SoldierNurse22, BSN, RN, EMT-B 53,704 Views
Joined Mar 29, '10.
Posts: 2,234 (67% Liked)
You are not alone.
Please re-read that first sentence as much as you need to before continuing.
You are a new nurse. It is normal to feel overwhelmed as a new nurse on a general med-surg floor. Specialties are a whole different can of worms! I was a new grad in oncology once, too, and I kid you not, I felt like I knew nothing for about the first year. The difference is--I expected that. I accepted it. I decided, OK, I know very little. So I made good friends with the experienced nurses on my ward. I talked to the docs, to my patients, and to anyone who would give me the time of day.
Your knowledge of nursing in general grows exponentially your first year working on your own. You have the unique challenge of trying to hone your basic nursing skills as well as your specialized oncology skills. The best advice I can give you is to hone your basic nursing skills first. Listen to your gut. If you're worried, ask an experienced nurse. Ask your charge nurse. The nice thing about floor nursing is you're never alone! If you feel that you are, you're probably working in a toxic environment that isn't safe for your license. That's an issue all its own!
Oncology can be, by its very nature, a depressing field. My unit also struggled with depression, especially when patient deaths were frequent and the winter months dragged on. Do you have hobbies? Do you have friends or family that you hang out with after work? Do not lose your social life and that integral part of "you" to "nurse you". Learn early that your professional life and your personal life need to be separate. That doesn't mean that you can't have friends on your ward if you so choose, but you need to go home and think about something other than work after hours/on days off.
Please visit this section of AN: Oncology Nursing This is where the oncology nurses hang out. There are a lot of great people who have had conversations very much like the one you've started here.
Specifically, this thread strongly resembles your post: http://allnurses.com/oncology-nursin...rn-819346.html Again, there is great advice in this thread. Please read it over and if you feel you are truly that depressed, take up your unit on the therapy! There is no shame in admitting that you need a helping hand to pull you out of the blues.
1. Accept the fact that you're new and you don't know everything. Anticipate that this will be the case for about a year.
2. Plan out how you will handle situations where you don't know something. Have coworkers and colleagues that you can go to for support. Practice saying "I don't know, but I'll find out and tell you in ____ minutes/hours/etc". That phrase works on docs, patients, and other nurses, too.
3. Analyze your personal life. Are you getting enough sleep? Are you eating well? Are you exercising? Are you maintaining social relationships and friendships? Any one of these areas can contribute to the strain inherent in working oncology. If you need help, talk to a therapist or your PCM if you're not sure you can fix them on your own.
Chin up, OP! Please feel free to PM me if you'd like.
And I KNOW her life experience. She had me very young so in the 24 years I've been alive not much more had happened than when she was my age.
But you don't make the decisions. New grads will go with any change. That's what hospitals want...its a business! Its the way it goes.
To follow up to your story and springboard off my previous post, I had a patient a few months back who was admitted for an elective IOL at 39 weeks. She was a G1P0 and had a borderline favorable cervix, but overall, I felt it was probably best to wait, especially because her Bishop score was close to favorable, but it was definitely not good enough to indicate induction under our new policy. My charge checked her and fudged the numbers a bit, I think because she didn't feel like going toe to toe with the doc that morning.
After my charge nurse left, I did exactly what you did. I advocated for my patient. I told her that if she kept her water intact, she could opt out of the induction at any time. I told her she could refuse an AROM and to make sure she stated to the doc that she didn't want to be AROM'd with a nurse witness present.
Anyway, I left for the day and came back that night just as they were taking this patient back for a stat C-section for fetal distress and failure to descend. Apparently, baby had been having lates all day. They AROM'd mom when she was 2 cm and ballotable.
As the icing on the cake, the doc had the gall to be in a huff and all pissed off that she had to section this lady because it was the doc's husband's birthday, and she was supposed to be eating out with him that night. Nevermind that this poor lady just had an unnecessary c/s because her doctor is a selfish, sad excuse for a human being. Nope, she was all mad because of the missed birthday dinner.
OK, then don't set up an unfavorable G1P0 for an elective induction the morning of your husband's birthday and expect to be footloose and fancy-free that evening, you moron!
It's really not that unbelievable. Hospitals hire based on their needs, and if they need an experienced L&D nurse, they will often wait it out until they find one instead of trying to leverage time and resources they don't have to train a new one. I agree with Rose Queen--start looking in other places for a job in L&D.
This is a reality in any workforce, nursing or otherwise. Welcome to the adult world. However, the poor attitudes of some nurses don't diminish the overall excellence of the profession.
I'd suggest you use the term "some" instead of "we", at least until you're a nurse versus a soon-to-be student. You really can't speak on behalf of a profession you've never joined, no matter how much CNA/MA/EMT/etc experience you might claim. And also because I and many other members surely don't want you speaking for us in your generalizations.
If asked the dreaded question -- "We have several other more experienced applicants that have already applied to this position. Why should we hire you?" -- I'd answer something like this:
"While I have no doubt that there are more qualified applicants to this position, if you hire me, you're hiring someone who is very interested in not only this job, but in learning about this new field of nursing. I have no previous oncology experience, so this facility has the opportunity to train me to do things right without having to be concerned about old policies or previous bad habits getting in the way."
Emphasize your inexperience with oncology as a plus. There's going to be a lot to learn. Let them know you're up for the challenge and that your inexperience might actually be of benefit to them!
Oh, I dunno... I would have liked avoiding all that work in nursing school and dealing w all those bizzarro instructors! ;D
Good luck to you! There are significant differences between your skills as a doula and the ones you'll learn as a nurse, though I think your experience in labor support will give you an edge when it comes to getting a job and becoming comfortable in L&D. Keep in mind that there are all kinds of work environments out there in OB. Be wary of where you're hired and don't be afraid to ask questions. Make sure the birth practices and policies in place at prospective places of employment fit with modern evidence and best practice!
Once upon a time all one needed to be a practical nurse was a certificate from a doctor stating that he deems you capable in providing competent bedside care.
Sweet mother of Elvis, OP. Just how much homework do you have?
Time to get comfortable with the search function on AN (top right corner). There are tons of threads on the topics you've posted already.
It's certainly an art mixed with a science. Cervical exams take lots of practice. When I was a new L&D nurse, my preceptor would often check the patient, then have me check her. Within a few months, I was pretty confident.
The Mystery That Is The Cervix – Cervix With A Smile
The market's tough in general. There are some areas that are better than others, but don't be fooled into thinking that just because you have your BSN, you'll be able to find a job. You'll still be a new nurse without pertinent nursing experience. That seems to be the kicker.
There's physical skills and then there's critical thinking. Critical thinking fits into everything you do, including physical skills.
For example, when accessing a port--especially one of an oncology patient--what if you break sterile technique? Of course, you know as a nurse the importance of keeping the procedure sterile in order to protect the immunocompromised patient from illness that could potentially kill them. Beyond that, you know about how chemotherapy affects the patient on a cellular level from the immune system to the gut to solid organs such as the liver and kidneys. Sure, you could teach just about anyone to do this skill--but someone less-trained than a nurse likely will not have the extensive knowledge to go with it. This is central to keeping patients--especially your vulnerable onc population--safe.
And absolutely, the big thing they're probably talking about is assessment skills and critical thinking. For example: you come in on at the start of a new shift. A patient has some faint rhonchi in their lower lobes, which you can see is a new development that the nurse before you did not hear. You teach them about the incentive spirometer, encourage them to get out of bed and walk. However, when you do your noon vitals, the patient has an elevated temperature and is displaying subtle signs of confusion according to his wife. What do you do? That is what nursing is about--catching signs of trouble and alerting the appropriate folks in order to secure early treatment for your patient. Someone who was unfamiliar with the signs and symptoms of early infection in an oncology patient may not put those things together. That's what your skills and knowledge allow you to do. You see the patient as the whole person down to the molecular level and can act accordingly.
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