New Onco RN struggling to adjust

  1. 0
    Hi all-
    Let me start off by saying I graduated in August of 2012 and have searched for jobs constantly until January of 2013. I wanted a job in OB and it was the only area I could see myself in. Student loans began to creep up on me and I was forced to make a decision to either find a job anywhere in nursing or sink. I was lucky enough to be hired onto a med-surg oncology floor for nights. With only one month in, I am feeling stressed, depressed, having nightmares about making nursing mistakes, and find myself emotionally distraught and crying a lot. I have had many patients get sent to hospice already or I hear news from day shift that something traumatic happened and they have died. I am becoming overwhelmed by the stress and have been getting sick to my stomach almost every day of work. I rarely see family and friends because I'm now a "night owl". I guess I'm just hoping for some encouragement... I don't know if its the nature of the job, the fact I work nights, or just being a new grad, but I was hoping that someone could offer some advice about how to cope. I don't feel like quitting is an option so I need some survival techniques to last 11 months before I can switch specialties. Please help...
  2. 11 Comments so far...

  3. 2
    I was physically ill most of the time as a new grad in med/surg. What helped me was to make friends anywhere I could. Let the RTs, CNAs, senior nurses, etc. know how much you appreciate them. Always ask for help or clarification when you're unsure about anything...even if you're only a little bit unsure.
    You'll learn to organize and re-organize as time goes on. You'll also run into fewer things that are completely new to you and get better at navigating around those constant bumps in the road.
    You can do this. Your confidence just needs time to grow.
  4. 2
    Hey RNewbie,

    I was an unwilling Onc recruit when I started out, too. I know it's a little more terrifying than some other specialties because our patients can be so sick. But like Orange Tree said, you're new and it's normal to feel anxious. Are you being oriented still or are you on your own?

    If you're being oriented, ask questions of your preceptor. Ask them what you need to chart on a daily basis and write it down--perhaps on the back of your name tag or somewhere accessible on every shift. This is how I survived my first few months of nursing until I knew everything that was expected of me. I would run down the list, check all my charting and make sure everything was in every night before end of shift. As you're going throughout the day, have different sheets of paper for each of your patients and write down things that you do for them / that you need to chart / that are important to their care (ex: Mrs. Smith is concerned about not having X medication ordered and wants you to call the doc).

    If you're having issues with organization, sometimes it helps me to write down orders by hand. I'll look at the order set and put it down on paper in a certain format so that I know where to find info when I need it.

    If you're not being oriented, ask questions whenever you're worried. I know this is hard because you probably feel like a pain in the a**, but it's the only way to learn and it's how to keep yourself and your patients safe. Don't be bullied into being silent. You have a right to feel comfortable at work and supported by your coworkers.

    As far as patient deaths/downtrending, that is an unfortunate reality of oncology nursing. If you're religious, lean heavy on your faith. Do you have other nurses who are friends of yours? Talk to them about things that bother you. If not, you can always PM me anytime. I saw things in onc that blew my mind and had it not been for having friends to talk with them about, I would've ended up on inpatient psych!

    Nights are such a challenge. I LIKE nights, but I still have issues with feeling normal when I'm on nights. It's hard to have a normal schedule of any kind when you're up all night, but there are techniques that can help you function. If you need to do something on normal business hours, try to schedule it for later in the afternoon or early in the morning. If you have to be up during the day, try to nap in the wee hours of the morning and trick your body into being awake.

    Keep in touch and hang in there! Let us know if you have more questions, and as always, feel free to PM me.
    SlightlyHumerus and jojo111 like this.
  5. 3
    Not sure if this will help, but I made up an example "brain" that I make for myself to keep track of my patients.

    I make one of these for every patient I have, usually on the back of the MAR I print for them (that way you've got your meds with you at all times, too). Some charting systems will make lists of what you need to do over the course of the day, but I find that I remember things better if I write them down myself.

    This one breaks down where I put what and explains the layout.
    Click image for larger version. 

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    This one is a mock-up of a basic patient you might see using the above format.
    Click image for larger version. 

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    Again, feel free to ask if you have questions!
    Last edit by SoldierNurse22 on Mar 6, '13
  6. 1
    Thanks for the organizational help.

    I think my main problem is really just trying to figure out if Nights/Oncology/Nursing is even "for me". I'm still in the orienting phase and actually considering quitting and finding another area to work in... but with the job market this bad, I don't know if it's even a good idea. I find myself just hating the job and trying to figure out why I did all this schooling in the first place... I cry on my way to work, in my car, run to the bathroom to cry in the middle of shifts if it's a bad night, and cry on my way home. I feel awful when I know I have to work the next night. I've never been depressed in my life and now I feel like I'm dying. I feel nauseated from staying up all night too. To top it off, I have an extremely good sense of smell, which means when I walk into a patient's room I can smell EVERYTHING. I have to hold my breath during assessments sometimes because I can't handle the body odor or urine smells. Cleaning patients is a nightmare and I find myself gagging and feeling really horrible because I can't control it but I don't want to make my patients feel bad. I just don't know if I chose the right career. :/
    SoldierNurse22 likes this.
  7. 0
    You should keep trying to get into OB. Sounds like oncology isn't your thing.
  8. 0
    Hey RNewbie, how are things going?
  9. 0
    Please do not get discouraged. I have been managing an oncology unit for 3 years. I never had done oncology sort of got the opportunity to manage a unit so I took it. I find it rewarding, the patients are very appreciative, yes some pass on but I always tell my staff we are helping them transition to a better place. Just a smile, holding their hand means alot. Have you tried to switch to days. I have had many of my nurse friends tell me thats depressing but I tell them not every one who comes in is dyiing we are trying to help them.
  10. 2
    Hi Rn newbie!

    I'm a seasoned nurse with onc and OB experience. Having worked all shifts I can tell you nights take a toll on your physical, mental and spiritual well being. Hang in there!
    And to put things in perspective , OB can be very sad and stressful. This month we had a baby that was born with hydrops ( not picked up on ultrasound-and died a few days later) a baby seizing and stroking, an 18 week twin demise, a full term demise, a baby born with ambiguous genitalia (the dad was devastated) a few months ago we had a mom that went into DIC and went to the unit-she was very sick. Some scary ****, pardon my French. It's not all happy happy. We have drug addicted moms-witnessing babies going thru withdrawals is heartwrenching! We have moms on their 8th kid, and the other 7 are in DCF/foster care, etc etc etc.
    Just thought you should be reminded that nursing can bring sadness, as time goes on you'll learn to cope with these things. And get off nights as soon as you can!!! Best of luck to you!!
    salvadordolly and SoldierNurse22 like this.
  11. 5
    Just a little update... I managed to speak with my director, and she helped me get into a position in OB! I'm really happy now and I can definitely say that it was onco that was killing me... I had never been so depressed in my life (and I am normally a happy, bubbly person). I am actually smiling at work again--- enjoying my job and life. I think that sometimes people are just "made" for certain areas of nursing. Oncology wasn't mine and I found that out pretty quickly. Kudos to anyone who works in that area (my heart couldn't take it!)!!! I know not everything in nursing is "happy" and sad stories hit no matter where you are, but at least now I am where I want to be and I wouldn't trade this for anything in the world. Thank you all for your encouraging words.


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