New nurse and feeling discouraged by older nurses?

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Hello everyone. I am a new nurse (about3.5 months). I know I am only considered a "newby", and a lot of the more experienced nurses may not feel like I know anything. I, myself, can admit that I know almost nothing and am still learning each and every day I am at work.

I love my job. I love working with my patients and learning more about their diseases and seeing their progress throughout their stay at the hospital. Throughout my 3.5 months at my job, I've definitely made some mistakes. I have let a patient's sats get down below 70 once. I learned to never let that happen again, should it get below 85, alert respiratory immediately. Learned my lesson, and I was grateful for it. The charge nurse that day pulled me aside privately and very nicely have me a teaching moment on it. There have been other instances where I have made a mistake (such as not documenting a temperature -- in order to justify blood cultures), and the charge nurse stated it was a teaching moment, and to take it as such. Again, I am very grateful for these moments. I am a new nurse, still learning...still very eager to learn and to do right by my patients.

Today, I went to work and I always go to work with a smile on my face. Like I said, I love my job. I worked with another nurse (older and more experienced), and a charge nurse (also older and experienced). I was discharging a patient, but prescriptions weren't filled out. The charge nurse told me to ask my patients about what they needed and I did, I got the patient discharged successfully. But it seemed like the charge nurse was upset with me. The patient needed a prescription for a blood thinner, and the charge nurse asked me what the blood thinner was for. I did not know off the top of my head (my fault, I should have known), and I told her I assumed it was because of a knee operation (I know, in nursing there should be no assumptions...but I was trying to do the best I could). I did not truly know how to find out why the pt was on that medication. And instead of helping me figure it out, the charge nurse looked at me with an amused and belittling expression on her face and basically ignored me.

The other older nurse then got onto me, because I had filled out discharge instructions on her patient. I had her patient the day before, and they had already had orders for discharge and I went ahead and filled out their papers. The nurse was upset because I had added on too many education leaflets about his medications. She asked me what was up with that, and I truthfully stated that I was told by another preceptor when I was orienting that if a patient were discharged home, to add all the medications leaflets to their discharge packet. The packet usually comes out to be about 60 pages long. A lot. But it was what I was taught. The nurse told me, "Well that doesn't make any sense. You're supposed to educate your patient about their meds and see specifically what meds they need leaflets for. Not ALL of them". Mind, she said it in a very condescending tone. And then her, and the charge nurse looked at each other, in a weird "this girl doesn't know what she's doing " sort of way, and I am pretty sure the charge nurse said something about me quietly....basically right in front of my face. I then saw the two of them gossiping at the desk, and I am positive I heard them whispiering about me.

Then I was giving report to the older nurse because we were low on patients, and I was PRN and sent home early. I gave the best report I could on her. I did not have time to look over patient history, so I went off what I got from report from the night nurse. One patient was reported to me to have had an MVA and TBI. I reported as such to the older nurse. I went to the desk to pick up my bags and I heard the charge give an annoyed face at me and tell the older nurse "That's not right. Scratch it off, he did not have an MVA. She doesn't know what she's talking about."

I left work in tears. I am a new nurse, and I try so hard to do well at my job. This is the first really bad day I have had. I have had othe rbad days, but today I truly felt like these nurses were almost ganging up on me. I do not mind constructive criticism. Like I said, I am a new nurse...I need it. But what I don't need is people talking behind my bad and gossiping about how I don't know what I am doing. I feel utterly discouraged, and I really hope this doesn't get to where I may lose my job. Even though today was a bad day, I still learned some things...I just wish they were conveyed to me in a more respectful manner, instead of having two nurses basically tell me I don't know how to do my job and gossip about me behind my back.

I know this type of stuff is actually pretty common in nursing. But any advice out there? Is my job in jeopardy? Should I try to talk to anyone higher up about this, or should I just take it as a lesson learned? I have not had any problems with any other charge nurse or nurse. Just these two ladies today, and I am almost confused as to why the work environment was so toxic today....Any advice would be helpful! Thank you so much in advance!

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First of all, I think it's great that you acknowledge that you're brand new and know very little clinically. It shows that you have good self-awareness. But also know that with time the clinical skills and knowledge will come. Without knowing the circumstances surrounding the things that happened to you like the patient desatting to the 70's, it's hard to offer advice. But assuming that the patient didn't have dyspnea on exertion or at rest at baseline, letting a patient get into the 70's should be basic nursing 101 that you need to intervene whether they're symptomatic or not. Regarding the temperature situation, are you saying that you consciously didn't document a temperature so that you didn't have to draw cultures? Because if that's the case then you were negligent and if I were your manager you would have been fired on the spot because it shows you lack integrity. If you just forgot to document a temperature, then yes, it's a teaching opportunity.

Let me give you some advice (which you may or may not already know). When you assume care of a patient, you need to physically assess that patient and have sufficient knowledge of the patient (H&P, PMH, etc...) in order to care for them. Don't take for granted that what was given to you in a previous report is accurate, you need to verify it in the patient's chart.

It sounds like your unit has somewhat of a challenging dynamic which could be difficult to navigate as a new nurse. You need to have a conversation with your nurse manager promptly; you need to discuss how you're feeling and the perception that you have regarding others attitudes toward you. You also need to discuss how he/she feels that you are doing at this point in time.

With that being said, if I was you I would definitely get my act together and be more squared away at work. Nobody should expect you to practice at the level of a 20 year veteran, but you do need to practice safely and continue to learn every day (which it sounds like you are doing).

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Specializes in NICU.

I am a new grad so this is not coming from a seasoned, experienced nurse

I have let a patient's sats get down below 70 once. I learned to never let that happen again, should it get below 85, alert respiratory immediately.

Patient's O2 sats drops into the 70s and you didn't see that as a problem. Were you waiting for the patient to collapse on the floor to think it was a problem?

The patient needed a prescription for a blood thinner, and the charge nurse asked me what the blood thinner was for. I did not know off the top of my head (my fault, I should have known), and I told her I assumed it was because of a knee operation (I know, in nursing there should be no assumptions...but I was trying to do the best I could). I did not truly know how to find out why the pt was on that medication.

What do you mean that you don't know why the patient was on blood thinners? Your job is to know why the patient is on certain meds. That was drilled into me in nursing school.

I gave the best report I could on her. I did not have time to look over patient history, so I went off what I got from report from the night nurse. One patient was reported to me to have had an MVA and TBI.

You didn't have time to look over the patient's history? If you are unfamiliar with a patient, you need to review their chart completely. THEY ARE YOUR PATIENT. We were given 15 minutes at the beginning of each clinical to meet our patient and review the chart. Then our instructor would state "tell me about your patient". We had to know what brought them to the hospital, what tests were done, what were the results, what other medical problems they had, what meds they were on and why, pertinent labs for the patient and why they were high or low.

I can understand that you are new, but all of these things are basic nursing school skills. You are a nurse now and you are responsible for these patients, not another nurse or your instructor. Nobody is looking over your shoulder to make sure you don't do something wrong. I can understand why they were acting that way.

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You will get your groove, but some things to remember. ALWAYS do a thorough assessment head to toe of your patients. Before you do said assessment, look at your orders, your medications, and a brief H&P note, so that you have a baseline from which to assess from. Make sure all of your vitals are done, always include a temperature. Anything that has strayed from patient's baseline needs to be paid attention to and responded to.

Patient education is huge, as is education regarding the patient's medications. These are all things that the computer "knows" if you are doing or not. And counts for "meaningful use" therefore, the facility wants most nurses to do it up, as that is how they get paid. AND this is an A-HA moment, as the last thing any nurse wants is "I have not any earthly idea why I am on this med/that I needed to take this med/that I needed to follow up on this med" and you have no proof that they ever received education that reflects the same. Should other nurses choose not to practice in such a manner, that is on them. Because you can bet the farm that regardless of what that patient actually received, it is now documented and tracked that YOU did what was supposed to be done.

Now, a small ditty on "where to find information". When anyone receives a new joint, or significant joint reconstruction, and the like, especially in a place where clots can form (ie: one's leg) most of the time you can expect them to be on a blood thinner. It is certainly not the only reason, as cardiac will also come into play for these meds as well. But, "To prevent clots" is a vauge but general answer to this question. Search engine it if you have to. "I am not entirely sure, but I do know where to get the answer" is also a good choice.

You need to know, so that you can educate your patient to know. This is a non-negotiable practice standard.

One of the most important things you can do is have a general idea before you educate a patient. With that being said, what is of high importance is that the patient knows HOW to take a med, WHEN to take the med, at what DOSE and that they may need labs, call numbers to get doses--this all needs to be CLEAR and documented in FULL. "You need to take this blood pressure medication from now on--including refilling said medication, until your doctor would tell you otherwise, and you have to follow up.....ect, ect......" is also a biggie. (OHHHH, I am NOT cured when I finish the bottle?!?!?! is a general theme I have seen as of late.....)

Don't let these ladies get you flustered. Stay clear and focused. "I have not gone in to assess this patient, as I just received report. However, in said report, I learned that the patient was in a MVA that resulted in a TBI....." and go on from there. Take a moment to just do a quick chart review beforehand, as you should do after report and before you see a patient.

Patient's who run temperatures is a huge blood culture reason. It would not behoove you to be all "why are we doing these" to an MD who orders them if you are aware (which now I bet you are) that this is the case.

And always, always check to be sure that a patient's O2 sat monitor is on correctly, you have a nice wave form, and if they are satting in the 70's, call resp. stat. But I am sure you now know that. This is how we learn.

If something doesn't seem to assess "right" with your patients, then ask for assistance of your charge. Because at the end of the day, it is about the patient, regardless of what the nurse "thinks" of you. But do learn where you can go to get information that you need--clinical books. medication books, ask your nurse educator on what they suggest are good references. Remember, people need to be able to get a complete picture of your patient's condition from your documentation.

And you could quietly and directly state "I find your comments to be highly inappropriate and rude, I would appreciate you not speaking about me in that manner." I am not a HUGE fan of directly stating as opposed to other nurses who are in charge roles who can actually "do" something about such behavior, however, if you are in a position to nip it in the bud for the moment, do so--and don't attach emotion onto it.

Document, document--and if said nurses go to your manager, you will have complete documentation to back up your practice.

You will get your groove, really you will. Best wishes, and you may want to search "paper brains" on AN, and try using one--it may help to organize your thoughts and plan your shift well. At first I even used highlighters and the multi colored pens to be able to have a visual of my paper brain (because I am a crusty old bat who is really type "A" HAHAHAHA)

Good luck, best wishes, and let us know how it goes!

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And always, always check to be sure that a patient's O2 sat monitor is on correctly, you have a nice wave form, and if they are satting in the 70's, call resp. stat. But I am sure you now know that. This is how we learn.

That is a great point, make sure that the pleth is good and that the PI is good, too. However, I don't understand what people are talking about with respect to a patient desatting and calling respiratory? You are the nurse... Intervene! Are you seriously going to wait for respiratory to arrive before putting the patient on a 50% venti mask or non-rebreather? You don't need RT, you need to put the patient on oxygen and call the provider.

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Man you guys are too hard on her for being new. If what the OP is saying is 100% true she is obviously experiencing workplace bullying. So a patient went into the 70s? Okay hmmmm why? Was it real resp failure? Did the patient turn? Was the probe on correctly? Of course maintaining in that range is no bueno but you need to assess why that person dipped into the 70s for a brief period. Same thing goes for BP and HR. I work in the ICU, I see ish hit the fan on the regular but I wouldn't jump down someones throat for not noticing a desat one time.

I am familiar with vent so I probably wouldn't call respiratory but for a M/T (I am assuming the OP is) I would slap an oxymask on, check lung sounds, perfusion and have them rest. Maybe toss a duoneb in. If that doesn't help then yes further intervention is necessary.

As for printing out education packets, they are being nitpicky for no reason and a bare bones report to the nurse taking over for you in that situation is warranted if you were just getting sent home. They can look up that stuff themselves, I am not going to baby them. Pertinent info only.

If I were you and I worked there I would have a field day with them if any said anything about me.

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"whispiering about me" I do believe you have formed a new word! And it fits perfectly.

This is not so much, old VS new nurse. This is about "proving " yourself. I had 30 years experience, was doing agency work and travel nursing.... I had to "prove" myself to each new facility I worked in.

Show your gratitude for the teachable moments, ignore the whispiering. You simple MUST get a thicker skin... or you won't survive.

What was your respiratory assessment of the patient with the sats in the 70's?

As far as not knowing your patients ( entire) history when you are being sent home mid-shift... meh. Happened to me all the time. Many eye rolls when I couldn't answer a question I couldn't possibly know. You need to tell oncoming nurse, you only got what you got in report and hadn't had time to look up the complete history.

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Specializes in Emergency, Telemetry, Transplant.

First, take a deep breath! Second, quit being so paranoid! Just because you see two nurses talking, it does not mean they are gossiping, particularly about you. If you walk into the nurses station, a two nurses are talking, see you, and then start whispering--it does not mean the conversation is about you. I think it will be very helpful to you if you do not always assume the worst.

If you did hear a nurse say that you don't know what you are talking about, that is not appropriate and it is rude. Anyway, learn who you can trust. Find out which of those people are open to sharing their experience with you and go from there. All the best! :up:

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Specializes in Cardiac.

I am also a new nurse, about 9 months in now. First off, I want to tell you this, the more time passes the more the "new" wears off, and your coworkers aren't going to see the need to find "teachable moments" in regards to your pts. They are going to see you as a coworker and expect you to be held to the same standard as them. This doesn't mean don't ask questions, but learn to be self sufficient and try to find things out on your own. You'll be thankful you did because not only will you know how to do it for next time, but also, if you still need help you can say ok I've tried this, this, and this... Where am I going wrong?

Ok next thing. I don't think the nurses should have talked about you behind your back, but I always don't think you should have been doing a discharge on a medication you don't know what it's for or giving report when you haven't read at least a note on the pt. I always go and read at least the latest progress note on all my pts before I start my shift. Because you never know, a doctor, family member, or charge nurse may have a question and if you have no idea what's going on you're gonna look stupid. I am not saying any of this to be mean!

The best lesson you can learn being a nurse is to have thick skin. The altercation you described is petty. Brush it off and move on. Oh and btw a quick way to figure out why a med is prescribed... Look at which doctor ordered it, then read their note. It's easier to figure out if they're a speciality doctor.

Don't give up! I promise you it gets better :)

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Hang in there. The only thing that surprised me a bit in your post was the saturation going to the 70's, but even that not knowing the whole story I wouldn't judge you. If the patient was asymptomatic completely for example you might have incorrectly assumed you could wait to sort out why he was sat'ing that low. I had to chuckle though at the new grad nursing student who said this

" We were given 15 minutes at the beginning of each clinical to meet our patient and review the chart."

I really think right after nursing school you have to hold off giving advice to RN's until you are working on the job and see what the real world is like. there is no 15 minutes/patient at the beginning of the shift to review the chart, that is nursing school only, you can take 15 minutes or as long as you need obviously to assess your patient and read the chart, but with 6 or 7 patients, it isn't always possible to get that all done at the beginning of the shift. That said you get better and better at getting a handle on the patient and being ready for report etc as you get experienced. I have only been on the job about 3-4 months without a preceptor and it is getting better everyday.

Coincidentally just the other day a Nursing student casually came up to me to tell me my patient had an O2 saturation of 75% at which point I jumped up went in the room and he looked better than ever so I took a deep breath and said 'Where is the vitals machine?' She said 'Oh, I gave it to another nursing student'.. I quickly got another one, confirmed his O2 saturation was 98% and then gave her some education on how to handle the whole thing properly and how O2 saturation in the 70% was critically low.

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Sorry, but I don't know what TBI is, anyone?? I agree with most of what the previous posts have addressed. I will say that working in the world of women can be brutal at times. You do need to develop thicker skin, but also, face the bullies that come your way. It was not appropriate for any nurse to say "she doesn't know what she is doing". You cannot top someone who has 10-20 years of experience and they were trained much differently than you were. However, you do not have to tolerate anyone talking down to you, if this should happen again and you are present when they are talking and you are certain it is about you, then I would simply tell them back how inappropriate they are, and for one professional to talk about another professional in a negative manner is the same as slander. Sometimes you have to face your bullies before they actually respect you. Needless to say, you are also dependent on these nurses for guidance and it is hard for you to respect them when they demeanor you. I would mention that to them!!! Now, find yourself a good paper brain, as was referred to from one of the posters and use it for your reference throughout the day. No one and I mean no one is perfect. However because of the type of work we do we are held with high expectations and you sound like you are a conscientious person. Believe in yourself, let the charge nurse know if you are uncomfortable with a patient. Do your assessments and think about what you are doing. Don't just do it and not understand why. I can understand how the day gets going and you may feel a little disorganized. You will find your groove, it will take time, but establish your priorities early in your shift and move on. Continue to ask questions but try to find the answer first yourself. It does get better, you can grow from all this experience. Just because they have more experience does not mean they know everything, they know a lot, and so will you!!! Hang in there, stay strong, put your brave face on and do your job!!! Anticoagulant medications can be used to prevent clots post joint replacement surgery, also for anyone who has mechanical heart valves, or who has had pulmonary embolisms in the past. Usually an injectable anticoagulant is used first post-op and may be changed to an oral form for a short duration during recovery. You should be monitoring PT-INR values depending on the type of medication. It will all come together in time!!

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TBI = traumatic brain injury.

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