Feeling sorta defeated

[TerpGal02, ASN]

I will have a year under my belt in May and started a new job a month ago. I started my career in community psych working with the sickest of the sick (love the chronic schizophrenics), basically doing home visits and making my own schedule. I am used to a lot of 1:1 and basically being able to be with one pt as long as they needed me. The new job is acute inpt, our hospital is small, 46 beds 6 child, 18 adolescent and 20 adult. I spent 3 shifts passing meds which went fine, 4 shifts on C&A which was fine (but none of the preceptors I was with on C&A had me run the whole unit myself) and did my 3rd shift on adults today, I am supossed to have 4 and start on my own on Sun. Well our nurse educator was my preceptor and she basically let me have free reign. It didn't go so well. I felt like I was running all the time. We had 3 d/cs and one admit all with tedious paperwork that I'm really not used to yet. I'm used to being able to spend as much 1:1 time I wanted with pts so when they start going on and on in an admit, I don't really know how or when to redirect them. Our unit is also insanely acute right now, almost everyone in with psychosis and two particularly delusional and nasty older ladies. Which brings me to my next point. We aren't supposed to get anyone with medical issues that are not mild and well controlled (we can deal with doing accuchecks on insulin or people with managed hypertension). Problem is a lot of our referring hospitals really like to basically lie to us about medical stuff because they don't want these pts. One of the aforementioned ladies was admitted last night with "just some wheezes with asthma". Turns out she's a COPDer that hasn't seen a doctor in years, barrel chested, skin and bones with no management other than an albuterol inhaler statting 88% early this am where the.night nurse put her on NC at 2L (and we had to dust off the ole O2 tanks to do it, no concentrator) and abruptly raised her O2 sat to 98% with a RR of 24. So I spent the first two hours of my morning fiddling with her O2 to keep her above 92% and not tachypnic with a regular rate and depth. With 19 other pts, most of which are very psychotic. Our ed nurse asked me if I wanted more days orienting and I agreed. I just feel terrible. No med errors were made, just little paperwork stuff the ed nurse looked over and showed me my mistakes (mostly boxes not checked). I still feel terrible to be making rookie mistakes when I am supposed to be a more experienced psych nurse.

[Sun0408, ASN, RN]

New setting takes time.. You are now in an acute setting so the ratios will be higher obviously but you will adjust. Give yourself time, you are an exp. psych nurse so don't discount that. You just have to learn your new settings, procedures/protocols etc. Take it one day at a time :) When I switched hospitals, I felt the same way.

[TerpGal02, ASN]

Thanks for the feedback. I feel better about it today. I found out the other nurse orienting with me was given the same offer as me, and she'll decide whether to take it on the word of the other nurse who she has been precepting with for a few days. She's finding her struggles are similar to mine and she had 2 years atan inpt drug/alcohol rehab.