Advice please

[AvaRose]

I know most new nurses ask questions similar to this so I apologize in advance. I tried talking to my Charge Nurse but she didn't want to talk to me any of my last 3 shifts and I have no idea how to dig myself out of this rut.

PROBLEM:

-I seem to be declining in performance. I was fine the first month on my own, but now 5 months into my Med/Surg position (3 months w/preceptor, 2 months solo) I am barely keeping my head above water.

For example: I've now had 3 patients in the last 2 weeks "fire" me as their nurse, today alone there were 2 of them and they complained about me to the doctor so they were reassigned supposedly so they wouldn't "make the rest of my shift miserable" (according to Charge RN). In addtion, the CNAs and UC all feel free to criticize how slow they think I am and complain about me asking them for anything at all so I have to total care all my patients because apparently "I don't do enough" during the shift. And finally, no matter what I try for time management the plan does not survive anywhere near intact for more than the first hour of shift. By mid 8 am med pass I am behind, running like a headless chicken, and unable to prioritize because I am constantly told that "everything is important so you need to hurry up and multi-task and get everything done in the next 15 minutes so you aren't any later."

I end up crying in my car everyday at lunch time and sometimes in the restroom during shift. We have no DON right now so I can't even go to anyone else to ask to change to night shift, or split my schedule (who knows if they'll give me my schedule request so I can have more than 1 day off in a row), or even change floors even though I'm supposed to stay for 1 year due to New Grad contract. It's so bad I even contemplated turning in my license and going back to working at Wal-Mart.

Sorry to unload I just don't know what to think. I've probably burned all my bridges already but I'd at least like to know that so I could quit instead of being fired.

[NurseCard, ADN]

How many patients do you have per shift? What types of patients?

What acuity?

If you are doing total care on 5-6 high acuity patients, it's no wonder

you are behind all of the time. You shouldn't be afraid to ask the

CNA's and UC to help you do things that is their job.

Of course, I know from my own unfortunate experience.. there are

CNA's that will gladly bite your head off for asking them to do

things that you likely could have done yourself... especially if

the CNA is busy doing something else. But if a CNA is sitting

at the desk charting, they can help you with those tasks.

[Cactus Nurse]

How many pt total. Why do you have to do total care? That's what CNA's are for? You should be doing only meds and tx, then if something is urgent then you can do care, otherwise the CNA should be doing care??

Why are the patients "firing you" that's the issue. Is it your bedside manner? Are you being rude? Rude to family? Are you not giving them their pain meds when they are "begging for it?"

---- If a pt is asking for pain meds- give THAT med only and finish your sequence, whatever path you were already on and tell them "i'll be back later for the rest of your AM meds, I'm at the other end right now" and walk away.

Are y ou forgetting pt preferences? Like crushes with applesauce? Whole with cold water, not warm? Things like that? Think about what it is that is making these people mad and see what you can change.

This just might not be the facility for you, maybe LTC, clinic, anything else? If you have to stay there another 6 months just work on what you need to so that patients aren't unhappy.

We are nurses so our patients are happy and can get healthy again, you need to find a way to make them happy and they will BEG to have you as their nurse not the other way around.

[AvaRose]

I have 6 patients of various acuity. I believe today there were three 3's and three 4's (5 is where we draw the line and refuse to take a patient). I had 2 that were pain management though one only asked for pain meds twice. The reason one patient fired me was because I didn't spend enough time in his room. Now I was told he was difficult to everyone when I took report, so I don't feel quite as bad about him as I do the other patient who's mother was upset that I took 10 minutes too long to give her daughter pain medication. The patient and I had a good rapport until her mother showed up and then I was the root of all evil somehow.

I do total care because I'm tired of being ignored when I do ask the CNA to do something while I pass meds. I have to pick my battles and honestly I just don't have the energy to argue anymore. No one gives a damn if my day is spiraling out of control as long as they don't have to listen to me.

As much as I'd like to just up and quit I know I probably won't get another nursing position. I'm already on job number 2 in just under a year (5 months in each job). At the same time though, I'm not overly confident that I have many more chances left to show improvement.

[Cactus Nurse]

In November I will have been working as a nurse for 2 years. In that time frame I have had 5 jobs. I'm on fifth now. In nursing it's not as bad to have a long resume of different jobs, because you can easily say, "I got a better opportunity" or "___ wasn't the right field for me."

Don't be afraid to quit if you can find something better! I think you need a talk with your unit manager or supervisor, who ever manages the CNA's, because it is not ok for you to take time out of your day to be doing care. That could be a potential for you being late on med pass and then have another family get mad for meds being given late, etc..

I have a pt who would constantly say to me she didn't like me as her nurse... well she has Narcs and I wouldn't leave until I saw her take them... so she didn't like me. I've always been sweet to her however, and she refused meds, I didn't push it, but I always tried to have a small chat when I could, if she was on a good mood with me... well finally about 2.5 months later, lol, she likes me haha. The other morning I woke her up for her 0600 meds and she was sticking her tongue out at me, kinda like a little kid does through a window, if you get what I mean, it was so cute and honestly made my morning.

Pt have bad days and when someone gets mad at me I always think... they are at a ****** time in their life. Something happened and they are here with us, they need care, they need meds, they can't go home just yet, or maybe never. Of course they will have bad days, be angry for no reason, be depressed, but there's always tomorrow. Don't let a family member who doesn't know what we do as nurses say she doesn't like you and let it affect you.... Those meme's about, "sorry I didn't answer your call light to get you water because I was doing CPR next door", is our real world.

And also remember, we always have pt discharging, going to hospitals, room changes, so it's not like your necessarily stuck with the same people forever, things will change and things will get better. Nursing isn't easy, if it was, we wouldn't need a license or a degree to do it.

[NightNerd, MSN, RN]

Chin up! The first year sucks, no matter how you slice it. I'm sorry you are freaking with these stressful things all at once.

First, I would ask to meet with your unit manager and possibly the charge nurse, during a time when no one is busy and can actually focus on the conversation. Say what you just told us about how you're concerned about your performance and ask for feedback, specifically regarding the patients who fired you. Some people just cannot be made happy; it's happened to all of us once or twice. Maybe they genuinely feel it was a fluke that it happened twice on the same day, or maybe they can help you refine your approach for the future. Even if you don't plan on keeping this job for long, it's good to have some different perspectives to take with you elsewhere.

With the multi-tasking and prioritizing, just do the best you can. You are still learning, and even the most experienced nurses just have those shifts sometimes where everything falls apart. Your goal is to keep your patients safe and comfortable, and to help restore their well-being. Sometimes little things get dropped, and it sucks; streamlining the little details with the big picture comes with time. Stick with your goal, ask for guidance and help when you truly need it, and try to tune out the negativity of, "You're moving too slow and you need to get everything done NOW." Yes, there is time-sensitive stuff in nursing, but if you're 15 minutes late with someone's Neurontin or whatever, everyone's life will go on! Tackle the most crucial tasks first and work your way down your list; it all gets done eventually, and you are one person doing everything you can for your patients.

As for the CNAs refusing to help you, that is a big problem. I have left a job in part because this was an issue across the board and nothing was being done, even after staff tried to resolve conflicts on their own. Being a newer nurse is tough, because techs sometimes have trouble taking direction from someone they view as a novice. I think a natural assertiveness tends to develop in all of us as we gain experience, so this WILL get at least a little easier on its own.

Are there a couple particular people who are the most common offenders? If it's one or two people you're having the most trouble with, it might be worth talking to them at a less busy time: "I feel like we're having a hard time working together. I want us to have a good working relationship and be able to take care of our patients together. What do you think is stopping us?" Listen, digest their thoughts, and remember to voice your own ideas as well. This can be an excruciating conversation and it may go nowhere, or it may help ease some tension and garner you some respect. You don't know until you give it a shot.

Do other nurses have the same issue with the techs that you know of? Unfortunately, sometimes whole work environments can just be toxic, and you can't fix it on your own. For your own sake, in that case it might be better to start looking elsewhere for work.

Hang in there!