Transferred to SICU, horrible orientation...what to do??

[nlhnurse1982]

I have been a nurse for 3 years 2 on a med/surg tele unit and 1 on a medical IMC unit so I have a good base background in nursing practice, my interest is in critical care and it is truely what I want to be doing but my orientation so far is making me miserable. I work at a well known level 1 trauma teaching hospital so I am expecting a wonderful orientation..I couldnt be more wrong! My first day my preceptor gave me 2 ICU patients and told me to do my thing with no direction while asking me multiple times if I was ready to cry yet. When I ask her about drips I've never seen and ventilators or anything i need explained to me I get an attitude. I have explained to her that I have never worked in an ICU so this is a whole new world to me. Today I had 2 patients one was a mess and gushing fluid from their abdomen, receiving tons of blood products on an insulin gtt using the portland protocol and having their fluids adjusted according to their abdominal output among other many other things going on. I was running back and forth like a crazy woman while she sat out at the nurses station, I did get everything done for my patients and at the end of the day she told me I need to be faster this is my 5th day working in an ICU. I asked her for suggestions on how to be faster or more effective she said she wouldnt have done anything different I am just not fast enough...I guess I will be slower when I am looking things up all of the time because she will not answer my questions. I dont feel like I am learning anything ,my preceptor is so miserable and unapproachable. Am I being unreasonable wanting a preceptor who can teach me how to organize my time as an ICU nurse as well as guide me through all of the new things I will have to learn to be a safe and effective nurse. How should I handle this, I dont want to make enemies as a new person to the unit but at the same time I need to learn how to do things correctly and have someone who is willing to teach me. Any suggestions on how to handle this would be greatly appreciated.

[RRRNNN]

I've made the mistake of stepping on the wrong toes when I transferred to a different unit, and that mistake followed me until I left the unit. You just never know, until you've been there a while, what the political climate is like and where she's at in the pecking order.

I think I might find a diplomatic way to ask my manager that she cosign all my work, if I were you. Then she might feel a little more inclined to make certain everything is done right. As long as your patients are safe, it might be a good idea to accept the rough initiation process and keep a stiff upper lip. Show her you're tough.

[diprifan]

That is how I felt at the beginning of my orientation. I have a medical background and moved over to MICU. My preceptor gave me 2 pts on the first day, one had to be intubated rather quickly. I was so overwhelmed. I could have sworn he made me feel stupid on many occasions. But I didn't lie down and take it. I found online resources to explain the vents, and some of the drips. I bought a book from the AACN to help with some of the common ICU stuff. After a couple weeks I realized that is just his teaching style, and he really isn't that bad. I definitely asked more questions on down time, not in the middle of procedures or right when we were going to do them. I'm starting to be more efficient at what I do, as far as getting everything done that I need to for that hour, plus some extras. Hang in there, it is just a completely different beast that the floor. I'm still having trouble with somethings, but there are tons of people to help. Seek them out, they will save you.

Nick RN

[Cessna172]

I am almost in shock after reading this. My advice, for what it's worth is...do not work another shift with this preceptor! She is setting you up for failure and when your patient finally crashes on you, I feel she will blame you. I'm sure you are good at your job, however, critical care is totally different than other types of units. You need and deserve a good orientation with someone who is going to actually give a darn about it. Secondly, your patients assume you know what you are doing and can give them the care they are there for. Without a good preceptor/orientation, they will not get that. Your manager needs to be informed of this, and so does senior management. The preceptor needs to get the boot also. If you have a patient die, and the family sues, guess what, you all will be taken "to the cleaners" IMO. Asking if you are ready to cry demonstrates her sadistic nature and seriously flawed character.

What do others have to say?

[diprifan]

I mean, I was trying to be positive. But burn her at the stake if you feel it is necessary... Have you tried to talk to her, or would that not work?

Jumping to conclusions never really works.

[nlhnurse1982]

I mean, I was trying to be positive. But burn her at the stake if you feel it is necessary... Have you tried to talk to her, or would that not work?

Jumping to conclusions never really works.

I have talked to her and it has gotten me no where....she even has told me that she made the last person she oriented cry and quit she was very proud of this too...she also told me that she is a bit*h and proud of it. I am sorry but when I precepted people the way I felt was that when they were off orientation how they conducted themselves and the care they provided was a reflection of myself since I trained them. I also question that she is able to teach me how to do things correctly since she has told me that it is acceptable to remove a central line wearing clean gloves and no mask and that it is acceptable to turn trauma patients without having their head stabilized before they have their spine cleared. Tomorrow she told me I will be taking a CRRT patient in addition to another ICU patient when I have never taken the CRRT course that we are required to take before caring for a patient on CRRT or even learned anything about it...CRRT is continuous renal replacement therapy which is a form of dialysis....I always have loved being a nurse now I find myself sick before work in the morning. I dont want one jerk to deter me from what I want to be doing however I also dont want to cause waves on a unit that has a lot of cliques. I feel between a rock and a hard place right now.

[love-d-OR]

" Are you ready to cry yet? " --- Classic lateral violence! Switch preceptors, this person sounds like the typical I'm-an-ICU-nurse-and -I'm-better-than-you kind of person. Sad, just sad!

[diprifan]

CRRT's are the sickest. I would try that without someone that is supportive, or competent at least.

[ICU, RN, BSN, B.S.]

That is horrible. No one should be thrown into the ICU like that. I just started last week, tonight was day 5. My orientation has been very good so far. My preceptor is really nice, wicked smart/critical thinker, and explains everything, doesn't make me feel stupid. Next week I am going to start to take care of my 1st patient officially by myself. There's a bunch of classes they have me set up for. She explained the vent/vent settings and everything we do with drips and titrating them.

Not sure how they can just throw you in there. That is unsafe for the patients, and makes you feel unsafe. Did they tell you this is how it would be done during your interview???

[ICU, RN, BSN, B.S.]

I have talked to her and it has gotten me no where....she even has told me that she made the last person she oriented cry and quit she was very proud of this too...she also told me that she is a bit*h and proud of it. I am sorry but when I precepted people the way I felt was that when they were off orientation how they conducted themselves and the care they provided was a reflection of myself since I trained them. I also question that she is able to teach me how to do things correctly since she has told me that it is acceptable to remove a central line wearing clean gloves and no mask and that it is acceptable to turn trauma patients without having their head stabilized before they have their spine cleared. Tomorrow she told me I will be taking a CRRT patient in addition to another ICU patient when I have never taken the CRRT course that we are required to take before caring for a patient on CRRT or even learned anything about it...CRRT is continuous renal replacement therapy which is a form of dialysis....I always have loved being a nurse now I find myself sick before work in the morning. I dont want one jerk to deter me from what I want to be doing however I also dont want to cause waves on a unit that has a lot of cliques. I feel between a rock and a hard place right now.

She obv isn't a good nurse if she is doing sterile procedures unsterile; putting patients in harms way. Her attitude sounds horrible, and she obv seemed to have forgotten what it was like to be new in an ICU! Talk to your manager, and get a new preceptor ....STAT!

[MeTheRN, BSN, MSN, RN]

" Are you ready to cry yet? " --- Classic lateral violence! Switch preceptors, this person sounds like the typical I'm-an-ICU-nurse-and -I'm-better-than-you kind of person. Sad, just sad!

Completely agreed. I bet this nurse has a superiority complex and is taking it out on the poor unsuspecting new nurse. Don't get me wrong, sometimes we get cocky nurses from the floor who need a reality check with two rough patients. But you definitely don't sound cocky or arrogant.

It is not a faux pas to change preceptors. I'd be very honest about why, I'd say a lot of the things you posted on here actually. If the management has an issue with this, then it's not a good unit for you to work on. Critical care is hard enough without BS from bitter nurses.

[himilayaneyes]

Your preceptor sounds absolutely awful. I 've been working in ICU for about 10 months and was blessed to have 2 really good preceptors. However, my fellow co-workers have had issues with their preceptors. There are very few people who like to train new icu nurses in my unit. Follow your heart. If you want to tough it out, then tough it out. No one has the right to bully you. If you have already tried talking to her and she's a b**** and proud of it, then speak with the manager about changing preceptors. I don't care for work-place politics. Get your experience and get out if you have to. Best of luck to you.