Quote from aimee32907
I have a question. I am a new nurse, and I begin my first job as a nurse next week. I'm sure it's normal to be anxious (with any job!), but I feel DUMB. I graduated with honors from nursing school, passed the NCLEX the first time, but for some reason I just don't feel ready to begin working as nurse (I was a CNA for 14 years). I still feel like I don't know everything I should know to take care of my patients. My question is: is that a normal feeling? Did most of you feel "ready" when you started your first job as a new nurse? Intimidated? How did you handle it? Will it look silly if I take notes? I have so much anxiety and so many questions! Help?
This is a very well known problem, there is a lot of research going on in the area of nursing education and how to help with transition into clinical practice but also what can be done to help nurses feel "ready." In my opinion, this is one of the major side effects that is connected to nursing education in a primarily academic setting as opposed to a hospital based nursing school.
When you think about your education, you probably find that you gained knowledge but clinical application skills are lacking. Nursing is one of a kind profession in which our proficiency depends on knowledge but also on critical thinking, clinical decision-making, and clinical practice. Nursing school does not allow for nursing students to develop the clinical decision-making, prioritizing, critical thinking with applications skills sufficiently. The problem is that nowadays the expectation is to get up to speed "in no time" and that a lot depends on your preceptor and how you get precepted.
I felt "ready" but I also graduated from a hospital based program in a different country. I had so much clinicals and spend so much time on the floor that after three years of nursing school I knew what to expect and what to do. In the US I find that most new graduates from ADN or BSN programs have a hard time with the transition into clinical practice and most of them suffer throughout the first year from anxiety and doubts. Most are overwhelmed and daily crying seems "normal."
You should take notes during your orientation - there is no way you will remember everything....
I recommend to get small notebook that fits into your scrub pocket to write down the stuff you need to look up a lot in the beginning - which includes most important phone numbers until you memorize them (the top 10 - the rest you can look up on the computer), how to calculate/formulas, important floor specific stuff for example can you give iv metoprolol ? Telemetry perls. Get a small simple calculator - there are clip on ones and there are also clipboards with an integrated calculator and a storage function that some nurses find useful. If you work on telemetry see if you can get a small plastic EKG ruler - I used one for many years - most places have electronic calipers you can use to measure your strips but sometimes you need to measure it the old fashioned way. Get a small pupil light / flash light - they are inexpensive and will serve you well - you can check pupils but also look into the mouth /nose etc.- there are some that look like a pen and they have pupil sized on the outside. Some form of watch to count pulse/respirations/ length of seizures... I like a wrist watch that has a second hand but there are also other options including clip on nursing watches.
Always use a "cheat sheet" on which you structure your day including name, code status, medication times, diet, basic dx, allergies, assessment. It is very important to structure your day around the landmarks of medication administration times, meals, dressings, teaching, admission and discharges, telemetry checks. There are certain times that are pre-determined like the ones for medication and tele checks, VS checks, blood sugar checks and so on and forth and in between you have to fit in everything else plus be prepared to constantly prioritize and react to the unexpected.
What I found helpful throughout working as a bedside nurse was to get report / look up all the information needed and write it down. After that make a quick round to see all patients at least for 5 minutes unless you give bedside report. You want to make sure that everybody is alive and not in acute distress by eye balling them quick check - responsive? breathing? appears ok? and at that time also verify is the patient on tele? which iv are running? pump on and verify that amount and medication/labels, if there are drains make sure they are ok, if they have chest tubes check those quickly - and introduce yourself at that time as well. That takes really only 5 - perhaps 10 minutes but will save you a lot of trouble along the way.
It is not good to take report and then get busy with all kind of things and by 8:30 you still have not eye balled the patient... A lot of things can happen. Always verify the drips especially heparin/ amiodarone/ beta blockers right away - I like bedside report better because you go in with the other nurse and can verify together and make sure everything is ok.
Super important : Find the CNA you work together for that shift as well and give them a report - establish the work flow for the day and discuss which patients need blood sugars, VS, repositioning, feedings, changing of diapers, empty foleys, I & O, diets. I am not joking when I way that how your day goes depends to a large extent on the willingness and goodwill of the CNAs - be diplomatic when you are new and establish a relationship with them - that will go a long way.
Other than that - just be a nice person and do not take your cell phone out in your shift unless you are on break in the break room. Make sure it is silent if it is in your pocket. I still like the drug reference books instead of looking up everything on the computer - you might want to consider getting a drug reference book and drag that along with you because you will look up medications all the time.
If you have patients who need an interpreter make sure you have the phone number and use the interpreter for all your assessments/teaching - if you need to use an interpreter for american sign language make sure that you also have a print out of the Wong Baker Pain scale / Faces scale because numeric pain assessments are not recommended for deaf patients whose first language is american sign language.
Expect your first year to be stressful.