Feeling like a failure most days

  1. 1
    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.
    roughmatch likes this.
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  3. 15 Comments so far...

  4. 3
    Hey, I am a new grad too (taking boards soon). The UA stuff being collected and such needs to be given in report. You shouldn't have to search through a chart to find that out.

    Here's how I figure I might work it. Get there, get pt assignment, get report (you should be going into the pt's room to do this and making sure the oxygen is what it's supposed to be, IVs running at the correct rate/no infiltration/redness, note whether they have drains or foley and other quick assessments; step outside to give code status), then do your blood sugars unless there is something very urgent that needs to be done (pt having airway issue or something emergency wise), then write down all your med times (i.e. rm 200: 800, 1000, 1200, 1400, etc.); and do your assessments when you are in the room giving the meds; and ask them if they need anything while you are in there to prevent going back in there right after; chart right when you get out of the room; then check your orders and such after pt assessments are done. If you have an emergency or something, that's out of your control. I can see why you get frantic. It's unexpected.

    Delegate some things; but please don't be the nurse that the pt needs to use the bathroom bad and you say "I'll call your tech to take you" when you have nothing better to do or you have a moment to do it.

    Well, airway and breathing is first, so the desat. one you do need to stay with, then take care of the high BP. If you need something hung immediately (i.e. antibiotic), see if the charge nurse can help. Here, the charge nurse has a lighter load, so they can be charge and take care of things.

    I, too, am scared out of my mind. But being new, you can only try and learn from your mistakes. Take time out at the end of your day to evaluate how it went. What worked, what didn't work, and how you can make it better.
  5. 5
    Quote from sagremus
    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
    Time management is the curse of all new grads. If you can manage a full assignment on mosts shifts, you're on your way to being able to conquer time management. It's the unexpected stuff that trips us all up . . . even sometimes when you're decades into the job.

    We've all had to pass stuff on to the next shift, too. That's why nursing is a 24/7 kind of job. The goal is to improve, so that you're passing on less stuff as time goes on.

    Brain sheets help with both of these issues. Another thing that helps is seeking out someone whose time management skills you admire and asking her how she manages. This accomplishes two things: it's flattering to the person being asked and may gain you an ally, and you might get some tips that help out enormously.


    Quote from sagremus
    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).
    Are you working two or three days in a row? The second and third days cannot help but be better as you'll already know your patient. Once you've picked your patient, scan the chart quickly for meds or treatments due within the first two hours of your shift. Report should cover the basics of history, abnormal labs and plan. Eyeball your patients quickly to make sure they're pink and not blue, and that no one is bleeding out, falling or trying to die. Again, seek out someone who you admire and ask them how they get their day started.


    Quote from sagremus
    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 ...
    Again, prioritization is a bugaboo of new grads. You'll get it. When you start feeling stressed, just take a few good, deep breaths and remind yourself that you can do this. If you're only a month into the job and you can already manage a full assignment on a good day, you're well on your way to being able to manage a full assignment on most days.

    Quote from sagremus
    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.

    All of these complaints sound like the first year of nursing blues. The first year of nursing is really, really rough. The only way to get through it is to GO through it. Trust me, we've all been there. We got through it and you will too.
    roughmatch, Equestrian, CherylRNBSN, and 2 others like this.
  6. 3
    A thing that helps a little with prioritizing that might sound wrong right out of school is considering how long a task may take. I can pass a pain pill pretty quickly, but assessing a new patient takes some time. So, I might help transfer the new arrival to bed, take a quick look, then go pass a pain pill. I can come back and do my full assessment with less pressure. It also helps to think about which jobs will save me work, later. One pt needs pain med, one needs bedpan. Doing the bedpan now saves a bath/bed change a few minutes from now. I don't like to keep people waiting for pain meds. I try to be proactive and ask before they call out--saves me time, saves them pain. But if it comes down to it, waiting 10 minutes for a pain pill isn't the end of the world (just remember it can feel like it, if you're the one in pain, so do the best you can.)

    The comment about calling a tech/aide to toilet a patient has some validity. The aides I work with don't think a lot of a nurse who assesses a patient, then calls them to toilet that patient while they move on. The poster's phrase, "when you have nothing better to do," is key. At this point in your career, when do you not have something "better," (more important, that only a nurse can do) to do? Support personnel are not doing you, or the patient, a favor when they do the work they're paid to do. I'm not a bit too posh to wash, but if I'm having to choose whether to do a bedpan or a pain pill, my aide better not be reading a magazine. I've seen a few new nurses since I was one, and most, like I was, are prone not to delegate enough. We're control freaks, and I'd still rather get my own manual BP when the machine isn't good enough. But when I do need to delegate, I look at it this way: most of my aides work hard. I work harder. That's just the way it is (and yes, I get paid accordingly, so I'm not trying to be a jerk about it).
    roughmatch, joanna73, and LobotRN like this.
  7. 0
    I feel that my delegation skills are okay, but go hand in hand with my time management. Sometimes I try to do too much and end up behind, but I can definitely tell when I am drowning and need help. For example, on nights where I was working with a reduced patient load, I got all of my own blood sugars. However another day, my patient needed his AM insulin and of course his blood sugar checked before, but I was dealing with a clogged tube as well as needing to give report (again envision me running around like a chicken with it's head cut off at 7am). So I asked the PCA to check the patient's blood sugar, and thankfully no insulin was needed (saves time as some of my other patient's needed 7am meds). It is also hard when they schedule a lot of treatments and meds half an hour before shift is over, and you also have blood draws, and to give report. I think I might start getting my labs and medications early.
  8. 0
    Sorry, nurse mike. I didn't mean it that way. I've teched before and I have had times where I was with a pt and there would be another one of my pts needing the bathroom and the nurse would be in the room and say "well, your tech will be here in a minute to take you to the bathroom" and they leave the room and they had extra time to get them to the bathroom. I have worked with nurses that were fabulous about helping and others that thought once they got that RN or LPN after their name; they thought they never have to toilet a pt again.

    I know the facility I was at, they had a time frame that was okay to give it (like if they did it 30 minutes ahead of time, it wasn't bad or they didn't have to write themselves up); know your facility's policy though. They didn't do their own blood draws though but they had to do their own blood sugars.
  9. 1
    Just know that once in a while even we senior nurses have to leave something undone/unfinished. Not a problem in my opinion because I know that we all do so (and that means the nurse after has done so also. If she said she hasn't, I'd know she's a big fibber).

    Having said that, it is a 24/7 job as RubyVee posts - the facility ran OK before I arrived, and it will run OK after I leave. NO facility is 100% dependent on 1 person to run. You do the best you can. You give report and just tell them. If you remember something after you leave, give them a call (don't we all have our work # programmed ?).

    I want to believe that many of us really do cut newbies some slack even if we don't toot-toot it. It's tough to be new, as a graduate OR as a seasoned new hire. And many seasoned nurses aren't perfect even being experienced - there's always room to improve for us all.

    So, take a deep breath and keep on ---
    Ruby Vee likes this.
  10. 1
    I guarantee you, 95% of new grads feel like this for the first 6-18 months. It WILL get better!!! Hopefully you have supportive coworkers, use any resources you can without feeling guilty! A plus on your side is that you are able to identify your weaknesses...work on one specific area at a time, and you will get it!
    nursemike likes this.
  11. 1
    Sounds like the normal new grad to me...heck, some nurses that have been doing it for years may still feel the same way. You have to figure out what works for you. Don't be ashamed to ask people for help. If you're assessing your new patient, it's ok to ask another RN to administer pain meds. However, like the above poster stated, sometimes it;s quicker to give the pain meds ten come back to do your detailed assessment.
    nursemike likes this.
  12. 0
    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


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