I am a new grad going through critical care orientation in CVSU, started 7/24/06. I am being flipped between nights and days, will eventually work nights. I am one of the only new RNs being flipped, but they said it's because there aren't enough preceptors. Anyway, I have been a mess the last few weeks--depressed, crying, can't sleep, etc. I have always been a night person, but lately it's easier for me to get up early than stay up all night. My self-confidence is decreasing, too. Instead of getting more confident, I feel lacking in my abilities every time I work. I was one of the top students in my class, but now I feel like I don't know anything.
I didn't have much experience with dressing changes and wounds in school. Today I did a wet-to-dry, which I know how to do. The problem was, it was an infected wound (the patient was a CABG and she's back b/c infected sternal incision). My preceptor didn't watch, but asked if there was an odor and how it looked after. There wasn't an odor, and I thought it looked ok--no pus, drainage, etc. There was some yellow (exudate?) tissue, I tried to clean it out but it wouldn't budge. When one of the MDs came later, he said we need to do more wound care and change it because there was the yellow tissue, etc. I feel like I did something wrong, missed something. I should have brought my preceptor with me. My preceptor went with me to put a new dressing on with the new orders. The doc wrote for more cultures, so she busied herself getting those and didn't say much to me. I only had an 8 hour shift, so it was time for me to leave then. She just said goodbye. She never tells me if I should do things differently, or if I'm doing them correctly.
There is a different pt that had to stay b/c of an infected leg incision that I had the other day. She didn't have the infection when I had her, not that I know of anyway. I had previously asked my preceptor if I should look under dressings when we do our assessments, but she said not really. The pt I'm talkng about had an ABD over her incision, with some of it exposed to air. The part exposed to air looked good, and I peeked under the corners of the dressing to see some of the incision, which also looked good. The nurse before me had just changed the dressing, so it was ok for another day. That was last Thurs pm shift. She was supposed to go to short-term rehab Fri. I came back this am (Mon) and found out she was still in our unit because of an infection. It wasn't found until just before she was going to leave--the husband had already gone to get the car. Luckily the she found the infection b/c she decided to change the dressing before the pt left. I feel like I failed the pt. Now I will look under dressings to view the wound myself.
I have different preceptors for nights and days, and so far have worked with 4 different nurses, plus 1 from a different unit because mine left one night after 3 hours--the nurse from another unit had never been to ours before, and the other nurse working was a travel nurse. Our unit is only 12 beds, and sometimes they close beds down so we only have a max of 4 pt/nurse. I like the unit, feel like it's a good unit to learn on b/c it's not completely crazy all the time.
When I ask, my am preceptor says I'm doing fine. I don't feel I've done anything really wrong, but feel like I'm missing something or not getting the whole nursing thing. I feel like quitting, but I didn't get through nursing school
to quit so early. Right now I should be sleeping since I have to get up in less than 5 hours, but I was in bed thinking about all this. It helps to come here and see I'm not the only one struggling, and that some day it'll get better. I feel like I'm missing the easy things though, and so far my pts haven't seemed that complicated. I hardly see my husband anymore and have no personal life because I'm so tired all the time.
How do you get through these months without going crazy?