Advice from experienced nurses please

Ruby Vee, BSN · Feb 26, 2019

15 hours ago, mtmkjr said:
First thing.. what?? I'm confused. What happens in the rest of the country that's different than on the East coast??

I've lived on the east coast, the west coast, the midwest, the mid-Atlantic region (which I see as east coast, but they don't), New England and Florida. Each part of the country has their own culture. It is more noticeable in the CNAs, Its and other ancillary staff (to me, at least) than it is in RNs and MDs who perhaps are more geographically mobile? For example, have you ever been to an outdoor festival in Seattle? Did you find toilet paper in the bathrooms? How about Jazz Fest in New Orleans? Did you take your own hand soap?

Ruby Vee, BSN · Feb 26, 2019

2 hours ago, ADN_Is_Complete said:
Thanks so much for commenting RubyVee. I've seen your advice on other posts and it is always spot on. Yes ma'am. I'm a new grad, 6 months in. And I thought the honeymoon and excitement phase lasted a little bit longer. It only took a few weeks for that to wear off for me. But you're right. I'm discovering the magnitude of everything I don't know and it's stressful. I still hate having to page doctors and relay information. But its a must. I'll get through the new grad experience somehow just like everyone else. I think my worst fear is being a dangerous and unsafe nurse. I just want to do right by all of my patients and keep them safe. I'm from South Carolina. And even when I try to be chummy with some of them, theyll stilI do what they feel is warranted. I think the attitude is because they feel they dont get paid enough for this. Plus, many are probably burned out from chronic short staffing. I definitely will continue to post updates.

You don't sound dangerous or unsafe -- you're learning how much you don't know. Dangerous and unsafe nurses rarely figure that out.

I've never lived in South Carolina, but the attitudes you describe sounds a lot like the attitudes I encountered in Baltimore. The CNAs really do not get paid enough for the work they do, and they have so much work to do that getting burned out is very real. Some CNAs also think they know more than they do -- so one way to cope is to explain to them why something needs to be done. Some will get it, some will refuse to get it. But it's worth a try.

Ruby Vee, BSN · Feb 26, 2019

1 hour ago, JKL33 said:
There is a mindset and an approach to this, as well. Communicating with other members of the care team, including physicians and other providers, should not be viewed as a necessary evil any more than we would want them to consider communicating with us to be a necessary evil. We are merely conveying something on a patient's behalf/in a patient's best interest. We can only take responsibility for how we approach others; we allow others to take responsibility for how they approach us and respond to us.
When I have communicated in an informed, straight-forward manner, the number of times I have been treated poorly is less than a handful. Those poor responders were outliers and I viewed them as such rather than basing my entire self-worth on their poor reaction.
On an occasion or two I received terse responses as a result of someone (appropriately) wishing that I had handled something a little differently - - I simply accepted the response and let it inform my future practice.
As a new grad, I had the (hard copy/paper) chart open and would even make a list of basic facts I wanted to convey, because I was well aware that I was still learning how to synthesize information and present an overall issue succinctly. Sometimes I either prefaced or ended my information/report with the fact that I haven't made too many of these calls and so if I don't/didn't present all the information they need, they are invited to let me know. Some people don't agree with this approach and find it self-deprecating - I personally never felt that way, and in every instance that I chose that approach, it put me on the fast track to a rapport and a very normal conversation ensued.
These are the kinds of concerns that are going to drive your development into a great nurse.

This advice is spot on. One more thing -- doctors are people, too. It's part of developing good workplace relationships to take a minute every time you encounter them for some brief personal chitchat. It's difficult at first.

Years ago, there was a physician who had a well-deserved reputation for being an asshat. He'd yell and scream at whoever was brave enough to call him for a change in patient condition, and once got into a physical altercation with a surgeon that resulted in a nurse being smacked in the face. I dreaded calling him. I dreaded seeing him. Then one day, I saw that someone had left a scuba diving magazine on the unit, and when I eagerly picked it up, I saw his name and address on the address label. The next time I saw him, I handed him the magazine and said "I didn't know you dove. What do you think of ___________?" It started a conversation about diving. From that day on, he looked for me whenever he came on the unit so that we could discuss his latest dive or mine.

He wasn't any nicer to the rest of the staff, but I never had another problem with him again. That's just one extreme example, but it pays to spend a few minutes with personal chitchat to develop good workplace relationships.

NurseSpeedy, ADN, LPN, RN · Feb 26, 2019

On 2/23/2019 at 12:24 PM, ADN_Is_Complete said:
@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.

By any chance did you work with these CNAs before you became a nurse? Sometimes there can be issues when moving from an equal position to one that is now delegating the tasks. It shouldn’t be, but if they are used to you doing the task and not delegating it, it may be why you’re getting brushed off now with your new role as a nurse.

Also, it may be that the CNAs don’t realize all the responsibilities you have that they can’t see you physically doing. When I worked at an ALF I was the only licensed nurse. I have a few calls out to physicians and was in the middle of transcribing some new medication orders as well as filling out incident reports/follow up for the falls that occurred overnight. A resident would put on their light to get ready for the morning and head for breakfast. I have no problem helping out but no one can step in and do my duties if I’m tied up with someone and cannot stop suddenly because I’m in the process of transferring a patient. I noticed that the Med tech and the aide were talking at the med cart and every time a light went off they were radioing me telling me to answer the light because they knew I was in the office. They didn’t know the duties of my job or that I was already doing several things simultaneously even though I wasn’t in a resident’s room. What got me irritated was that I was getting pulled away from what I was doing and I saw two employees standing in the hallway next to the meg cart. Write ups would not help for that facility. It was happy to be able to say a warm body was in the building. It didn’t write up or terminate someone until they no call no showed for three consecutive shifts. They would literally not show up for the weekend and report to work Monday with no administrative action taken.

ADN_Is_Complete, ADN · Feb 27, 2019

15 hours ago, JKL33 said:
There is a mindset and an approach to this, as well. Communicating with other members of the care team, including physicians and other providers, should not be viewed as a necessary evil any more than we would want them to consider communicating with us to be a necessary evil. We are merely conveying something on a patient's behalf/in a patient's best interest. We can only take responsibility for how we approach others; we allow others to take responsibility for how they approach us and respond to us.
When I have communicated in an informed, straight-forward manner, the number of times I have been treated poorly is less than a handful. Those poor responders were outliers and I viewed them as such rather than basing my entire self-worth on their poor reaction.
On an occasion or two I received terse responses as a result of someone (appropriately) wishing that I had handled something a little differently - - I simply accepted the response and let it inform my future practice.
As a new grad, I had the (hard copy/paper) chart open and would even make a list of basic facts I wanted to convey, because I was well aware that I was still learning how to synthesize information and present an overall issue succinctly. Sometimes I either prefaced or ended my information/report with the fact that I haven't made too many of these calls and so if I don't/didn't present all the information they need, they are invited to let me know. Some people don't agree with this approach and find it self-deprecating - I personally never felt that way, and in every instance that I chose that approach, it put me on the fast track to a rapport and a very normal conversation ensued.
These are the kinds of concerns that are going to drive your development into a great nurse.

Thanks for addressing that JKL33. I think the biggest issue for me is knowing what information is important and what can be omitted. I understand how busy everyone can be and I just want my call to be straightforward. I've started jotting down notes and before I call I mentally reheorifice the important points. I don't find that method self-deprecating.I think I'll try including that. And like you said having the chart open and ready.

ADN_Is_Complete, ADN · Feb 27, 2019

13 hours ago, Ruby Vee said:
You don't sound dangerous or unsafe -- you're learning how much you don't know. Dangerous and unsafe nurses rarely figure that out.
I've never lived in South Carolina, but the attitudes you describe sounds a lot like the attitudes I encountered in Baltimore. The CNAs really do not get paid enough for the work they do, and they have so much work to do that getting burned out is very real. Some CNAs also think they know more than they do -- so one way to cope is to explain to them why something needs to be done. Some will get it, some will refuse to get it. But it's worth a try.

I agree. They really aren't well compensated for the work they do. I try to always explain what tasks I have to do if I can't do something myself. I feel like some understand this most times and don't just think that I don't want to do something. I really try not to overload them. I believe in helping however I can. I remember when I was precepting as a SN in ICU, I expressed interest in working there once I graduated. An aid told me I needed to go to the floor first because it's scary what the new nurses don't know and how badly they are talked about. I was really shocked. I agree sometimes aids do think they know a bit more than what they do.

PacoUSA, BSN, RN · Feb 27, 2019

If it makes you feel any better, I was a train wreck as a new grad and used to fumble with many details as you are doing. To be honest, I read your post and I have to say I was worse than you ? ... I remember ignoring an order to stop a heparin gtt at 10pm and by george it was still running at 7am when handoff occurred. Needless to say, the patient could not get surgery that day.

7 years later, I have gained much more confidence in my skills. The ONLY thing I still struggle with even so many years later is delegation, which stems from the fact that I worked in a facility as a new grad where CNAs where notorious for hiding out and as an RN you were forced to do certain things you would normally delegate because it was faster than searching out the CNA (but wouldnt you know, they magically appear the second you are completed). Because of that my time management was affected too.

That is my worst PTSD but it has gotten a tad better.

Wanted to share my story because I know how you feel. I could have written the same post years ago. It gets better and in a few years you will laugh like I Iaugh at my new grad days too. I only wish I had a YouTube video to post of me back then so you could see. I am proud of how far I have come, and you will too. Hang in there!

ADN_Is_Complete, ADN · Feb 27, 2019

12 hours ago, NurseSpeedy said:
By any chance did you work with these CNAs before you became a nurse? Sometimes there can be issues when moving from an equal position to one that is now delegating the tasks. It shouldn’t be, but if they are used to you doing the task and not delegating it, it may be why you’re getting brushed off now with your new role as a nurse.
Also, it may be that the CNAs don’t realize all the responsibilities you have that they can’t see you physically doing. When I worked at an ALF I was the only licensed nurse. I have a few calls out to physicians and was in the middle of transcribing some new medication orders as well as filling out incident reports/follow up for the falls that occurred overnight. A resident would put on their light to get ready for the morning and head for breakfast. I have no problem helping out but no one can step in and do my duties if I’m tied up with someone and cannot stop suddenly because I’m in the process of transferring a patient. I noticed that the Med tech and the aide were talking at the med cart and every time a light went off they were radioing me telling me to answer the light because they knew I was in the office. They didn’t know the duties of my job or that I was already doing several things simultaneously even though I wasn’t in a resident’s room. What got me irritated was that I was getting pulled away from what I was doing and I saw two employees standing in the hallway next to the meg cart. Write ups would not help for that facility. It was happy to be able to say a warm body was in the building. It didn’t write up or terminate someone until they no call no showed for three consecutive shifts. They would literally not show up for the weekend and report to work Monday with no administrative action taken.

Hey NurseSpeedy! I was floating all around the hospital when I was an aid. The funny thing is I never floated to that floor and I didn't even realized it existed. Haha. I didn't know about it until I was interviewed by the Cardiac Division. This included CCU, CVICU, Cardiology and Heart & Vasc. My original goal was to go to Cardiology but when I finally took NCLEX, I only had an offer from Heart & Vasc. At that point I was broke and ready to accept any offer.

ADN_Is_Complete, ADN · Feb 27, 2019

4 minutes ago, PacoUSA said:
If it makes you feel any better, I was a train wreck as a new grad and used to fumble with many details as you are doing. To be honest, I read your post and I have to say I was worse than you ? ... I remember ignoring an order to stop a heparin gtt at 10pm and by george it was still running at 7am when handoff occurred. Needless to say, the patient could not get surgery that day.
7 years later, I have gained much more confidence in my skills. The ONLY thing I still struggle with even so many years later is delegation, which stems from the fact that I worked in a facility as a new grad where CNAs where notorious for hiding out and as an RN you were forced to do certain things you would normally delegate because it was faster than searching out the CNA (but wouldnt you know, they magically appear the second you are completed). Because of that my time management was affected too.
That is my worst PTSD but it has gotten a tad better.
Wanted to share my story because I know how you feel. I could have written the same post years ago. It gets better and in a few years you will laugh like Iaugh at my new grad days too. I only wish I had a YouTube video to post of me back then so you could see. I am proud of how far I have come, and you will too. Hang in there!

Thanks for commenting. I couldn't help but laugh when you said "by George it was still running at 7am". You're right. Hopefully I will look back and laugh on all of this. Maybe I'll make a post in a couple years about how unrealistic I was as a new grad. Haha. I think the delegation thing for me stemmed from when I was orienting, my preceptor would have me do everything so I knew how to do it. She had me shaving patients, lab draws, ADLS. Which is good but she never really showed me how to delegate. We would just do whatever came up. So in my mind, I'm like I'll just do whatever and not even look for an aid. I've gotten better. I don't call them for everything. But like a previous poster stated, it's not fair for me to hustle and for them to be sitting around. And right "magically appear. They knew what they were doing.

PacoUSA, BSN, RN · Feb 27, 2019

28 minutes ago, ADN_Is_Complete said:
Thanks for commenting. I couldn't help but laugh when you said "by George it was still running at 7am". You're right. Hopefully I will look back and laugh on all of this. Maybe I'll make a post in a couple years about how unrealistic I was as a new grad. Haha. I think the delegation thing for me stemmed from when I was orienting, my preceptor would have me do everything so I knew how to do it. She had me shaving patients, lab draws, ADLS. Which is good but she never really showed me how to delegate. We would just do whatever came up. So in my mind, I'm like I'll just do whatever and not even look for an aid. I've gotten better. I don't call them for everything. But like a previous poster stated, it's not fair for me to hustle and for them to be sitting around. And right "magically appear. They knew what they were doing.

I have been on this site since I started my prereqs about 10 years ago. I bet I can go back and find a post or two and be like WOW! were you thinking? Lmao! ?

LilPeanut, MSN, RN, NP · Feb 27, 2019

In the NICU, we cluster care for the babies. I'm sure it won't work exactly the same with adults, but when you cluster care, you know when each feed, diapering/reposition, assessment is going to be, then you figure out when the meds are going to be. When I was a bedside RN at first, I would just write down the 12 hours I would be there and what needed to happen each hour (whose cares were which hour, whose meds were when, standard unit things like weighing and bathing, etc) Now other stuff would happen too, but it gave me a plan for the night to start with.

ADN_Is_Complete, ADN · Feb 27, 2019

2 minutes ago, LilPeanut said:
In the NICU, we cluster care for the babies. I'm sure it won't work exactly the same with adults, but when you cluster care, you know when each feed, diapering/reposition, assessment is going to be, then you figure out when the meds are going to be. When I was a bedside RN at first, I would just write down the 12 hours I would be there and what needed to happen each hour (whose cares were which hour, whose meds were when, standard unit things like weighing and bathing, etc) Now other stuff would happen too, but it gave me a plan for the night to start with.

Good points. I try to cluster when I can especially since I work nights. I assess with my med pass. Also, I ask the patients about pain, potty, positioning, etc before I leave the room. Most times that helps, but you have the occasional patient who hops on the call bell 3 minutes after you leave the room.