New Grad feeling like I can't do anything right!

Nurses General Nursing

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Specializes in SICU, trauma, neuro.

The thing is, in a CVICU these are HUGE mistakes. A chest tube with suction disconnected will allow fluid to accumulate around the lungs or heart, because it's not being pulled out. Forgetting to mix antibiotics, just giving 50-100 ml of NS (while that vial of powder is hanging conspicuously below the bag?) and letting pathogenic microbes live? Infection in these people can be life threatening! You don't say what type of pt this was, but if you forget the medication for someone who is given an ATB prophylactically, you can forget it for someone who is post heart or lung transplant. Forgetting to attach heparin can mean reocclusion of blood vessels...........

I mean this is basic, basic stuff. We're not talking about being proficient at interpreting all of those hemodynamic numbers.

The one issue I have with your preceptor is, why isn't s/he catching these mistakes right away? With two of you assigned to the pt, the next shift really shouldn't be finding your mistakes.

But I wholeheartedly disagree that they should be reassuring (e.g. "assuring you that the pt is fine.") With mistakes as basic as med administration, it's time to get serious -- lives depend on it.

ALL THAT SAID:

Are you using a good brain sheet? I forgot things during clinicals my last semester; actually my instructor said she was close to failing me! My passing was contingent on solving my problem, and agreeing to a med-surg final practicum. (Because she felt I would gain the most competence there. I had requested either neuro or PACU, if I remember correctly) I ended up being placed on the med-tele floor and doing well.

From that discussion and still to this day, I write important tasks/times in red. Timed head CT, labs at 1800, meds q 1 hr -- written in red, and crossed off as completed. Unique/important things such as "No info," "Bloodless Surgery pt," "Keep SBP 180-220" are written in big block letters at the top, by their name/dx.

Have you met with your preceptor, manager, educator to come up with an improvement plan? That should happen.

Please know that I am not trying to make you feel bad. I have nothing to gain by hurt feelings, and your pts don't have anything to gain either. You might be a fine nurse...but possibly in over your head FOR NOW. CVICU is a Himalayan learning curve! It's incredibly complex, and much of the info is not taught in nursing school. If it doesn't click soon, you may need to work somewhere less acute for a while to get the basics down pat, THEN come back in a better place to learn the critical care pieces.

NuGuyNurse2b

927 Posts

But I wholeheartedly disagree that they should be reassuring (e.g. "assuring you that the pt is fine.") With mistakes as basic as med administration, it's time to get serious -- lives depend on it.

Where did I say that it's not serious? Of course if the patients weren't fine she should be aware of it, but if the patients did not have any serious issues because of her mistakes, why shouldn't she be reassured that they are indeed fine? I don't understand how people on these boards just misread my post and then go on to "disagree" when it's not even what I wrote.

Wuzzie

5,116 Posts

Where did I say that it's not serious? Of course if the patients weren't fine she should be aware of it, but if the patients did not have any serious issues because of her mistakes, why shouldn't she be reassured that they are indeed fine? I don't understand how people on these boards just misread my post and then go on to "disagree" when it's not even what I wrote.

While I agree there's no reason to make a new nurse feel "awful" these are some pretty big mistakes and need to be addressed. There's an extremely fine line to reassuring someone and having them not understand the implications of their mistakes.

BadwomanM

40 Posts

Specializes in Case manager, UR.

I agree with the posters who question where the preceptor was. I had a horrible time orienting to ICU, even with a great preceptor. But my worst mistakes came after I was off orientation. My manager even asked me if there wasn't something I'd rather do than ICU. A very low point in my beginning career. But, with luck, making lists, attention to detail, and a person who was kind enough to mentor me, I started turning things around. Working nights did make a big difference.

Anna Flaxis, BSN, RN

1 Article; 2,816 Posts

I'm working in CVICU and just graduated last May. I feel like a crappy nurse because there is still so much I don't know. I leave work after a shift and the next morning when I show up for my shift the next day, my preceptor/ night shift nurse ambush me with things I did wrong or issues that they noticed (i.e. forgetting to hook a heparin line, mix my antibiotic, chest tube was off of suction, a med wasn't given etc.). I'm almost off my 12 wk orientation and I still feel like I can't do anything right and don't know if I'm just being too hard on myself. Anyone else ever experience these issues when they were starting out? Words of wisdom?

Words of wisdom: It's normal to feel like a complete incompetent idiot as a new grad. Take your co-workers' "ambushings" as opportunities for improvement. Pick yourself up, dust yourself off, and come back and do it again the next day.

Where did I say that it's not serious? Of course if the patients weren't fine she should be aware of it, but if the patients did not have any serious issues because of her mistakes, why shouldn't she be reassured that they are indeed fine? I don't understand how people on these boards just misread my post and then go on to "disagree" when it's not even what I wrote.

We humans are flawed. Miscommunication happens all the time. I'm sorry you were misunderstood. It is soooooo frustrating.

The unit you are working on requires a certain skill set that some can pick up quickly and others learn over a extended amount of time. Find out where you fit. It may or may not be for you.

Specializes in Cardicac Neuro Telemetry.

What I want to know is this: where in the hell was your preceptor when you forgot to hook a heparin line or set a chest tube to suction? Obviously the ultimate responsibility is on you for making these mistakes. But this speaks volumes of your preceptor for not catching your errors. Having said all that, this is about you and not your preceptor so let's brainstorm ways to remedy your problem.

Yes, these were serious errors. You can learn from them and rise above them. The cvicu is no joke and I'm sure the pressure you feel is immense. It's okay if this isn't your cup of tea. It doesn't make you any less of a nurse.

I would strongly suggest utilizing a brain sheet. Write things down. There is no way I can remember all the information about patients from memory and I'm sure the same applies to you. Also, read your orders at the beginning of shift and check them throughout the day. Chin up, hun.

ashrnbsn12

4 Posts

Thank you everyone who took time to reply to me about my concerns. I wholeheartedly appreciate your input. To be honest, my preceptor never showed me anything about a "brain sheet" as many of you suggested. I tried to write things down while working, but with our unit relying on us for total pt care, sometimes I get so busy I'll forget to write down everything or not even have the time to sit at the computer to go through it all. When these mistakes I made occurred no one was harmed at all. However, when these errors were brought to my attention, they were simply just said to me in a "how could you be that stupid" tone and not really any explanation was given as to how serious the mistakes could have been. I learned more from your reactions to the problems I expressed rather than my preceptors reaction to it. My preceptor has only been a nurse for 1 year and is my age. I thought I had a pretty good teacher but now I'm not so sure. I agree that she should be catching these errors as well. Honestly, I've been doing everything for my patients with very little help from her at all. She sits at the nurses desk and helps me as needed but never assesses the pts with me or watches me give meds or really goes into the rooms much at all. Really she has a very hands off approach and lets me do everything mostly by myself. I liked this at first but now I'm not even sure she's been showing me the right ways of doing things. Last night I worked with a new preceptor. I felt even more like a total idiot because everything she told me to do conflicted with my training thus far. This new preceptor is very Type A and slightly abrasive but a very good ''by the book'' sort of nurse. I'm hoping with my last 2 weeks on orientation with her I can learn more of the right ways of doing things. I'm still terrified going into every shift and want to do my best but its so hard when you feel you are too stupid to be working in this unit. I graduated Summa Cum Laude from nursing school and expected myself to have more confidence but its been really difficult. Hoping everything improves soon.

ybot

4 Posts

Specializes in ER, ICU, POST ACUTE CARE.

"Hi, try to find what I call a "seasoned" nurse, one who is willing to teach, and help you out. I have been a nurse for 20 years, I always try to take the new nurses under my wing, and teach them. I know this is not true of a lot of nurses, some get a thrill out of seeing a new nurse fail. I just feel that all I can teach new nurses will help them give better patient care. Good luck.

ybot

4 Posts

Specializes in ER, ICU, POST ACUTE CARE.

Yes, that was going to be my suggestion, a "brain". You can create one with times on it, a place for patients room number and name, then circle the times they will have meds due, mark thru it when completed. Also, have a place to write any PRNs you may administer. Mix or spike, and prime tubing on IV antibiotics before you enter the patients room. It should not be the duty of the other nurses to "ambush" as you stated, they should make the charge nurse aware of this, and a good charge nurse will teach you, not reprimand you. Also, working you first job in CVICU is a little heavy to start out.

NuGuyNurse2b

927 Posts

While I agree there's no reason to make a new nurse feel "awful" these are some pretty big mistakes and need to be addressed. There's an extremely fine line to reassuring someone and having them not understand the implications of their mistakes.

Nobody is asking for false reassurance, if that's what you're trying to say. The mistakes can be addressed, but if the patients did not suffer any adverse effects from said mistakes, the new nurse should be aware so she could breathe a little easier. She obviously feels bad enough with the mistakes. And likewise, if adverse effects resulted, she should be aware of them as well. I don't think I can state it any simpler.

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