I am a new grad at a hospital med/surg floor and I work rotating shifts a month. I can manage a full assignment on most shifts and have been performing at a very rudimentary level. I am having trouble in a few areas though:
1- Time Management: When everything goes mostly as expected and is an uneventful or mostly uneventful shift, I can handle myself and feel confident. When something goes wrong or a patient's condition changes, I start to feel myself get anxious and panic, and run around like a headless chicken. When it's 7:15am and I'm coming off nights and I'm running around like crazy while trying to give report, I feel like a hot mess! One night I had to pass on a bunch of stuff to the next shift and I felt sooo bad, and like they will judge me as a bad nurse
2 - Being too task orientated: I am so scared about missing a medication, or being too late on vitals or assessments, or forgetting to chart this that I'm often more focused on checking off boxes on my report sheet rather then seeing the whole picture of the patient's condition. For example, my charge will ask for updates and I will have no idea what the patient's plan for discharge is. When we start shift, the nurses pick their patients, which takes up a lot of time (10-15 minutes). Once I get my assignment I need to look through charts and then get report, if I took all the time I needed, by the time I even see my first patient it would be an hour into the shift! So I often skim through the charts and miss minor things (like patient A needs a UA/UC collected).
3 - Prioritization: I know how to prioritize but in the real world it's so hard. For example, although I've got a new post-operative patient I need to assess, the patient in room 6's family keeps calling and calling for pain meds for the patient and getting angry at me. It makes me feel so stressed. Or, my patient is desatting into the low 70's-80's when simply speaking, is on CPAP, respiratory is on the way, but I can't leave the room. But the PCA tells me that my patient in room 8 has a blood pressure of 180/95. Or the patient in room 7 needs an antibiotic hung, 8 needs insulin ...
4 - Just being nervous in general: Nervous about an unsteady patient falling, nervous about making a medication error, nervous about missing something significant, not sure what to do when weird situation X happens ...
I have a good brain sheet that has helped a lot, but I am often sick to my stomach and so nervous when I go home that I missed something or made a mistake. I try to avoid obsessing about it, and I can calm myself down soon after the shift is over. But I can't help but feel a lack of confidence and like I'm not sure this was a good career for me, or if I can really do it and be a safe nurse.
I've seen the same thing, from time to time, so no apology needed. I've also had patients who've said they would rather "hold it" until the female aide could get to them--although most are more than happy to let the male who is there do it now than to wait for one of the gals. I've also experienced, and seen with others, that some of our aides will test a new nurse. Most are looking to see if you are the sort of nurse they can respect, who will roll up your sleeves and do whatever needs done. If you are "too good" to toilet a patient, you won't have their respect, and to me, that's fair. A small minority will test you to see if they can let you do your work and theirs, too. Fortunately, it isn't that common--lazy aides tend not to last long. But it happens.
I mostly meant to emphasize that a new nurse may feel a strong desire not to seem too full of herself/himself for the dirty work. But new nurses are typically busier than experienced nurses, and there should be no shame in that. It takes time to find a rhythm. After seven years, I still have an occasional shift where it seems all I get done is running around putting out fires. But there are others where I have time to toilet another nurse's patient, or bathe my own, because little things like getting the pills out of their packets don't slow me down like they once did. Time was, placing an IV was a minor disaster, now it's just another chore. But a new nurse, learning the ropes, needs to be able to lean a bit on the other staff, and realize that nearly all of us have been in the same position. New aides go through it, too.
Last edit by nursemike on Sep 6, '12
: Reason: meant to reply to wish_me_luck