Advice for new nurse

[SCM01]

A hospital came to my school last year basically hiring my entire class. Although I was on of the first people to interview, I was the last to hire. I accepted a position on medical rehab. I was excited just to be in the hospital. Unfortunately because of the overload of new grads, my manager did not give myself and other nurses the proper orientation. I was not put on days, go to GI or ER to learn how to place IVs and do blood draws, admissions, discharges, etc. I was put on night immediately. I learned how to admissions but they are few and far in between on nights in rehab. My orientation was fairly easy, which it shouldn't have been. Flash forward to a few months ago, I was told I have to be in charge when other senior nurses aren't around. I had to learn as I go basically or call my preceptor if I had questions. I got yelled for waiting till day shift came to ask questions about certain duties I had perform because I wasn't taught how to do charge during my orientation. Flash forward to now. I am somewhat "capable" of being charge but I do not like because I'm not familiar with rapids and emergency situations, I have only been in 3 rapids the entire time I've been there. I just stand there looking like a deer in head lights because I have no idea what to do. The most I can do is take the vitals and BS. But knock on wood, it hasn't happened on my shift as charge. All of a sudden our manager decided to have a "designated charge" which means the 2 most senior nurses are charge and no longer have to float. That being said, the patient to Staff is usually 3 nurses for 16 patients or more. Currently our census is 6 and so we do not call for 3 nurses. The issue I'm having, along with other new nurses is that we are now the only ones able to float to other units. We have little to no experience with fresh post ops, hanging iv meds other than antibiotics, no iv push, how to even put in an iv, etc, basic skills that a new nurse should have learned but we have not. I'm scared that my license is in jeopardy if I go to a floor and end up getting patients that I cannot care for because I was never trained properly. I floated once to another floor and I was blessed that all the nurses and charge were helpful and helped me and guided me in my charting and admissions. They showed me how to hang iv Tylenol and chart for ETOH withdrawl, which I have never done because by the time they reach rehab, they have been in the hospital for awhile. I'm not sure what to do. I asked my manager if we are rotating floats even though there is a DC and she said no, That I'm gojng have to float each shift because the other nurses haven't completed their 90 days. I want to float to get the experience because I want to learn. I am just horrified that I am going to screw something up because I am not properly trained and I will ask a million questions but I feel like that is not helpful to the other nurses who are busy with their patients. I just don't know what to do. Idk if I should bring it up my manager why if the other nurses are capable of being charge when the two senior nurses aren't there, why do you we need a DC? Do I just take the floats and pray that I don't screw up?

I am stuck on my unit for another 4 months before I can bid off my floor. But I'm counting down the days.

[llg, PhD, RN]

If it were me, here is what I would do.

I would have a sit-down meeting with my Manager (or Educator or whoever is appropriate in your setting) ... and tell them that I am very willing to float, do Charge, etc. ... I would say that I look forward to those opportunities to grow in those ways. However, because I went straight to working a permanent night shift schedule as a new grad, I don't feel adequately prepared for some of the situations that these new responsibilities might demand of me. I would then ask if the Manager has some suggestions on how you can brush up on those skills so that you can be sure to be prepared to handle those new responsibilities.

Be positive, be willing, be cooperate, etc. ... but ask for some advice and learning assistance. If that gets you nowhere, then develop a learning plan for yourself. You're a professional nurse. You should be able to make a learning plan.

[JKL33]

Agree with the above.

It might be useful, before having this conversation w/ your manager, to make a list of actual deficits - positively phrased as "goals." Try not to let your fears and perceptions overshadow reality - for instance, if you say you can only take a glucose and vitals in a RR/code, that means you have not attended BLS class, let alone ACLS. Is that really true? If so, then heck yes, BLS training (or better yet ACLS) can go on your list of "desired learning opportunities."

Keep an upbeat outlook and by all means choose your words carefully. It's one thing to say, "I'm excited about all the things I've learned thus far and looking forward to _______" and another thing entirely to say, "With all the new grads no one gave me/showed me/taught me/let me do ______."

Don't get me wrong, I "hear" you, and I'm capable of getting on a soapbox to defend a situation like yours. Just the same, your goals should guide and determine your handling of this. Talk future, not past, and use positives as opposed to negatives whenever you can. "I'd love to increase my confidence with IV starts" not "No one ever taught me how to start an IV."

Good luck!! :)

[SCM01]

I did speak with my manager asking if I had to float this week and next week, would it be possible to for me do a shadow float so I can get a feel of what kind of patients and what I'm expected to know, including time management. I'm not used to do getting admissions in the middle of night while taking care of other patients. Usually the admissions are done in the day. She said she would take it into consideration. I did voice my concern that I want to float but I'm nervous because I lack the experience/skills that those floors demand. She hasn't responded back. I did talk to the union about the floats not being rotated and their mentor director called me. They will be setting me up with a new mentor because my orginal one never reached out to me and I just forgot about it because I wasn't sure how a mentor would be able to help me. She suggested that I should follow the rapid response team to get a feel of what goes on in a rapid and how to respond to emergency situations in a way where you don't get in the way but still able to help. I said yes, please take me off my floor and send me with someone so I can learn. So we shall see if this really happens. If not, and I have to float, I just hope that the other nurses on the floors won't feel like I'm a burden or get mad when I'm asking a million questions. I did take the BLS class but I feel like it just told me how do CPR if I find my patient unresponsive/not breathingbut nothing about how to handle rapid responses/codes, especially when there is a room full of people. Like heart attacks/chest pains/ strokes, like what do in those situations or how to handle it if my patient is in the middle of stroking out or having a heart attack. My floor doesn't require for me to get my ACLS so they won't pay for it. Once I get to another floor though, I will have to be certified. I will ask my manager if she is willing to let work pay for my ACLS, maybe I will feel more comfortable in those kind of situations. I do watch a lot of YouTube videos on skills. My issue with starting ivs/blood draws is find the vein and going in at the right angle. When I do get a chance to do blood draws and starting ivs, which is rare, I miss the vein or blow it. Any advice on how to practice finding and getting the right angle when I have no patients to practice on?