors have mentioned but I also feel like it's nitpicking a lot since they are sitting down and watching me for 12-13 hours...I also feel like if they do have to intervene such as a critical blood sugar level, its gets immediately reported back to management.  I feel uncomfortable asking them any questions and feel like I just need to be faster/more efficient....

As of right now I believe that they think I am a safety concern because I am not responding to alarms fast enough (I think I get so fixated on a specific task that I just can't hear the alarm going off)- but, I will do my best to be more aware. 

If anyone has any advice/tips please let me know! I feel like I am under a microscope right now and will continue to be even off of orientation until I can really prove myself. 

[SweetSouthernLove, ASN, BSN]

Hello AmandaPanda101,

First and foremost, congrats on your new job! 🙂 I am unsure if you are a new graduate nurse or a nurse who has switched into the NICU specialty. After orienting many a nurse in multiple nursing specialties I can give you what I know to be true. 

Now to business, entering into such a specific specialty of NICU is very challenging. There is a vast array of knowledge and experience you do not know. Also, while 4 months is a decent amount of time for an orientation, you will not truly have your bearings until about a year, and this goes for nursing in ALL specialties no matter what your experience level. Everything is new...patients, people, coworkers, management, etc. I do sense by your post that maybe the preceptors/management may not be the most supportive/patient people in the room...however, now that you are in the thick of it, you must make the most of every single minute of whatever orientation you have left. 

As I tell all my nursing preceptees, be happy for this moment, this moment is your life. On orientation, really from day 1, you should see one, do one and then teach one. I am sorry if this has not happened to you. DO as much as humanly possible, DO it AGAIN until you feel comfortable doing it alone. ANYTHING that is offered for you to attempt, do it. Be ANNOYING with asking questions. There is someone who knows the answer, even if it isn't your preceptor that day. 

My second piece of advice would be to find the most patient and educational preceptor out of the bunch you have had and request them, if possible. I was selected to precept nurses for this personality trait, some nurses will stop in their tracks and love to educate, some see you as an anchor for their entire shift, some see you as compromising their already short staffed overloaded unit with critically ill babies and don't think you should be there in the first place. While it is the 11th hour in your training, be very transparent and speak up about what you need from your unit, even if you think you need an extension on your orientation, who you think can best provide that to you and also put this in writing and give it to your manager. The same way they have a competency packet for you, please give this to them and self-assess and explain to them you may need to extend your orientation by a month or two so you feel absolutely comfortable caring for their patient population, also this CYAs and I tell all nurses to do this because you have worked so hard for your license, protect it. Also if you haven't, please please PLEASE purchase malpractice insurance if you haven't already.

My third piece of advice is, whenever you are not in the clinical arena, STUDY, STUDY, STUDY. Study your most common diseases, pathophysiology, medications, your emergency event information, whatever it is that is giving you anxiety and the jitters. A competent nurse, a nurse who KNOWS her specialty will be the best nurse to care for that patient population. The true education starts before, after and any moment that you are not in a clinical setting. I would say this to all nurses if I could but you actually ARE the sum of what you know in this career. Medicine and nursing is everchanging at light speed and honestly you will never know ALL there is to know. But do not give up because your patient's lives however big or small or young or old literally depend on it.

All this to say I am not implying you are incompetent, just novice to the specialty and while experience comes with time, knowledge is immediate and something you are in full control of. 

I also sense from your post you may be worried about your position and your work environment with your coworkers. I am not saying to go and tattle at HR anytime soon but if the work environment is aggressive or hostile in a way where you cannot safely perform your duties or continue to precept in this environment this may unfortunately be the next step in this position. You are there to learn, and with that comes YOUR learning style, not their predated timeline. Ideally, yes, you should be safe enough at this stage to perform basic nursing duties in your unit, however, when critical events arise they should definitely continue to overshadow until you are fit for duty for the best interest of their patients. I would ideally like to see an experienced nurse take a new nurse under his/her wing for a year until they are safe to practice. No ifs, ands or buts. But this is an ideal world, not the one we live in. So please, soak up every bit of training you can, dive in also with any experiences offered, find YOUR people and don't let management/administration or otherwise make you feel like you can't become what you want here because you TOTALLY CAN. Best of luck and I hope this helped.