. . .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: