Can't stop arguing!

[Blue_186281_red]

I've been training for dialysis for 6 months. It's been really long for reasons I don't want to get into. I've had many nurse preceptors and often get contradictory instructions. I often have no confidence in my ability to judge how important a given issue is. And I can't help it. EVERY time, I push the issue like a 3 year old asking "why?"

There's an older nurse I've been following & he has been very blunt with personal criticisms - he's trying to help. He says I just need to do what I'm told. My questions are disrespectful. I try to explain my thinking to guide his teaching & he calls it defensive. He got irritated when I said "you say A, but someone else taught me B. Do you think we should discuss this in the monthly meeting?"

IDK. He starts the day with "do what you're told, stop asking questions. learning time is over." And I come back with "Yeah, but..." WTF is wrong w/ me?

The rest was an ADHD tangent. I'd delete it but I spent so much time on it...

I also suck at memorization. This is a very detail oriented job with a thousand tasks which often need to be done in a specific order. When learning complex things, like anatomy & physiology or my previous career in home health, I compensate for poor memory by trying to get a fuller understanding of the system e.g. WHY does CHF cause certain symptoms, WHY does medicare require certain patient info. If I understand the whole, then I can often work out the parts until it becomes habit.

In my training I ask too many questions. My higher up boss cited excessive focus on theory & irrelevant details as a problem my trainers reported. Early on I was punished for not taking on more work, even though I had been repeatedly refused opportunities by my preceptors because I "wasn't ready." After that, my stress went up, my ability to focus went down, & every minute I'm grinding out repetitive tasks feels like time wasted that I could be learning how to keep my job! A dialysis run takes about 6 hours & about 2 of that is writing down vital signs every 15 min. When I asked to take an extended break so I could better use my training time I was told by my preceptor & regional boss "do what your preceptor says. they know what you need to learn. BUT THEY DON'T! There's this one older nurse who's been

[Knitting20projects]

Can you pivot to another department? I’m wondering if evaluating your strengths and matching them to a different specialty might benefit you. Nephrology is unbelievably complicated and has very high stakes if mistakes are made. I’m a physician and definitely knew I wasn’t going to specialize in Nephrology because I understand it well enough as a generalist. I don’t want to have to know it as well as a specialist! Are there other nursing jobs nearby that might be a better fit? Best wishes to you.

[Blue_186281_red in reply to Knitting20projects]

The hospital is Union, so they outsource dialysis to my company. It had just occured to me that I should go around my regional boss and ask about going in to chronic where I would have the chance to drill tasks over and over.

I'm not worried about the theory. I can do the pathology part of the job. Patho really takes a back seat to just getting fluids off of hospitalized people. It's the Technician work - clamping the right line in the right order, glancing at the air chamber regularly, and getting more and more stressed out by a poorly managed teaching program that, despite being run by RNs who check a learning style assessment box 3 times daily, have been unwilling to consider cost free accomodaions to augment my learning. Both my preceptors and I have suggested alternative teaching strategies which were not even considered. The closer I'm scrutinized, the more I bounce around like the wacky professor, messing up stuff I've learned well.

As for other specialties... IDK. After new grad unemployment in 2009 I could only get work in home health. I was afraid to look for work after that. what really stumps me on job apps is the reference list. With 10 years in home health, 6 jobs, and no interest in maintaining on line contact I have formed 0 relationships at work. I was alone in my car.

I really wanted to get into burns from school. THE burn unit in this quadrant of the country is 10 min away. They were actually one of the 3 real job interviews I managed to land in my 16 month unemployment. a preceptor suggested call nurse (Ugh. "hello? hang nail? hmm. Lets try billing your insurance for a trip to the ER!)

Wow. I'm kinda remembering this stuff as I type. Thanks for listening to me doc. Do you need my insurance card?

[Mamamichl]

I always found myself asking a ton of questions throughout k-12 as well as college. Whenever teachers would finish early, I would have a question and it would tick off my classmates.

As for contradictory information, it is good to ask questions since each doctor interprets information differently. It is your way of making sure doctor is making an informed decision. If you don’t like their diagnosis/information, feel free to get another doctors opinion. However, procedures are made so that doctors can get the information they need, so be glad they are finding procedures to give them information. My kiddo has been constipated her whole life, and we have been through several doctors and are finding new procedures still after 9 years. I don’t mind the hoops since it will help the doctor get the information they need.

As for work, try not to ask why so much. Someone that interprets your documentation is the one that needs to know the why. If everyone that took information asked why then none of the documentation would get done. If you want to know the why, ask who needs the information, get their job title and go to school to get the degree in that profession.

Ultimately it is good to ask why, but try to get those answered in your own time with online research since taking time of others is not helpful. It definitely seems like they are getting frustrated with it. Maybe ask instead of some resources for more information (websites or articles) instead of why.

[Blue_186281_red]

I wouldn't say I'm enthused by the theory. e.g. I asked my preceptor how the dialysis machine detects pressures. I was thinking that this info would help me learn faster to set up the machine as I would understand how connecting the hardware interacted with the software. Priming a dialysis set up is a very routine if complicated task where time management and safety are very dependent on little details like the timing of clamping lines and connecting sensors; I just wanted enough knowledge to help me put it all together. This question was reported to my regional boss as an example of my lack of focus and seen as wasting time, delving into the weeds for no reason.

Yes, I started taking adderall about a year ago. It helps direct my hyper focus as long as I time it right. Given a chance it's just as likely to send me down a youtube rabbit hole as to improve my productivity, but that's not really an issue with 12 hour shifts. Socially, I think it's a negative. I have not been very political in fighting for learning style accommodations and have been written up for behavioral problems; It infuriates me that nurses, who supposedly are educated on learning style assessments, just tell me to shut up and do what I'm told as I repeatedly tell them WHY I don't understand what they're telling me! Claiming an ADA exception should not be a necessity in this environment.

The same learning disabilities clinic has therapy but she didn't know anything about ADD. Therapy I had as a kid was much more like what I hear coaches described but I don't have the $ to waste crossing my fingers that unlicensed internet people might help. The clinic didn't even assess me - I told the psychiatrist my Dx/drug history and they gave me drugs. After 13 years in medicine, I'm pretty sure most services are closer to insurance scams than Dz Tx. Services for adult ADD seem pretty rare and IDK where to look beyond this clinic.

For this job, the die has been cast I think. After encouraging me to quit, my regional boss said he will schedule one last assessment with the nurse educator but he has me waiting by the phone for the last 5 days to schedule this. He told me sunday that it would be today or tomorrow, but who knows? I have finally been able to organize what I need to learn in a way that I can understand. I'm reciting hourly every step I need to take through a dialysis run.

and as I finish this, the boss says to come in tomorrow AM. Wish me luck.