"When nurses eat their young"... I think I've been eaten...

caliotter3 · Nov 8, 2009

Just keep your feelers working. You can tell who to approach and who to avoid. You will know when you have gone overboard and when you should have spoken up and didn't. Just don't let these naysayers keep you from asking valid questions. You need to ask questions to, hopefully, learn and keep yourself out of hot water. Calm down a little and take it one day at a time. Learn to put these comments in proper perspective. These people are not the be all and end all. Just remind yourself of that fact. Good luck.

sassyrn333 · Nov 9, 2009

I'm a (fairly) new grad, about 1.5 years out from graduation. I started in my unit with a group of about 4 new grads. I have noticed a few things as the process has unfolded before me:

1) Although I hate to admit it, you sort of do have to approach the older/experienced nurses with some finesse. They basically deserve respect, they've been nurses for a while. A lot of them have been doing it so long they are crusty and burned out. I don't really take any of the negative things they have to say to heart-God knows what I'll be like when I get to that point.

2) In any job there is a certain amount of PR you have to do. Offering to help is good, taking OT is good, bring food, go out for beers after work if the group offers, join committees, teach classes, etc. All of this builds good working relationships and probably leaves a good impression on the manager. If your manager likes you, you're golden.

3) (Bear with me on this one) You know in the movies when they talk about going to jail and how you have to "go in there right away and make someone your bi*ch"? Every work environment has its bullies, and I think its really important to get a feel for who those people are and establish dominance early when they try to push on you. Granted, you aren't officially working in the RN capacity yet, but when you are-don't let anyone bully you.

4) Tact. Choose your words carefully (and know when to keep your mouth shut). Although your intent may be good, you may actually be coming off as a jackass. However, you should never feel like you can't ask questions relevant to patient care-that's not safe.

5) This is a big one: as novice RN's we are soooo green. We know so little we don't even know what we don't know (if that makes sense). The nursing school scene is NOTHING like what actual nursing is really like. On the other side of that, I think we intimidate some of the experienced nurses too. We come in all fresh and idealistic, working hard and implementing all of this cutting edge stuff we learned in school, we have all this energy...they have to be pretty sharp or we make them look bad

6) No thin skin. Its the ICU, every one there (MD's/RN's) is "aggressive and independant,...focused on the details, and have 'an authoratative tone' when discussing concepts" they just have the knowledge and experience to back that sass up! You'll get there, but in the process you're going to butt heads with people. That's what happens when you get too many dominant personalities in one place, and that is what the job is about. No one should put up with a hostile work environment, but if you aren't ready to do battle some times you are in for a lot of hurt feelings. In the end, we are all professionals and the most important thing is caring for the patient. As long as you are providing good care, you are never wrong.

7) It will all come in time, don't get wrapped up in minutia or the drama. Try to think "big picture" and at 1.5 to 2 years out you will feel much, much better-I promise.

fiveofpeep · Nov 9, 2009

:yeahthat:

One of my teachers talks about "becoming vulnerable to the learning process." Basically, he means, dont walk in there and show everyone how amazing you are and all the knowledge you have. I learned this on my own too.

I love learning and am very excited about learning new things and excelling. Well, I started to notice negative feedback and learned that when someone is taking the time to teach me something I need to be "vulnerable to the learning process." I need to accept their lesson and not try to show what I already know because that is just off putting and then you will miss out on learning things you dont already know.

I think it's a hard transition because in nursing school you are trained to show off your talents but then you walk into the real world and learn you dont know jack squat and this isnt the place to show off.

The fact that you are so introspective means you will be able to pick up on cues and learn how to adjust your personality to others without compromising patient safety or your sanity.

Good luck :)

detroitdano · Nov 9, 2009

You have to pretend to be an idiot to be accepted your first few months. I would question a lot of nurses on procedures/actions of medications and they'd tell me I was wrong, we'd look it up and I was right. Does that matter a bit? Nope. Makes you appear full of yourself, even though you were just clarifying some information so you're not learning or doing something wrong. Kinda sad, but it's the reality.

I had one nurse go nuts on me when I told her a central line dressing was a sterile procedure. She told me to do it with regular gloves, I told her no, she called me insubordinate or whatever words she chose. Just because they've been there a long time doesn't mean they're right about everything. Heck, I was explaining hypercapnic respiratory failure to a nurse with years in the ICU and she looked at me like it was French.

The nurses who want to learn and want to understand the physiology will have a civilized discussion with you. Those that want to punch in at 7 AM and leave by 7 PM on the dot and don't care two shakes about the difference between x and y will give you hell for questioning them.

fiveofpeep · Nov 9, 2009

Heck, I was explaining hypercapnic respiratory failure to a nurse with years in the ICU and she looked at me like it was French.

Yeah. I think in a microcellular chemistry / patho type of way because that is my strength so I rely on it for reasoning, and often times I get crap for it if I answer that way...but if I am more comfortable with the content and answer more broadly but essentially the same way I get a good response.

Either way, they have lots to teach us and we have lots to learn. Its just about politics

aCRNAhopeful · Nov 9, 2009

Wow all of these posts describe so well what its like for a new grad in ICU. I haven't really butted heads with anybody but I have bitten my tounge several times to avoid coming off like I'm full of myself. I'm one of those physiology types that LOVES that sort of reasoning and problem solving but I've learned not to speak about it too much. For some reason many nurses dont care about that stuff AT ALL and don't fully understand the whys and hows, they just do. So I bite my tounge a lot to avoid coming off like I know it all or to avoid hurting someones pride. Theres so much to learn from the experienced nurses and all new grads have SOOO much growing to do. Even if we know lots of cool scientific answers sometimes its better to just step back and play dumb so that people will want to continue to teach you and share their knowledge. Maybe its a good topic for another thread but why is it so many nurses don't care about the reasoning and the science behind what we do??

Rabid Response · Nov 9, 2009

Perhaps I am misreading your post, but it appears that the ICU nurses who are giving you this advice are not actually working on the unit into which you have been hired. These are not your future co-workers but nurses you have worked with in your position as a tech? Try not to get worked up. I don't think what you're experiencing qualifies as being "eaten." It's possible that they weren't giving advice so much as venting about new nurses whom they have had to precept in the past.

Of course you can express your opinions and ask questions; any good preceptor would encourage you to do so. Your preceptor should also press you to communicate with physicians as that is a huge part of what you're being trained to do. In my opinion they should hang back and only at the end chime in with any pertinent info you may have left out or that you might have explained better (there are ways of doing this that don't make you look inept).

If you've been told on more than one occasion that you are not a team player, then you should do a bit of self-examination. It may be that you have to alter your behavior or communication style a little bit in order to be perceived as a team player by your co-workers. When I first started on my unit, I managed to irritate a few senior nurses, first by being a new grad and then because I babble when nervous, and sometimes that comes across all wrong. I know there were plenty of times I talked when I should have been listening. It has taken a couple of years to gain a bit of respect from veteran nurses.

The tone of your post makes me think that you may be defeating yourself before you've even gotten started. The first year is going to be hard for a million reasons anyway, so don't get worked up about things that haven't happened yet.

Best of luck to you! I love working in ICU.

phoenixfire · Nov 9, 2009

That is correct. I was just doing a self evaluation to make sure that I am taking the positive aspects of my tech experience with me, and leaving behind anything that isn't. I guess what I was expecting when I asked for feedback were things like "Pay attention to labs, don't be afraid of the doctors, ask for help when you need it...", etc. I had a chat with someone that knew me back in the day, and he reminded me that when I was the senior person of a unit (military, not nursing) how it felt to have a newbie come in and do things a certain way. It made me take a step back. I'm going to try and implement the advice that I have been given, even if I have to take some of it with the proverbial grain of salt. Thanks to everyone who answered my post, it is so refreshing to be able to express things that are bothering me to people outside of my school and my workplace. You guys are awesome!!

RedhairedNurse, BSN, RN · Nov 10, 2009

I actually think you are a good candidate for the position you seek. I will tell you how I was told to ask questions......without it sounding so bad. Apparently, I had a preceptor that complained to my NM because I asked "why", and believe me, I wasn't trying to pretend I knew more.

NEVER ask a nurse "Why?" This word is perceived as questioning the nurses judgement. I was told by my NM to use the word "Rationale." So when you need to ask a question, say "What is the rationale behind doing so and so, thank you for educating me on this topic."

bucknangler · Nov 14, 2009

"I've been told that I'm not a team player, and that people in general do not like me because I'm aggressive and independant, too focused on the details, and have 'an authoratative tone' when discussing concepts."

Sounds like my first Peer eval in the ICU!!

And guess what? If you are a male, female nurses take extra offense! My first yearly peer eval in the ICU was 50% awesome person to work with/eager to learn/smiles a lot and 50% arrogant/cocky/there is no "I" in team type responses. And in my first year, I did exactly what you planned on doing: ask questions and voiced an honest opinion to better my nursing skills. And trust me, they WILL take offense!

I feel your frustration, but believe me. I started an orientation program with 3 other new nurses and have yet to completely taken a fresh heart by myself. However, the other 3 nurses have...and guess what? I am only one of 5 CCRN nurses within an ICU of 80 RN's! I've only been a ICU nurse for 18 months. It does make me upset because I feel like I actually know what PA pressures mean, while these other nurses just interpret them as either High or Low. But patience is a virtue. Also, there is a popularity contest in my ICU and it seems a nurses skill level is based on her relationship with her peers. If a nurse has a great personality...then she's a great nurse. Or, If she has a bad personality...she must be a bad nurse.

My advice, stick to your textbook to get answers, drop the "why" questions, speak softly, say "really? I didn't know that?" to your elder nurses....and you'll be fine!

Sewbusy~RN · Nov 14, 2009

I think the first year of nursing is the year of "am I cut out for this???" for everyone, but from what I've heard, it is even worse in the ICU. I think you've already gotten great advice and I don't have much to add, other than hang in there!! I'm still on the teeter totter myself....some days I feel like super nurse, other days I feel like I'm some moron off the street that they shouldn't have even let in the hospital. But I keep showing up and giving it 110% every shift. I have faith that it will keep on getting better as I learn!