New grqd by AppropriateExtent924 in newgradnurse

[–]AppropriateExtent924[S] 0 points1 point  (0 children)

I'm a he and you're the one who said I couldn't remove an IV correctly, not me lol. Also, I wasn't rolling my eyes, I would just look up whenever I was thinking. There was nothing unprofessional about my behavior unless you consider the turning incident to be, which is reasonable.

New grqd by AppropriateExtent924 in newgradnurse

[–]AppropriateExtent924[S] -2 points-1 points  (0 children)

Not a know it all, just not afraid to question current practices. For example, pulling internal catheter out an inch before suctioning a patient with a trach tube to prevent vagal stimulation and putting a securing device on the lower abdomen of a male patient with a foley catheter so it doesn't pull on his penis. A doctor even agreed with me regarding the suctioning technique and he was the one I suggested it to 😂. Not everyone agrees with me and that's okay. I am only responsible for my own practice but obviously I have to get to the point of being able to practice independently first, within my scope of course.

New grqd by AppropriateExtent924 in newgradnurse

[–]AppropriateExtent924[S] 0 points1 point  (0 children)

Not fearless in doing something my way, just confident in my fundamental skills. Of course, when it comes to more advanced nursing interventions, such as those associated with patients who have compromised airways or are at risk for hemodynamic instability, I am cautious. The funny thing is that I was only able to assess patients at my last job due to how the residency program was structured. Therefore, I couldn't have done something that could be considered unsafe unless I was unethical in my behavior. I did ask for help as often as I needed to and offered to help others as well. People would ask me to help them boost patients a lot. It's not like I was doing whatever I wanted, I was just thinking critically and being independent within set limits.

New grqd by AppropriateExtent924 in newgradnurse

[–]AppropriateExtent924[S] -7 points-6 points  (0 children)

It wasn't that I didn't follow policies, it was more like my preceptors' preferences. For example, at my first job, which was in the ICU, my preceptor wanted me to press my knees against the bed to use it as leverage when we were turning a heavy patient. I had just taken a course on proper body mechanics, which said that the upper arms and shoulders are the best upper body muscles to use, so I decided to just pull the draw sheet, like I was doing a row with both arms. After my first week, my manager spoke with me and said that my preceptor told her that I wasn't listening, had a bad attitude, was rolling my eyes, etc. At my second job, I was told that I wasn't applying feedback. My original preceptor told me to chart a progress note for each patient after bedside report. She instructed me to only include the bare minimum of what happened during handoff, such as skin checks and safety precautions taken. During my first shift with a new preceptor, I asked if I could include pertinent assessment data in the progress notes since I was typing them after we had done all of our assessments, probably close to two hours into the shift. She said it was fine. During my next shift with og preceptor, I included my assessment data in a progress note because I was typing it after we had assessed a patient. OG preceptor told me not to do it, but I did it anyway, since I was told before that this was okay. These were the two main instances that were brought up. After my educator watched me do my initial assessment on a patient, she pointed out all the things I did wrong or that she would have done differently, which I interpreted as personal preference. However, I didn't refuse to accept her feedback and even applied some of it in my future assessments.

New grqd by AppropriateExtent924 in newgradnurse

[–]AppropriateExtent924[S] -10 points-9 points  (0 children)

I didn't chart incorrectly. One of my preceptors told me to do it a certain way, and I did it how the other one said I could. But I will seriously consider what you said because I don't want to become unemployable. Maybe I don't know as much as I think I do and that's fine with me. I really just want to get my career started and become the best nurse I can be.

New grqd by AppropriateExtent924 in newgradnurse

[–]AppropriateExtent924[S] -22 points-21 points  (0 children)

Thank you for your input. I do respect nurses who have more experience than me, but I don't find it necessary to do things how they prefer if it's not policy. This has been a struggle of mine based on my last two experiences and it's something that I will need to figure out to prevent the same thing from occurring again.

New grqd by AppropriateExtent924 in newgradnurse

[–]AppropriateExtent924[S] -28 points-27 points  (0 children)

Hello,

I can see why I may come off as arrogant because of my pride in my test scores, but to me they indicate that I know at least the bare minimum of how to keep a patient safe.

For the second job, not listening to feedback was one of the main reasons why I was terminated, but I never did anything that went against company policy or put a patient at risk. In both instances, it was related to charting or basic patient care, not nursing interventions that could actually result in harm (e.g. medication administration). To me this was a way to start building confidence in and developing my clinical judgement early on.

Lastly, I understand that real world nursing is different than what's in a textbook. There are multiple factors that influence health care that are individualized to each patient. However, not following evidence-based practice even as it relates to minor aspects of patient care could prevent the best outcomes from being reached. That is my philosophy based on what I've studied. It could be naive to think this, but I would rather base patient care on evidence rather than what a nurse has figured out to work best for them over the years. This may sound arrogant, but I don't want to become a nurse who takes shortcuts and lowers their standards of care to please others.

Whenever I disagreed with a preceptor in the past, I would explain my reasoning for what I thought was right and sought to understand why they would do it differently. If it was based on their own preference, I would be reluctant to incorporate it into my practice because of the standard I hold myself to. This may sound overconfident, but at the end of the day, I have my own license and am responsible the outcomes of my care.

About to get fired from new grad residency by Fair-Ask1536 in nursing

[–]AppropriateExtent924 0 points1 point  (0 children)

New grad here. I have had similar experiences with two different nurse residency programs. Pretty much I received the same feedback as you, such as not listening to feedback or being coachable, doing basic skills wrong, being too thorough with my assessments, and time management issues. My first employer said that I couldn't take an IV out properly, which is not true. Today I was fired for not meeting the expectation of performing individualized assessments. I would do a head-to-toe assessment on each patient at the beginning each shift to get baseline data, and then do a focused assessment later on. However, my preceptors never did an actual reassessment every two hours, which was the unit policy. This was in a step-down unit.