Advice from experienced nurses please

Nurses General Nursing

Published

Specializes in Cardiac & Vascular.

Good morning everyone. I'm back again to vent lol. So, I've been a nurse for 5 months now going on 6. I currently work on a Heart & Vascular floor in the hospital, where our ratio is 5-6 patients. I'm on the night shift.

Anyway, I just thought I'd feel a little bit better approaching the 6th month mark but I don't. I feel worse. I don't feel like I'm performing as I should. I've talked to my director and she stated I was doing great. She also said she isn't hearing from other nurses that I'm leaving work for them, even though I feel I am.

The other day I had to call a critical WBC count @645 am, it was an expected value anyway since the patient has cancer and is on radiation and chemo. When I called, I didn't realize the BMP was back as well and I should have also told the physician about that to see if he'd order replacement for a 3.0 potassium level. The day shift nurse ended up replacing it once the doctors rounded that morning and put in orders.

So, when I met with my director, we talked about working on my time management. I just didn't realize how busy charting, assisting with toileting, meds, and other tasks can get. I get frustrated when I have 4 patients and an empty room, because I already know I have to get a patient. Which I don't mind, it just throws me off a lot. I feel so busy most times that I'm overlooking things.

Ex. 1. Friday, I received a patient from another floor around 2am in with encephalopathy, and narcotic dependency. She had a fentanyl patch on.

I remember to put her on telemetry since there was an order for it. She didn't have any meds due. Normally, the MAR system gives a message about continuous pulse ox for fentanyl patches. It didn't this time and I forgot to put her on pulse ox. Her vitals were good and she was on 3 L NC and was sating high 90s.

The day shift nurse asked me later in report did I put her on pulse ox and I felt so embarrassed. I told her I'd do it once I gave her report. She beat me to it.

Ex 2. I've had 2 mislabeled blood specimens in the past month and a half, which were both caught by lab promptly.

I've been using the 2 person system, but I think that person was just signing instead of verifying it was the correct patient.

I'm just very afraid to be considered an unsafe nurse and it worries me.

On my days off, I still think about how I could have been better during a shift and what I didn't do.

Anyway, I just feel like I'm barely making it each shift. I have support from other nurses if I need it but I hate nagging them. I know they have their own load. Now, the CNAs are another story. Some will flat out refuse requests or either forget. How convenient, right?

Ex. "I'm not going to the cafeteria to get the patient a snack box. He should have eaten his dinner".

Seeing as dinner is served between 4-6, and its now 11pm. I'd think he'd want a snack.

Ex.2 " I forgot to retake the BP you asked me to retake because you gave PRN hydralizine.

Even though I'm just sitting at the desk on my phone, I still managed to forget.

I have one cna who thinks I just like to find work to do. No, we're supposed to reposition patients and recheck vitals, sugars, etc., when they are high or low.

I had another one tell me since she had 4 3am labs that morning, we needed to split them. Normally, they have more than that seeing as they can have between 8-10 patients. I normally help with labs anyway. But that morning I was swamped, I had to in and out 2 patients, finish charting, and get ready to pass 6 am meds.

I really don't think some of the aids understand how busy we can get. And I'm not one to overly delegate. Most of the time, I do things myself if I can. But I'm learning I can't do everything. Especially when I'm leaving work after 8 or sometimes 9 and the cnas are leaving before 730 am. I really want to switch floors soon. But I'm not sure if Id get the same support elsewhere.

Sorry for the long post, I just really wanted to give the full picture. Thanks for reading.

4 Votes

I’ve only been a nurse for 7 months but I too feel like I’m drowning still. I swear it’s become worse in the past month.

The issue with the aides is absolutely unacceptable. They don’t respect you. Have you asked other nurses on your unit if they act this way toward them? Did you bring it up with your director?

1 Votes
Specializes in Cardiac & Vascular.

Yeah, everyone I've talked to stated the drowning feeling is normal, and you don't get comfortable until after a year. I don't see myself making it that long. I already feel burned out. And the other, day and night shifters complain about the aids. The aids only do as much as they feel they should do. I've heard 1 or 2 of them bragging about having 5 writeups! The director is aware. She wanted me to give her names. I didnt feel comfortable with that.We have such a high turn over of them. I think we have at least 5 or 6 new aids now. Yet, we're always short. But we're short nurses too. I wonder why. I've seen 2 or 3 aids leave or get fired so far. I don't think its going to change.

1 Votes

I think you're doing great at 5/6 months in. Here's why:

  • You know what you don't know and you're fixing it.
  • You have developed an intuitive grasp of the big picture, and you're getting a good sense of priorities.
  • You take responsibility for your mistakes, and learn from them.
  • You feel like you're "barely making it" each shift, but you ARE making it.

I hope you don't mind if I give you some suggestions.

You need to start caring less about what the CNAs think. In your career you are going to deal with a lot of people who have all kinds of motivations. Some will want to do as little as possible and still get paid. Some will spend a good part of their shift comparing the amount they have to do with you and others. They aren't all going to have your professional values, leading them to agonize over every missed task and mistake. Some will conveniently "forget", others will actually forget; it doesn't matter, it's your job to pleasantly remind them. They may or may not get how busy you are and want to help you. They may be resentful and think you are making work for them. That needs to be OK with you because you can't control how they think, but you can direct their actions. On the other hand, some will be a pleasure to work with. Maybe just on some days, but still. . . Validate the hell out of them when they do perform well. Tell them you really enjoyed working with them. Tell them you appreciated the good care they gave. Tell them it's nice to work with someone who tries to give such good care to OUR patients. Celebrate with a high five or a "toast" over a glass of juice or water something that went well. Congratulate yourself and others when things go well.

Some things to reconsider: If you already have a high turnover of aides, why not give names to the director of the ones who are not pulling their share? (After, of course you have talked with them and see no change) If a bad actor stays, you have no chance of getting a helpful assistant. If the bad actor leaves, the next one might be a bright and shining star or not, but there's a chance he or she will be. Also, reconsider how much help you are asking for and how much you delegate. If you are hustling and someone else is not, you must delegate or your time management will suffer. If you think you need help, ask yourself if you can do it and ask for just the help you need, no more and no less. If you're in a supportive environment the other nurses won't mind your questions and requests for help because you are being thoughtful about it. Even if you're in an unsupportive unit a nurse's failure to ask for help when needed can cause bad outcomes for patients. Which is worse, asking for help or seeing someone with a bad outcome because you didn't? Lastly, please consider sticking with that unit for at least a year. If you transfer, you just have the standard learning curve of a new unit PLUS the new grad learning curve. That's the frying pan into the fire.

This is too long. Sorry.

9 Votes
Specializes in Cardiac & Vascular.

@Katillac Thanks for your kind words and advice. I realize it is better to ask for help than to see my patients suffer the consequences. The other nurses are very understanding and will usually come to my aid if they aren't too tied up with their own patients. That's one of the great things about my floor. You're right about the aids. I do tend to let them stress me out, because I'm not a good enforcer. Most times I do things myself because I don't feel like dealing with attitude. But, I've been getting better with delegating appropriate tasks and not worrying what they'll think. The only reason I didn't want to name drop is because I didn't want to be responsible for someone losing his/her means of income. But like you said, sometimes people have to move along so other motivated people can come in and do what's needed. Lastly, I'll try my best to stick it out for a year. I've talked to the nurse I oriented with. She's a seasoned nurses with 23 years of cardiac experience. She suggests sticking it out for a year and then going to the CVICU or CCU. She thinks a lot of my problems stem from delegating and how detailed I am. The latter she considers a good thing and she states that's why she thinks I'm such a good nurse. I just have this strong desire to make sure the 4-6 patients I have get the best care I can give. And I just get so frustrated when I don't feel like I'm giving the best care.

5 Votes
1 hour ago, ADN_Is_Complete said:

Now, the CNAs are another story. Some will flat out refuse requests or either forget. How convient, right? Ex. "I'm not going to the cafeteria to get the patient a snack box. He should have eaten his dinner". Seeing as dinner is served between 4-6, and its now 11pm. I'd think he'd want a snack. Ex.2 " I forgot to retake the BP you asked me to retake because you gave PRN hydralizine. Even though I'm just sitting at the desk on my phone, I still managed to forget.

17 minutes ago, ADN_Is_Complete said:

You're right about the aids. I do tend to let them stress me out, because I'm not a good enforcer. Most times I do things myself because I don't feel like dealing with attitude. But, I've been getting better with delegating appropriate tasks and not worrying what they'll think. The only reason I didn't want to name drop is because I didn't want to be responsible for someone losing his/her means of income.

It sounds like you are doing fairly well. ?

I will address the CNA issue.

Although it's a very normal (or common) reaction - give some thought to your overall negativity with regard to the techs/aides. Please know I am not calling you "negative." I'm saying that you are thinking about it negatively. Two different things.

You are dreading the interactions and expecting the worst.

You will approach them differently when you maintain a straightforward-but-genuine kindness and expect the best.

How they choose to receive your appropriate, kind, and professional interactions is on them.

Let's take the lunch box example: You are going to approach kindly and for now forget being irked about the apparent laziness/phone use.

"Are you able to run down and get a lunch box for 421 please?"

One of two basic things is going to happen:

They will do it with or without complaining; if they choose to complain it has nothing to do with you. Just say thank you and let them go about it - and you go on your way since you have many other things to worry about.

Or, they will give you some sort of feedback and ultimately refuse to do it. For example maybe they will say it's unnecessary and if you want the patient to have one you will need to go get it yourself.

These types of responses you will write up and report. Factually. Few words as possible.

Then, you will refuse to worry about someone else's paycheck under these circumstances where they are not being mistreated or wronged in any way. Why should you worry about their paycheck more than they do?

14 Votes

You will undertake all of your other communications with these principles in mind.

- During your report you are reminded that a patient needs a pulse oximeter in place and that you haven't done it. You say, "I remembered the telemetry and didn't get the pulse ox yet. I can do it right away after report." If they hustle in there and get it done before you can, great. Resist the urge to consider whether they meant to one-up you in some way - - they'll wear themselves out with that behavior eventually and they don't have a good self-esteem anyway if that was their intention - - but it might not have been. Maybe they are just organized and have the time and feel better getting it done right away. Fine. None of it has anything to do with you. Just take it as a good lesson that you'll probably remember next time you have a patient with a fentanyl patch. That's how you learn. ??

Use your positive communications when asking someone to check/double-check your work, as well. If someone is checking your lab labels, ask them to take a good look at it because you want to make sure you have done it correctly. No big deal. Be pro-active with this communication rather than waiting to try to correct after they haven't looked properly.

"Can you do a lab label verification for me? I'm trying to get better at this so please scrutinize it! [smile]" Make sure to thank them.

It's all good.

I very highly recommend approaching from a positive mindset as much as possible. Expect the best. Take appropriate actions based on the responses you get.

Refuse to let negative people get in your head.

As always, be kind and friendly. Thank others. Help them when you can.

7 Votes
Specializes in Cardiac & Vascular.

@JKL Thank you for your advice. I appreciate you giving me a different outlook on the aids. I try to always be respectful to them "Could you please" "Thanks so much". I was an aid while I'm school, so I feel like I have a lot of understanding for them. But I really don't like to ask them for help due to some of the attitudes. I'm really working on that. I inderstand we're both here to do a job and we both need to do it. The lunchbox was a different CNA on a different day. Basically, she told me point blank she wasnt going to do it so i had to. The same one who told me I'm always finding extra stuff to do. But you're right regarding the need for write-ups if need be.

3 Votes
Specializes in Critical care, Trauma.

I think you're right on schedule with where you "should be" for your level of experience. None of the mistakes you've described are terrible. They don't show any glaring lack of critical thinking. They're just little mistakes that people will make, especially when they're busy, trying to rush, and maybe a bit distracted. No patients were harmed. ? You're doing better than you realize.

I wasn't a new grad when I entered the hospital (3 years primary care) but I still felt like I was drowning. My expectations of myself were not realistic and I beat myself up for every little mistake, no matter how insignificant. I went to my boss crying and she was surprised because she'd been hearing good things about me. I just expected that I should be doing better.... more time efficient, more knowledgeable, etc. Unfortunately the only way to get rid of that feeling of drowning.....is to continue to allow yourself to drown. I had to take deep breaths, remind myself that other people went through this same process and that's how they got to be the people that I looked up to and admired. None of them started out that way. I worked on that floor for 2 years before I moved to the ICU and I became someone that new hires and nursing students looked up to because I made a point of letting them know that it's okay to feel overwhelmed and to make mistakes, as long as you learn from them.

Writing everything down helped me a lot. If I have to rely on my own memory by the end of the shift, that information is going to be gone. lol I updated my little nurse brain sheets to have a "things to do this shift" section where I could write down things that needed to be done as I was getting report or along the way, and a "things we did this shift" section so I could give updates in a prompt way during hand-off rather than trying to look back over the shift in my head.

Take note of that voice in your head that says you're not good enough. If you pay attention, you might be able to decide whose voice that is.

You'll figure out your way, in your own time. Self-flagellation will not make you a better nurse or a happier human being. Be patient and kind with yourself. Remind yourself at frequent intervals, that a lot of people that have been where you are right now and lived to tell about it, all say you're doing a good job.

3 Votes
Specializes in Community and Public Health, Addictions Nursing.

I don't have any other advice to add, but I just wanted to say that based on your OP, ADN_Is_Complete, you sound like a very conscientious nurse who has the initiative to reflect on your work regularly and think about areas where you can improve. Kudos to you for that!

If your nursing coworkers and director are being supportive of you, and you're getting good reviews from them, I'd encourage you to hang in there and try to stick at this position a little longer. Having that support can really make the difference with a hospital job. As for the CNAs, I agree- the issue needs to be addressed, but at least it sounds systemic and not like anyone is targeting you specifically to give a hard time to.

Good luck to you!

1 Votes

You're right on track..... minimum one year to start feeling comfortable.

I worked with one CNA who was infamous for valid sounding reasons to not do things.

Advice I got here on Allnursus was to say "I need" not "could you" for recalcitrant CNA's. (I use this in my grandson also.)

I have to add almost all CNA's I've worked with have been amazing and saved my hiney numerous times

3 Votes
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On 2/23/2019 at 8:23 AM, ADN_Is_Complete said:

Goodmorning everyone. I'm back again to vent lol. So, I've been a nurse for 5 months now going on 6. I currently work on a Heart & Vascular floor in the hospital, where our ratio is 5-6 patients. I'm on the night shift. Anyway, I just thought I'd feel a little bit better approaching the 6th month mark but I don't. I feel worse. I don't feel like I'm performing as I should. I've talked to my director and she stated I was doing great. She also said she isn't hearing from other nurses that I'm leaving work for them, even though I feel I am. The other day I had to call a critical WBC count @645 am, it was an expected value anyway since the patient has cancer and is on radiation and chemo. When I called, I didn't realize the BMP was back as well and I should have also told the physician about that to see if he'd order replacement for a 3.0 potassium level. The day shift nurse ended up replacing it once the doctors rounded that morning and put in orders. So, when I met with my director, we talked about working on my time management. I just didn't realize how busy charting, assisting with toileting, meds, and other tasks can get. I get frustrated when I have 4 patients and an empty room, because I already know I have to get a patient. Which I don't mind, it just throws me off alot. I feel so busy most times that I'm overlooking things. Ex. 1. Friday, I recieved a patient from another floor around 2am in with encephalopathy, and narcotic dependency. She had a fentanyl patch on. I remember to put her on telemetry since there was an order for it. She didn't have any meds due. Normally, the MAR system gives a message about continuous pulse ox for fentanyl patches. It didn't this time and I forgot to put her on pulse ox. Her vitals were good and she was on 3 L NC and was sating high 90s. The day shift nurse asked me later in report did I put her on pulse ox and I felt so embarrassed. I told her I'd do it once I gave her report. She beat me to it. Ex 2. I've had 2 mislabeled blood specimens in the past month and a half, which were both caught by lab promptly. I've been using the 2 person system, but I think that person was just signing instead of verifying it was the correct patient. I'm just very afraid to be considered an unsafe nurse and it worries me. On my days off, I still think about how I could have been better during a shift and what I didn't do. Anyway, I just feel like I'm barely making it each shift. I have support from other nurses if I need it but I hate nagging them. I know they have their own load. Now, the CNAs are another story. Some will flat out refuse requests or either forget. How convient, right? Ex. "I'm not going to the cafeteria to get the patient a snack box. He should have eaten his dinner". Seeing as dinner is served between 4-6, and its now 11pm. I'd think he'd want a snack. Ex.2 " I forgot to retake the BP you asked me to retake because you gave PRN hydralizine. Even though I'm just sitting at the desk on my phone, I still managed to forget. I have one cna who thinks I just like to find work to do. No, we're supposed to reposition patients and recheck vitals, sugars, etc., when they are high or low. I had another one tell me since she had 4 3am labs that morning, we needed to split them. Normally, they have more than that seeing as they can have between 8-10 patients. I normally help with labs anyway. But that morning I was swamped, I had to in and out 2 patients, finish charting, and get ready to pass 6 am meds. I really don't think some of the aids understand how busy we can get. And I'm not one to overly delegate. Most of the time, I do things myself if I can. But I'm learning I can't do everything. Especially when I'm leaving work after 8 or sometimes 9 and the cnas are leaving before 730 am. I really want to switch floors soon. But I'm not sure if Id get the same support elsewhere. Sorry for the long post, I just really wanted to give the full picture. Thanks for reading. * I've tried to break this up in paragraphs but the spacing looks really weird. Not sure why.

The way I read this is that you're a new grad only six months in to your first job. Is this correct?

At six months, you're not only still learning the job, your co-workers, time management, the drugs, the labs, how to talk to physicians, etc. you are only now beginning to realize how very much you DON'T know. This is more or less what we old timers used to call "reality shock." You THINK you know what you need to know to do your job, and you are only just beginning to understand the sheer magnitude of things you DON'T know. It's pretty overwhelming.

It takes about a year for a new grad to start to feel comfortable in the job, and about two years to become confident. Changing jobs not only looks bad on your resume, but it slows the process as well. So please, do not even think about changing jobs at this point. The time to change jobs is when you're competent at this one.

This is a normal part of being a beginning nurse. Unfortunately, the only way to GET through it is to GO through it. We have all been there -- at least those of us with enough healthy fear not to be dangerous. We got through it and you will too.

As far as working with aides -- you don't say where you're from, but what you describe sounds like an east coast (of the US) thing. You have to learn how to work with aides. They are part of the health care team as well. It doesn't seem fair that you have to cajole them to do their jobs, or spend time talking with them to get them to want to work with you, but sometimes that's what it takes. Aides are people too, and if they think you like them and care about them, they'll work much harder than if they think you don't like them and don't care about them. Take the time to get to know them as people, and you'll probably find you'll have less trouble getting them to do their jobs.

I hope this helps. Stay in touch with us and let us know how things go.

6 Votes
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