New grad: Feeling lost, incompetent, and wants to quit

[jl18]

Hi everyone,

I am a new grad and I graduated in December 2016 with my BSN (with honors) and got my first interview and was hired at a well-known hospital the day after I pass my NCLEX. However, I had no prior experience before I got into nursing school. The only nursing experience I had were clinicals. Throughout nursing school, I made so many friends and I loved the intellectual challenge and I looked forward to clinical because I got to see some of my friends and I loved taking care of my patients. At the end of each clinical, I would always get a "thank you" or "you're going to become a great nurse" from my patients and it always boosted my confidence and motivation to become a nurse. Now that I have been working for about 2-3 months and close to finishing my orientation, I dread coming to work and I am always scared on the job. I feel like I am not the bubbly, happy person I used to be. When I am on the job I feel like I forgot everything I was taught in school. I am on a heavy telemetry unit and get 6-7 pts who are confused, sundowns, or coming back from surgery and I feel defeated after each shift. My medications would always be late, my reports would be unorganized and confusing and I would forget important information because there was so much stuff that happened. I would make mistakes on documentation because of the constant pressure of finishing everything quickly. I also feel like I don't know my patients. I don't know what I would do without my preceptor and I am terrified to take care of these patients and even take responsibility for their lives on my own. I feel like I would freak out if any of my patient codes or won't even know what to do if my patient codes. In addition, there was a day when I was giving meds, I stepped out of my patient's room and I overheard the someone saying "how did anyone let this girl graduate nursing school? How did she even pass the boards?" I didn't let that get to me the rest of the shift, and I did the best I could for every one of my patients and stayed positive and always attended to their needs with a smile. I feel so overwhelmed, lost, alone, confused, and I try to stay positive and tell myself that things will get better and my skills will improve, but I am terrified that I will not become a medically safe nurse because of these feelings that I have. I am also terrified that I will lose this job and won't be able to find any other jobs because I am so new with very little experience. I'm not sure if I should endure this hardship and pray that I survive for a year until I gain some experience and transfer somewhere else (to another unit, hospital, office, practice, etc.) or if I should just give up on nursing all together and choose a different career.

[NurseCard, ADN]

You're doing fine. What you are describing is very typical feelings for

a new nurse. Not trying to downplay your worries or fears, but just

trying to encourage you that the things you are feeling really are

quite typical "new nurse" feelings and yes it will get better. That

first year is very very tough. For some nurses, the first few years

are tough. For me, the first 13 years were tough, lol.

Just keep doing what you are doing. Remember to document

everything that you do. Remember your five rights when giving

meds. Slow down when giving report if you need to. Make

yourself a comprehensive report sheet if you need to. Do

your head to toe assessments. Remember that you are

doing the best that you can, and always remind yourself

of that.

Every shift, get report, then go in and do a quick visual

assessement. Then check your medications and your orders.

Find out vital signs. Then go see each patient, give evening

meds, and do your assessments.... then plan the rest of

your night. (or day?). Or, find a routine that works for

you.

Good luck, it will get better.

[cleback]

I have a feeling you ll be ok. I imagine you're used to performing at a high level and now that you find yourself struggling, your confidence has taken a hit. For confidence, fake it til you make it... the rest will come.

I wouldn't reevaluate until st least a year. In the meantime, practice excellent self care to help with anxiety.

[NICU Guy, BSN, RN]

You need to develop organizational skills which will come with time to find out what works for you. You need a "brain" for each patient to help keep track of what needs to be done on your shift. For meds, I write down somewhere on my brain what meds are due by hours. When I give the med, it is crossed off. We also use EPIC EMR which has a "Work list". It includes times that certain documentation is needed, when meds are due, and when labs are scheduled. I look at that many times throughout the day to ensure I am not forgetting anything. At the end of my shift there shouldn't be anything left on the Work List. You also need to write down anything that needs to be passed onto the next shift soon after it happens. For example "Patient went for MRI at 11 am, Surgery came by at 2pm to look at the patient's incision and said ...". That way you don't forget to tell them something and it is readily available to help report go smoothly.

[drkshadez]

HANG IN THERE! It will come! SERIOUSLY! Out of orientation I was scared to death, but my determination overcame my fear. You will get through it.

[nrsang97, BSN, RN]

Hang in there. It does get better. It takes a good year to get comfortable, and for some people even longer. Try to use a brain sheet like one poster suggested. They are helpful to organize yourself and your report. 6-7 patients on a medical telemetry unit is tough. If after a year you are still unhappy then move on.

[jl18]

Thank You everyone for the tips and advice! I really feel the love and support. Ill keep doing my best each day.

[BlueShoes12, BSN, RN]

Good luck! I'm also a newly licensed RN and feel the same way, especially since I'll be done with orientation in a week. The basic knowledge is there, as are the basic skills, but I don't necessarily have the confidence to trust myself in making decisions yet. I think it'll come in time and further practice in making the right decisions. Time to just leap off the dock into the deep water and start swimming!

[Racer15, BSN, RN]

I came home crying on a regular basis during my orientation. I was convinced I was going to be fired, it was awful. 4.5 years in and new nurses come to me asking questions, help with hard sticks, etc. Not sure how I got here. There is still A LOT I do not know, and I ask questions almost daily. But it does get better. Do I still get scared and need help? YES! But I'm glad I stuck it out. Find someone on your unit you feel comfortable with as a go to for questions and advice. IT WILL GET BETTER!

[jvanwoman]

I am a new nurse, as well. Graduated with honors in Dec. 2016, just like you. Honestly, I don't feel overwhelmed or stressed out about my job/duties, and I think it is because of the unit I work on and the orientation I had. I had 3 weeks of core education orientation and 9 weeks of on the floor orientation. I work on a huge 144 bed unit but we have a maximum or 4 patients per nurse. I also of a nurse educator and multiple resource nurses on the floor each shift. Maybe, find a unit that works better for you.

[Nonyvole, BSN, RN]

I've been working in healthcare for...a long time, a nurse for only about four years.

I started working on an inpatient med-surg/tele unit for the first time this year; my background is all sorts of, well, not this. Patient acuity ranges from "why are you even here?" to "why aren't you in step-down, if not ICU?" We have up to seven patients, depending on staffing. In short...it's tough. I walk out of there every day asking myself why I took that position.

What I have found helps me out the most is to have multiple sheets. Each patient gets a comprehensive brain with their ROS, labs, plan, etc. Then on a single sheet of paper I write down everything that needs to be done and when so that when it's done, I can cross it off. So patient sticker, and next to it "assessment, care plans, education, meds X X X, tele X X X, BS, IV/pain/vitals X X X." Leave some space for notes during my shift, repeat for the next patient. It's...like I have a book, and that cover sheet is my table of contents and each patient gets their own "chapter" with their individual sheet. And a clipboard to keep them all on; on the clipboard I have general notes like a pain scale for my Spanish speaking patients.

It's also that golden phrase - "time management." At my facility med administration times have buffers, and I use them. 10 AM meds I'll start at 9:30, if not a touch earlier. I'll get my assessments done, but sometimes things just don't get charted until later on in the day. I'll combine my assessments with med pass, even!

And it will get better, it will get if not easier, but you'll learn your own style. Because student nursing is nowhere near being on your own. What works as a student, like taking 15 minutes to sit down with your patient and learn their life history, doesn't always work once you graduate and get that all-important first nursing job. As you've found out, unfortunately.

In the meantime, while you're still finding your feet - and you are still finding your feet - use your resources. Your preceptor isn't there as some amorphous shadow in the background, they are there as probably the first person you should be asking for help from. If you aren't getting feedback from them, ask. Talk to your unit educator, that's another thing that they're there for.

[SmilingBluEyes]

What you're going through is so normal. Like the others said, hang in there; it gets better. Takes about 6 mo to a year to begin to feel competent. Til then, find a mentor nurse or follow someone whose work you admire and is good. It will be ok. We've all been there. IF there was ever a time when this phrase applied, this is it: FAKE IT TIL YA MAKE IT.