New Grad just started Med-Surg job 2 weeks ago-crying!!!!

Alana R. · Jul 27, 2012

Dear tmoney, it takes at least 6 months to become comfortable and to know most things in any new job. Since after 2 weeks you already feel ok with 3 patients, I think you are doing GREAT! It is a learning process, please be patient with yourself. It is the normal process to question yourself, to feel overwhelmed, to not know what to do, and to ask questions, so don't be so harsh on yourself. Of course you can do this!

Candyn · Jul 27, 2012

Did you take 4 patients right away or gradually increase the amount of patients? What my preceptor and I did was I took 1 patient first then until I am comfortable with doing everything for that patient, I would take 2...then increase to 4 patients. And yes there will be days I feel like what you are doing, there are days I feel like I can easily make a mistake. That is where it is important to stop what you do, take a big deep breath, look at the big picture and prioritize.

cjcsoon2bnp, MSN, RN, NP · Jul 27, 2012

You're a new grad. RN and your orientation on a Med/Surg unit is only 4 weeks? For a brand new nurse, most hospitals in my area have a 3 month (12 week) orientation that is a combination of classroom and preceptorship time. I think that for only two weeks out you are doing great being able to handle 3 complete care patients. Many people (myself included) find that making a checklist is helpful for planning your care by keeping track of the things you need to do when you need to do them. It can be a seperate sheet that is done by time or you can keep a small checklist for each patient on your worksheet/brainsheet/kardex/shift-to-shift report (or whatever you may call it). I think that keeping a seperate checklist organized by time is most helpful to me. I'm not saying you have to do this way, its just something to consider.

For Example:

1500 -

Get shift-to-shift report on my patients (Rooms: 101, 102, 103, 104)
Introduce self to patients and assess which patients need to be seen first.
Review orders for any 1500 meds. and admin. any requested PRNs (i.e. pain meds.)

1600 -

Finish reviewing all orders.
Review my patients' V/S in the computer/flowsheet (if obtained by CNA and not done so already)
Obtain any pre-dinner B/S on diabetic patients (Rooms: 101 & 104)

1700 -

Administer insulin to patients if necessary. (Room 101 - B/S = XXX, Room 104 - B/S = XXX)
Administer pre-meal/1500 meds.

Obviously this is a really generic list but you could make your own list and add things to it as you go along. This is a good way to remember all the things that you need to do without having to waste your time trying to memorize the order of routine tasks and you can focus your energy on thorough assessments, succinct documentation, prioritization and time management. And lastly, if you feel you haven't had enough orientation time you should speak to your manager or nurse educator for an extended orientation. You may not get additional time but if you express your concerns you may get an extra week or you may have a nurse mentor who can check in with you during your shifts to see if you need any assistance but wouldn't be your assigned preceptor per se. Good luck and let us know how things are going!

!Chris :specs:

Kasandra · Jul 27, 2012

Hi, tmoney! I am one of those nurses who writes my brain down. I like to write things down like Chris does, but this is how I do it:

1. Take a sheet of paper.

2. Make a column for each patient going down the paper.

3. Go across and make a block going across the top of the paper: Put the pt and room number. With this info, you can put "ISO" as a reminder that they are on ISO or "D/C" if they are going home. These 2 things are not necessary though.

4. Make another block by drawing a line across. A (assessments): 8 12 4. (Of course do what your floor is for assessments.). This way, you can draw a line through the numbers respectively after you have charted these assessments.

5. Below "A" in this same block: Write a "M" (meds) with the times they are due: 8 12 16 18. Draw lines through these numbers after you are done with the med admin.

6. Now, draw a line across further down the page so that you have a large rectangle within your column: jot down important labs you want to follow up on as well as tasks that need accomplished. DO NOT BOTHER to write down a time to execute tasks unless it is a time specific one because you will be interruped and your day will be chaos. Mark across after you have completed your tasks.

7. If you pt is on telemetry, you can also make a box going across just for tele: "SR 80s, SR 60s" to track what they have been running all day cardiac wise at a glimpse.

The trick is to make this work for you. Your way of doing things must be efficient. You do not have the time to write long sentences for tasks and so forth. When you come in to your shift, grab your charts, sit down, and review orders for the past day or so. Make your sheet as I have described. Look up your lab values, and write down important ones that you need to follow up on or simply know. Look at their blood pressures and write down their current and baseline so you know their normal b/p and if there is an issue. This is how I do things. You must be efficient so that you can hit the floor running with your patient care.

I hope that this helps. If you need me, my name is really Kasandra. Most call me Kat. Write me on here. I will be here for you. Do not give up on yourself: Be patient and ASK QUESTIONS. Cocky nurses hurt or kill people with mistakes that could have been prevented. This is not you! Remain humble and your patients and colleagues will love and trust you for it! :nurse:

Kasandra · Jul 27, 2012

Oh yes, one more thing: Make a block for your accuchecks with the times: 8, 11, 17.

turnforthenurse, MSN, NP · Jul 27, 2012

I think it's great that you're able to take 3 patients after 2 weeks! :up:

When I started, my preceptor(s) gradually added to my load of patients until I was able to take 4 (the max we take on my unit, unless we're short staffed and then we take 5). It took me awhile once you factor in all of the charting (and learning a new computer system on top of it!), calling the doctors ( :uhoh3: ), admissions, discharges and everything else that they don't teach you in nursing school. It took me 6 months to begin to feel comfortable and probably about 9 months until I started to feel really comfortable. It's normal to feel overwhelmed as a new grad, so please don't be so hard on yourself! :redbeathe

MyUserName,RN · Jul 27, 2012

It will get better I promise! Have you considered working night shift? I started out on night shift and am really glad that I did. The reason why is because it gives you a chance to learn how to be a nurse without having to worry about discharges all day, doctors writing new orders all day long, patients going to procedures and back from procedures all day long, etc. I worked nights for almost a year before finally moving to day shift and now that I'm working days, I really appreciate starting out on nights and getting comfortable in my nursing shoes and learning a lot without all this extra stuff getting in the way. Don't get me wrong, nights can still be tough, but it's nowhere near as hectic as days. A lot of new grads do start on dayshift, but personally I'm glad that I didn't. Even if you do stay on dayshift, you will eventually get comfortable, it just takes time.

MsSocalRN · Jul 28, 2012

The OP stated she started her job in May and has only two more weeks left with her preceptor. Sorry just needed to point it out because people are thinking you only had 2 weeks of orientation period!

MsSocalRN · Jul 28, 2012

Your title is contradicting your post too! So did you start in May?? Two months or two weeks ago?

9thwonder · Aug 15, 2012

awesome outline

tmoney · Aug 15, 2012

Hi all-new to the boards. I have been very lucky to get a job right out of nursing school in May. But so far it's very overwhelming. I go home crying, thinking, is this really what I want. I love patient care but I'm having a hard time with time management and documentation. Also-new admissions and discharges is something we NEVER did in school. I thought I was prepared to take 4 patients but when adding in all this paperwork, I feel out of my element. I feel inadequate in my new position.
Has anyone felt this in a new RN position or am I way over my head. Today was better having only three patients with total care but I'm terrified to lose my (preceptor) with me on a daily basis. I have two more weeks of preceptorship and I'm on my own.
Please give me a vote of confident to stick with something I so loved in school or maybe I wasn't cut of for this.
Thanks for reading.

I grad from Nursing School in May and got a job in July. I have been on the floor for a total of 11 days now.....now I'm nights. Still having a hard time.