New Nurse feeling a bit overwhelmed

MICUSarah · Aug 26, 2015

Wow! That sounds like a rough situation! However, if everything you say is true, then it sounds like you're off to a great start. You sound like a very competent nurse who is a good patient advocate. Unfortunately, if you can handle it, it may be best to try to get in at least 6-8 months. At that point, it is probably safe to start applying/interviewing for other jobs. I don't have much in the way of advice but just keep it up! Work your 36 hrs, and try to find really great things to do on your days off to keep you sane!

AcuteHD · Aug 26, 2015

Are the techs union?? Fire them! They are underpaid, overworked and if they don't want to be there anyway, why keep everyone in misery? Even with the best support, 6-7 pts on a regular basis is too much, IMHO. I really have no compassion when it comes to poor work ethics that will end up harming a patient. Thankfully, almost all of the techs I've worked with have been great, and the others didn't stick around for long. Unfortunatly, this is a mgmt problem and is probably out of your control. Sorry, and good luck.

NursingInChaos · Aug 26, 2015

Are the techs union?? Fire them! They are underpaid, overworked and if they don't want to be there anyway, why keep everyone in misery? Even with the best support, 6-7 pts on a regular basis is too much, IMHO. I really have no compassion when it comes to poor work ethics that will end up harming a patient. Thankfully, almost all of the techs I've worked with have been great, and the others didn't stick around for long. Unfortunatly, this is a mgmt problem and is probably out of your control. Sorry, and good luck.

not union, I have raised the question about why they are still here- no answers from management. Up until the temperature incident they were merely a pain to work with, now it is a safety issue. I will just have to cover my rear and ensure that what I delegate does get done correctly or do it myself. I think some of it lies in the area/town as it has a lack of people willing to work (not a lack of unemployed people mind you) Almost every industry in town is complaining about how hard it is to find GOOD employees right now, even though our local unemployment rate is through the roof. No ambition here anymore.

I am hoping to make it a whole year, then moving FAR away to a place that has not lost it's ambition and will to improve lol. In that year I will do all that I can not to kill any one (patient or employee ROFL) and learn as much as I can so when I do land a good job I am prepared and a real asset.

I can do this, a year will fly by (I hope!)

Been there,done that, ASN, RN · Aug 26, 2015

Change the things that you can. Your job will be much smoother with a good assistant.

You have brought this up to management, no answer doesn't cut it. I found writing them up for insubordination each and every time produced results. You state that you are a patient advocate, but you are letting the assistants fake vital signs ? That is patient endangerment. You may be able to cover for them, but not all nurses are. You need to act.

AcuteHD · Aug 26, 2015

Reach out to the good techs and see if they have any friends they can vouch for that need a job. Then develop a plan to encourage therapeutic turnover.

icuRNmaggie, BSN, RN · Aug 26, 2015

This sounds like one of those low level hospitals that does not pay enough to attract quality employees - or management - so any warm body will do. It is what it is.

If you have to work with the disappearing CNA call your house supervisor and say we have a CNA missing in action.

If the CNA spends more time on her phone than anything else report that privately to your manager.

Falsifying VS requires an incident report.

If you get pushback about doing

assigned tasks send an email and ask for the CM to meet with you and the cna

Direct visitors and patients to call customer relations, the CM or the house supervisor when they have an issue with a cna.

Management will have their

favorites and their relatives working there. You are just off orientation. Choose your battles wisely and tell no one if you report or write up these

incidents. Stay far away from and out of the unit gossip. A good manager knows that disciplinary matters are handled privately. And don't tell a soul that you are leaving after your year is up.

Finally, do not invest all of your mental energy into worrying about and trying to fix this dead

end job. Take acls pals and med surg certification so that you are a good candidate for when you can put all of this behind you.

NursingInChaos · Nov 14, 2015

Just an update, things are looking better- still have some techs that I don't trust to look at a patient but I am finding ways to make it work- 7 months in lol- got my ACLS and almost done with PALS too.

Going to be cross trained in the ED next month so I will be able to add that to my resume too.

Ohhh- and our floor manager stepped down- we are in between managers at the moment but I am hoping they get the lady that usually is our PCC to take his job- she is super firm and I think will do good to clean the place up lol

All I need is one year on my resume and I am off to another area- just have to soak up all the knowledge I can- paper charting and all!

Thanks again for all the support and tips! (And I finally got Liability Insurance too! Lol)

SouthernizedRN, ASN, RN · Nov 16, 2015

I totally understand your sense of feeling overwhelmed. When I got my first job in nursing it was in a specialty...OR. I lasted 2 years and moved on to Med/Surg, basically Medical as they are separated in my hospital. I work a very small hospital and at times we can have up 8-9 patients a piece. I had an understanding Nurse Manager who was willing to really work with me. I had issues with fitting in because I wasn't from the State let alone the area. I worked hard. I allowed myself to be vulnerable and asked those I worked with "What can I do that will change how you perceive me?" "What is it I'm doing wrong or can do better?", I found out that certain ingrained non-verbal communications (facial expressions) were perceived NOT as they were meant. If I rolled my eyes it often meant "Oh man, I can't believe I did that." They took it as "Oh man, I know that already." I stopped. I can tend to be loud and when I'm shocked or upset my voice rises. Some considered that yelling. I had to learn to tone myself down. I was close to losing this job because of these misconceptions. I worked real hard to change ingrained habits, to open my mind and shut my mouth. I had 30 days to make these corrections. At the end of 30 days, my Nurse Manager was pleased to see that I listened and made changes. She didn't think I could do it. Next month will be my 1 year anniversary. I love my job, I love my patients, and for the most part I love the people I work with and I work night shift.

I had a CNA who charted all Respiration Rates as 20 on all patients. I caught him on it and called him on it (nicely...he was new). I explained you can't do that because a change in respiration rate could mean they are either, dead, dying, or filling with fluid with the end result of death. It misleads me as the nurse in their care and treatment. I also explained that's lying and illegal. It will cost your job. Yes, I also have had p.o'd CNA's that hate their job. Just remember regardless of what a CNA does that patient is ultimately your responsibility. If you don't think they are doing something correctly, do it your self and CYA (CHART IT).

I too get crappy morning reports and we bedside round. Again, your responsibility as the nurse coming on shift to CYA. I have a nurse that notoriously does not chart her meds. Thankfully, I know this so I don't worry too much about her, because I know she gave them. She just hates charting and forgets to scan the meds. THIS IS NOT RIGHT! We all know if it's not charted it's not done. Because I know this nurse does this I'm not willing to take the chance and overdose for a "missed med." You will learn these things.

I've had nurses leave me with Doctors to call, IVs to resite, meds on their shift to start, new admit assessments to complete even though the patient showed up at 15:00. You will find their are just plain lazy nurses. It's frustrating and aggravating, but unfortunately now it's your responsibility. I do my level best to not leave anything for day shift that I needed to do on my shift. The LOVE to complain to the NM.

Now I said all that just to let you know there are things the first year of nursing you need to be aware of...first off, it will be the most overwhelming time in your life. Nursing school was easier than this. Also, there will be people out to undermine you. I had it in both OR and Med, and I still do to some extent. I just choose to do my very best for my patients, that's who I'm there for. With all of this long windedness being said, I do have some tips that greatly helped me. A suggestion my NM made was to create a checklist of the things you will need to do during your shift. We are 100% paperfree (EHR). My list includes the following:

1) Print MAR

a. 1st print (I reprint the list after I have given all of my evening meds, so I can make sure

the scanner scanned them all).

b. 2nd print (This is for my a.m. meds for the same reason as the first.

2) Patient assignment - We can have anywhere between 3-9 patients this is just one way to make sure I have seen them all.

3) Pulled Meds - I use the MAR to checkoff the meds I've pulled, but I mark they have been pulled on the checklist.

4) IV fluid pump check 22:00 & 06:00 - as nurses have to check and clear the pumps 2x a shift for the I & O's.

5) Bed alarms on

6) 24 Hour chart check completed

7) Completed shift assessments

a. Morse fall assessment (we do this on night shift)

8) Verify any new orders

10) Patient Summary for chart

11) Closing Shift note

12) Hourly rounding completed & documented

13) Locked reports at End of Shift

This checklist keeps my time managed and that I make sure I don't miss important things that are required of my position. Time management comes with more practice and the better you get at what you do and how you do it during your shift. I have only been on this unit 1 year and I can tell you that I RARELY have to stay over to complete charting or to finish a med. My NM doesn't like OT, but sometimes you just can't help it. It will get better.

I have almost 3 years of nursing under my belt now. It was a hard 3 years. I dealt with feeling overwhelmed, beaten down, and made to feel like I don't belong. I have fought hard to overcome this. I have been eaten by older nurses. I'm still here and I continue to do what I need to to be the best nurse I can. Be willing to listen to the nurses who do have your best interest at heart. It may not seem like you have any, but you will find one that does. I did. Open you mind and your ears. Avoid saying "I know" even if it's a throw away statement (a space filler, but doesn't really imply you do know). You will get used to time managing multiple patient loads. I can because I also don't allow myself to get rushed. Is it safe to have so many patients? Heck No! But, I don't allow the number of patients I have overwhelm me and their safety. I'd rather be late on a med than give the wrong med to a patient in a rush.

In my time I have been placed in the position as Charge Nurse (most RN's alternate this position), but I feel good that my NM thinks I am good enough after a year to take on this position. This was one of her wishes, that I continue to learn and grow.

Never be afraid to ask questions, even if you think you've asked it before, or you think it may be stupid. THERE ARE NO STUPID QUESTIONS. Understand many nurses are going to have very different ways of doing the same thing, but analyze what each one does and decide for yourself which one does something that fits your paradigm of patient safety or is more according to hospital policy. There is never any really wrong way if it is safe.

If you work smart you will never work hard.

Good luck!

Libby1987 · Nov 16, 2015

I totally understand your sense of feeling overwhelmed. When I got my first job in nursing it was in a specialty...OR. I lasted 2 years and moved on to Med/Surg, basically Medical as they are separated in my hospital. I work a very small hospital and at times we can have up 8-9 patients a piece. I had an understanding Nurse Manager who was willing to really work with me. I had issues with fitting in because I wasn't from the State let alone the area. I worked hard. I allowed myself to be vulnerable and asked those I worked with "What can I do that will change how you perceive me?" "What is it I'm doing wrong or can do better?", I found out that certain ingrained non-verbal communications (facial expressions) were perceived NOT as they were meant. If I rolled my eyes it often meant "Oh man, I can't believe I did that." They took it as "Oh man, I know that already." I stopped. I can tend to be loud and when I'm shocked or upset my voice rises. Some considered that yelling. I had to learn to tone myself down. I was close to losing this job because of these misconceptions. I worked real hard to change ingrained habits, to open my mind and shut my mouth. I had 30 days to make these corrections. At the end of 30 days, my Nurse Manager was pleased to see that I listened and made changes. She didn't think I could do it. Next month will be my 1 year anniversary. I love my job, I love my patients, and for the most part I love the people I work with and I work night shift.
Now I said all that just to let you know there are things the first year of nursing you need to be aware of...first off, it will be the most overwhelming time in your life. Nursing school was easier than this. Also, there will be people out to undermine you. I had it in both OR and Med, and I still do to some extent. I just choose to do my very best for my patients, that's who I'm there for. With all of this long windedness being said, I do have some tips that greatly helped me. A suggestion my NM made was to create a checklist of the things you will need to do during your shift. We are 100% paperfree (EHR). My list includes the following:
1) Print MAR
a. 1st print (I reprint the list after I have given all of my evening meds, so I can make sure
the scanner scanned them all).
b. 2nd print (This is for my a.m. meds for the same reason as the first.
2) Patient assignment - We can have anywhere between 3-9 patients this is just one way to make sure I have seen them all.
3) Pulled Meds - I use the MAR to checkoff the meds I've pulled, but I mark they have been pulled on the checklist.
4) IV fluid pump check 22:00 & 06:00 - as nurses have to check and clear the pumps 2x a shift for the I & O's.
5) Bed alarms on
6) 24 Hour chart check completed
7) Completed shift assessments
a. Morse fall assessment (we do this on night shift)
8) Verify any new orders
10) Patient Summary for chart
11) Closing Shift note
12) Hourly rounding completed & documented
13) Locked reports at End of Shift
This checklist keeps my time managed and that I make sure I don't miss important things that are required of my position. Time management comes with more practice and the better you get at what you do and how you do it during your shift. I have only been on this unit 1 year and I can tell you that I RARELY have to stay over to complete charting or to finish a med. My NM doesn't like OT, but sometimes you just can't help it. It will get better.
I have almost 3 years of nursing under my belt now. It was a hard 3 years. I dealt with feeling overwhelmed, beaten down, and made to feel like I don't belong. I have fought hard to overcome this. I have been eaten by older nurses. I'm still here and I continue to do what I need to to be the best nurse I can. Be willing to listen to the nurses who do have your best interest at heart. It may not seem like you have any, but you will find one that does. I did. Open you mind and your ears. Avoid saying "I know" even if it's a throw away statement (a space filler, but doesn't really imply you do know). You will get used to time managing multiple patient loads. I can because I also don't allow myself to get rushed. Is it safe to have so many patients? Heck No! But, I don't allow the number of patients I have overwhelm me and their safety. I'd rather be late on a med than give the wrong med to a patient in a rush.
In my time I have been placed in the position as Charge Nurse (most RN's alternate this position), but I feel good that my NM thinks I am good enough after a year to take on this position. This was one of her wishes, that I continue to learn and grow.
Never be afraid to ask questions, even if you think you've asked it before, or you think it may be stupid. THERE ARE NO STUPID QUESTIONS. Understand many nurses are going to have very different ways of doing the same thing, but analyze what each one does and decide for yourself which one does something that fits your paradigm of patient safety or is more according to hospital policy. There is never any really wrong way if it is safe.
If you work smart you will never work hard.
Good luck!

This is one of the most open minded things I have read. It's so hard to receive criticism and so courageous to allow yourself to be vulnerable and open to change.