When does it get easier?

  1. I work on a med-surg unit with high-acuity patients (it's at a well known research hospital). I got sixteen days of orientation on days, then a couple days of orientation on nights. Now I'm on my own.

    This has been so hard. I'm finding myself dreading going into work because I'll be faced with something I don't know how to do. What's more, I find myself forgetting how to do some of the basics because I'll go a few shifts without doing it and then forget. I've not yet made any errors, but the experience has been nerve-wracking.

    I'll hear about patients that other nurses have--extremely unstable, needing NG tube placement (I've never done that), or needing other procedures that I've not done for a long time or have never done--and feel both stupid and demoralized. Or I'll have a patient who's disoriented and refusing meds, etc., and I just don't know how to handle it.

    When will this get better? I'm going to give myself at least a year to get into the groove, and I'm surrounded by nurses who seem to be able to take everything in stride. I just wish I could fast forward a year and be more comfortable...is this normal?
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  2. 11 Comments

  3. by   EmerNurse
    Yep it sure IS normal. It'll take a while for you to get your groove in your new job. Every one of those nurses you're watching have learned their "rhythm" if you will, for how they go about managing their time and their patients.

    In the meantime, do this. Every day when you run into or hear about something you don't know about, go home and look it up. You needn't memorize every word but being familiar with these things will take some of the angst out of it all. The skills you'll get in time - soon you'll be dropping NG tubes while holding down the patient's hands and preventing them from diving off the bed.

    You're in a steep learning curve right now and the best thing you can do for yourself is to look up and learn at home, each and every time you hit something that makes you feel like a deer in the headlights. It'll get less and less over time.

    Also, if you can find one or two nice, supportive nurses who'll take you under their wing (or at least answer questions without growling), then find them and value them.

    Hang in there - it really does get better!!
  4. by   LeesieBug
    I am just hitting the 6 month mark, and I would say that, in just the past few weeks, much of my anxiety is starting to dissipate. I don't magically know a lot more, but I am at the point where I know enough that things roll relatively smoothly, and when things I don't know how to do come up, I can take it in stride a little better.

    I have also learned that the earth will not fall if I can't handle something on my own, or need some instruction. It's sinking in that this nursing thing is a TEAM effort...it's OK to need help. WE ALL DO . go figure.

    Hang in there. It does happen. I have days where I think back to what it was like in July, when I started, and am in AWE of how far I have come. My first day I had to ask a nurse how to connect the iv tubing and j loop , now I roll along doing 8-10 IV starts a shift with no problem...one pt overwhelmed me, now five is no big deal....who knew! Can't imagine the super nurse I'll be in five years!
    Last edit by LeesieBug on Jan 8, '07
  5. by   NaomieRN
    Say a prayer before going to work. It works everytime!
  6. by   Pachinko
    Thanks guys--your words of encouragement and advice mean a lot to me. I'll take your word about feeling more confident eventually I guess I just didn't think it would be this challenging.
  7. by   AliRae
    I remember about a month into my orientation (new grad in PICU), crying on the phone to a friend. "They told me there was a learning curve ... no one told me it was freaking Mount Everest!" He was ever-so-calm, and quietly replied, "Relax. It's just Kilimanjaro." I have never forgotten that. I'm now 15 months into this crazy world of nursing. I'm still learning every day - we all are. It will get better. One of the best things you can do is find a nurse who seems to have it all together and watch her (or him). How does she organize herself? How does she manage to make 1 trip to the med room for every 3 you're making? I've got a whole hybrid system worked out by now, culled from the minds and practices of more experienced RNs on my unit.

    So breathe (which is what I tell myself every single day as I clock in). Relax. It's just Kilimanjaro.
  8. by   crb613
    I have been a nurse a little over 7mos. & I know how you feel. I am on a med surg floor & am constantly being floated between the medical & surgical sides. There is a lot of things we do on the surgical side that we do not do on the medical side & visa versa.....it is hard trying to remember & become efficient in skills especially when you are new & do not do them every day. I carry my skills book from school w/me, & ask for help if I am not sure. I also spend a lot of time studying at home after work. I had no previous experience of any kind & that did not help either.....Lord the thought of setting up a PCA was like doing brain sx to me! I would just dread getting orders for one! Now of course its no problem.....funny how the small things can drive you nuts! My biggest fear now is a code....never been in one & I can feel it coming......I have gone over CPR/code a thousand time in my mind....will I do it right? Do I know how to place my hands? How hard, how fast, paddles where to place them, can I get the headboard off the bed & put under the pt? Can I get an IV under pressure if needed.....will I know what the heck to do? I pray every day for the Lord to guide me & give me the knowledge I need to care for my pts. Now I have to go over this code thing one more time......... Good luck & one day we will be pros too!
    Last edit by crb613 on Jan 3, '07
  9. by   incublissRN
    Quote from crb613
    I have been a nurse a little over 7mos. & I know how you feel. I am on a med surg floor & am constantly being floated between the medical & surgical sides. There is a lot of things we do on the surgical side that we do not do on the medical side & visa versa.....it is hard trying to remember & become efficient in skills especially when you are new & do not do them every day. I carry my skills book from school w/me, & ask for help if I am not sure. I also spend a lot of time studying at home after work. I had no previous experience of any kind & that did not help either.....Lord the thought of setting up a PCA was like doing brain sx to me! I would just dread getting orders for one! Now of course its no problem.....funny how the small things can drive you nuts! My biggest fear now is a code....never been in one & I can feel it coming......I have gone over CPR/code a thousand time in my mind....will I do it right? Do I know how to place my hands? How hard, how fast, paddles where to place them, can I get the headboard off the bed & put under the pt? Can I get an IV under pressure if needed.....will I know what the heck to do? I pray every day for the Lord to guide me & give me the knowledge I need to care for my pts. Now I have to go over this code thing one more time......... Good luck & one day we will be pros too!
    I graduated in May and transferred to a critical care unit in November. I will be off orientation in 2 weeks and of course during my orientation I've not had any codes. I'm like you, I keep going over stuff that could happen and what I need to do!
  10. by   Cattitude
    Quote from crb613
    i have been a nurse a little over 7mos. & i know how you feel. i am on a med surg floor & am constantly being floated between the medical & surgical sides. there is a lot of things we do on the surgical side that we do not do on the medical side & visa versa.....it is hard trying to remember & become efficient in skills especially when you are new & do not do them every day. i carry my skills book from school w/me, & ask for help if i am not sure. i also spend a lot of time studying at home after work. i had no previous experience of any kind & that did not help either.....lord the thought of setting up a pca was like doing brain sx to me! i would just dread getting orders for one! now of course its no problem.....funny how the small things can drive you nuts! my biggest fear now is a code....never been in one & i can feel it coming......i have gone over cpr/code a thousand time in my mind....will i do it right? do i know how to place my hands? how hard, how fast, paddles where to place them, can i get the headboard off the bed & put under the pt? can i get an iv under pressure if needed.....will i know what the heck to do? i pray every day for the lord to guide me & give me the knowledge i need to care for my pts. now i have to go over this code thing one more time......... good luck & one day we will be pros too!

    aaaah codes... my first one my knees were shaking so hard i thought everyone could hear them knocking! but there are always other more experienced people there to help. and it gets much better. believe me, i used to feel so inept, now i could ambu, do compressions in my sleep if i had to. you will be fine with everything with experience as your teacher.

    :smilecoffeecup: :spin:

    beez
  11. by   crb613
    Quote from casbeezgirlrn
    aaaah codes... my first one my knees were shaking so hard i thought everyone could hear them knocking! but there are always other more experienced people there to help. and it gets much better. believe me, i used to feel so inept, now i could ambu, do compressions in my sleep if i had to. you will be fine with everything with experience as your teacher.

    :smilecoffeecup: :spin:

    beez
    thanks for the encouragement!
  12. by   NYCRN16
    I started in a busy ER as a new grad, and 3 1/2 years later I am still there, and still alive to talk about it Believe me, I was an LPN before graduating RN school so I thought it would be a little bit easier for me to adjust, but believe me, it doesnt really help that much at all. I was still pretty much on the same page as my fellow new grads when we started working as RN's.

    I remember that first year and being terrified every time I went into work praying that nobody died on me and that I didnt screw something up. The first few months are the worst, you feel like you dont know anything and that you will never get it. I think it was about 6 or 7 months when I started to feel like I was "getting it" and things were running smoother. After 1 year I was gaining confidence and I was ready to take on more difficult assignments.

    How you are feeling is totally normal, as you gain experience it will get easier. Do not be afraid to ask questions, that is the only way you will learn and is the only safe way to do something that you are not familiar with. We will ask questions our whole career and there are still plenty of times that I still ask more experienced nurses about things I am not familiar with. I remember when I was new, some nurses doing when I would ask a question like "how can I not know that". But the truth of the matter is, they asked the same questions when they were new too, and if they dont like it too bad. You will know who you can go to and who you cant. You are wrong if you dont ask questions when you dont know something. That is how mistakes happen and patients get hurt.

    A word of advice to new grads:

    Put yourself in the position to try new things. The new grads that I work with now are progressing very well because they are totally open to trying new things under supervision and are learning very quickly and developing great skills. There was another nurse that works with me who started as a new grad and is now leaving after a year and a half. She always avoided high stress situations by making the excuse that she was "too busy with other patients" to do intubations, drips, ect, so now at this point in her career she has no idea what to do and she is not working at an equal level to other new grads of the same experience. I dont know how she was able to push this all off for so long, but now she is really suffering for it. I think when nurses are new they tend to push off difficult patients because they are scared and dont know what to do, but after a certain point you just have to jump in and do it in order to learn. She has no clue how much this has hurt her learning, and wonders why the charge nurses will not start training her in other areas of the ER like triage and critical care when nurses who started after her are. The doctors dont trust her, and the "new nurse" title does not apply anymore since she has been there too long for it to be used as an excuse anymore. She was not a bad nurse by any means, but has not taken any initiative to learn how to deal with really sick patients, but avoids them instead. Because of this, she has not learned how to prioritize effectively and becomes overwhelmed a lot when she should not be. I believe that this type of thing can happen to anyone, no matter what area they work in, if they are not open and willing to try some "scary" things.

    Good luck to all my future coworkers!!
  13. by   amy0123
    Quote from Pachinko
    When will this get better? I'm going to give myself at least a year to get into the groove, and I'm surrounded by nurses who seem to be able to take everything in stride. I just wish I could fast forward a year and be more comfortable...is this normal?
    When you are off orientation, somehow everything that your preceptors taught you become your own. Your own thoughts, your own hands, your own walk. When you don't know what to do, ask another nurse (someone you feel comfortable asking) this nurse that you ask, should be able to bring some light on how they've figured the task out. That opens your horizons. "Wow, a new way that I could use to make it easier!" All of those nurses that are striding have gone where you were. It's intense and has it's dark moments. Any job that someone is starting can have the same effect on the new person around "the experienced."

    Oh, here's another helper -- toon into your textbook's nurse interventions, or look in your hospitals protocols of how to do stuff. The most helpful thing to me was to find an experienced nurse I admired who had worked there forever and knew the ropes. I requested to follow her for a few shifts so she could download her brain to mine. That worked really nicely

    I asked her to write me the routine for the day, and she took a small post-it, scribbled what I should be doing from the time after report (checking charts, MARs, V/S, I/Os, changing linens, baths, document, progress to outcomes, etc. Wow. It was my treasure!

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