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Scary Preceptors and Residencies!

I graduated in June, got married in July, moved in July and decided to wait a little while until finally starting a new job in Dec. I found a residency in an ER thats really close to my house, and I was really excited. However now that I've been there for 4 weeks, I'm feeling sooooo overwhelmed. The first week and a half was the hospital orientation, followed by another 13 weeks of residency. The first two weeks of my residency my preceptors kept changing and it was really hard to figure out what was going on because there was no consistency ever! So they switched me over to a new preceptor and boy do I wish I would have continued on with my non-consistent preceptors.

On my first shift with the new preceptor she pulled me aside and told me that her last resident had failed and that she didn't want me to feel blindsighted if I failed so she was going to have really high expectations and was going to be very blunt with me. She also told me that I shouldn't be surprised if I didn't make it through residency either. Great way to start out huh?

The person in charge of the program gives goals assigned to each week, and the week that I'm currently on is to take one stable patient, key words being one and stable, from start to discharge. So she gave me two stable patients on my own and then when I would ask questions, she'd tell me I need to problem solve on my own. Then when I discharged those two, I got thrown a critical patient, which she helped with a little, but not much.

The second shift I ended up with two critical patients and got talked to about how I need to learn to prioritize and focus, which is very true, but I haven't had a chance to practice on a stable patient yet. I've cried after both shifts and now totally and cringing about going back to work. I tried to talk to her and told her I was frustrated about it, and all she said was that I was doing a really good job and that she was impressed, but I still feel like I totally can't do this job! Has anyone else had an experience like this?

What would you recommend?


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7 Responses to “Scary Preceptors and Residencies!”

  1. Montana Says:

    Amy, I’m so sorry to hear about your experience. Your preceptor should want her preceptees to succeed, not take pride in failing them. I would talk to the manager of the department or the person in charge of the residency program. Some nurses are very good nurses but not good teachers or preceptors. It sounds like this may be the case with your preceptor. Everyone feels very overwhelmed at first. I know I left work in tears several times when I first started as a nurse. Having a supportive preceptor, though, could really make a difference. Good luck! I hope things get better!

  2. Dawn Says:

    I completely agree with Montana about everything. However, I never started in the ER and from what I understand turnover is high. I think starting in ER is going to be extremely difficult. Keep trying and ask lots of questions. Remember you are there to care for an individual and what you do or don’t do can be harmful. So ask questions even if people are rude. I remember when I first started. I didn’t start to feel somewhat confident until at least 6 months. If you talk to lots of nurses it seems 6 months is when you finally feel like you can handle it. I moved to ccu a year ago from a stepdown unit and felt quite lost. I have been a nurse for 6 years prior and still felt lost. I am continuously asking questions even now. Being new is difficult. Having a preceptor that isn’t teaching you is even harder. Talk to the department manager and tell her/him how you feel about your experiences and hopefully things will get better. I wish you the best of luck and continue to ask questions. I cannot stress that enough. Keep up the good work. I hope this helped some.

  3. Angelica Says:

    Fresh out of school, I started off on Med/ Surge floor. That was overwhelming enough. I transferred to Level 1 Trauma center, Charity hospital of New Orleanswith in 15 months. Talk about overwhelming!! You got a 6 week orientation to the medical part(MER) and stayed there for 6 months until you graduated to the citical care area of medical (Monitor cube), then finally if ya were good enough, went to be tyrained in the trauma part (AR). My first preceptor was not only a poor teacher as far as information goes but she was also a poor resource person because she apent most of her time socializing and dolling up her face. It was “sink or swim” with or without direction. I cried multiple times on the way to and from work. My next preceptors were wonderful. While I wanted to give up during the first part of my training, I didn’t! I tried harder and used other nurses,that had been there for a while and obviously were compassionate for the patients they took care of, as resources. Nurses can be cruel. And yes it may be true that some are not good teachers. But it is also true they may be “hardeneing you up” to take seriously that you are dealing with a person’s life.My top motto is ” a nurse that thinks she knows everything is a dangerous nurse”. Even if it is humliating or hard to ask, please do; someone’s life depends on it. I have been an ER nurse for 12 years and L&D nurse for 3 years, I still ask and look things up.We are all human.

  4. Ileana Says:

    I’m a new nurse too. My first job I actually left. It was the most horrific Med/Surg floor ever! I had a very similar experience as you, but 3 x worse! Don’t let any person ever shake your confidence. No question is EVER A bad question. People who are secure appreciate questions. If you get insecure preceptors, ignoree their insecurities and keep asking questions. Don’t give up! You are doing great! Don’t let anyone bring you to tears. People who have that type of attitude are miserable individuals! The best way to address that is to succeed and keep on truckin!

    Keep up the good work and best wishes with your new family.

  5. Jean Roberson Says:

    Amy, I also agree with all the other commentors, but I have several things to add. I coordinated a New Grad Residency program for 3 years. We did accept new grads who were starting in the ED, but 13 weeks is WAY too short for a normal ED Orientation. Six months is what our ED gradually increased to, because turnover among all new nurses was way too high!
    To be truly called a residency, most programs now are 6-12 months. (I wrote an article which appears here, under “Managing Careers”. It is called “The New Model of Orientation”.
    The personalities of ED staff tend to be “rough around the edges”–no time for niceties, quick assessment, little patience, etc. (not all, but I think your Preeptor fits this description). She is not an example of a good Preceptor. You definitely need to talk with your Manager &/or the Coordinator fo the Residency.
    The hospital I was at had a 12-month Residency program, with 8 days of class, spread out over 3 months, after “Hospital and nursing” Orientation. Each day, we spent time discussing th eproblems the group was experiencing, whether it was trouble with the Manager, Preceptors, adjusting to nights, delegating to CNAs, etc. After those class days were over, we had discussion groups every other month, with all the new grads throughout the hospital attending. We continued thos groups until the new grads had been with us a year. They all said this was the best part of the program, and they were so relieved to know they were not the only one havign an issue.
    As a result, our retention at 12 months was 100%, and the graduates were much happier than peers they had talked to at other hospitals.
    But that doesn’t help you where you are at. I would suggest you try to get some other new grads together and have your own peer support group. Make sure some other ED grads attend. It can be informal, at someone’s house, and just share issues. Or email each other.
    Also, there are many seasoned nurses out there who will suppport you. Try to ifnd one in the Ed who you think is a great nurse, and also likes to teach. You could ask him/her to be your Mentor. Tell her of the concerns you have, and wht you specifically would like help with. Keep the personality issues of theother Preceptor out of it. Hang in there!

  6. Anonymous Says:

    I’m not an RN, but had to do several hundred hours of rotations in the ED to become a paramedic. Jean was right about some nurses being “rough around the edges” to put it nicely. I’ve had no problem pinning combative intox patients to the sidewalk while waiting for PD but I still cringe at the sight of some of the ED nurses from my rotations. Unfortunately I learned towards the end of my rotations that the doctors were happy to answer any questions and loved to teach. I had my medic preceptors laugh at me while telling me that I could never be a medic because the equipment was bigger than me as I carried everything by myself through the subway, and would only call me “White Girl” instead of my name. They would leave the heat turned off in the back of the ambulance where I was in the winter. They made it very obvious they didn’t think a little white girl from the suburbs belonged on a NYC ambulance in the projects. Now that I’ve graduated I love my job, and when I have a good partner it’s like getting paid to be with my friends all day! If you show them that you can handle them in the ER, maybe they will gain respect for you and treat you better. Or perhaps like me you just aren’t suited for where you are and would be happier somewhere else? Maybe you could switch to a different floor?

  7. AmyJohnsonRN Says:

    Thanks for all the comments, just wanted everyone to know that I finished my residency and things are going really well! The preceptor I had problems with eventually got alot better, I think she just needed to know that I was there because I wanted to learn from her and that I was a safe RN and just needed to learn how to do the job.

    She really taught me alot and I think that she did harden me up a little bit. I was really frustrated in the beginning but looking back I really appreciate everything that she taught me.

    My preceptor actually just left the ED, but I’ll definitely remember her for a long time and the advice that she gave me.

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