Current Struggles as a New Grad

Nurses General Nursing

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Hey everyone! I would like to vent and seek some advice. Input and words of encouragement to any of the questions is appreciated.

I'm been on my own for a little over a month now on a med surg floor on night shift. My anxiety has gotten slightly better. I get anxious about the feeling of being stressed/overwhelmed/the feeling of the unknown of how my shift will go. Sometimes I would cry before going into work, but I've been praying and trying my best to be kind to myself since I am still new. I will be going to therapy soon and am considering medication. I understand I won't feel comfortable until I'm about 6 months - 1 year in, and my coworkers and management have been supportive. I just hope I'm able to stay in bedside for 3-4 years so I can get into nursing informatics.

Another issue I find myself struggling with is remembering information about my patients. The ratio is 1:5. I have a report sheet for my patients, but for the life of me I can't remember important details like hx or their admission info. For example, I've had pts deteriorate and couldn't answer some questions, and I felt so stupid and disappointed in myself.

Another thing I would like to work on is critically thinking and putting small details together to think of the big picture. Connecting my assessment with labs to their diagnosis and thinking of interventions. Besides studying my floor's common diagnoses, is there anything else I can do?

Lastly, I do go into work about 40 mins early to review my pts chart. This was recently addressed in another topic in this forum, but I go in early because it relieves some of my anxiety when I'm organized and know what to expect. I also have more time to look through the orders throughly. I've already missed one order before and don't want to make the mistake again. Since I'm working on my time management, having looked through their charts also gives me a head start on my assessments. Management hasn't said anything about me coming in early.

Overall, even though I give myself as much time as I can to get ready for the night, I still feel unprepared which makes me anxious.

Thank you for reading.

2 Votes
Specializes in ER, Pre-Op, PACU.

Do you think some of the forgetfulness or absentmindedness is coming from working night shift? This may be part of the issue as well as simply being a new nurse. I do not really have any advice to your questions, but just want to tell you that a lot of your concerns or questions are likely just a combination of being a new nurse and on night shift. It will get easier to connect the dots and put things together in critical thinking over time. 6 months later you will be amazed at the difference and then again, a year or two later.

1 Votes
30 minutes ago, speedynurse said:

Do you think some of the forgetfulness or absentmindedness is coming from working night shift? This may be part of the issue as well as simply being a new nurse. I do not really have any advice to your questions, but just want to tell you that a lot of your concerns or questions are likely just a combination of being a new nurse and on night shift. It will get easier to connect the dots and put things together in critical thinking over time. 6 months later you will be amazed at the difference and then again, a year or two later.

I don’t think I’m forgetting things because I’m on night. I still had trouble remembering even on orientation during day shift. Thank you, I am counting the days until I reach my 6 month mark.

0 Votes
1 hour ago, crush_RN said:

Another issue I find myself struggling with is remembering information about my patients.

Understand that part of remembering information has to do with things like knowing what is/isn't significant in a patient's case and just growing in other critical thinking processes. People with photographic memories remember unattached random facts, but for most other people remembering stuff like this has to do with knowing that something is relevant and how it fits together with the picture. So this will improve as you learn.

I remember one of my first code as an RN--the code team stormed in and the CC PA roared, "what happened here??!" I was like..."??‍♀️...she stopped breathing....and she had ______ [admission diagnosis]??"

1 hour ago, crush_RN said:

Another thing I would like to work on is critically thinking and putting small details together to think of the big picture. Connecting my assessment with labs to their diagnosis and thinking of interventions. Besides studying my floor's common diagnoses, is there anything else I can do? 

That's a good start. You can also review in your mind (at the end of the day or whatever) the cases you encounter to help synthesize information. When I was new I learned a lot by carefully reading providers' notes.

It's going to come together and the worst thing you can do is decide that you're off-track somehow because you don't know everything. I know the environment seems to not be very tolerant of human imperfection in general, but you just have to understand that it is irrational to place beginners into acute situations and then begrudge them for not knowing everything/enough. That just isn't your problem as long as you are doing what you can to appropriately grow in your critical thinking.

3 Votes
Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Try to keep a very detailed worksheet. If the ones available on your floor aren't adequate, make your own to recopy and use. Make a column for age, dx, surg, pertinent hx, another column for IV fluids and rate, another column for hardware (Foley, JP, etc.), I&O. Another for labs and pertinent results. The biggest column will be your to-do list, med times, treatments, etc.

It might seem cumbersome at first, but if you're already coming in 40 minutes early, this might be worth your while and eventually you can streamline the process. Your eyeballs will quickly get trained to spot the information you need and you won't be struggling trying to remember pertinent details when someone is grilling you.

That's why we refer to our worksheets as our brains; our actual brains are constantly being pulled in too many directions at once.

3 Votes

Thanks for the replies! I will keep being kind to myself and that it is OK to not know everything and being able to piece information together to see the big picture will come with experience.

@TrishaJ yep, I made my own brain sheet and carry it around with me. It has their hx, admission info, assessment, access, fluids, labs, etc. I'm proud of it, haha. My problem is recalling information if someone were to ask me on the spot. I tend to get flustered and my mind blanks.

1 Votes
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
8 minutes ago, crush_RN said:

My problem is recalling information if someone were to ask me on the spot. I tend to get flustered and my mind blanks.

This will certainly get better with time. Just keep in mind that no one is trying to put you on the spot (I hope). They just want the info. You'll get better at anticipating.

2 Votes
Specializes in ED, med-surg, peri op.

I think you are putting to much pressure on yourself, and maybe why your forgetting things? You got threw nursing school, you can remember details!

No nurse is completely pre-pared. Things happen and change all the time. But Things will come with time, you learn with each pt. you are a month out, no one expects you to know everything. sounds like your in a good environment though, use that to your advantage. Don’t be afraid to ask for help/advice in new situations.

take a breath. You don’t need to be perfect. No nurse is.

3 Votes
Specializes in Medical/Surgical/Telemetry RN.

Bro!! I'm in the same boat. Honestly my preceptor has taught me that nursing can only be honed through time. Time is the greatest factor. It's experience and sometimes if your like me...you want to know everything right now. Which is hillarious because you can't know everything about a patient. You have to realize that your taking care of 4-5 patients that you don't even know. People have so many crazy stories and histories that yes it's going to be hard to piece together the facts and to actually figure out the hell is going on. I mean during my shifts I ask myself what is going on with my patient, why is this lab value off, what tests need to be ordered, why is my patient going to get an MRI right now? SOOOO MANY QUESTIONS as a new nurse and guess what...it is perfectly normal to feel that way. No nurse knows everything...I'm on a medsurg/tele floor and damn some days I don't even have time to remember my patients name. It's okay bro. I am on dayshift and damn *** changes fast on the floor. You gotta be runnin. Best of luck. Hope this encourages you and helps. Don't worry your not alone and I am in the same boat as you. It will click some day.

2 Votes
Specializes in Psychiatry/Mental Health.

I don't know if it's the same for you, but my issue at that point was being overwhelmed with everything. I am about 16 months in now, and things are getting easier. I think it is because so many things have now become second nature, that there are less things to actively think about. I notice that when I float, my day is slower and more difficult, because I have to remember new things.

As a new grad, I had a hard time remembering the patient's names. I was keeping patients in my head as "the GI patient at the end who you shouldn't forget to check and see if they need Zofran", or "the new hip pt who needs to be OOB for each meal". And then, an MD would ask what they hip pt's urine output was that day and I would draw a blank.

Now I remember sooooo much more. The person's name, nickname, their husbands name and what he does, the fact that the person has a wedding to get to next week, which lytes were off this AM, what the potential plan for the patient is, urine output for today and yesterday (and can suggest a bolus during rounds). I still forget some things, especially if something happens, like I have a patient who requires a rapid response right after I get report. That throws my whole day off, but I just move slower and write down everything. I try to make sure I round hourly, then try to go somewhere quiet for 5 minutes and collect my thoughts and catch up on my plan for each patient for the shift. When you're flustered, you're more likely to forget. Deep breaths, you can do it!

3 Votes
Specializes in Community Health, Med/Surg, ICU Stepdown.

It sounds like you are very conscientious and motivated to do a great job. Those key ingredients will take you from being an excellent new nurse to an even more excellent experienced nurse. It sounds like your brainsheet is great and it is OK to look at it when someone asks you an on the spot question.

I write down little things that someone might ask me on my brain sheet so I don't have to memorize everything or open the pt's chart in an urgent situation. (Such as new lab results, urine output, abnormal vitals, etc). Of course I also report anything urgent to the MD, but if it's not urgent I just have the info ready in case they ask for an update. Also useful when giving report. Be kind to yourself and keep up the good work! Once you have similar types of patients over and over you will notice patterns and know what to look for ?

1 Votes
On 2/25/2020 at 2:08 AM, nznurse93 said:

I think you are putting to much pressure on yourself, and maybe why your forgetting things? You got threw nursing school, you can remember details!

No nurse is completely pre-pared. Things happen and change all the time. But Things will come with time, you learn with each pt. you are a month out, no one expects you to know everything. sounds like your in a good environment though, use that to your advantage. Don’t be afraid to ask for help/advice in new situations.

take a breath. You don’t need to be perfect. No nurse is.

*takes a deep breath* I agree I am putting too much pressure on myself. I'm very hard on myself which is a blessing and a curse! However, my coworkers are awesome with asking me if I need any assistance and help me walk through things I'm unfamiliar with. Thanks @nznurse93 ?

0 Votes
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