Am I Cut Out For This?

[Nutrix_de_Volcano]

It's 2am and I cannot sleep. I'm supposed to be up in about 3 hours to get ready for work. As I already have a stinking cold, I think I will call in to staffing for a sick day.

But, this day won't be just to rest my body, it will also be for my mental health. Besides not being able to sleep, I was dreaming about my work - going over patient charting and feeling overwhelmed by things I had forgotten to do that I suddenly realized that had to be done. When I woke from this, I started to cry, because it was just like how it has been at work in my orientation.

It is hitting me that I am losing my confidence that I will get through my orientation. I really feel that I just plain suck as a nurse, that all I learned in nursing school has not adequately prepared me for what I am doing right now, and that the best of what I have to offer is not coming through in my work. Nearly every day on my unit, I throw myself 100% into my work, yet at the end of the day I feel like a complete failure. The day feels like a battle lost.

Specifically, I am presently taking three patients without delegation to a CNA. I do complete care, with my preceptor hanging back. With the exception of a couple of days, each seems like a step backwards in my learning process. For example, how one day went: Right out of report I was bombarded with a STAT PICC draw on one patient, a new admit with radiology calling on hold about her, with my 3rd patient's call light on for 10/10 shooting pain. This is before I have even looked at a single chart! By the time I put out all the fires and get caught up with assessments, vitals, and morning meds, it's 11am. By then my brain has turned to mush and I have 3 bed baths to do. My brain sheet is filled with chaotic scribbles that cease to make sense to me. I spend the rest of the shift scrambling to get charting done, along with I&O's, IV flushes, more meds, and giving report. More often than not, I end up staying 1-2 hours after shift to finish my charting.

My last shift pushed me to the tipping point. I was given a preceptor I had specifically asked not to be placed with (had a previous BAD day with her). Sure enough, about 3 hours in she berated me in a really sarcastic fashion about what I was planning to tell a doc I had paged re: a patient with a blood glucose of 40. Our protocol calls for "collaboration with a physician" in the giving of a D50 bolus for hypoglycemia. (The pt was NPO pre-procedure). So, rather than clarifying with me about how to act quickly for this pt (which I knew I had to do - she was disoriented, shaky, and diaphoretic), my preceptor went ahead and wrote the order herself (as a telephone order from the MD WITHOUT having talked to him yet!) and ceased to explain her rationale behind this. For the rest of the day, I tried to get everything done while avoiding my preceptor at all cost. She didn't review any of my charting and just hung back to care for her ONE patient. She left at the end of shift without saying WORD ONE to me. I was in such a bad way that I wasn't doing my job well at all. I was 2+ hours late doing an initial assessment on a patient who was a new admit (didn't even do a complete head to toe), I missed a dressing change on another patient, and my 3rd was awaiting discharge. The doc wrote the med orders at 3pm and left the unit. Between myself and the nurse coming on for this pt, we realized that 2 of the meds were wrong (one was a med the patient has a sensitivity to and the other was a wrong dose).

So, between that and having to catch up on charting, I had to stay in extra 1.5 hours. When I got to my car, I broke down crying.

On my way home, I left a voice message with my unit manager to request a meeting with her. I warned her of the possibility that I might be calling in sick tomorrow since I was really feeling cruddy, but that I wanted to talk with her either way. I feel like I am just not cutting it, especially since I was to start having 4 patients this week. I just cannot get a core work flow down. My day will start off with plans but then all falls apart 3-4 hours into the shift. It seems uncanny that I'll have one patient EVERY SHIFT who becomes unstable - syncope w/ low BP or new onset A-fib and tachy (becoming a tele transfer) or change in LOC. I get sucked into these situations and my day goes to heck. It makes it so I can't get back on track to address all of my patient's needs.

On one of these days, I didn't get to turn one of my patients Q2 as much as scheduled. The next day, I learned that her red bottom was turning into a stage 2 decub. I felt repsonsible for that!

Right now I feel like a wreck and I am crying as I write this. I plan to talk to my manager but I just don't know what to do. To make matters worse, I really need this job as I have debts (student and other loans, and ironically some medical bills) that I have to pay down, without delay. It feels like things are caving in on me. As much as I have told myself that I WILL get better at this, that things will become less difficult to do, I am suddenly very doubtful.

In a postscript, a classmate of mine just quit her residency at another local hospital. She has gone through a similar new nurse crisis, and her coworkers were treating her horribly. I haven't talked with her today, but I plan to touch bases with her.

No one warned us in nursing school of just how difficult things would be. Thanks for reading.

[Hairstylingnurse]

hang in there, i'm finding that this is alot more common than you think. i still have days like that unfortunately. i wish there were a way to prepare new nurses and returning nurses for the nursing world. i honestlydon't know how we could do that or even where we would start. best of luck to you and just know your not alone...

[nursemike, ASN, RN]

Hey, nutrix, glad you're feeling better. I think the switch to nights is going to help you some. Passing 20 zillion meds is definitely less hectic than 100 zillion meds, it's less crowded, fewer patients off the floor for testing, and on my unit, there's a camaraderie among the night crew that you just don't see on days.

I've also found that most nurses enjoy sharing their knowledge--don't be afraid to ask questions. I've been told countless times that the nurses they worry about are the ones who know everything. And, really, it isn't unusual to see two 20-yr nurses bouncing ideas off each other. This truly is a lifetime-learning situation we're in. Ain't it cool?

One of my clinical instructors used to complain a little that none of us seemed to be having fun in our clinicals. Well, duh! Sheer terror and total confusion isn't fun. But I'm finally starting to see what she means--on some demented level, nursing truly is a blast.

I work on a neuro unit, too. It's definitely a different world. Our docs can be mighty stingy with pain meds (for good reason--it's hard to detect mental status changes when they're snowed) and my first patient fall was on Oct 2--fortunately, only our second for the month. Also the first time I've ever seen a Foley come out inflated. And all this while another patient was running the halls, naked. Yeehaw, indeed. One upside, I guess, is that I've been able to do several proceedures for the first time on patients who were single digits on the Glasgow scale. It's a lot easier to straight cath someone when they don't know they're being straight cath'ed.

It sounds like you're nurse manager is as crazy as mine. I was totally hopeless--the worst nurse ever! And she kept telling me I was doing fine. Very unsettling, but I finally just started to take her word for it, and you should, too.

On a totally unrelated note, I'm guessing nutrix is Latin for nurse? If so, would that make a male nurse a nutor? I'm not sure I like the sound of that...

[AviatrixRN]

Hi, Nutrix_de_Volcano . . .Well, you're experiencing what many of us went through as new graduate nurses. I don't want to belittle your feelings because I know they are real. Many of us had similar emotions and experiences as new grads as you are having now. I guess the first thing I want you to think about is whether you have been told by your manager, or whoever is the overall director of your orientation, that you are doing a poor job. You didn't mention that had happened, so my guess is that the people orienting you are feeling that you are at the place you need to be in your orientation. Otherwise, my experience as a manager has been that an orientee who is doing very poorly gets reported right away and called in for conferences. So, no matter how rotten you think you might be doing, unless someone is telling you that you are doing a rotten job, you should assume that you are doing OK. Does that make some kind of sense to you? I hope that makes you feel a little more at ease.

Nursing school can only give you the tools to help you get through this time you are having. It's kind of up to you to learn how to use those tools. Consider nursing school much like being given the how-to instructions. That doesn't make you an expert with them, however. That comes with hours and days of using them.

My days as a staff nurse start off with a plan as well which often falls apart a couple of hours into the shift just like yours. The difference is that you have not yet mastered the art of prioritizing and figuring out how to get back on plan. This is not something you master in a week or a month. It takes months and lots of hands-on, in the trench, experience with it. You are working on a particularly busy kind of unit (telemetry, right?) Telemetry is a very intensive kind of work situation, even for an experienced RN. I worked on a stepdown/telemetry unit for 5 years, so I know. And, it sounds to me like the preceptors you are with are giving the reins over to you while they watch. As cruel as it may sound to you now, it is the only way you are going to learn how to handle yourself. Shadowing someone isn't going to help you a whole lot anymore. Your preceptors understand that you have to be thrown into the melee and there's no easy way to do that. The various preceptors that you are going to be working with are not the same as your nursing instructors from school. Most of them got into the position of a preceptor because they are being recognized for the good job they do as staff nurses, but it doesn't necessarily make them professional teachers. However, for the rest of your career as a hospital staff nurse you will be paired with other staff nurses to learn new things. That is how it works in each place of employment. What the hospital doesn't lose sight of is that you are a paid employee. And, based on what you have written I know you understand that relationship.

Here are a few things I would suggest you do to help you feel like you have some control over what is happening because right now I know you feel like you are on a runaway train going downhill and waiting for a crash to occur! First of all, you need to forgive yourself for not living up to YOUR standards. That is something that will come with time. You need to debrief yourself after each day you work. You need to allow yourself time when you get home to have a good cry and then go back over what you did successfully and what you could improve upon. For example, your patient with the blood sugar of 40. . .I would have done the same as your preceptor. I learned after a few experiences with this to treat the patient first and worry about writing the order and calling the doctor later. So, after you dry your eyes and are in a calmer state ask yourself why the preceptor handled the situation the way she did. (Asking yourself these "why" questions is how you are going to master this stuff to your satisfaction.) First of all, a blood sugar of 40 is a panic value. It is pretty close to 20 which is where I've seen patients go into full blown seizures. If I was satisfied that the value of 40 was correct (and by the symptoms she had, it was) my priority is to get that blood sugar up immediately or you're going to possible be witnessing a grand mal seizure. Now, what the preceptor knew that you don't yet, is something about the doctor. She knew the hospital protocol and she knew the doctor wasn't going to read her the riot act for taking action without calling him. She acted to get that blood sugar up. This was one of those famous "nursing decisions" you heard your instructors talking about all the time. Well, you witnessed one and had a front row seat! The emotional excitement of the moment clouded your common sense for a bit. Not to worry as this is probably going to happen a number of times over your career. Re-read the hypoglycemic policy. Notice that it doesn't list the order of the steps you need to take. It does, however, list all the things that you need to do which gives you the freedom to adapt it to the situation at hand. This is called "nursing judgment". As long as you get that list of things completed you have followed the policy. As you learn the various doctors and how they like things done for their patients you will learn who will be OK with you taking an action first and then notifying them. Something you need to realize is that your chances of actually getting to speak with the doctor on the phone in order to get the order for the 50% dextrose bolus was slim to non-existent. The doctor expects you, the RN, to handle this situation. The different preceptors you work with will help you with this, so ask each one how they would handle a situation like that and I'm going to bet that they will all pretty much tell you they would have done what your preceptor did. File that information away in your head, as it will come in handy in the future. Next time you will have a better idea of what to do in this situation. Now, that doesn't mean that your heart isn't going to pound like crazy, that you are going to remain perfectly calm and not experience one pang of anxiety, because you will. But, that is normal as you are learning to make this kind of nursing decision. After a couple of experiences with low blood sugar, you too will react exactly the same way that your preceptor did.

It is going to kind of go this way for many of the things you are going to learn. You will have patients crashing, code blues, a dressing change that got forgotten about, patients who fall out of the bed, patients throwing up blood, relatives complaining about something that didn't get done for grandpa, patients who didn't get turned every two hours like they were supposed to. . .oh, I could go on and on. You know the book-learned part of it, but not how it is actually put into everyday practice.

Will you believe me if I tell you that it takes at least 6 months to even begin to feel like you are making any headway in understanding what you are doing as a hospital nurse? This is a conservative estimate, too. It takes time and patience. Patience is not something we hospital nurses are always good at practicing. Most of us like things done yesterday. You will have some days when you will cry all the way home, so you might want to keep a box of Kleenex in your car. When you are calmer you have to look beyond the emotion and analyze your actions. What did you do right? What did you do that wasn't very efficient? What did you forget to do? And, most importantly, what will you plan to do the next time it happens? And, these kinds of things do happen again and again. The thing is you just never know when. Murphy's Law: anything that can will go wrong. A good philosophy to have some respect for and try to plan ahead for. That adds an element of anxiety to the whole thing. Maybe you'll get your actions absolutely right the next time around; maybe you'll leave a few things out again. But, you self-analyze and decide where you need to improve, make a plan of what you will do the next time the situation comes up, and move on. If the best thing you can say happened is that you didn't kill the patient, then you've had a degree of success. Maybe not the kind of success you had hoped for your first time out of the box, but you'll get another whack at it, I guarantee it. :icon_hug:

If you are a writer or a good typist, I recommend that you start to keep a little journal of these experiences you are having. Memorialize them on paper so that a year or so from now you will be able to read them, realize how far you will have progressed and perhaps have a good laugh at yourself for being such a worry wart (well, that may not happen for another couple of years). I'm not belittling your feelings in any way. I am trying to give you some hope. All new grads go through this. You experiences may be a little more hectic and harrowing than someone else's. Telemetry is like the wild, wild west. But I guarantee that you are not alone. We have all gone through this process. It would help to have really kind preceptors at your side to always be nurturing, but the fact is that some will just not be that kind or nurturing. After you've had your cry when you get home then you can cuss them out to your satisfaction for treating you so badly. What you do is keep moving forward and make a solemn promise to yourself that when you someday precept someone you will treat them much differently. I was treated horribly as a new grad and never forgot a minute of it. I think that what kept me going was that I don't like to fail so after each episode of being beaten down, I got back up and tried again. Eventually, I wasn't getting beaten down as much. For that reason I have a very soft spot in my heart for young people like you who are struggling with your new role. I understand what you are going through. You have it within you to triumph over this. After all, you finished nursing school and passed your NUCLEX. I've been in nursing for 30 years. I still have an occasional day when I come home angry--you see, the tears got replaced by anger at some point along the way. My problems are also due to a failure in mastering some nursing skill or nursing judgment although for awhile it had to do with the management of employees rather than nursing procedures. Learning is a lifelong pursuit. There will always be something to learn. It's just that right now it's being thrown at you by the bucketful. Just plant your feet with a wide base of support as you get ready for the next bucket! If you get knocked down pick yourself up and widen your base of support a little more.

Rest today. Try to do something fun even though you're not feeling that well. Oh, and the dreams. . . I used to get some doozies! They are just a manifestation of your anxieties and fears and an attempt by your subconscious mind to make some kind of sense of what your day was like. Don't read too much into them. As your anxiety calms down, so will the wildness of your dreams.

Daytonite,

What a terrific post! I will be graduating in December from an ADN program and have been offered a position on a Med/Onc unit. I am very excited to start my career but know that there will be days when I will be pulling my hair out and wondering "what was I thinking?!"

I just wanted you to know that I have saved your post and printed it out for future reference ( for when I am having a bad day!)

Thanks again!

[NYCRN05]

You are SO normal, and you make me feel like one of the gang!

I've been placed with FOUR preceptors, in the last eight weeks (I am an ER newbee, new grad May 2005, without ANY nursing experience).

Every darn one of them has a different way they think I should do nursing.

I've had nurses argue that "they didn't have time for me" - where I could overhear them.

I've had preceptor rattle off (as she's headed down the hall) what I am supposed to do, I go in there to do it, can't figure it out, ask another nurse to help, he tries to help and screws it up worse, then I go BACK to my preceptor and then SHE proceeds to dress me up and down in front of DOCS, NURSES, UNIT CLERK, AND patients at the top of her lungs saying "I sent you in there and HOUR ago! You can't be doing one on one patient care here!" (She may as well have just cut to the chase and called me an incompetent idiot) :chair:

At that point, I'd finally had it with her abusive behaviors. I stopped dead in my tracks, turned around and yelled back at her (in front of ALL to hear) "OK, then YOU go do it ______(her name)". "I DON'T KNOW HOW!!! ______(her name). You have not SHOWN me how to do it_______.(her name) So YOU go do it, _____her name".

I think everyone is going to remember HER name, don't you?

Most unprofessional of me...but NOW she knows MY boundaries and has piped down. I think sometimes we new graduate just have to establish a pecking order and let them KNOW we are not going to take such abuse.

Good luck. Everything you are experiencing is NORMAL. Just remember it when you become a preceptor, and don't be a crappy preceptor like they obviously are.

:yelclap: :yelclap: :w00t: :w00t: Jerico, You are MY HERO!!!! I hope I can develop a backbone like yours and put a certain preceptor at my hospital in her place like you!!! From one new grad to another... :kiss :balloons:

[oldiebutgoodie, RN]

Hi, all,

I am working on an ICU, still in orientation, now about 3 1/2 months into the job, and I, too, feel like everybody else on this board. I have had about 8preceptors, nurses who ask, "What did you learn in nursing school?" because of my inexpertise in various areas, one preceptor that accused me of med errors that I did not make and generally made my life a living hell. I requested that she not precept me anymore, but unfortunately, I am working tonight, and though she's not precepting me, she will be there being the bane of everyone's existence.

I, too, hate the thought of going into work, I have wild dreams about work where people criticise me constantly, and I feel less confident as the days go on. I still have 6 weeks of orientation left, and frankly, I am starting to think that orientation is more confidence-sapping that confidence building.

At least it is comforting to know that I am not alone in these feelings. Why, oh why, can't precepting nurses be more supportive? I have a friend who has been just devastated by her preceptor. This is crazy.

Good luck to everyone, and hopefully, we will survive this.

Oldiebutgoodie

[shortsteph12]

I am working on a tele floor, and I am up to 6 patients. I have been on orientation for about 10 weeks now. I know exactly how you feel. My preceptor sometimes keeps me over to go over my charting and we don't leave until she sees something wrong. On Friday I made some mistakes there was a rhythm on the tele strip that my preceptor said not to label and that the Dr was aware. Well at the end of the day she berated me for not calling the Dr with the strip, since the patient was having some more PVC's. So I called the Dr and the Dr came and looked at the strips, at one point the patient bradyed down to 38 for a couple of seconds. The patient was asymptomatic. I go in and out of my patients rooms all day, to check on them, give meds, make sure they are not in pain. I take a 15 minute lunch break if then. Otherwise I am doing patient care. Sometimes I feel so stupid, how did I pass nursing school? Its nice to know others feel that way. My preceptor berates me for every little thing that I miss. My manager said I am getting better, calmer, more organized. ( by the way I am working days). So I think that 6 patients is quite a bit to handle. I have had to take 5 patients and a CHF transfusion patient. Which I think is just insane. I am doing the best I can but sometimes I think maybe I have made a mistake.... But then at least once a week I have patients tell me I am the best nurse there. Which helps me feel better

[Bambury]

Daytonite - what a wonderful and encouraging post that was. It was great seeing things from a nurse manager's perspective.

Jerico - I agree with you. I think that sometimes we have to put our foot down. I did the same when I was still a nursing student. I wouldn't take my clinical preceptor's abuse (even to two clinical instructors), so I would point it out EACH time when she was being a bully and inappropriate. She would be stunned by it. But each time, I did it respectfully, but very honestly. Towards the end of my clinical preceptorship, she apologized direly for her behavior. I think she was afraid of any bad remark I might write on her evaluation (which I did). Conversely, she wrote me the best evaluation, as did the clnical instructors. I think that it was eye opening, as well as refreshing for them to hear someone they wouldn't have expect to speak, to indeed, speak up!

Nutrix - Take good care! I'm feeling for you! I will begin my orientation day 1 this Monday. Keep on talking to other nurses, the nurse manager, and to anyone else who will listen. I think it will make your day feel possible and lighter just to talk.

[mediatix8]

Just look at where you are right now and where you once were... your first day of clinical, your first day at this job. Don't quit... it would be disrespecting all the things you learned and all of what you have learned... big and small... is a wonderful asset to society. I've seen difficult nurses everywhere... every clinical I've had, and now at my current first job. I've seen really good nurses too... not everyone makes a good preceptor. There are difficult CNAs and MDs, too. (Everybody's stressed, and some people handle that by lashing out at others, that's all). I know it's hard to convince yourself of your high self worth when you know that you didn't know something you think you should have known or can look back and see you didn't handle a situation the best way, but I think often we forget to praise ourselves of the difficult journey we have gone though and all of the learning we have done in the short time that nursing school is. Society needs you, yes, you... you, who has to stay late to chart, you who missed a dressing change, and you who was late on an assessment for a new admision. Besides, it will all get better once you can delegate to a CNA... seems strange they are making you do that much work. I wouldn't take any more patients without being able to delegate. Also, you need a good sleep! I take Melatonin, found at your local walgreen's pharmacy... it's considered a "nutritional suppliment" and can be located by the other nutritional supplements. It doesn't last so long that you're groggy when you wake up.

[Newbie_RNA]

Hi,

I too have just qualified and have had the most awlful past 6 months in nursing. I have to say my experience's have been thorughout my placements as a student. I have found many nurses to be less than human like towards patients and staff, especially students, and you also get the added bonus of HCA's trying to outwit you at every opportunity. Also I do agency work (for needed spondoolies) and have found many of the nursing staff can be so damn bitchy. Trust me I have also been through the mill, been bullied, lied too, lied about, and I have actually over the past few months really questioned why I am doing this. I have now just taken my first post (havent started yet) and I have opted out of the acute environment and have taken a post one step out of the hospital. I just couldnt and wouldnt let myself even go through that hellish 6 months to get my confidence and skills up to date, because in all honesty I dont think I could last 6 months, in that tye of environment.

Just know that there are sooo many of us feeling the same,and just remember theres always another ward to consider should this become unbearable.

Take care x

[dorimar, BSN, RN]

nutrix,

If it makes you feel any better, my orientation as a new grad was eerily similar to what you are going through. I felt responsible for things i wasn't ready for, and I knew it wasn't enough that I just didn't know better. I always realized that i was dealing with people's lives & that even a little screw up was a big deal. It wasn't like working on computers or even billion dollar accounts. I knew exactly how important it was to know what i was doing. It made it 100 times worse, when an experienced nurse be-littled me for my mistakes or errors in judgement. I can still feel my stomach drop into my rectum and my ears buzzing and my hot red face just thinking about it. But here is something positive: That was 20 years ago, and I made it, and I am an exceptional nurse today. We all STILL have days like you describe. Part of the reason that it upsets you so terribly, is that you care. KEEP CARING! There are many out there that do not. Their job is much easier. You are NOT a failure. You are very normal. And SHAME on your preceptors, and nurse manager.

Doris