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Am I In The Right Place?

el0489 el0489 (New) New

I am very frightened right now. I have only been a practicing nurse for a few months. This is my 2nd career. I've had 2 months in the hospital and 3 months working on a busy acute rehab unit. I could not handle the stress level of the hospital and so I got into rehab thinking it would be more manageable. This is an acute rehab unit and is almost as bad as the hospital where I used to work. I haven't been a nurse for very long and I feel unprepared for a lot of the challenges we deal with on a daily basis. We get some very unstable patients who can crash on us at any time, we have unstable diabetics who are tricky to manage, we're under a lot of pressure to get meds, treatments and charting done in a timely manner. There's also pressure on me to make sure I leave on time to pick my son up. Although the directors are trying to be helpful and supportive, I feel incompetent and wonder I if I should quit before something happens where I could lose my license. Once you lose your license that's it, right? Maybe I need to chose another type of nursing.

sbic56, BSN, RN

Specializes in Obstetrics, M/S, Psych. Has 24 years experience.

There may be less acute types of nursing, but I'm wondering if your fears are more real or imagined. Have you made mistakes or are you just alert to the possibility that you could make one? I'd say most of us need ayear to start to feel really competent, some require more and that's no crime. The fact that your managers are being supportive tells me they may have more confidence in you than you do in yourself. I bet it'll come.

sirI, MSN, APRN, NP

Specializes in Education, FP, LNC, Forensics, ED, OB. Has 30 years experience.

I am very frightened right now. I have only been a practicing nurse for a few months. This is my 2nd career. I've had 2 months in the hospital and 3 months working on a busy acute rehab unit. I could not handle the stress level of the hospital and so I got into rehab thinking it would be more manageable. This is an acute rehab unit and is almost as bad as the hospital where I used to work. I haven't been a nurse for very long and I feel unprepared for a lot of the challenges we deal with on a daily basis. We get some very unstable patients who can crash on us at any time, we have unstable diabetics who are tricky to manage, we're under a lot of pressure to get meds, treatments and charting done in a timely manner. There's also pressure on me to make sure I leave on time to pick my son up. Although the directors are trying to be helpful and supportive, I feel incompetent and wonder I if I should quit before something happens where I could lose my license. Once you lose your license that's it, right? Maybe I need to chose another type of nursing.

I'll bet you have received more experience in how to handle these situations than you think. You probably are just too hard on yourself.

Why not try another area? Maybe, clinic/office nurse. The hours are less...........usually no weekends...........no holidays...... more time to spend with family. Less pay, however.

Good luck in whatever you decide!!

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

Give it a little more time.

I deal with acutely ill patients that can crash at any minute too. It's what nurses do.

The fear you have is entirely normal and reasonable, I feel it every day. But I can't let it stop me.

You are competent because #1 you graduated from nursing school, #2 the state says you are as you've passed NCLEX, #3 they people that hired you think you are.....you just need a healthy dose of self-confidence and self-esteem.

Everyone of us experienced those feelings of fear and doubt at first. For a long time I longed to just give up my license and go back to being a tech because I felt too incompetent to handle "real" nursing.

If I can do it, you can too. Hang in there and good luck to you.

SmilingBluEyes

Has 20 years experience.

what agreat post from Tweety. And so true. Be kind to yourself and never be afraid to ask ANY questions. Never pretend to know what you don't. Good luck.

Happy-ER-RN, RN

Specializes in Emergency.

You can't live in constant fear of losing your nursing license, that is just no way to live. I have been a new nurse in the ER for almost 3 months and I feel like you do. I think it just takes time to get used to everything and to learn. I have had a LOT of people tell me that it's the ones who aren't scared at this point and who think they know what is going on that are really having a problem and are a risk to their patients. So the fact that you are scared means you are right where you should be! I too have felt like running at times but I know if I tried something else I would be bored out of mind.

Good luck!

student4ever

Specializes in ER.

Tweety, as always you have such wonderful things to say! I'm not a new RN yet, but I've just started a new job as a CA, with a lot of patient care responsibilities in a busy ER, and I must say there are days I want to go home and give up on my new job and to give up on nursing completely. It can be so overwhelming, especially after coming from a job I could do in my sleep! But the fact that I am aware that I can make mistakes tells me that I'm aware of my own limitations, and if I need help, I need to ask for it. It also causes me to check and double check myself - which is a good thing to do. Give yourself some time and some credit - I can't say it as eloquently as Tweety, but yeah... you'll do fine, just give yourself some time and believe in yourself!

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience.

Unfortunately, nursing school can't totally prepare students for the actual chaos of a busy unit. It's just not the same when you are shadowing someone or managing just a few patients as a student. The pressure, as you've discovered, can be overwhelming. You haven't asked for opinions or advice, but I'm going to offer you something that can be very empowering for you and a very valuable tool. One of the best things you can do for yourself in order to keep some control is to self-evaluate your own performance when these "challenges" are over. I understand that you are busy with a child to raise, but this self-evaluation is also part of your education and you should try to make some time for it. At home, take some time to go back through your textbooks and notes on something that has been a "challenge" for you at work. Apply your nursing process to yourself. You collect your data (what happened at work, what your textbooks and notes say), then assess your performance. List, either on paper or mentally, what you did that was right and what you missed and should have done. Think about how you could have used the things you missed in your work scenario. Then, think about how you are going to handle the same kind of situation the next time it comes up. Sometimes you'll do very well the next time and sometimes you'll feel helpless again and not perform up to the standard you set for yourself. You just pick yourself up and keep on doing the self-assessment process because you will learn from it.

When I first started working on a cardiac unit we had a lot of people that got chest pain. Whenever I would chart the incident I would realize that I had forgotten to assess for SOB, or check the time, or ask more specific information about their pain. I finally typed up a one page guideline for myself (no computers in those days! :coollook: ). I still have it somewhere around here. It had a list of symptoms to look for and a guideline for charting an incidence of chest pain. Incidences of chest pain were the first time I started pulling up a chair and sitting with the patient for 5 minutes or so while watching for their response to nitroglycerin. I would pull this guideline and place it on top of my clipboard and refer to it while I sat with the patient. After awhile I didn't need the written guideline anymore, but it was like my training wheels until I got the hang of what I needed to be doing. Over the years I've done similar guidelines for myself for diabetes, seizures and handling chest tubes.

The first months working as a new RN are very stressful and laden with self-doubt and guilt that one is not performing perfectly. It was somewhere between 6 months to a year before I started to feel like I had a handle on things, and more like 3 years before I began to feel really confident and that I could handle most situations. The incidences of "challenges" begin to become less and less as you become more confident. However, they don't stop. Every once in awhile something will come along that will send me back to the books. This self-evaluation exercise has helped me all through my career. If you weren't advised to do something like this, you should consider trying it. It will help you feel more in control of your practice.

Thanks. Part of my fear probably is imagined but I have made some mistakes that were pointed out to my attention. One of them was a serious mistake. This patient had multiple issues and was suffering from a CVA. I mistakenly gave him insulin when he wasn't eating. His blood sugar was 101 but that was based on his having OJ, which I didn't know only lasts 1/2 hour. The insulin was intermediate acting but he bottomed out and had to be given glucagon several times before he was sent to the hospital. It was scary. As I said, he has had multiple issues, including CVA history, renal failure, but I find the business of diabetes management very complicated.

There may be less acute types of nursing, but I'm wondering if your fears are more real or imagined. Have you made mistakes or are you just alert to the possibility that you could make one? I'd say most of us need ayear to start to feel really competent, some require more and that's no crime. The fact that your managers are being supportive tells me they may have more confidence in you than you do in yourself. I bet it'll come.

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience.

Thanks. . .I find the business of diabetes management very complicated.

As I suggested above, I would go back into my textbooks and work up a little cheat sheet for yourself. Include in it, the facility protocol for handling hypoglycemia and assessing the patient's food intake. This is how you will learn it.

I also sent you a private message.

sbic56, BSN, RN

Specializes in Obstetrics, M/S, Psych. Has 24 years experience.

Thanks. Part of my fear probably is imagined but I have made some mistakes that were pointed out to my attention. One of them was a serious mistake. This patient had multiple issues and was suffering from a CVA. I mistakenly gave him insulin when he wasn't eating. His blood sugar was 101 but that was based on his having OJ, which I didn't know only lasts 1/2 hour. The insulin was intermediate acting but he bottomed out and had to be given glucagon several times before he was sent to the hospital. It was scary. As I said, he has had multiple issues, including CVA history, renal failure, but I find the business of diabetes management very complicated.

It sounds as if this patient was very comprimised and even though he may have received more insulin than he should have, I don't believe that was the sole reason for this type of reaction. There was probably alot more going on systemically that wasn't fully understood. As you said, along with a CVA, he had renal failure. He might have ended up in the hospital anyway, but happened to crash on your watch, which even though was exacerbated by too much insulin, was not the typical insulin reaction. I am sure this incident prompted you to do some extra research on these conditions. This is how we learn, by our experiences and also by our mistakes. Seize this as a great learning moment and realize you are now that much wiser!

krob0729

Has 8 years experience.

Unfortunately, nursing school can't totally prepare students for the actual chaos of a busy unit. It's just not the same when you are shadowing someone or managing just a few patients as a student. The pressure, as you've discovered, can be overwhelming. You haven't asked for opinions or advice, but I'm going to offer you something that can be very empowering for you and a very valuable tool. One of the best things you can do for yourself in order to keep some control is to self-evaluate your own performance when these "challenges" are over. I understand that you are busy with a child to raise, but this self-evaluation is also part of your education and you should try to make some time for it. At home, take some time to go back through your textbooks and notes on something that has been a "challenge" for you at work. Apply your nursing process to yourself. You collect your data (what happened at work, what your textbooks and notes say), then assess your performance. List, either on paper or mentally, what you did that was right and what you missed and should have done. Think about how you could have used the things you missed in your work scenario. Then, think about how you are going to handle the same kind of situation the next time it comes up. Sometimes you'll do very well the next time and sometimes you'll feel helpless again and not perform up to the standard you set for yourself. You just pick yourself up and keep on doing the self-assessment process because you will learn from it.

When I first started working on a cardiac unit we had a lot of people that got chest pain. Whenever I would chart the incident I would realize that I had forgotten to assess for SOB, or check the time, or ask more specific information about their pain. I finally typed up a one page guideline for myself (no computers in those days! :coollook: ). I still have it somewhere around here. It had a list of symptoms to look for and a guideline for charting an incidence of chest pain. Incidences of chest pain were the first time I started pulling up a chair and sitting with the patient for 5 minutes or so while watching for their response to nitroglycerin. I would pull this guideline and place it on top of my clipboard and refer to it while I sat with the patient. After awhile I didn't need the written guideline anymore, but it was like my training wheels until I got the hang of what I needed to be doing. Over the years I've done similar guidelines for myself for diabetes, seizures and handling chest tubes.

The first months working as a new RN are very stressful and laden with self-doubt and guilt that one is not performing perfectly. It was somewhere between 6 months to a year before I started to feel like I had a handle on things, and more like 3 years before I began to feel really confident and that I could handle most situations. The incidences of "challenges" begin to become less and less as you become more confident. However, they don't stop. Every once in awhile something will come along that will send me back to the books. This self-evaluation exercise has helped me all through my career. If you weren't advised to do something like this, you should consider trying it. It will help you feel more in control of your practice.

Wow...what a post. I am definately going to take this advice.Thanks for sharing it with us. Too bad they don't share 'little' things with us like this in Nursing School.

The first thing to do is get your personal worries dealt with so you can shine at work. Explore all the caregiver options for your son; you may have to change jobs or move near your mother or aunt or there may be a viable option in your own neighborhood right now. Have back up plans in case a babysitter cancels at the last minute. Talk to co workers who would be willing to fill in temporarily or ask their spouse if it was okay if they be your back up babysitter. I keep toys at my house even though I'm single/no kids because I want to be there for my friends with kids in emergencies. Next take some ACLS caliber classes so you feel more comfortable in emergencies. If you work when it's slow see if you can participate in a mock code. One of the best things I ever did was befriend some ICU nurses. See if you can shadow an ICU nurse for a couple hours; it would be a chance to discuss how you've been feeling with someone experienced in the very stress you are desiring to master. And I'm sorry, but your hospital needs to wake up to the fact that unstable patients that could crash at any time are not appropriate for an acute rehab ward. They need to make room in step down or ICU for them, and your interns need to have a clue. If you feel like you have to go into a patients room every 2 hours instead of every 4 hours just to make sure they have vital signs inside parameters, they are not appropriate for a unit where the nurses carry more than 2 patients at once. On a unit that gets unstable diabetics, I would request a unit in service from the internal medicine department on the critical thinking skills necessary to anticipate problems before they become "an amp of D50, stat." Before then, ensure on your watch that they have a working IV, 20g or better, to accept that D50, before problems start. Find out the nurse to patient ratios in your state laws and expect your unit to live up to that, in writing, and in practice. Tell yourself, you took the time to become a nurse and get a license. Then tell yourself, you're not going to do anything or forget to do anything that takes that license away from you. On my unit we have nurses that have to leave by a certain time to pick up kids from daycare, take kids to classes, karate, etc., and these are the same nurses that come in early, look at the board, look at what patients they're getting and make a stink if they have a hard assignment that they know is going to keep them past their shift, and explain why they have to leave on time. Caught early, we work with them to fix the problem, and give them an appropriate assignment.

I am very frightened right now. I have only been a practicing nurse for a few months. This is my 2nd career. I've had 2 months in the hospital and 3 months working on a busy acute rehab unit. I could not handle the stress level of the hospital and so I got into rehab thinking it would be more manageable. This is an acute rehab unit and is almost as bad as the hospital where I used to work. I haven't been a nurse for very long and I feel unprepared for a lot of the challenges we deal with on a daily basis. We get some very unstable patients who can crash on us at any time, we have unstable diabetics who are tricky to manage, we're under a lot of pressure to get meds, treatments and charting done in a timely manner. There's also pressure on me to make sure I leave on time to pick my son up. Although the directors are trying to be helpful and supportive, I feel incompetent and wonder I if I should quit before something happens where I could lose my license. Once you lose your license that's it, right? Maybe I need to chose another type of nursing.

Did you have a detailed orientation? It does not sound as though you did. I wouldn't keep quitting however. That won't look good on a resume. If you are ovewhelmed, though, maybe you need to start back at square 1 and go into a nice orinetation program or what they call an internsip (like a critical care internship). Best of luck.

Wow...what a post. I am definately going to take this advice.Thanks for sharing it with us. Too bad they don't share 'little' things with us like this in Nursing School.

I think this is the reason so many new grads either burn out, quit, or change careers. They are so busy giving all the fluff that no one managers to share information on how it really is when you graduate.

Thanks for all your input. I do live with my mother so the caregiver situation is generally under control. The times when my mother cannot babysit I do have a babysitter who is often available. People I work with generally understand why I have to leave by a certain time and cannot stay to work a double. Some other people I work with have the flexibility to do that but I do not. I've explained my situation at work and they seem to understand. I make it my business to get in early, look at the assignments, count, get report, etc. If my relieveing nurse is late, sometimes I have to leave report for her so I can leave.

Participating in a mock code might be helpful. Unfortunately, at my rehab unit we are expected to be able to manage unstable patients whom the hospital sends our way. It's because of medicare limitations. If someone is really unstable, as in "bottoming out" with vital signs or blood sugars, or very high, we often send them out to the hospital but we are generally expected to manage them. That's why it's called acute rehab and yes, we get some unstable diabetics. I am learning more about how to manage those patients by looking at how their blood sugars generally range and then if they're out of range, acting on it - give the medications or hold them, call the doctor, get vitals, etc. My patient load can go up to 18 patients and then, of course, there's a lot of meds that are given out for 9 AM. And someone could crash right in the middle of your busy med pass. On top of that, I am inexperienced but am trying to learn and grow, sometimes by the seat of my pants!

I have a lot to learn, as I said, but I am trying to be courageous. It's just unfortunate that we have a medical system that really is not well-equipped for extremely sick people.

The first thing to do is get your personal worries dealt with so you can shine at work. Explore all the caregiver options for your son; you may have to change jobs or move near your mother or aunt or there may be a viable option in your own neighborhood right now. Have back up plans in case a babysitter cancels at the last minute. Talk to co workers who would be willing to fill in temporarily or ask their spouse if it was okay if they be your back up babysitter. I keep toys at my house even though I'm single/no kids because I want to be there for my friends with kids in emergencies. Next take some ACLS caliber classes so you feel more comfortable in emergencies. If you work when it's slow see if you can participate in a mock code. One of the best things I ever did was befriend some ICU nurses. See if you can shadow an ICU nurse for a couple hours; it would be a chance to discuss how you've been feeling with someone experienced in the very stress you are desiring to master. And I'm sorry, but your hospital needs to wake up to the fact that unstable patients that could crash at any time are not appropriate for an acute rehab ward. They need to make room in step down or ICU for them, and your interns need to have a clue. If you feel like you have to go into a patients room every 2 hours instead of every 4 hours just to make sure they have vital signs inside parameters, they are not appropriate for a unit where the nurses carry more than 2 patients at once. On a unit that gets unstable diabetics, I would request a unit in service from the internal medicine department on the critical thinking skills necessary to anticipate problems before they become "an amp of D50, stat." Before then, ensure on your watch that they have a working IV, 20g or better, to accept that D50, before problems start. Find out the nurse to patient ratios in your state laws and expect your unit to live up to that, in writing, and in practice. Tell yourself, you took the time to become a nurse and get a license. Then tell yourself, you're not going to do anything or forget to do anything that takes that license away from you. On my unit we have nurses that have to leave by a certain time to pick up kids from daycare, take kids to classes, karate, etc., and these are the same nurses that come in early, look at the board, look at what patients they're getting and make a stink if they have a hard assignment that they know is going to keep them past their shift, and explain why they have to leave on time. Caught early, we work with them to fix the problem, and give them an appropriate assignment.
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