trouble with NICU orientation :/

NicuGal, MSN, RN · Mar 7, 2014

I replied on another thread :)

Bortaz, MSN, RN · Mar 8, 2014

What are the questions you're asking repeatedly?

If you're sitting around "inside your head" during slow times, I don't blame your preceptor for questioning your drive. Unless you have the only baby in the unit, there is surely something that needs to be done with another patient. That is the time when you should be asking for chances to start ivs or observe procedures or feed a baby or go with the c-section nurse to a delivery, etc etc.

Your reading and study should probably be done at home. Ask for assessment/procedure videos to watch, or to practice setting up for lines or chest tubes, etc. Ask for a gown and gloves so you can practice sterile gowning. Learn to break down a Giraffe to learn to properly clean it/change filters.

Most preceptors aren't going to be impressed with you sitting idle, pondering. But I guarantee they will like seeing you up and looking for stuff to do.

crystalNC · Mar 14, 2014

I have found myself in a similar situation. I am sorry I cant offer advice, but if you want to vent privately, send me a message. I too am six weeks into an orientation that is not going well.

msygrnbw · Mar 14, 2014

I am just starting my preceptorship, but there are a few tips I picked up from some really good threads here that I think might help you too.

- Keeping a little notebook in your pocket. Write important numbers, things you have asked about. This way, when you think of that question again you will remember that it is in your notebook. Verbalize this troubleshooting out loud so your preceptor can hear your thought process. A preceptor not hearing anything from the RN they are orienting can be scary. They wonder if you get it, how you will troubleshoot when you are on your own, etc.

- Keep a notebook at home about things you have learned. Our program gives us a day book for new nurses with an area to write a reflection. I am using this as an area to reflect on what I learned that day, as well as to explore any diagnosis, etc that I haven't encountered. It only takes about 30min - 1 hour to really read well through information I have looked up and reflect on how it will apply to my patient population.

- Verbalize how you are prioritizing. I have such trouble with prioritization, so this is and will continue to be key for me. Hearing why my preceptor agrees with the order I am doing things or how she would do it different makes it easier for me to get immediate feedback/reinforcement on my thinking.

- Have a good brain sheet. I have been trying some out and what works for a lot of the nurses on my floor hasn't worked for me, so I am trying to use one with a little more guided information areas. That way I know I'm not missing key things.

- Engage your coworkers and preceptor when you pass by them and be as interactive as you can. While it's not directly in the job description, having a good attitude and offering to help out others can go so far in showing that you're invested and care about your coworkers/job.

- If you have downtime use it to reflect on your plan of care, how it has related to other babies you have taken care of, and what additional things you anticipate. Talk these over with your preceptor. For example, today we ordered XYZ on this patient and they went for CT/we changed this med. In the coming days I expect to see this and if not, this is what we probably will implement. Or I think we could expand on this plan of care by adding this and that intervention. Or this reminds me of our patient last week, but I see we're using this medication as opposed to that. Maybe I will spend this time looking up these two meds real quick and try and understand more of the background of why the md chose it.

- Thank your preceptor. I don't know about you, but after a long or frustrating day having just one coworker genuinely thank me for my time goes a long way. While it might not solve that you missed this or that or asked a few too many questions, it will show that you appreciate their time and effort (and I sometimes have to add thank you for your patience!). I had one pharmacist I worked with in a previous job that would take the time to thank every pharmacy tech as they left - Even on our hardest days I ended up leaving with a smile.

Anyway, I hope some of that helps - and if you think of any tips or anything that ended up helping, please let us know! I could use tips too =)

Bortaz, MSN, RN · Mar 14, 2014

This is great advice from msygrnbw. I have a self-made brainsheet that I have shared with nurses around the world. If you are interested, I can attach it to this thread when I get home tonight. It probably won't be exactly perfect for you, but it is a good (and popular) blueprint that is easily adjusted, in Excel, to fit your needs.

When I was a new, overwhelmed nurse starting in the NICU, I found that I needed structure more than anything. Designing that brain to fit my needs greatly eased my difficulties with time management and keeping up.

Bortaz, MSN, RN · Mar 15, 2014

My brainsheet is attached.

NICU Brain - Jan 2013.xls

NICURNgrad · Mar 15, 2014

Thank you for the brain sheet

NICURNgrad · Mar 15, 2014

I am just starting my preceptorship, but there are a few tips I picked up from some really good threads here that I think might help you too.
- Keeping a little notebook in your pocket. Write important numbers, things you have asked about. This way, when you think of that question again you will remember that it is in your notebook. Verbalize this troubleshooting out loud so your preceptor can hear your thought process. A preceptor not hearing anything from the RN they are orienting can be scary. They wonder if you get it, how you will troubleshoot when you are on your own, etc.
- Keep a notebook at home about things you have learned. Our program gives us a day book for new nurses with an area to write a reflection. I am using this as an area to reflect on what I learned that day, as well as to explore any diagnosis, etc that I haven't encountered. It only takes about 30min - 1 hour to really read well through information I have looked up and reflect on how it will apply to my patient population.
- Verbalize how you are prioritizing. I have such trouble with prioritization, so this is and will continue to be key for me. Hearing why my preceptor agrees with the order I am doing things or how she would do it different makes it easier for me to get immediate feedback/reinforcement on my thinking.
- Have a good brain sheet. I have been trying some out and what works for a lot of the nurses on my floor hasn't worked for me, so I am trying to use one with a little more guided information areas. That way I know I'm not missing key things.
- Engage your coworkers and preceptor when you pass by them and be as interactive as you can. While it's not directly in the job description, having a good attitude and offering to help out others can go so far in showing that you're invested and care about your coworkers/job.
- If you have downtime use it to reflect on your plan of care, how it has related to other babies you have taken care of, and what additional things you anticipate. Talk these over with your preceptor. For example, today we ordered XYZ on this patient and they went for CT/we changed this med. In the coming days I expect to see this and if not, this is what we probably will implement. Or I think we could expand on this plan of care by adding this and that intervention. Or this reminds me of our patient last week, but I see we're using this medication as opposed to that. Maybe I will spend this time looking up these two meds real quick and try and understand more of the background of why the md chose it.
- Thank your preceptor. I don't know about you, but after a long or frustrating day having just one coworker genuinely thank me for my time goes a long way. While it might not solve that you missed this or that or asked a few too many questions, it will show that you appreciate their time and effort (and I sometimes have to add thank you for your patience!). I had one pharmacist I worked with in a previous job that would take the time to thank every pharmacy tech as they left - Even on our hardest days I ended up leaving with a smile.
Anyway, I hope some of that helps - and if you think of any tips or anything that ended up helping, please let us know! I could use tips too =)

This helped me sort through all I'm going through! I do keep a pocket notebook and it's so handy :) I try to keep myself on track with writing times down and what I have to do. My preceptor is a big part of my problem, I followed someone different around got just a day and my experience was so much more positive, it was like night and day.

NICURNgrad · Mar 15, 2014

Hey I would love to vent privately but I'm unable to use this sites messaging, if you want we could find another way , is like to hear your experience and compare

NICURNgrad · Mar 15, 2014

I have found myself in a similar situation. I am sorry I cant offer advice, but if you want to vent privately, send me a message. I too am six weeks into an orientation that is not going well.

I replied below, not sure why it didn't quote your response, but wanted up make sure you got it

Bortaz, MSN, RN · Mar 15, 2014

In 5 more posts, you'll be able to use private messaging here.