New Nurse Vent - 2.5 months in

[Nanz_B]

This post may be kind of long. I am having SOME KIND OF week this week and I really feel the need to vent. Luckily, today is a real Friday and I am off for 3 days. I'm a new nurse. I got my license in March and my first nursing job in May at an LTAC. Orientation went well and I learned alot...and am continuing to learn lots. The only thing that bothered me about orientation was the fact that I didn't have just one preceptor - which was a challenge for me - just feeling like I didn't get the opportunity to develop a relationship with someone during this time of my transition from student nurse to newly licensed nurse. I can't really dwell on that now though - the nurses I work with are great and are really great about providing help when I need it. OK - now to the real story.

Yesterday I had my first textbook spinal injury patient and from the start of the shift I felt really inadequate. He was a pretty heavy patient and during the start of the shift it was up to me if I wanted to keep him or give him to a more experienced nurse and take another patient (one who will be getting blood). I chose to keep him because I never turn down a challenge. In retrospect, he was heavy but not that heavy at all. My problem was letting the nurse who was giving report get into my head about how this patient was going to be alot of work - blah blah blah. At the start of the shift, the pt was getting a PICC line and the MD was going to put in an NG tube. I had to assist with that and kind of drew a blank when it came time to put the tape on and set up suction. The patient was vented to was already connected to one of the suction tanks in the room. So, we had to get a portable suction machine that would be used for the vent suction and the wall suction was to be used for the NG tube suction. My nurse manager helped me out in getting the additional suction device that I needed and showed me how to use it - and that was fine. In the end, it all turned worked out. The PICC line was placed and ready to be used, the NG tube was in its proper location and ready to be used. The patient turned out not to be that bad. There was just alot going on at the start of the shift. I almost had a break down when the charge nurse kept checking in to make sure that I was OK. I thought that it was nice of her and she is a great charge nurse (I would have loved to have her as my sole preceptor).

I know this post is all over the place - it's basically a new nurse vent. So, that was that patient. I followed the doctors orders and although long - my night finally ended - way past 11:30. Then, it was time to give report. This was one patient that I had trouble giving report on. It was hard for me to give report for this particular patient that I had for the first time and didn't get a chance to read his chart to get the backstory. I only had time to read the full page of new orders that I the MD gladly left for me - one which includes a straight cath q4h. At any rate, I had to give report to a nurse that never had him before. So, she was as ubberly confused as I was at the start of my shift. I felt so inadequate. She said that it wasn't me - but the full page of MD orders that were left during the day. As I sit here and think about the orders, they all make sense now. I don't know why they just didn't keep a foley cath in the pt (I get that it is a breeding ground for bacteria). But, isn't straight cathing a pt q4h just as bad? Hopefully strict sterile procedure is used by each nurse who does it. I't's basically ordered to be done at least twice a shift. To be honest, I really hope that I get the patient tonight because it is an opportunity for me to practice my skills as a new nurse. I have a feeling though that the charge nurse tonight will try to take the patient and give me someone easier.

Another vent of mine is that I feel like the nurse manager doesn't like me. I've already had two situations when she talked to me based on some information from some incident reports that were filed. The first was because the patient of a family accused me of basically be negligent and not paying enough attention to her father and the other was one that I filed mentioning that I told the family of a pt that I would file an incident report to report that an iPod shuffle was missing. I guess I didn't take the proper steps when filing the report. I was told that I should have called the laundry department to inform them of a missing device and also that I should not have mentioned to the family that I was filing an incident report. The only thing about this situation is that I wished that my nurse manager would have spoken to me in her office instead of reprimanding me in the hallway for all to see - with other people being in earshot. I felt like it was low blow and I was embarrassed. I think that part of my feeling inadequate with my nurse manager is the fact that I think I remember her saying that she hired another student from my school (I got my ADN from a community college) who didn't work out well. My goal in this life is to be a great nurse! I love nursing and all that it has offer. I'm not in it for a paycheck. I could have heard her wrong. Come to think of it, she may not have said that because there are three people on my floor along who went to the same community college as me.

Another vent of mine is some of the CNA's that was have on the floor. I don't want to call them lazy. But, sometimes they march to the beat of their own drum! I have learned alot from the CNA's though. I didn't work as a CNA during my time in nursing school. My only hands on practice came from clinical and lab.

All in all, my first nursing job is good. I am learning loads. There are alot of things that I get to do as a nurse because we don't have specialized departments to do them for us (i.e putting in IVs, drawing blood, etc). Sometimes I just feel inadequate because the pts on my floor are really sick and I know that my knowledge base is lacking. The family's are alot to deal with and I hope that I answer their questions to their liking. If not, they go right to administration and then administration comes to me...you get the idea! Another reason that I feel inadequate are because my orientation checklist is not all checked off. There are some things that I can't do on my own until after they are checked off. It is really hard to get those things done when everyone has their own set of patients and are extremely busy. I know that the orientation checklist is my responsibility - I feel like I really dropped the ball on it.

I know this post is all over the place. I just needed to get some of what I've been holding in - OUT!

[NottaSpringChik, BSN, RN]

Nanz B, thanks for your post. Seems like you were full of adrenaline. I hope you get some rest on your days off. Sounds like a pretty great job and that you are learning a ton and really being challenged. Don't make what your nurse manager says to you personal; doesn't sound like anything serious at all and if it were she probably would have said something in her office. Obviously she thought it was minor or would have taken you there. Not knowing what to do about an missing IPOD seems like something that one would just learn as situations arise. It was nice the way she looked in on you to help, that sounds great and it sounds like you did well too. Have some good time off and when you start thinking about work just say, "Stop It!!" and think about something else. Got that tip from someone else on AN!! If I could remember who I would say, but what a great tip. Helps stop the mind from racing and racing.