Raw: Two Months After Graduation. One Month After Employment.

[ixchel]

I watched that video in orientation thinking, "these people are crazy. I'm a ray of sunshine and hope! I am a positive person! I believe in myself and I am ready to learn and BE AWESOME!!!! I LOVE THIS PLACE!!!!!!"

But here I am. Three days shy of a month in on my first job. And there is a bit of dread in my heart. I'm not sure how it got there. It snuck up on me rather insidiously. A couple of weeks ago, I was walking toward my car and I passed some respiratory students. I beamed at them happily and said, "Hello!" As I walked away, I heard one of them say, "Wow that was a happy person!" She was right. There was joy in knowing I could wake up to the hospital, my new home.

What happened? Is it that the high of graduation has settled, and the reality of going back to grown-up world has come back? Is it that I feel so completely incompetent?

I know what you students are thinking while you read this. "I'm going to be on top of the world! I'll never feel that way!" But mark my words - there is this strange feeling that sinks in where you realize that school didn't prepare you for this, and that you really aren't good at it no matter how hard you tried to be, and you have so, so much to learn.

I read that so many times here, and I believed it. I think I held that giant beaming smile on my face because honest to god, I went in prepared for how hard it was supposed to be. Even then, it overwhelms me knowing how much I need to know, but just don't yet. I wish I could take home the charting system to practice. I wish I could take home the omnicell to practice. I wish I could take home the policies and procedures link on the intranet to memorize. But then again..... surrounding myself by the ongoings of my children on days off has kept me sane.

Four days off.

Four.

Why do I feel like I'm always at the hospital? I'm home more days than I am there.

You know what is a little bit more frustrating? I'm a bit of a junkie for the critical care unit I am on. I absolutely love it. And yet.... I have buyer's remorse. I think to myself, "there is no way I'll get good enough for this... Maybe if I chose (med/surg/OB/peds/ortho) instead it would be easier......" Realistically, I know that's not true. I mean, probably not true. I usually STRIVE for a challenge and feel let down when I miss opportunities. I know I'd be frustrated if I were anywhere but where I am. But I'm frustrated, too, because I am where I am.

Being on orientation, I am frequently pulled for other experiences. In 4 weeks, I've had two days with my own patients. I've loved my experiences, of course, but I'm feeling the weight of, "I should be making progress by now, but I'm not getting the opportunities to." I'm not meeting goals. I've gained a lot of experiences, but I haven't met goals. Is trading one for the other good? How does that work exactly?

I have the blues. I'm very much a fighter. I'll keep moving and striving to be awesome. I know it's a long haul before I will feel like I'm awesome. I've waited through nursing school, I can wait longer.

But.... man.

You graduate nursing school, and you think to yourself, "I reached the goal! I'm there!!!!"

And then you pass the NCLEX, and you think, "No more studying these giant ugly books!!!"

And after that, at work you get your first name badge with the words "registered nurse" on it.

And you think, "I made it. I am here. I have arrived."

You save your energy up for that finish line. And then you reach it. And you feel you're on top of the world. No one thinks about what happens next, emotionally speaking. You walk into your first job, and find out that because you were so high on that mountain on top of the world that it is that much further to fall down when you have really hard days.

And you look up to where you were, up there on that mountain, and you remember...

"I wasn't supposed to fall."

[ixchel]

Let's not hijack, friends. I was intending to post a new update in the near future, but I wanted to address the question, since it's been raised a couple of times - why critical care?

I interned on this unit and fell in love with the culture of it. I loved the complexity of the patients. I've never been a person who could choose an easier path for myself. Perhaps I'm an idiot that way. lol I'm one of those people who can easily be good at many different things I try, but will always choose the thing that challenges me most. Sometimes, it is a push to be a better person and it brings me great satisfaction when I succeed. Other times, I admit I regret it deeply.

So why critical care? It's the one area I know the least about. I've studied pediatrics and OB independently before school. They're the things I know the most about. They're the things that come easiest to me. I don't at all mean to suggest that these areas are easier, but for me I think the challenge would be less. Critical care? I've learned and grown exponentially. I'm challenged every shift. Frankly, I love it. But there are many things I dislike as well. Those things have little to do with critical care itself, though. They're related to staffing and other issues that might exist anywhere.

So yes, it's hard, but I'm really not sure I'd enjoy my job as much anywhere else. In the overall scheme of things, though, I do believe the powers that be are considering making me the last new grad hired to our unit. They recognize how overwhelming it is, and while they assure me they think I've done well, it doesn't do much for employee retention and it doesn't benefit the patients to have a nurse who is so unsure of themselves.

[didi768]

Hi Ixchel...thank you so MUCH for your loving response and now I understand, forgive me if I made it sound like anyone who would go into critical care first had to be an idiot, I certainly didn't mean that. I was just a little shocked thinking new grads might try just a medical floor to begin with, but actually it makes sense to start in critical first to learn it all...makes perfect sense now. I still think you guys are wonderful...GUYS AND GALLS haha. All of you!!

[MissyWrite]

Why do I feel like I'm always at the hospital? I'm home more days than I am there.

Your mind is there, so you feel like you're there. Consider practicing mindfulness-based stress reduction -- MBSR. It teaches you to live in the present moment, rather than lost in thought about work or other things that cause worry and stress, and it really works. Those four days off will feel like four days off.

Online MBSR (free)

So why critical care?

I think this was a great choice. It will help you greatly no matter what area you go into in the future, should you decide to do something different. You're getting the best education possible, one that will transfer to any setting. I'm surprised, though, that you have a 4:1 or 5:1 ratio; usually it's 2:1. What type of unit is it?

I've gained a lot of experiences, but I haven't met goals.

Are these goals you've set for yourself, or goals you're required to meet? What goals do you feel you're not meeting? Have you met them now (I realize your post is a few months old)? You're probably accomplishing far more than you realize. It would be interesting to hear you talk a little more about this.

[iPink, BSN, RN]

I'm surprised, though, that you have a 4:1 or 5:1 ratio; usually it's 2:1. What type of unit is it?

Critical care doesn't always mean ICU/MICU/NICU, which has a ratio of 1-2:1. There are other critical floors that take less critical (or less unstable) patients that are still not well enough to move to a Medsurg floor. Units such as Trauma, Telemetry, Stepdown ICU (or PCU), and other Cardiac units are considered critical care. I worked in PCU and had a 4-5:1 assignment. Most of my patients had cardiac issues. The higher the patient acuity, the less patients you have.

Sent from iPink's phone via allnurses app

[AmyRN303, BSN, RN]

Let's not hijack, friends. I was intending to post a new update in the near future, but I wanted to address the question, since it's been raised a couple of times - why critical care?

I interned on this unit and fell in love with the culture of it. I loved the complexity of the patients. I've never been a person who could choose an easier path for myself. Perhaps I'm an idiot that way. lol I'm one of those people who can easily be good at many different things I try, but will always choose the thing that challenges me most. Sometimes, it is a push to be a better person and it brings me great satisfaction when I succeed. Other times, I admit I regret it deeply.

So why critical care? It's the one area I know the least about. I've studied pediatrics and OB independently before school. They're the things I know the most about. They're the things that come easiest to me. I don't at all mean to suggest that these areas are easier, but for me I think the challenge would be less. Critical care? I've learned and grown exponentially. I'm challenged every shift. Frankly, I love it. But there are many things I dislike as well. Those things have little to do with critical care itself, though. They're related to staffing and other issues that might exist anywhere.

So yes, it's hard, but I'm really not sure I'd enjoy my job as much anywhere else. In the overall scheme of things, though, I do believe the powers that be are considering making me the last new grad hired to our unit. They recognize how overwhelming it is, and while they assure me they think I've done well, it doesn't do much for employee retention and it doesn't benefit the patients to have a nurse who is so unsure of themselves.

Ixchel, I feel we're living a very similar experience right now! I too work step down, with a 3:1 and sometimes 4:1 ratio. And yes, it's hard. I never know what I'm going to walk into, even when I have the same patients from the night before. Things go sideways very quickly. I chose this area to challenge myself, and have been told by veteran nurses that I will learn quite a bit in the first year or two. I am fortunate to have a supportive unit where the experienced nurses answer questions and lend me a set of hands with new experiences. It is somewhat daunting, knowing that there is so much I don't know, but so far, so good. I could have written what you wrote.

[ixchel]

Hi Ixchel...thank you so MUCH for your loving response and now I understand, forgive me if I made it sound like anyone who would go into critical care first had to be an idiot, I certainly didn't mean that. I was just a little shocked thinking new grads might try just a medical floor to begin with, but actually it makes sense to start in critical first to learn it all...makes perfect sense now. I still think you guys are wonderful...GUYS AND GALLS haha. All of you!!

You didn't sound like that at all, love! And you aren't the first to express surprise at this career path choice. A few times in this thread it's been brought up, actually. I don't scoff at the surprise at all, actually, because I get why someone would question the choice. I think maybe if you'd said the same thing 6 months ago, I would have been annoyed by it, but now that I know? I totally get why you would ask. It's hard! I can't tell you how many times I've been told, "this is the hardest floor in the hospital."

Your mind is there, so you feel like you're there. Consider practicing mindfulness-based stress reduction -- MBSR. It teaches you to live in the present moment, rather than lost in thought about work or other things that cause worry and stress, and it really works. Those four days off will feel like four days off.

Online MBSR (free)

Thank you for this suggestion.

I think this was a great choice. It will help you greatly no matter what area you go into in the future, should you decide to do something different. You're getting the best education possible, one that will transfer to any setting. I'm surprised, though, that you have a 4:1 or 5:1 ratio; usually it's 2:1. What type of unit is it?

I am on ICU stepdown in a small, rural hospital, which is considered critical care. On top of that, because it is small, we don't have specialized ICUs, so every type of patient gets floated through there. We do cardiac, neuro, GI, you name it. If they aren't critical enough to require 2:1, but almost, they come to us. I love that because it gives variety. I don't love that because it gives variety. lol It's taught me so much in such a short amount of time.

Are these goals you've set for yourself, or goals you're required to meet? What goals do you feel you're not meeting? Have you met them now (I realize your post is a few months old)? You're probably accomplishing far more than you realize. It would be interesting to hear you talk a little more about this.

Both. We had an orientation "checklist" with things that were required of us, but I also had my own goals. I wanted to learn basics, like what it takes to get through a shift. You know, when and how to do each thing necessary for the patient, like assessments, med passes, stuff like that. It was probably 6 weeks before I started getting more appropriate patient assignments, and at that time, it was a bit soul crushing to realize how much I didn't know how to do. I felt, at the time, that it was a bit of a disservice that I didn't know how to get through assessments before 1000 meds were due, but I could totally do central line dressing changes, discharges, med administration, and lab draws with my eyes closed. The way they approached my orientation felt completely backwards to me. In my opinion, and orientee should be given the ability to learn basic time management before throwing in complicated, skill intensive situations. But, that honestly is my opinion, and others feel differently, I'm sure. I got plenty of, "be happy you're seeing this on orientation and not after when you have no help." Probably I would have rejoiced in that idea if I had preceptors who were more supportive, but instead they would disappear because, after all, I should know how to do this stuff without a crutch. :\ Orientation was definitely frustrating.

Critical care doesn't always mean ICU/MICU/NICU, which has a ratio of 1-2:1. There are other critical floors that take less critical (or less unstable) patients that are still not well enough to move to a Medsurg floor. Units such as Trauma, Telemetry, Stepdown ICU (or PCU), and other Cardiac units are considered critical care. I worked in PCU and had a 4-5:1 assignment. Most of my patients had cardiac issues. The higher the patient acuity, the less patients you have.

This is exactly the case for my unit. We have 20 beds on the unit, and the goal is to have 5 nurses and give the nurses who have more acute patients a lower assignment, but unfortunately it doesn't happen that way consistently. At night, we very often have 4 nurses. It seems as though the nights when we are lucky enough to start with 3, we always end up with 5 by the end. But at least on those nights, the three you start with are quick to start your assessments and meds on, so you can brace yourself for the impact of two admissions.

Ixchel, I feel we're living a very similar experience right now! I too work step down, with a 3:1 and sometimes 4:1 ratio. And yes, it's hard. I never know what I'm going to walk into, even when I have the same patients from the night before. Things go sideways very quickly. I chose this area to challenge myself, and have been told by veteran nurses that I will learn quite a bit in the first year or two. I am fortunate to have a supportive unit where the experienced nurses answer questions and lend me a set of hands with new experiences. It is somewhat daunting, knowing that there is so much I don't know, but so far, so good. I could have written what you wrote.

I'm so glad you have a supportive unit! I think, overall, I do, too. I can tell by looking at staffing for the night what kind of night it will be. I have my favorite charges, techs, and nurses. One tech, she just left and I'm telling you, I could have danced when I saw her go. Most of the other techs, though, are amazing, and dependable, which is so incredibly vital for a newbie. The vibe of the shift tends to be determined by the nurses that are on. When it's my old preceptor and her favorite gossip buddies, I tend to hide during the night because I don't want to be around the negativity, and frankly offers of help from them come only when you're obviously not busy. I'll take my computer to a quiet corner and just work from there. When that group is spread across different shifts, I feel better supported as the unit newbie. Not a shift goes by without hearing the words, "Do you need help with anything?" And it's not just me they ask. Everyone helps each other, usually. We all have our favorites to work with.

I haven't mentioned this on either of my raw threads, but I will say I absolutely love that I feel like I'm part of the team now. I'm still the newbie, but I think I've become "one of them" now. I feel more comfortable being myself, admitting weakness or defeat, being silly when it's appropriate, expressing frustration when the moment warrants it. As soon as the "one of them" (or, I guess it's "one of us" now?) feeling fell over me, I think it helped exponentially. Feeling like an outsider who can't be trusted to stay once I pay my dues made me feel less supported than I am now. They see I'm invested, and so they invest in me. It's a good feeling.

Anyone who might be interested - I wrote a new Raw post as an update. You're welcome to check it out. Some things have definitely gotten better. Some things still sting. Here is the link - https://allnurses.com/first-year-after/still-raw-six-958489.html

[didi768]

I love you guys. I really do.

[AmyRN303, BSN, RN]

Ixchel: tried to message you back, but your inbox is full :)