What is wrong with me??

[fancee free]

I graduated from nursing about 7 years ago and went into management in LTC and worked there for about 5 years. I just started a new job in Emergency, and am being orientated in Observation. From the get go, I was very honest about my background about the fact that I have little to no experience in nursing skills. Plus I never worked in a acute care setting. I was told that this was not a problem as they would orientate me to these skills.

My orientation feels like a horrible nightmare, and at this point I don't know if I have gone crazy or am needy or what, I am at a total loss.

• I am buddied up with someone different almost everyday of orientation, which is stressful in itself.
  
• I constatly receive contracdicting information, for example some nurses say we need a MD order for lab work, other say we do not.
  
• I have two people telling me to do two different things immediatly because each thing is a priority (one being my buddy, the other the CRN).
  
• I feel like I am running around in circles like a circus freak doing nothing productive and forced into doing one thing when I am in the middle of doing something else.
  
• I am always being told that I missed something (like a MD order, consult etc, etc), however I am not sure how to avoid this. I am so frazzled that I don't even think of asking how this can be avoided and I don't remember anyone telling me how to avoid missing this information.
  
• My buddy will do some of the paper work and patient care without telling me and then expect me do to other paper work, it all seems very random. For example, I have the MD returning my buddies telephone call about my patient, but I cannot figure out why she called the MD in the first place (of course, I am the one answering the call and my buddy is no where to be found and nothing is charted), yet I am blamed for screwing up because I missed faxing a consult. Is this normal?
  
• I want to cry in the middle of the shift.
  
• At the end of the day I feel more stupid and incompetent.
  
• I asked for constructive critizism and was told that I am slow, disorganized and a safety concern. Is this constructive or just critizism?
  
• Am I wrong for asking what some tests are, what some diagnosis mean, or how to provide some simple nursing skills such as giving a bolus of normal saline?
  
• What is the role of the buddy nurse, and should she (or he) posses a level of understanding?
  
• What is a supportive environment, and does it include giving any encourgment?
  
• I feel like everyone has given up on me.
  
• I do not want to ever to return to that place, but I need the money.
  
• Am I being too sensitive?

I use to be confident as a nurse and felt that I had enough "soft" skills to survive, such as assessments and communication skills. I always thought I was a smart nurse and a quick learner. However, any confidence I had went down the toilet very quickly. I am pretty sure I suffered from false confidence and now reality has set in and I am actually an idiot nurse. I no longer know what is normal or not because I am so dazed. Please help.

[TazziRN, RN]

Time to sit down with your nurse manager and tell him/her exactly what you've said here. Don't mention names. Ask him/her if it would be possible to be assigned to one buddy......same schedule, etc., so that the learning can be consistent. If he/she balks at this, point out that this is the industry standard, to be assigned to one preceptor.

[llg, PhD, RN]

I won't sugar-coat it. You need the cold hard facts so that you can make some tough decisions.

Having no acute care experience -- and being far removed from any acute care skills you may have learned in school -- an Emergency Department is probably the last place you belong right now in your career. It is an area that requires a very high level of acute care skills so that you can handle the rapid pace, wide variety of possible patient problems, tense atmosphere, etc. If you have a dream of being an ED nurse, then understand that you should probably postpone it until you have acquired some of the necessary skills before you try tackling such a job.

To make an already bad situation worse, it doesn't sound as if your ED is prepared to orient a nurse who needs a lot of support. That's a bad sign.

What are your other options? Can you transfer to another unit in the same hospital -- one that is not so fast-paced -- one that can give you the support you need to help you ease into the acute care setting? If so, I would strongly recommend you consider doing that ASAP, before your reputation suffers too much. Simply say that you made a mistake in choosing to begin your acute care career in the ED and don't make any enemies as you leave.

Are there other options in your community for nurses that do not require acute care skills? I would also be exploring those options.

Good luck to you.

[kanzi monkey]

You are not alone. You are experiencing a learning curve in an entirely new culture. Hospitals have very specific ways of communicating things, there are many rituals (not like, religious ones, but social ones), and certain expectations of anyone who joins.

You are learning huge amounts all the time, cannot possibly absorb all of the information that's being thrown at you from all directions, and the people you are working with probably have not considered how much of daily routine is completely foreign to you. It's culture shock. As well as having to use your nursing skills in an entirely new way at a completely different pace.

When I had just started as a new grad, I had a preceptor one day who did everything differently from my first preceptor (I was lucky--I only had 3 during my orientation. Well, 4 if you include this nurse since I only worked with her once).

I kept trying to work out how they could be so different--in an environment that was supposedly so systematic--and was just blown away. Finally, after I asked her about like the 20th thing that she did differently from my other preceptor (and asking her why they were so different--she took this very well actually, which I am grateful for) I said "so, basically, this whole environment is kind of "laissez faire" she said, laughing, "probably, but I don't even know what that means". I said "anything goes"--she replied "ah yes. but never forget to CYA"

Honestly, I felt like I was practicing alone sometimes, even with supportive preceptors and colleagues. And now--I'm just over 6 mos. at it-- I truly feel that way still. Not abandoned or lonely necessarily...just that, well, here I am with this knowledge and these skills, and in this crazy environment. And I have a responsibility to my patients, and quite frequently I find myself researching my pol./procedures, current clinical guidelines, and tapping knowledge from nursing school and research to shape how I will care for a patient. Of course I go to my colleagues as well--but, the buck stops with me when I'm at the bedside.

Anyway, kind of a tangent, Just wanted to share that I feel your pain. I would consult my policy/procedure manual frequently if I were you. Preceptors are great because they are sharing responsibililty with you. But they are not the end all be all, and usually do things differently. Learn from them, but learn on your own too.

You'll be fine. :)

-Kan

[ebear, BSN, RN]

Is there a "refresher course" offered for nurses at your hospital offered during orientation? ER and LTC are ENTIRELY different animals. It would help immensely in getting your skills up to par. As the other posters have said, speak to your NM about preceptor situation. I know this must be so frustrating for you!

[fultzymom]

Maybe some experience in Med-Surge before working in the ER would help you out. I have been in LTC my whole career and I would not want to jump right into ER. There is such a difference in the two fields.

If you are going to stay there, you really need to talk to the NM about getting one preceptor that has had a lot of ER Nursing experience. And someone who is patient and open to teaching someone who is brand new to the field.

One thing I did not understand was why your preceptor would call the MD and not tell you what was going on then left you? That is not a good preceptor. When I am precepting someone I am with them the whole day. I even go to lunch with them because I want to make sure that I am on the floor with them the whole time so that they are never without someone to rely on while they are working.

[jmgrn65, RN]

I won't sugar-coat it. You need the cold hard facts so that you can make some tough decisions.

Having no acute care experience -- and being far removed from any acute care skills you may have learned in school -- an Emergency Department is probably the last place you belong right now in your career. It is an area that requires a very high level of acute care skills so that you can handle the rapid pace, wide variety of possible patient problems, tense atmosphere, etc. If you have a dream of being an ED nurse, then understand that you should probably postpone it until you have acquired some of the necessary skills before you try tackling such a job.

To make an already bad situation worse, it doesn't sound as if your ED is prepared to orient a nurse who needs a lot of support. That's a bad sign.

What are your other options? Can you transfer to another unit in the same hospital -- one that is not so fast-paced -- one that can give you the support you need to help you ease into the acute care setting? If so, I would strongly recommend you consider doing that ASAP, before your reputation suffers too much. Simply say that you made a mistake in choosing to begin your acute care career in the ED and don't make any enemies as you leave.

Are there other options in your community for nurses that do not require acute care skills? I would also be exploring those options.

Good luck to you.

I am sorry to say this was my thought as well, I think the CNM should have known this and told you that.

I also agree with the op that suggested discussing this with the CNM.

[UM Review RN, ASN, RN]

I've never worked in ER but from your post, I'd say that you're not in your niche. You might want to get your skills down on MedSurg first.

[Hellllllo Nurse, BSN, RN]

I won't sugar-coat it. You need the cold hard facts so that you can make some tough decisions.

Having no acute care experience -- and being far removed from any acute care skills you may have learned in school -- an Emergency Department is probably the last place you belong right now in your career. It is an area that requires a very high level of acute care skills so that you can handle the rapid pace, wide variety of possible patient problems, tense atmosphere, etc. If you have a dream of being an ED nurse, then understand that you should probably postpone it until you have acquired some of the necessary skills before you try tackling such a job.

To make an already bad situation worse, it doesn't sound as if your ED is prepared to orient a nurse who needs a lot of support. That's a bad sign.

What are your other options? Can you transfer to another unit in the same hospital -- one that is not so fast-paced -- one that can give you the support you need to help you ease into the acute care setting? If so, I would strongly recommend you consider doing that ASAP, before your reputation suffers too much. Simply say that you made a mistake in choosing to begin your acute care career in the ED and don't make any enemies as you leave.

Are there other options in your community for nurses that do not require acute care skills? I would also be exploring those options.

Good luck to you.

I agree. Homecare might be an option.

[traumaRUs, MSN, APRN]

Hi there! Sorry for your frustrations. I worked level one trauma center for 10 years and loved it. That said, a lot of nurses found that it takes a lot of work to get thru orientation. Do you have a didactic (classroom) part of orientation? Or is it all on the floor? With the classroom portion, you should be able to ask questions in a nonthreatening environment. For me, the classroom helped to be able to prioritize the care and also knowing the routine (where the rooms were, the numbering system, the computer system, where and how you obtained supplies, etc). This is a lot of orientation, so its important you have a good understanding of how the systems work with each other.

My other concern, is that if they are hiring nurses that have no acute care experience, they must be desperate and might not be in a position to offer a supportive orientation period. How long is orientation? In the ER where I worked, 12 weeks for a new grad or someone w/o acute care experience was the norm.

Good luck.

[classicdame, MSN, EdD]

Nothing is wrong with you. You are like a new grad thrown in a fast paced environment. Very poor decision on the part of management & HR I would say. Get to another dept or have the manager assign ONE preceptor. You need more time to assismilate and will not learn under stress. Consider another facility who will hire you as a new grad with a long orientation period.

[SuesquatchRN, BSN, RN]

I was hired into med/surg from LTC and had 5 preceptors in two weeks. I could have written your post.

I don't know if this is normal or not but I got all of the same complaints you did and ended up fired after four weeks on the floor.

Good luck.