New Nurse ... not distinguishing myself as brilliant

Nurses General Nursing

Published

Hello,

I am a new nurse. Just passed the NCLEX July 16 after graduating in May and acquiring a job which started June 8. I graduated top of my class. Not because I am all that smart but because I work very very hard. It's not helping me in the new job ... a busy 38-bed oncology med-surge unit at a local hospital. I had to get an actual nursing job to discover how imbecilic I can really be. My hope had been that if I just tried really really hard and worked really really hard, I'd do well. Not happening. I'm a nervous wreck. About 100 times every day I wonder if I should see a doctor, myself, and get a prescription for a beta blocker, because when I lay down at night I go over everything that happened during the shift, and my heart feels as if it will beat out of my chest and fly around the room. I'm 50 years old and should be way too mature to be having these emotional ... reactions.

Here is a list of my so-far mess ups (after only 7 weeks!!!)

1) I hung meropenem and there was still about 50 mLs of vanc left to infuse. What was I thinking? I don't know. Nothing. It was time to hang the meropenem and the pump had stopped on everything else so I just hung it. For this the charge nurse stomped down the hall, hauled me into the patient's room, and dressed me down in front of the patient. I was surprised the patient even let me into her room after that. I can only say that the patient actually liked me, after complaining bitterly of day shift's neglect. I checked on her often ... I have people skills. Too bad I didn't THINK and check the vanc before I hung the meropenem. Stupid.

2) (and very serious) I was late administering Reg Insulin. Really late. As in, about 2 hours late. I gave the Lantus but not the Reg insulin, and discovered it in a run-through of the MAR 2 hours later. Had to call the doctor and then WAIT on his call back, after checking the insulin level (which had risen), and reporting to him the value. Then I could administer the late dose.

3) Didn't know how to interpret under the "orders" tab and so didn't put telemetry on a patient who had come in for DKA. On shift change the nurse I was reporting off to asked me about it and I was like ... "duh ... what?" and had to put on the telemetry before going home.

This is not to mention that I am slow at EVERYTHING. And it makes it even slower because I can never find my preceptor to ask things. Protonix? It comes in a powder. Great. I didn't know what to reconstitute with and couldn't find it on the little vial. Had to find someone to show me how to do it. So another nurse notices how long it took me to administer this because it takes long to find someone, gather the necessary materials from the overwhelming supplies room (where nothing seems to be in logical order) and administer, and tells me she's glad she's not my patient. Not to mention it was only LUCK that I looked it up in the computer and discovered it needed to be administered over 2-5 minutes, or I would have pushed it at lightening speed and maybe done some damage.

I swear, too, that if I had a nickel for every time someone has said to me or asked me "didn't I tell you this before?" or "your license is at stake!" or "you must go faster!" etc., I wouldn't owe anything for my school loan. It'd be paid. My list of fantasy comebacks is growing ...

The other night I tried to administer a PRN percocet (PO) to a patient, and the minute the pill touched the back of this poor lady's throat, she spit it out and began to cough. Hard. Then gasp. Drool coming from her mouth. I had no idea what to do besides raising the bed and patting her back ... and I called for help. Immediately 4 nurses and 2 young doctors in the room. And we all stood there and watched her get over it gradually. I was told I over reacted and that my problem (among many) was that I was always looking for zebras and there are only horses. I need to get out of the HURST mindset where every symptom is one where the patient is potentially dying (and if I don't recognize it I am a scary nurse ... which of course I already AM a scarey nurse) and recognize the horses, so to speak.

I made up a new sheet for myself - since the hand-off sheet is confusing to me and doesn't help with med administration. It DOES help me, but I've been told numerous times that it's no good ... I shouldn't be using all that paper I should just be writing down times of administration, not meds, or should be remembering things, or writing down the first letter of every med, and then not taking the WOW into the pixus room. And I definitely shouldn't be standing there with my sheet asking the handoff nurse questions and writing down her answers to fill in my sheet ... it's insulting to the handoff nurse. And I should not trust anything the handoff nurse says ... I should check the WOW myself, because she could be mistaken and my license is at stake. So what good is a handoff? Apparently just to report what the patient did on the last shift. Everything else should be gotten from the machine. Only there is little time to gather the information from the machine. It does no good to come in early because they don't make patient assignments until 5 minutes before shift change. I could REALLY use them doing it before that, and would get my "stuff" together off the time clock, so that I'd have more of an idea of what was going on, before shift change. 15 minutes after report people are asking me if I've made rounds on my patients (I'm supposed to have done a head to toe on 6 patients in that time period, like everyone else does).

Anyway ... I'm not doing well. I'm seriously not doing well. They've put me on an extra week of orientation. I feel like I could use another 4 weeks of it. They said they're taking it week by week and tried to be very reassuring that so many new nurses have been through this. And I've been switched to day shift for a week, so that I can precept with this other gal, who the Nurse Manager says is more like me and "quiet" ... which, I'm not all that quiet, but seem so when I go to work. Sitting there in the Nurse Manager's office, I was trying to be very calm and professional, but was preoccupied by my uncontrollable mouth, which wanted to quiver. Geez. I wasn't about to cry but my mouth disagreed. I have not told anyone except my best friend about this. Too humiliating. Will I be a bad nurse? Is this a bad omen? Am I only fit to sit by someone's side and pat their hand? Heck it's my only skill. Oh except for charting. Apparently I'm a rock star when it comes to charting, and apparently this is an unusual skill for a new nurse. Not exactly going to help anyone get better though, being good at charting, which carries no stress because no one ever got hurt or sick from a nurse forgetting to chart gastrointestinal sounds, have they?

I am frightened.

Murse9185

22 Posts

Well that was an intense read. Pretty much what I'm getting from this is you're a new nurse who has made some mistakes. We all make mistakes as nurses, as humans. The important thing is you learn from them and don't let them happen again. At least you're at an age( I'm half of your age) that you realize you need to fix these mistakes and get better. When I first came out of NS I thought it was no big deal, whatever. Obviously now I'm older and realize every little thing in the nursing world matters. The mistakes you have listed I bet don't happen again. However if they do that can become a problem. That nurse who belittled and tore into you in front of the pt was unprofessional. One day you'll be the vet nurse talking with a newbie. Take a breath and strive to be the best nurse you can be.

RNperdiem, RN

4,592 Posts

Nursing is humbling. Give yourself a chance.

If you took up piano, would you really expect to be performing at a professional level in the time you have been a nurse?

There is a reason that most of those nurses-of-the-year are not young and inexperienced.

It takes time to learn and learn from experience.

It sounds from your post that negative self-talk is getting out of hand.

Specializes in critical care, ER,ICU, CVSURG, CCU.

Nursing school only prepared you to take and hopefully pass the NCLEX

and furnish a foundation, facilitating your critical thinking skills.

clinical experiences, are lacking, especially compared to the diploma program I attended in 1970.

just keep attempting to do the next right thing, THINK

also use the search tool on this site for "brain sheets". They will help in organization and time mgt.

you accomplished something's very impressive, did very well in school, got a hospital job, and quickly passed NCLEX!

i am proud of you....you will in time be a great nurse.

i am sorry the charge nurse reacted as she did, related to the vanc, left, with the new drug you hung, I would of quietly corrected the situation....then pulled you in a private place, and explain the rational behind your error. I hope you run into similar experienced nurses as my self......

Specializes in SICU.

It will get better I promise. New grad orientation is intense . You will find your footing.

nurse.ethel.RN

25 Posts

Definitely give it time. While these are 'rookie' mistakes - I've seen experienced (20+ year veterans) make way bigger mistakes ((like hanging versed and fentanyl at the same time in the wrong pump w/ the wrong rate)). SO, administering protonix or insulin late is OK. Floor nursing is a BEAST! It will get better. It seems, too, that you don't work in a very friendly facility. I work in a teaching hospital which has an unspoken mantra that s**t happens, mistakes are going to be made BUT fixed and learned from. Hang in there and maybe find somewhere else to work.

maxthecat

243 Posts

You are still in a learning stage, as you should be. You will make mistakes. Believe me, there are nurses who have made far worse mistakes than what you have shared. What jumps out at me is how you are being treated by your fellow nurses. Shaming someone is no way to help them learn. And reprimanding you in front of a patient is truly unprofessional. Talk about raising a patient's anxiety unnecessarily! That, to me, was far worse than what you did. I have every confidence you will get better with time. Oh, and you did't mention it, but if someone tells you, "Typical book smart nurse, can't cut in the real world," please ignore them. It's true that some book smart nurses do poorly, but the vast majority do just fine.

iowa27

21 Posts

I feel for you as I'm a second career nurse at 51 years of age. I've been off of orientation for a few months now and those first few were almost unbearable. I was having many of the same thoughts as yourself and have already made a few mistakes (fortunately nothing major).

It is starting to get better as I'm now getting the "feel" of what to be concerned about and what to not worry about.

I'm very fortunate in that I'm working on a med-surg floor that nearly all of the nurses (and doctors) are very helpful, understanding and there to help you at the drop of a hat. Never any judgment from them and I've asked them several questions, sometimes over and over. It is embarrassing, but I'd rather keep asking then to harm a patient.

About the charge nurse "dressing you down". If that is truly the way it went down, then they were out of line. As a 51 year old, I have no problem with being educated in a positive manner, even reprimanded/scolded if I have it coming to me. But not in front of the patient. How are you to display a confident manner later after that happens?

The first time that a nurse belittles me in front of the patient will be the last, I will simply move on. Life is too short.

Hang in there, it will get better. Soon there will be more "good days than there are bad".

SilverSister

7 Posts

Hi Iowa,

Congrats on a second career at 51! Was it as odd for you to be back in college again after so many years? Was for me. Chalk boards and pencils have DISAPPEARED! Lectures are all from the power points that come with the books! My learning curve had to be fast and furious when I went back.

Indeed that is the way it went down, with the vanc error. In fact I didn't make it as terrible as it actually was. That young nurse is a horror. Not the first time she has said something to someone that was "mouth-hanging-open" awful to someone ... this time it was me. The Nurse Manager now knows about it (because MY error with the vanc was reported to her - thus my extra week in orientation - and she talked to me about it and I mentioned the way it went down) so I think that's all I need to say about the matter - it will be resolved by those whose job it is to take care of such things. I can't just walk away ... this is now my livelihood and I have loans to pay back. Part of the weirdness of it, though, was the fact that I AM 50, and she's in her mid twenties. The arrogance sometimes just astonishes me. On the flip side though I'd love to grab some of that "No problem I can do this" attitude that is coming so easily to my younger classmates. An attitude adjustment is in order. And a few extra layers of skin. LOL.

Susie2310

2,121 Posts

1) I hung meropenem and there was still about 50 mLs of vanc left to infuse. What was I thinking? I don't know. Nothing. It was time to hang the meropenem and the pump had stopped on everything else so I just hung it. For this the charge nurse stomped down the hall, hauled me into the patient's room, and dressed me down in front of the patient. I was surprised the patient even let me into her room after that. I can only say that the patient actually liked me, after complaining bitterly of day shift's neglect. I checked on her often ... I have people skills. Too bad I didn't THINK and check the vanc before I hung the meropenem. Stupid.

2) (and very serious) I was late administering Reg Insulin. Really late. As in, about 2 hours late. I gave the Lantus but not the Reg insulin, and discovered it in a run-through of the MAR 2 hours later. Had to call the doctor and then WAIT on his call back, after checking the insulin level (which had risen), and reporting to him the value. Then I could administer the late dose.

This is not to mention that I am slow at EVERYTHING. And it makes it even slower because I can never find my preceptor to ask things. Protonix? It comes in a powder. Great. I didn't know what to reconstitute with and couldn't find it on the little vial. Had to find someone to show me how to do it. So another nurse notices how long it took me to administer this because it takes long to find someone, gather the necessary materials from the overwhelming supplies room (where nothing seems to be in logical order) and administer, and tells me she's glad she's not my patient. Not to mention it was only LUCK that I looked it up in the computer and discovered it needed to be administered over 2-5 minutes, or I would have pushed it at lightening speed and maybe done some damage.

I encourage you strongly to concentrate on administrating medications safely. Medication errors can seriously harm patients. I was taught in nursing school never to take short cuts with medication administration. I suggest slowing down and really thinking about what you're doing. You need to know why the med is ordered, whether it is appropriate for the patient at the time of administration, or whether it is contraindicated. What are the patient's labs like? Are the labs such that the patient can receive the medication safely? Are the patient's vitals signs such that they can receive the medication safely? Are any other assessments necessary before you administer the medication? You should be using your 6/7 rights of medication administration. I was taught to check these rights 3 times before administering medications. You do need to know all about the medication: purpose of medication; the medication's action; indications for giving; contraindications; assessments prior to and after administration; drug interactions; patient monitoring necessary; expected effects; common side effects including more serious side effects; adverse reactions and action to take. With IV meds, in addition to the above, I was taught to check a comprehensive IV drug guide for administration information, and to determine whether the medication is compatible with other IV medications in the line, and with the various IV solutions, and to determine appropriate rate of administration, and whether further dilution of the drug is necessary. Also, don't forget to check patient allergies to ensure they can receive the drug safely.

Don't sacrifice safety for speed.

Best wishes to you.

MichelletheRN

40 Posts

Specializes in Med/surg.

Oh my goodness, honey.....you are FINE....NOT A THING WRONG WITH YOU!!!!

It is just normal to be slow at things at first. I don't think you are probably as slow as you think you are. You are not stupid.

You just passed your boards....they need to give you 6 weeks or more of orientation!!! It is hard to learn everything.

Don't put yourself down in front of people there, though....this is something i have to work to not do. Fake it til you actually feel confident.

Every nurse feels this way at first, everyone in health care I am sure goes through these feelings of self doubt. A friend of mine who is an OB/GYN said that when he started, he kept feeling like a phony, like someone would come in when he was doing a hysterectomy or something, and say, "OMG, get out of here...YOU cannot be doing this!" He felt like, why am I being allowed to do these things, i am stupid, i am going to screw up something....but he didn't....other than developing a drinking problem for a while...lol (not at work!)

You are just fine....you graduated college and passed boards, so you are obviously competent. It is alot to know. (((((hugs))))) Twenty years, and I still feel like an idiot at times. Intellectually, I know I'm smart....but emotionally, there is that voice, ya know?

SHAME on the one that yelled at you....and in front of a patient, no less!!!! You NEVER correct someone in front of anyone else, ESPECIALLY a patient! And you NEVER yell....people need to BE NICE. Everyone has bad days, maybe that person was upset about something else, but that is TOTALLY UNACCEPTABLE.

Things happen. Generally, no one is harmed. I'm sure mistakes happen that are never even noticed...all the time. Some insulin was late, a telemetry didn't get turned on right away. Everyone lived to see another day. The telemetry obviously would have been a much bigger deal in someone having chest pain with a third degree heart block....but of course, had that been going on, you wouldn't have forgotten it. Because it's normal, heck, it's CRUCIAL, that you focus on the most important things first.

The percocet lady was coughing and moving air...I choke on stuff....I don't need a Heimlick maneuver. It's not fun, but it happens. If she was losing her airway, not moving air, turning blue, passing out....would you have intervened? Of course you would.

You are fine....breathe, honey.....breathe....it is okay!

Specializes in PDN; Burn; Phone triage.

Your coworkers sound like dicks.

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