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

  1. 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?
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  2. 33 Comments

  3. by   aflahe00
    I felt the same way at that point too! Honestly I don't think I felt better until I gave it a year. My advice to you is don't give up. I know your confidence is low right now but just keep going. It'll get better. For me, working midnights was what saved me. Much slower pace at night gave me the time to think about what I was doing and learn.
  4. by   aflahe00
    Before that I was always making mistakes and honestly felt that I couldn't do this. I just didn't seem to get it.
  5. by   Lil Nel
    First, do you have any previous ICU or CVICU experience? I ask because if you did a Capstone, or worked as a CNA in those areas you should have somewhat of an idea of what the specialty involves.

    Having said that, my first RN job (last year) was in CVICU. I came at the position with NO prior experience in the area. Like you, every shift was a struggle, and I felt as though my preceptor treated me with indifference, rather than actually helping me to learn.

    I hated the job so much, I used to wish to get into an accident before my shift! By shift number five, I knew I had to get out in order to save my sanity. Since you are almost at the end of orientation, you must be doing some things right! Maybe your preceptor is finding more "faults" with your work because you are about to go out on your own.

    What kind of weekly feedback have you been receiving?

    On the other hand, I think it is completely ridiculous to expect a NEW grad with no prior ICU or CVICU experience to excel at this specialty. There is a steep learning curve. I think that many medical centers (large teaching hospitals), hire new grads for these jobs and it's like throwing pasta at the wall and seeing what sticks.

    You will know in your heart if CVICU is the right place for you. Is there a cardiac step-down unit you could transfer too?

    Good luck!
  6. by   Mavrick
    Quote from ashrnbsn12
    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?
    These are not minor mistakes.

    I would be concerned about a pattern. Did they all happen at the beginning of your orientation and are getting fewer? Did they happen when you started taking more complex patients? Have you made any of these mistakes twice?

    You use the word "ambush" but how would you like to be informed of these errors? Call you at home after your shift? Have the whole list laid out before you at your exit interview?

    Do you have a self-prepared check-off list of stuff that you know you have to get done or chart on? It is not always possible to get your stuff done and leave on time until you really get your habits and routines perfected. I used to make it a habit to mix my antibiotics before I spiked the bag after running in 50ml of plain ole D5W and having a day nurse chide me.

    Of course we all make mistakes, it's what we do about them that makes the difference. Do your best to objectively analyse how you made the mistake and think of a way to correct that. Don't just count on your memory. Believe me, that is a losing proposition.

    Most, if not all, nurses have a "Brain Sheet" they use to keep themselves organized. You need one specifically for you. Ask around. There are also some templates on this site that you could tweak.

    Work the problem. You can do this.
  7. by   akint19
    it can be overwhelming, since we are still new grads, but you are still learning! What is your nurse: patient ratio? Mine is about 8 on a med surg unit and sometimes I forget things too. Keep learning and learn from your mistakes!
  8. by   LovingLife123
    Missing Heparin or a chest tube to suction are big things. I would 100% expect you to miss small things and be like, don't worry about that. But hooking up Heparin? That's a pretty big deal. Especially on your floor. Look at your orders, first thing, every day. Not just med orders. All orders. Look at your patient head to toe. What do they have going on? If your chestvtube is not to suction, that tells me you are not assessing that chest tube fully. You may be looking at the insertion site, but you need to assess the chest tube itself.

    You are new. Take your time. Do not rush. Thoroughly assess your patient. If you don't get everything done, you don't get it done. But assess your patient. That's what's important.
  9. by   TriciaJ
    Forgetting things and getting "ambushed" makes me think you are relying too much on memory. I second the suggestion that you get a brain sheet and learn to use it. When you get your patient assignment, everyone gets their section of your sheet. Name, age, procedure and postop day. Divide your sheet into categories according to what your patients will typically need. IVF and rate, med times including antibiotics, heparin, insulin, etc. Additional hardware such as chest tubes, foleys, NGTs, etc.

    Before you leave every day, look over your sheet carefully. Did you address everything on there? Did you add new things as ordered? More critical things could be written in red ink. Anything discontinued or a discharged patient should be yellowed out with a highlighter. It might seem cumbersome to track everything on paper like that, but it will help you to keep track of everything throughout your shift and make sure your work is thorough and complete before you go off duty. It will also help you give a concise and useful end of shift report.

    If you're already doing this, then you're on the right track. Hang in there and things will start to fall into place.
  10. by   djh123
    Hang in there, and you'll almost assuredly get better and FEEL better about it all.
  11. by   NuGuyNurse2b
    Your problem isn't the fact that you're new and making mistakes, it's that the people who are guiding you aren't being supportive enough. Yeah you forgot to mix the antibiotics, and they told you you did so, but did they offer any tips for how you can remember to do so for next time? (Hint: pop the seal and mix the antbiotics before going into the room - once you're in there, you are distracted by everything else) Did they reassure you that the pt was fine, the missed dose caused no adverse reactions and they kept things moving? It's about presentation. Making a new nurse feel awful about their mistakes is just a terrible group mentality.
  12. by   LeenishaThompson
    NO ma'am. If you were indeed a crappy nurse you WOULDNT of made it this far. You continue to strive and maintain.
  13. by   Kooky Korky
    Quote from ashrnbsn12
    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?
    All of these are serious matters. 3 med errors and a treatment error. You are right to be concerned. Hopefully, they did not result in problems for the patients.

    That said- and you do already know it, right? - where is your preceptor? Isn't he or she supposed to be teaching you how to not make these errors? Does she bear some of the blame for letting this stuff happen by her preceptee?

    By this time - at the end nearly of your orientation - you need to put a stop to all these errors. Now. You are NOT being too hard on yourself.

    You simply need to figure out a way to remember everything. Lots of folks here use a "brain". You simply write down every single patient's name, all of their IV's (rates, location, type of fluid, piggybacks, etc.), all of their oral, topical, eye, orifice, aerosol, spray, etc. meds by name and time, write down everything about each patient, everything. Tests and treatments they're scheduled for, discharges to be done, and so on.
    Follow your list, check each item off after you do it, do not allow yourself to be pulled into giving any bedside direct care that you don't have to do. Let the aides answer lights if at all possible. Once you are 100% on your RN duties, you will be able to help with other things. If anyone faults you, give in and do other than RN stuff if you think the person will crab about you not doing it even if you explain why you're not jumping at the bit to give baths and get people in and out of bed - unless these are absolutely expected of you.
    Do your I&O's on time. Try to round with the doctors. You learn a lot and can ask questions that might help prevent calling the doctor later.
    Get some extra sleep and take your vitamins and become a real whirlwind. You can do this. You are working in what I assume is your choice of jobs. So give it all you've got and come back and tell us you made it!!

    BTW "ambush" - it might feel that way, but they do need to tell you when you do stuff wrong. I hope they don't try to make you feel stupid or tell you stuff you did wrong in a public way. They know you're new, they should be helping. Take their informing you of errors as teaching, which you do need. Thank them for caring enough to let you know. What does your boss have to say about these things?

    Best wishes.
  14. by   Here.I.Stand
    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.

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