[Motolady2001]

I graduated from school in May 2006 and passed my NCLEX-RN in June. I started my new job towards the end of May 2006. We spent the first two weeks of our orientation in a classroom.

When I went to the floor, no one showed me where anything was, I had to figure it out myself. I really don't feel that I have received a good preceptorship or training. Maybe it is just me, that I am not sure.

I have worked at the hospital for almost 3 years, but not in the department that I am currently working in. Maybe they expect me to know more than I do about the facility.

I am really struggling with my new job. I was a good student. I was also a paramedic for several years. I am now at the point that I wonder if I have made a bad decision to be a nurse. I cry most nights after work. I hate it so far. I am staying over my shift sometimes for 2 hours to get my charting done. I am working on the medical/surgical unit of my hospital.

I can't seem to get everything done. I am in charge of sometimes 7 patients. It can even be up to 10 patients when I go to nights. I am absolutely overwhelmed with 6 patients.

How do you experienced nurses keep track of your patients? How do you set up your "brains"? I have so many papers. I have trouble keeping track of everyone.

My coworkers state that my assessments take too long. I just like to be thorough and talk to my patients.

It also takes forever for me to chart. We use computer charting. I have to get used to that program too.

When I state at work that I can't handle another patient, they simply say, "You have to!". They also say, "you have to get faster". I was also told by one of the charge nurses as I left one night, "When you come to nights and are here until 11AM charting, you arent going to want to come back even when you have too!".

Help. How can I try to survive this job? I have to remain within the company due to signing a contract to get money for school.

[Angie O'Plasty, RN]

Originally Posted by Motolady2001

I graduated from school in May 2006 and passed my NCLEX-RN in June. I started my new job towards the end of May 2006. We spent the first two weeks of our orientation in a classroom.

When I went to the floor, no one showed me where anything was, I had to figure it out myself. I really don't feel that I have received a good preceptorship or training. Maybe it is just me, that I am not sure.

I have worked at the hospital for almost 3 years, but not in the department that I am currently working in. Maybe they expect me to know more than I do about the facility.

I am really struggling with my new job. I was a good student. I was also a paramedic for several years. I am now at the point that I wonder if I have made a bad decision to be a nurse. I cry most nights after work. I hate it so far. I am staying over my shift sometimes for 2 hours to get my charting done. I am working on the medical/surgical unit of my hospital.

I can't seem to get everything done. I am in charge of sometimes 7 patients. It can even be up to 10 patients when I go to nights. I am absolutely overwhelmed with 6 patients.

How do you experienced nurses keep track of your patients? How do you set up your "brains"? I have so many papers. I have trouble keeping track of everyone.

My coworkers state that my assessments take too long. I just like to be thorough and talk to my patients.

It also takes forever for me to chart. We use computer charting. I have to get used to that program too.

When I state at work that I can't handle another patient, they simply say, "You have to!". They also say, "you have to get faster". I was also told by one of the charge nurses as I left one night, "When you come to nights and are here until 11AM charting, you arent going to want to come back even when you have too!".

Help. How can I try to survive this job? I have to remain within the company due to signing a contract to get money for school.

My goodness, you really got thrown to the wolves, didn't you? I truly sympathize.

There are a few things you can do to handle it, however. You need to become more time-oriented. Not to rush you through your assessments, just cut way back on the chit-chat with the patients. You should be able to do a thorough head-to-toe assessment in about 5 minutes.

You need to ask how others organize their papers. Watch how their papers look when you're in Report, and ask for tips. Some people use different colored pens, others highlight. I put my Report info on the Right side of the sheet and my assessment stuff on the left, with medication times at the bottom, so I can see it at a glance.

Most importantly for anyone who is struggling, you MUST keep a journal when you get home. Write down what you did RIGHT. What made you feel you did a good job as well as what you could have done differently. It'll help you sort things out.

Please know that the crying every night thing DOES get better as you gain experience and efficiency.

I am thinking that you didn't get enough orientation and that you don't get much support on your unit. Those are two very serious issues for the new grad. Please talk to your manager about those things and see if you can get more orientation and more support.

If not, I don't think any of us would argue that you have a good case for moving to a different unit. But please remember two things:

1. You'll have to get used to another unit, so you will essentially be starting over again. On a more supportive unit, that might be a good thing. So check it out before you leap.

2. No matter how awful you think you are, no matter how bad it is, you have learned some valuable things about that area of nursing that you will always carry with you. No one can take that away from you!

3. No financial obligation is worth your self-esteem or your sanity. If it's gotten that bad, you might talk to your EAP person for more in-depth counseling.

And please check back here and let us know how you're doing, ok? You have a lot of nurses here who have been through what you're going through and who care.

[alluvme]

Hi everyone, I'm hoping for a little guidance. I graduated in May and took the NCLEX today. I haven't applied for a job anywhere yet but would really like to specialize in labor and delivery (the reason I went to nursing school). My problem is that I'm a little unsure if thats what I should be pursuing initially. I'm an EMT in NYC and I've been told by several instructors that I would do well in the ED and that is where I should begin my career. I do enjoy the trauma, but it's the everday sore throat, back ache, intox and abdominal pain that I'm sort of tired of. I really enjoyed my OR observation as well as my short time spent in the ICU. Not moved by pediatrics, orthopedics or psych. Med/Surg was ok but not crazy about it. I'll just get to the point. I want to make the most of my new grad orientation and get the experience that will help me the most. Sorry about the length of this post. Any input would be greatly much appreciated. Thnx.

[silvienurse]

Hi

I'm feeling a lot like alluvme; I too graduated from RN school this past May (06') and waiting to take my NCLEX (very soon I hope); in our area we had a nursing fair for all soon to be nursing grads to come and meet with all the different dept mgrs etc. of all the local hospitals in our area and schedule interviews for whichever departments we were interested in.

I ended up interviewing for 5 different departments and was called and offered my choice of any one of the 5 I interviewed for. I was really surprised.

BUT…..instead of starting like all the other new grads I decided to wait and take some time off after nursing school and study for the NCLEX instead which I haven’t been quiet so faithful in doing.

The areas which I was offered a position in included areas such as (ICU, MICU, OR, ED).

I have once again contacted HR and have pretty much well the same interviews coming up in the very near future.

Only thing is; if I’m offered a position; I won’t receive as much and as intense of an orientation as new grads do; the new grad orientations is only offered once a year and is 12 wks long.

I do have healthcare experience but not in a hospital setting and I feel I really could’ve used this intense orientation; too late now………….

What I guess I’m trying to ask is………what do you recommend I do at this point?????

Please help; any and all suggestions are GREATLY appreciated.

I don't have any interest in working Med/Surg or L&D.
I like Psych but find it much too depressing.
Please help; I really need your advice / input; after all; you’ve been there done that and I’m only just beginning; what areas other than med/surg would you recommend as a good starting point?

Thanks in advance for all your assistance.

[C'wing]

Hi SilvieNurse, we're in similar situations --graduation in May, studying for NCLEX, received a few job offers...I guess the one difference is I'm starting work sooner...Coming Monday. So I don't have much experience to share but I really do think a good new grad orientation/training is important, esp. when you want to start in critical/intensive/specialized units right away. Having a good solid training will serve as a great foundation for future. I don't know where you live, but in my area, there are lots of hospital that offer orientation more than once a year (once in June-July and once in Sept)...maybe you want to check other hospitals and see. If you can get into the Fall program (Sept), then you still have some time off...and time for studying.

Good Luck!

[scnewgrad06]

Originally Posted by silvienurse

Hi

I'm feeling a lot like alluvme; I too graduated from RN school this past May (06') and waiting to take my NCLEX (very soon I hope); in our area we had a nursing fair for all soon to be nursing grads to come and meet with all the different dept mgrs etc. of all the local hospitals in our area and schedule interviews for whichever departments we were interested in.

I ended up interviewing for 5 different departments and was called and offered my choice of any one of the 5 I interviewed for. I was really surprised.

BUT…..instead of starting like all the other new grads I decided to wait and take some time off after nursing school and study for the NCLEX instead which I haven’t been quiet so faithful in doing.

The areas which I was offered a position in included areas such as (ICU, MICU, OR, ED).

I have once again contacted HR and have pretty much well the same interviews coming up in the very near future.

Only thing is; if I’m offered a position; I won’t receive as much and as intense of an orientation as new grads do; the new grad orientations is only offered once a year and is 12 wks long.

I do have healthcare experience but not in a hospital setting and I feel I really could’ve used this intense orientation; too late now………….

What I guess I’m trying to ask is………what do you recommend I do at this point?????

Please help; any and all suggestions are GREATLY appreciated.

I don't have any interest in working Med/Surg or L&D.
I like Psych but find it much too depressing.
Please help; I really need your advice / input; after all; you’ve been there done that and I’m only just beginning; what areas other than med/surg would you recommend as a good starting point?

Thanks in advance for all your assistance.

I'm a new grad that started one month after I graduated and on the day I got my Lic. In retrospect, I wish I had taken a job at a hopsital with a great orientation program because the one I joined wasn't like that. At this point I have a horrible taste in my mouth regarding nursing, which is part regret for not going to the hospital with the orietation program versus the one i am at. Bottom line, STRONG orientation programs are extremely important. I hope this helps. . . . .

[chichi3]

I don't have any tips, but more questions. I graduated in December of 05 and I am in my second job, and could leave it today!! What is wrong with me????

I can't explain it. When we were graduating I didn't know what kind of nursing I wanted to go into, it was suggested by many peers and cllinical instructors to go into ER. So I did. I liked it but I didn't get the patient contact I enjoyed. It was go, go, go and I would get into trouble for talking to patients. It was stupid, there wouldn't even be anyone waiting but we had to move them out! I felt like I was in prison when I was there and I was so burnt out in 3 months, that it was a relief when I got into a car accident and had to take some time off. However, they played dirty and I found another job.

Now I am with woman and children (the one thing I really wanted to do). Well, the politics and the people I work with are horrible. My lead is TERRIBLE and again, I feel miserable at work. I have never been so stressed out. These places play so dirty and are so dishonest and I find that really hard as well. I don't want to quit because I think it will look so bad I will never get a job, but what do you do when you are not where you feel happy and it's early in your career? I am just waiting for my 90 days to move to another department.

Is something wrong with me??

[happytobehere]

thank you from a new grad!

[dmeyes]

I completely understand how motolady feels, I too have had a rough going since graduation and passing boards, I was hired on as a GN on a med surg unit, I have had in 4 weeks a different preceptor every shift, and have been rotating from days to nights every week, that is why I am still awake at 4 am even though I am on days this week.I also have been trying to take care of a team of 5 to 8 patients and feel inadequate and when I do have a question have a hard time finding my shift preceptor to ask so I worry that I will make a major mistake by trying to figure it out for myself. I feel that I cannot establish a working relationship with a person I only work with for one day and then the next shift I have to start over again. I am considering switching jobs but have the same thoughts of what if it is the same way, then what have I gained. The experience I believe I am getting is good, however, I haven't gotten any feedback from anyone and I am too shy to just say so how did I do today I suppose I need to get over that and start asking. Any suggestions would be greatly appreciated on how to launch a successful practice under these learning conditions. Thanks for letting me vent without repercussions, yes I have talked to my educator and manager and no changes have occurred yet.

[ZASHAGALKA]

I posted this in another, similar thread:

Originally Posted by ZASHAGALKA

Until you know your way around practical pharmaceuticals, never give more than two of ANYTHING: vials, pills, etc. without double checking w/ a more experienced nurse.

Some of the biggest med errors in new nurses that I have encountered had something to do with "I didn't know 3 of them were too many". And let's face it, doctor's aren't known for clear handwriting and intent with their orders. . .

(There used to be a chemo med that required 10 pills per dose. After the FDA approved it, the off-label use required a much higher dose. There are times when 4 or 5 or 10 pills IS the right dose. But, you're better off being able to say, "I checked the dose with the charge nurse.")

~~~
At the end of a shift, decompress the shift before you leave. Spend 10 minutes going over everything you did and didn't do. Critique how you 'time managed' with the goal of learning from what you did right - and what you did wrong.

Then, give a follow-up report if needed (so you don't have to call back) and THEN, let it go.

Nursing can be so stressful you HAVE TO LEARN when to leave work at work.

~~~
More than anything else you learn, learn to chart as you go along. Consider having to 'stay and chart' to be a time management failure that you have to work on improving.

Too many times, you have 10 things to do at any given time, and that will completely take over your shift. Charting must be a higher priority item in that list.

Besides, I find that, by taking 'time outs' to chart, I can get a better handle on the chaos. Humans work better when they can take a few minutes and decompress and reanalyze their situations. A few minutes here and there charting does JUST THAT FOR YOU.

If you want to learn to 'work smarter, not harder', then learn to chart as you go. DECIDE that 10 minutes of every hour is 'charting' time and ONLY pain meds and emergencies can invade in that sacred time slot.

~~~
Find an older nurse or two you trust and enlist them to be a 'mentor'. Not a 'preceptor', but someone you can turn to to help you analyze a situation. Someone you trust there is no 'stupid' question you can't ask.

~~~
Respect your contribution. You can only work so hard. Work diligently and learn and be proud of what you are doing.

All of us have situations that overwhelm us. Just don't let those situations overwhelm the value YOU place on your efforts.

~~~
Don't get so caught up in your own routine that you can't find the way to observe the 'learning' stuff that happens on your unit. Get in to see the codes, the central line placements, etc. Watch not just in awe, but with an eye as to the nursing roles you see going on about you.

~~~
Start every IV you can. Make sure everybody knows that YOU will try their IV first. My first job, I was REQUIRED to try twice on every IV on my unit before anybody else could look: no matter how busy I was.

Stressful to be sure, but 500 IVs my first year as a nurse, and hey, I'm fairly good at it.

~~~
Ask nurses from other job types (OB, ER, OR, med/surg, etc.) about their jobs. Learn not only what they do, but get to know THEM. Network. It'll make you a better known nurse around the hospital, and it will give you insights about where you might like to end up.

~~~
Grab all the certs (ACLS, PALS, TNCC) and CEUs you can. Your hospital will probably even pay for most of them.

~~~
Volunteer for committees, especially P&P (policy and procedure) committees. Being a voice there will not only help you make a real difference in YOUR job, it'll give you insight into WHY things are the way they are. Besides, your manager is always looking for such volunteers: the brownie points are just a bonus.

~~~
Smile and never seem hurried in front of pts. I won't go so far as the goofy "how can I help you, I have the time" campaigns, but nursing is as much acting as it is caring.

Spend 2 minutes 'acting' the calm unhurried part (even though you're frazzled and falling apart) and the reassurance you give your pts is worth hours of your time.

I can't tell you how many times I hear in report, "so and so was on the call bell ALL DAY". When I get out of report, sure enough, call bell. I'm johnny on the spot. Five minutes later, call bell - johnny on the spot again. Now, once that pt knows I'll materialize when called, they don't feel the need to hit the button NOW JUST IN CASE they need something in twenty minutes.

It never ceases to amaze me how the pts that are 'always on the call bell' never bother me again after that 2nd or 3rd call that I promptly answer.

~~~

Nursing as acting: never admit you don't know something to a pt. Their confidence in YOU is based on your competence. Always front that competence. If a pt asks me a question I don't know, I'll say something like "give me a sec to take care of xxxxx, and I'll come back and explain it to you." Then, I go look it up.

~~~
ON the same topic: never give a med if you don't know what it does. Always look it up again until you learn it. Nothing is more deflating than a pt asking you what x pill does and then getting a blank stare from you.

After all, if YOU don't know what it does, why are you giving it to ME?!

Exactly.

~~~
When a new med comes out, ask the pharmacist to send you a package insert and read up on it. You can learn all kinds of things that way.

For example, did you know the molecular wt of Viagra is 666. Don't believe me, look it up!

I'll think of more next week when I get back from camp.

~faith,
Timothy.

One more: when I first started out, on a medical unit with 10 pts, I organized myself into 3 first rounds. The first time through, I just introduced myself and stated I would be back soon.

That way, I could make sure that everyone was where they're supposed to be (not on the floor) and nobody was in acute distress (my first priority on everyone).

Then, 2nd rounds: I'd go back through and do my assessments.

3rd rounds, med pass and taking care of 'creature comforts'.

I found that those 3 'first' rounds organized my shift better, highlighted the priorities more soundly, and gave me time to 'impress' my pts. Nursing is at least part an acting gig. You can't 'take the time' with x pt when you don't know anything yet about 'y patient'.

I never stopped until my 'first rounds' were complete. But, at that point, my shift was well organized.

~faith,
Timothy.