Any words of wisdom for a struggling almost-RN?

[glovedgoddess]

HI all nurses,

I am finishing my final practicum of nursing school, I graduate at the end of May. The thought of graduating was really exciting a couple months ago, but now that I have only a couple shifts left and will be losing my student status I am honest to god terrified!

I am sorry this will be all over the place but I just need to get these thoughts out!

I just got off a night shift and I need to vent badly! I really try to approach my clinical days with a positive attitude but lately the days haven't been going well for me. My mentor emphasizes that I am at the point where I should be doing "everything" as the role of an RN. It boggles my mind how an RN can ever get to the point where she is organized and knows everything about all 8 patients and sound like a total pro when reporting off.

Last nights shift went not so great for me, I felt really behind in everything I was doing. I had planned on assessing 5 of the 9 patients we had but I ended up only assessing 3, while the LPN and other float nurse assessed the rest. I was really hesitant about asking for help b/c I know that I really need the practice to get the hang of assessing at least 4 but being aware of all 8+. There were so many moments during shift that I had to hold back tears and just remind myself that it wasn't a good time to breakdown (to save that for later at least!). One patient was a really agitated, jumpy neuro surg pt that took so much time and energy to get her to take her meds. I would spend at least 10 mins each time just trying to talk her into opening her mouth to take them. In the morning when she was being extra difficult about it, I was stressing about everything I still needed to do and it was all I could do to not burst into tears b/c of how frustrated I was, she was just pulling on my last straw. I felt horrible having those thoughts b/c I am supposed to be the caring nurse at all times but when the stress builds up I really struggle! I feel huge pressure to impress my preceptor b/c she is such a good nurse, every time I ask a stupid question or forget something I feel like I am sinking further and further down in her books. Did I mention I don't even really know how to probably transfer or safely ambulate a patient? (Nope didn't learn this in school, thanks university that was money well spent..) Or that I don't really ever know how to decipher what prn meds to give when I have multiple pain meds/anti-nauseants/sedatives to choose from and all sorts of routes...

To end the shift my report was less than stellar (I never really know what I am supposed to say), I never have time to read progress notes or even look through my patients' histories b/c I am so darn busy the entire shift, running running running I literally don't sit EVER! During report the nurse asked me well has this patient improved? What's the plan for her? ..my answer, "To be honest I'm not sure, I didn't get a chance to read through her chart". The nurse just shrugged and gave me the "thanks for nothing" look. I had a knot at the back of my throat for the entire last hour of shift and as soon as I was in the safety of my car the tears started flowing. I have been feeling so overwhelmed, unorganized, unknowledgable, incompetent, & STUPID for the last couple sets and tonight I reached my breaking point. During shift I kept thinking "I hate nursing..", I don't really believe I hate "nursing". I just hate knowing that I am struggling when I am used to being such an over-achiever is all other aspects of my life. In nursing school I have achieved top marks all 4 years, but it seems as though that doesn't help me in real-life nursing. Leaving shift feeling frustrated and torn apart inside every day is really taking a negative toll on my self-esteem. Graduation is supposed to be exciting. I feel like a total fraud saying I will be a registered nurse, because I don't feel that way at all!

It's just so frustrating that 4 years later I feel like I am barely prepared to begin caring for 8+ patients on a daily basis.

Thanks for taking the time to read my vent sesh. If you are a new graduate who at some point felt similar to how I am feeling please speak up and let me know if things "really do get better" like the nurses keep telling me (although there is no way I can imagine how things can improve right now). Even experienced nurses, you were students once too..do you remember ever feeling the way I do? What can I do to help myself feel more confident that things will get better?

[Inori, BSN, RN]

@glovedgoddess - The fact is you care and are stressed out over your performance. Rest assured if you were really screwing up professor would step in as after all its her license on the line. Since she didn't intervene that means whatever you were able to complete it was in a safe, competent way. Continue practicing you'll get it .

I am a new graduate as well December 2011 and just passed my state boards. As a student I was always the last to finish from semester one and every clinical day 'd get a grousing from professor, "Are you almost done yet?" "we're going to be going to lunch in 20 mins". or a loud sigh. Ok person A, B go help Inori finish up we need to go home now. It wasn't until the very last 2 weeks of the semester was i able to finish my patient care early in time for lunch and also to offer my assistance to other classmates had more complicated patients. In my final semester I usually had 1-2 patients and rarely was it 3 patients that's when i'm covering for my classmate because she had to run to bathroom for GI distress.

The only time I had 8 pts when I was "charge nurse" for a day and assigned patients to my classmate team and they reported to me . I assigned 1 pt to myself so i could have time to go around and checking and keeping track of the other 7 pts. I must say it was one scary experience. I almost forgot to give an insulin shot that was suppose to be given at 1pm and it was 1:50pm and i ran in there with my supplies said, Hello sir i'm here to give your insulin, finger stick please.

You want to organize your day even before you start it. Nite before write up how you'll assess, steps to take prior to meds, review procedures. You have pockets .. so keep pt's stuff together maybe pocket 1 for 1 person. Most important do not mix up thier meds

START OF DAY: I get report from the nurse, then go assessing 8 pts just means going into thier rooms and doing a quick head to toe, take a write down the most recent vital signs, look at your patient as a whole. This walk around takes about 10 mins or less. Then go back to nurses station or a quiet corner and figure out what and who you'll do first. Meds take priority gotta be on time, the least stable pts you go visit first to see if they have pressing needs, but stuff like morning care I start with the most mobile lol they can help me wash up, and eat so saving me time for the weakest pt.

Have a sheet of paper in your pocket that list each pt by room number, vitals, special needs, meds given, thigns to do. what changes each patient had, and actions you took, so at end of shift when you're giving report you can just pull out your sheet and rattle off the newly updated info to your nurses. Ex: pt A has decubiti on sacral area 2x3cm possible stage 2 because of descriptiong xyx,

TO DO LIST: Assess everyone>meds for all>morning care> reassess real quickly everyone who got meds for adverse reactions> back to morning care, feed em all and take a peek at pts all around see if they're ok.

TIP: always do your assessments first, then meds, stuff like morning care etc well if you dont finish those then so be it that's why there's CNA's there. The reasoning is if you didn't get to assess your patient how will you know if he's running into problems, breathing etc and needs your help so .. its not just about finishing the list. Nurses assess thats what we're trained to do.

GOOD LUCK

[WKredz5]

I really think you'll do great once you relax a little. You sound like you have the perfect attitude, you take things to heart, stick with it and work your way through the tough, early years. Good luck :)

[mitral]

This Is very helpful, thanks for posting!