Am I Cut Out For This?

  1. It's 2am and I cannot sleep. I'm supposed to be up in about 3 hours to get ready for work. As I already have a stinking cold, I think I will call in to staffing for a sick day.
    But, this day won't be just to rest my body, it will also be for my mental health. Besides not being able to sleep, I was dreaming about my work - going over patient charting and feeling overwhelmed by things I had forgotten to do that I suddenly realized that had to be done. When I woke from this, I started to cry, because it was just like how it has been at work in my orientation.
    It is hitting me that I am losing my confidence that I will get through my orientation. I really feel that I just plain suck as a nurse, that all I learned in nursing school has not adequately prepared me for what I am doing right now, and that the best of what I have to offer is not coming through in my work. Nearly every day on my unit, I throw myself 100% into my work, yet at the end of the day I feel like a complete failure. The day feels like a battle lost.
    Specifically, I am presently taking three patients without delegation to a CNA. I do complete care, with my preceptor hanging back. With the exception of a couple of days, each seems like a step backwards in my learning process. For example, how one day went: Right out of report I was bombarded with a STAT PICC draw on one patient, a new admit with radiology calling on hold about her, with my 3rd patient's call light on for 10/10 shooting pain. This is before I have even looked at a single chart! By the time I put out all the fires and get caught up with assessments, vitals, and morning meds, it's 11am. By then my brain has turned to mush and I have 3 bed baths to do. My brain sheet is filled with chaotic scribbles that cease to make sense to me. I spend the rest of the shift scrambling to get charting done, along with I&O's, IV flushes, more meds, and giving report. More often than not, I end up staying 1-2 hours after shift to finish my charting.
    My last shift pushed me to the tipping point. I was given a preceptor I had specifically asked not to be placed with (had a previous BAD day with her). Sure enough, about 3 hours in she berated me in a really sarcastic fashion about what I was planning to tell a doc I had paged re: a patient with a blood glucose of 40. Our protocol calls for "collaboration with a physician" in the giving of a D50 bolus for hypoglycemia. (The pt was NPO pre-procedure). So, rather than clarifying with me about how to act quickly for this pt (which I knew I had to do - she was disoriented, shaky, and diaphoretic), my preceptor went ahead and wrote the order herself (as a telephone order from the MD WITHOUT having talked to him yet!) and ceased to explain her rationale behind this. For the rest of the day, I tried to get everything done while avoiding my preceptor at all cost. She didn't review any of my charting and just hung back to care for her ONE patient. She left at the end of shift without saying WORD ONE to me. I was in such a bad way that I wasn't doing my job well at all. I was 2+ hours late doing an initial assessment on a patient who was a new admit (didn't even do a complete head to toe), I missed a dressing change on another patient, and my 3rd was awaiting discharge. The doc wrote the med orders at 3pm and left the unit. Between myself and the nurse coming on for this pt, we realized that 2 of the meds were wrong (one was a med the patient has a sensitivity to and the other was a wrong dose).
    So, between that and having to catch up on charting, I had to stay in extra 1.5 hours. When I got to my car, I broke down crying.
    On my way home, I left a voice message with my unit manager to request a meeting with her. I warned her of the possibility that I might be calling in sick tomorrow since I was really feeling cruddy, but that I wanted to talk with her either way. I feel like I am just not cutting it, especially since I was to start having 4 patients this week. I just cannot get a core work flow down. My day will start off with plans but then all falls apart 3-4 hours into the shift. It seems uncanny that I'll have one patient EVERY SHIFT who becomes unstable - syncope w/ low BP or new onset A-fib and tachy (becoming a tele transfer) or change in LOC. I get sucked into these situations and my day goes to heck. It makes it so I can't get back on track to address all of my patient's needs.
    On one of these days, I didn't get to turn one of my patients Q2 as much as scheduled. The next day, I learned that her red bottom was turning into a stage 2 decub. I felt repsonsible for that!
    Right now I feel like a wreck and I am crying as I write this. I plan to talk to my manager but I just don't know what to do. To make matters worse, I really need this job as I have debts (student and other loans, and ironically some medical bills) that I have to pay down, without delay. It feels like things are caving in on me. As much as I have told myself that I WILL get better at this, that things will become less difficult to do, I am suddenly very doubtful.
    In a postscript, a classmate of mine just quit her residency at another local hospital. She has gone through a similar new nurse crisis, and her coworkers were treating her horribly. I haven't talked with her today, but I plan to touch bases with her.
    No one warned us in nursing school of just how difficult things would be. Thanks for reading.
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  2. 21 Comments

  3. by   traumaRUs
    Oh gosh - I'm so sorry you are having such a rough orientation! I gather you are on a med-surg/tele floor? How long is orientation? Can you be scheduled with only one preceptor for the rest of orientation? Then...talk with your preceptor and tell her your concerns and both of you come up with ideas to streamline your day. This will be a start. Perhaps some of the things you are doing could be delegated to a CNA? Or...if you do primary nursing, perhaps sticking with 3 patients this week would be better. Please talk with your manager and educator about your concerns. You are among friends here and we have all been there in one way or another.
  4. by   KatieBell
    Wow. Sounds like you are having a difficult orientation. Specifically the preceptor does not need to be as inappropriate as she is with you, and you need assistance from a CNA. There is no reason for you to be running around worrying about giving a bath or turning that a CNA is perfectly competent to provide. What your preceptor was doing was not precepting.

    The transition between New Graduate to new nurse can be very very rough. I'm guessing your school did not have you do a preceptorship as your last class in school... I'm really sorry you are struggling.

    You will get better at this, if you hang in there. However, if the manager is supportive of you, and the majority of the staff are OK to work with, it's really worth it to stick it out. Be firm about preceptor placement. If you have worked with someone you liked, ask to be permanently with her or him for the rest of orientation.
    From your post you seem to be picking up on important things. You didn't ignore the low blood sugar, and you were doing the required collaborative action... and you knew the appropriate treatment, you realized before sending your d/c home that the meds were totally wrong. So try to put your chin up, and take a rest break...you are not the only one feeling overwhelmed- and you can really improve and become a good nurse. I know it doesn't seem that way right now, but it really will all come together slowly. One other poster suggested that new grads keep a journal so they can look back on progress, and I think its a great idea. You might be surprised at home much you have processed in a short amount of time.

    You really can do it
  5. by   Daytonite
    Hi, Nutrix_de_Volcano . . .Well, you're experiencing what many of us went through as new graduate nurses. I don't want to belittle your feelings because I know they are real. Many of us had similar emotions and experiences as new grads as you are having now. I guess the first thing I want you to think about is whether you have been told by your manager, or whoever is the overall director of your orientation, that you are doing a poor job. You didn't mention that had happened, so my guess is that the people orienting you are feeling that you are at the place you need to be in your orientation. Otherwise, my experience as a manager has been that an orientee who is doing very poorly gets reported right away and called in for conferences. So, no matter how rotten you think you might be doing, unless someone is telling you that you are doing a rotten job, you should assume that you are doing OK. Does that make some kind of sense to you? I hope that makes you feel a little more at ease.

    Nursing school can only give you the tools to help you get through this time you are having. It's kind of up to you to learn how to use those tools. Consider nursing school much like being given the how-to instructions. That doesn't make you an expert with them, however. That comes with hours and days of using them.

    My days as a staff nurse start off with a plan as well which often falls apart a couple of hours into the shift just like yours. The difference is that you have not yet mastered the art of prioritizing and figuring out how to get back on plan. This is not something you master in a week or a month. It takes months and lots of hands-on, in the trench, experience with it. You are working on a particularly busy kind of unit (telemetry, right?) Telemetry is a very intensive kind of work situation, even for an experienced RN. I worked on a stepdown/telemetry unit for 5 years, so I know. And, it sounds to me like the preceptors you are with are giving the reins over to you while they watch. As cruel as it may sound to you now, it is the only way you are going to learn how to handle yourself. Shadowing someone isn't going to help you a whole lot anymore. Your preceptors understand that you have to be thrown into the melee and there's no easy way to do that. The various preceptors that you are going to be working with are not the same as your nursing instructors from school. Most of them got into the position of a preceptor because they are being recognized for the good job they do as staff nurses, but it doesn't necessarily make them professional teachers. However, for the rest of your career as a hospital staff nurse you will be paired with other staff nurses to learn new things. That is how it works in each place of employment. What the hospital doesn't lose sight of is that you are a paid employee. And, based on what you have written I know you understand that relationship.

    Here are a few things I would suggest you do to help you feel like you have some control over what is happening because right now I know you feel like you are on a runaway train going downhill and waiting for a crash to occur! First of all, you need to forgive yourself for not living up to YOUR standards. That is something that will come with time. You need to debrief yourself after each day you work. You need to allow yourself time when you get home to have a good cry and then go back over what you did successfully and what you could improve upon. For example, your patient with the blood sugar of 40. . .I would have done the same as your preceptor. I learned after a few experiences with this to treat the patient first and worry about writing the order and calling the doctor later. So, after you dry your eyes and are in a calmer state ask yourself why the preceptor handled the situation the way she did. (Asking yourself these "why" questions is how you are going to master this stuff to your satisfaction.) First of all, a blood sugar of 40 is a panic value. It is pretty close to 20 which is where I've seen patients go into full blown seizures. If I was satisfied that the value of 40 was correct (and by the symptoms she had, it was) my priority is to get that blood sugar up immediately or you're going to possible be witnessing a grand mal seizure. Now, what the preceptor knew that you don't yet, is something about the doctor. She knew the hospital protocol and she knew the doctor wasn't going to read her the riot act for taking action without calling him. She acted to get that blood sugar up. This was one of those famous "nursing decisions" you heard your instructors talking about all the time. Well, you witnessed one and had a front row seat! The emotional excitement of the moment clouded your common sense for a bit. Not to worry as this is probably going to happen a number of times over your career. Re-read the hypoglycemic policy. Notice that it doesn't list the order of the steps you need to take. It does, however, list all the things that you need to do which gives you the freedom to adapt it to the situation at hand. This is called "nursing judgment". As long as you get that list of things completed you have followed the policy. As you learn the various doctors and how they like things done for their patients you will learn who will be OK with you taking an action first and then notifying them. Something you need to realize is that your chances of actually getting to speak with the doctor on the phone in order to get the order for the 50% dextrose bolus was slim to non-existent. The doctor expects you, the RN, to handle this situation. The different preceptors you work with will help you with this, so ask each one how they would handle a situation like that and I'm going to bet that they will all pretty much tell you they would have done what your preceptor did. File that information away in your head, as it will come in handy in the future. Next time you will have a better idea of what to do in this situation. Now, that doesn't mean that your heart isn't going to pound like crazy, that you are going to remain perfectly calm and not experience one pang of anxiety, because you will. But, that is normal as you are learning to make this kind of nursing decision. After a couple of experiences with low blood sugar, you too will react exactly the same way that your preceptor did.

    It is going to kind of go this way for many of the things you are going to learn. You will have patients crashing, code blues, a dressing change that got forgotten about, patients who fall out of the bed, patients throwing up blood, relatives complaining about something that didn't get done for grandpa, patients who didn't get turned every two hours like they were supposed to. . .oh, I could go on and on. You know the book-learned part of it, but not how it is actually put into everyday practice.

    Will you believe me if I tell you that it takes at least 6 months to even begin to feel like you are making any headway in understanding what you are doing as a hospital nurse? This is a conservative estimate, too. It takes time and patience. Patience is not something we hospital nurses are always good at practicing. Most of us like things done yesterday. You will have some days when you will cry all the way home, so you might want to keep a box of Kleenex in your car. When you are calmer you have to look beyond the emotion and analyze your actions. What did you do right? What did you do that wasn't very efficient? What did you forget to do? And, most importantly, what will you plan to do the next time it happens? And, these kinds of things do happen again and again. The thing is you just never know when. Murphy's Law: anything that can will go wrong. A good philosophy to have some respect for and try to plan ahead for. That adds an element of anxiety to the whole thing. Maybe you'll get your actions absolutely right the next time around; maybe you'll leave a few things out again. But, you self-analyze and decide where you need to improve, make a plan of what you will do the next time the situation comes up, and move on. If the best thing you can say happened is that you didn't kill the patient, then you've had a degree of success. Maybe not the kind of success you had hoped for your first time out of the box, but you'll get another whack at it, I guarantee it. :icon_hug:

    If you are a writer or a good typist, I recommend that you start to keep a little journal of these experiences you are having. Memorialize them on paper so that a year or so from now you will be able to read them, realize how far you will have progressed and perhaps have a good laugh at yourself for being such a worry wart (well, that may not happen for another couple of years). I'm not belittling your feelings in any way. I am trying to give you some hope. All new grads go through this. You experiences may be a little more hectic and harrowing than someone else's. Telemetry is like the wild, wild west. But I guarantee that you are not alone. We have all gone through this process. It would help to have really kind preceptors at your side to always be nurturing, but the fact is that some will just not be that kind or nurturing. After you've had your cry when you get home then you can cuss them out to your satisfaction for treating you so badly. What you do is keep moving forward and make a solemn promise to yourself that when you someday precept someone you will treat them much differently. I was treated horribly as a new grad and never forgot a minute of it. I think that what kept me going was that I don't like to fail so after each episode of being beaten down, I got back up and tried again. Eventually, I wasn't getting beaten down as much. For that reason I have a very soft spot in my heart for young people like you who are struggling with your new role. I understand what you are going through. You have it within you to triumph over this. After all, you finished nursing school and passed your NUCLEX. I've been in nursing for 30 years. I still have an occasional day when I come home angry--you see, the tears got replaced by anger at some point along the way. My problems are also due to a failure in mastering some nursing skill or nursing judgment although for awhile it had to do with the management of employees rather than nursing procedures. Learning is a lifelong pursuit. There will always be something to learn. It's just that right now it's being thrown at you by the bucketful. Just plant your feet with a wide base of support as you get ready for the next bucket! If you get knocked down pick yourself up and widen your base of support a little more.

    Rest today. Try to do something fun even though you're not feeling that well. Oh, and the dreams. . . I used to get some doozies! They are just a manifestation of your anxieties and fears and an attempt by your subconscious mind to make some kind of sense of what your day was like. Don't read too much into them. As your anxiety calms down, so will the wildness of your dreams. :angel2:
  6. by   lesrn2005
    Hey nutrix: I'm a new grad also-I'm right there with ya-I'm feeling your pain!! Daytonight-you brought tears to my eyes!! You sound like a great nurse-you're definitely a great writer!!
  7. by   MackNJacks mom
    Hi Nutrix,
    Another new grad here. Hang in there and do your best. I know all about the crazy days, I live it too. Soak it all up and don't be so hard on yourself, you are doing the best you can under the circumstances.
  8. by   Tweety
    I hope you get some rest today and take care of yourself. I hope your meeting with the manager goes well.

    Things will fall into place. Honestly, I've been at it a lot of years and I have many days like you describe. I walk out of report and immediately get bombarded and put out fires and have to stay late catching up. Sometimes, I'll miss a dressing change or something else and ask the next shift to pick it up. Sometimes my 9am meds are an hour or more late.

    The difference is now I don't question whether or not I'm cut out to be a nurse, and I don't even think for a minute that I'm a bad nurse. It's just the day I'm having.

    It gets easier and you'll feel better about yourself soon. It's normal for the first year to be a little topsy turvey.

    I would definately let the manager know about the preceptor not setting the good example and practicing medicine without a license, and that you previously had an agreement not to work with her in the first place.

    Good luck and may you find peace and be well.
  9. by   loriannlpn
    Another new grad here: I just finished reading your post and It moved me. I am feeling everything that you were feeling when you wrote your post.

    I am so under confiedent at that this point. I had so much cofiedence in nursing school. Was aware, now, I feel like all of that ceases to exist and I am wondering the very same. Am I cut out for this work?

    With great pride, I go to my job, plan out my day, keep my brain ( my note book of notes of meds, BS ect that I have given or need to give) at hand, and by the end of the day --- it is mindless dribble to me. I can remember what I did. But to organize it into a fashion that I can intelligently give in report.

    Your post has helped me! Thank you for posting, for helping me realize that I am only human and I will be better with more experience. That is why I love this website.. Much appreciated!

    Lori
  10. by   nursemike
    Nice posts, Daytonite and Tweety. You both make a lot of sense, and yet there are some serious differences there, aren't there? No wonder it's so darned confusing to us newbies!

    I'm coming up on that magic 6 month mark, and what people say is true: it's far less horrible. Still plenty of stress and uncertainty, but it seems like more and more of my moments of sheer terror are things that would be at least a little alarming to a more experienced nurse, and some of the things that used to cause serious anxiety are more routine. It's still a lot like riding a roller coaster, but not so much like riding my first roller coaster.

    I don't know what to tell you about the D50. I guess it depends a lot on how quickly your docs answer pagers. I did page over an FSBS of 60, but that's way better than 40, isn't it? My first call would be to the charge nurse, if it happens again, then the doc. Of course, with a preceptor right there, it would be natural to go to them. Either way, an experienced nurse on the spot is a big plus when you're talking to the doctor. (Mine ordered an amp of D50, which I've never given before. He was off the line before I remebered we had no IV access, and a very hard stick. After consulting the CN, we gave orange juice through the PEG tube. An hour later the blood glucose was 110.)

    Hang in there. I'm afraid only you can decide whether youe orientation is tolerable. I've been lucky to have a much more supportive team. Even my nurse manager only nudges gently when I'm charting two hours past my shift (which only happens after a really bad night. 30 mins is still pretty typical, though.)
    There were times I wondered if I needed to transfer to a little less complicated floor, but I decided to tough it out and hope it would get easier, and it sort of has. But I've known others who have moved and founf themselves a better fit. The only advice I can offer is that they seemed to know it was the right move for them, in much the way I was always convinced I would somehow get it, someday, if I just kept struggling.
    One of my classmates is also working on my floor. We often laugh about back when we thought nursing school was hard! Hopefully, we'll be laughing about our first year, someday.
  11. by   Jerico
    You are SO normal, and you make me feel like one of the gang!

    I've been placed with FOUR preceptors, in the last eight weeks (I am an ER newbee, new grad May 2005, without ANY nursing experience).

    Every darn one of them has a different way they think I should do nursing.

    I've had nurses argue that "they didn't have time for me" - where I could overhear them.

    I've had preceptor rattle off (as she's headed down the hall) what I am supposed to do, I go in there to do it, can't figure it out, ask another nurse to help, he tries to help and screws it up worse, then I go BACK to my preceptor and then SHE proceeds to dress me up and down in front of DOCS, NURSES, UNIT CLERK, AND patients at the top of her lungs saying "I sent you in there and HOUR ago! You can't be doing one on one patient care here!" (She may as well have just cut to the chase and called me an incompetent idiot)

    At that point, I'd finally had it with her abusive behaviors. I stopped dead in my tracks, turned around and yelled back at her (in front of ALL to hear) "OK, then YOU go do it ______(her name)". "I DON'T KNOW HOW!!! ______(her name). You have not SHOWN me how to do it_______.(her name) So YOU go do it, _____her name".

    I think everyone is going to remember HER name, don't you?

    Most unprofessional of me...but NOW she knows MY boundaries and has piped down. I think sometimes we new graduate just have to establish a pecking order and let them KNOW we are not going to take such abuse.

    Good luck. Everything you are experiencing is NORMAL. Just remember it when you become a preceptor, and don't be a crappy preceptor like they obviously are.
  12. by   christvs
    Hi! I read your story & totally understand what you're going though. I'm a new RN (graduated with my BSN in May 2005) & I've been working for 3 months on a med/surg/tele unit as well. I finished my orientation a week ago, but I had bit of a crazy orientation because I had 9 different preceptors when I oriented on days & then I had 6 others when I started orienting on my 3-11 shift! So it was nutty trying to get used to 15 RNs' ways of doing things! I had all kinds of preceptors-very involved ones, one that even literally followed me around constantly (that was a little weird cuz it was the last day of my ENTIRE 12 wks of orientation! ) , another couple I never saw the entire shift, etc...I basically learned that I could just ask any nurse for help if I needed it-if my preceptor was too busy or nowhere to be found, I'd ask whoever I could get my hands on! So I think I was still nervous (and still am a bit now at times) but I felt like as long as I knew there were more experienced RNs & LPNs around me that I would be ok-cuz they were there to help if I needed it. I do still get nervous at the begininning of my shift until I meet all my patients-then I usually relax once I 've met them & know what care needs to be done. At 3 months, I feel pretty good with things. But I also did my last semester of senior year (my internship) on this same unit-so that could also be why I feel pretty comfortable here. I think you will be fine with a bit more time-you sound like you have a good head on your shoulders, & you also sound very caring. I bet you are learning so much every day & don't even realize how much you know already. It really does get easier with each day. But it's still a good idea to sit down with your manager to discuss how things are going. Good luck!
    Christine
  13. by   Nutrix_de_Volcano
    Hey Everyone,
    THANK YOU for all of your encouragement and wisdom. I stayed offline for most of today and this evening, was pleasantly surprised to find all of your posts. I did stay off of work today, resting, hydrating, and nourishing myself. (Also, I nourished my heart and soul with a visit from my sweetie .)
    My manager called me and we had a good, productive conversation. She was very empathetic to my situation and agreed that I had been confronted with situations that were impeding my sense of progress in my orientation. But as far as she is concerned, I am progressing at an acceptable pace and that the standards of how many patients I should take are not arbitrary. She encouraged me to give myself credit for what I am doing right, reflect upon the things I can improve but not to expect I will have my core workflow down right away. (That echoes similar advice you have given me!)
    What my manager did propose is that I move up my transition to night shift (what I am hired for, but presently orienting on days), so that more time within my orientation can be devoted to getting used to the workflow of that shift. I told her I am open to that.
    So, with some rest, contemplation, love--and support from you all--I am feeling prepared to take on the day tomorrow!
    Off to bed - good night!
    PS For those who asked, I work on a Neuro unit.
    PPS Your posts are all fantastic, but special mention to Daytonite - you are an excellent writer!
  14. by   Hairstylingnurse
    hang in there, i'm finding that this is alot more common than you think. i still have days like that unfortunately. i wish there were a way to prepare new nurses and returning nurses for the nursing world. i honestlydon't know how we could do that or even where we would start. best of luck to you and just know your not alone...:angel2:

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