New Nurse Stress

[MayRN2987]

Maybe this is just a rant, but I am feeling extremely overwhelmed at work. I work midnight shift in a rural Midwestern hospital. I started this position as a new grad in August. I work on a medical surgical floor with a max patient to nurse ratio of 8 to 1 on midnights. I have had several nights with 7 patients bit none with 8 and I still feel so unsafe when I have that many patients. Between my assessments and med passes I have very little time to get in their charts and really get to know what is going on with my patients. In the past week I have worked 6 out of 7 nights due to high census and being short staffed. I am just having a really tough time with it all. Whenever I give report to incoming day shift, I feel as though they are upset with certain tasks I may not have completed such as med reconciliation for a new admit that came in at 5 am and so on. They ask a lot of questions that I can't answer because I haven't had time to thoroughly review the charts and it makes me feel incompetent. In addition, I am often staying late just to complete my charting. Also, I am having an issue with an aid who I feel speaks to me very inappropriately. I feel like because she has worked on the floor longer than I have, she is trying to establish dominance early on. The issue is, when I ask her to do things it's not because I am lazy, I am just very busy and always little behind being a new nurse trying to get comfortable on the floor. She has been very disrespectful and I am not sure how to remedy the situation. I am also going back to school online for my BSN at the moment, and I have 2 young children and a spouse who does not understand why I have no time or energy for date nights and family activities. I am just so very overwhelmed. I was so excited to start my career as a nurse but now I am just physically, mentally, and emotionally exhausted. I don't know why I am sharing this. Maybe I just needed to vent, or maybe I am hoping someone will tell me it gets better. I don't know...

[iluvivt, BSN, RN]

First of all you must take control of your schedule and your life.. You have a lot on your plate and it's very difficult to balance all that without good organization and with you and your husband working as a team.Why are you working 6 out of 7 days? It is not your responsibility to staff the floor if staffing is problematic. You needed that day to rest,do laundry ,homework,mother your children and pay some attention to your husbsnd.You must learn to say NO! Perhaps Full time is just too much for all you have to do. I think that if you worked even 3 days per week you would still be very busy. Think about this...you just started in August and you are already stressed out. You need to make some changes now before you burn out!

As far as the disrespectful aid is concerned she will continue to mistreat you if you allow it. Whether she likes it or not you are the one with the license and the one with the responsibility to make certain the nursing care is safe and meets the standards. Her job is to take direction from you! So professionally and respectfully put her in her place.If you draw the line in the sand more often than not the bad behavior stops when they realize you will not tolerate it. You can whip through a chart really fast and get the highlights.Look for an H and P and go right to the summary.Then check the main reason why they are hospitalized,then take a quick look at the labs,cultures,recent blood sugars or other pertinent values.Check current orders and MAR and available prns and type of VAD in place.I can do all of that in 5 mins. Please make some time for your life and family because why else are you working so hard if not to have a good life.

[MayRN2987]

Thank you for your advice. I am actually only hired for 3 nights a week but I feel obligated to fill in when needed. You are right, I do need to learn to say no.

[beekee]

1. Say no. Once they learn you are a push over, they'll start calling you first. One of the most important skills in nursing is to be able to say no.

2. Get a better brain sheet to help you stay organized. Eight is a lot to keep straight, so a brain is vital to help you keep it all straight.

3. Cluster! For example, you might take sally to the bathroom, reposition her, get her vitals, get her pain pills and fresh ice pack and water all in one trip. It'll facilitate sleep and you won't have to keep going back in there. At bedtime, I usually ask if they usually take anything to help them sleep at home. Warm milk, a warm blanket, the lights out and maybe some soothing sounds to block out some of the noise helps. A lot of elderly take Tylenol before they go to bed. They'll say they have no pain, but they always take some Tylenol. I also will take a look at what meds are ordered overnight. Lovenox at 3 am? Remove a pain patch at 2 am? Nope! I ask pharmacy to move it to earlier to later so I don't have to wake them up.

[iluvivt, BSN, RN]

Yes...start saying NO and only work if you need some extra cash and it DOES NOT interfere with your goals for the week. Three shift per week is enough with all your other responsibilities and oligations.

[Munch]

I'm with the others..6 days a week is outrageous especially for someone brand new. Definitely stick to 3 days and once you get your bearings(and you will) then if YOU decide you want the extra shifts then take an extra day or two. You need your days off to be with your family, rest and sometimes to just process all that has taken place at night.

What Beekee said is vital! Try and condense as much as you can for your patient in as little time as you can. I do the same thing. If my patient is due for meds I will go and take their vitals, give them a clean gown, help them into bed etc.

You will learn over time little tricks that help you with time management. You will also learn which co-workers/support staff you can go to for help and which ones you are better off just staying away from(hopefully it is none)! But for me when one PCA is working I find it easier and better to just go and change out the patients bedding myself..path of least resistance..at least for me anyway! Good luck sounds like you are doing good so far but as others have said you don't want to burn out!! Slow down!