Current Struggles as a New Grad

[crush_RN]

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.

[crush_RN]

19 hours ago, al3x117 said:

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.

Thank you for your response! It's a relief to know that others are riding the same struggle bus LOL. I have non-medical friends that would ask me how work is, and they just... don't get it.

It drives me a little crazy that we need time and experience to feel comfortable in our jobs, but that's the reality of it. I guess it's hard for me because I enjoy consistency and a predictable day.... LOL which definitely isn't med-surg. Thank you for sharing!

[crush_RN]

9 hours ago, NurseJamillah said:

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!

Feeling overwhelmed is definitely a factor in regards to my performance and mental state. I do agree that things have already started to become second nature and will only continue from there.

I feel better knowing someone recovered from the new grad short term memory loss ? I hope that within the next year are so I will be able to remember so much more. Thank you for sharing!

[crush_RN]

3 hours ago, LibraNurse27 said:

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 ?

I'll start writing down bits of info to have ready. I realized I need to start doing that after my last shift. During shift change, the day nurse asked for the pt's UOP and the dose for the lasix gtt. I had the rate but not the dose written down. Thank you for the words of encouragement. I really appreciate it.

[mermer_rn, BSN]

Just know that everything you are experiencing is so common and so normal. Forget-fullness and not being able to latch onto details I find is common for new grad or transitioning RN because you are overwhelmed and essentially almost always in flight or fight....so it's difficult to learn and remember in that type of situation and you are also in the stage of nursing I call task fixation. You have so many tasks, demands, interruptions, changes in the course of your day and prioritization that your mind is swirling and you simply move from one task to another forgetting to prioritize appropriately and are often finding yourself sidetracked and doing the work someone else should/could be doing. I think the thing that finally made things click and made me feel much more calm and capable was the advice of a lovely doctor "remove yourself from as much as you can and know that this is not your illness to manage alone and that I have seen patients survive things I didn't know the human body could endure." Meaning....if it's not your job ie: lab calling to ask if the doctor meant to order these two labs...well that's an excellent question for the doctor here is his number, pharmacy tech calling to ask if the patient in room 101 is paying cash or credit care...well that's a great question to ask the patient, here is their room extension and so on. Also realizing that you are working in a team and you yourself are not the one that is ill, so it's not your job to take responsibility for the illness, merely the job of assisting the patient to get well and educating them on how to take the responsibility of managing it...TALK TO ALL THE CARE PROVIDERS...ask lots of questions even if people get impatient or make you feel stupid, ask for another set of eyes, or learn phrases like "I really feel like I need another set of eyes in here" and you'll start to learn all the things you are wanting to learn, assessment, labs, etc. I always made it a point as much as possible to follow the doctors into my patients rooms and to ask the more senior nurses advice, opinions, help. And take notes, lots of notes, like when you notice a change in a patient, write down the time and your assessment, because you might not have the time to chart it at the exact moment. Make use of your printer...I print a lot of the patient summary so I always have it to look at if needed. Also no one can remember everything, take a breath and say, "you know I'm not positive on that, let me badge into the computer and I can let you know". And lastly...just know that you are doing your absolute best to take care of this other human and that if something goes wrong, it's not your fault, there are lots of other hands and eyes involved and you do your job and you let them do theirs. You've got this and soon you'll lift your head up and be able to look around with more clarity and even start to wonder why you were running around so overwhelmed and stressed.

[crush_RN]

On 2/27/2020 at 1:09 PM, mermer_rn said:

Just know that everything you are experiencing is so common and so normal. Forget-fullness and not being able to latch onto details I find is common for new grad or transitioning RN because you are overwhelmed and essentially almost always in flight or fight....so it's difficult to learn and remember in that type of situation and you are also in the stage of nursing I call task fixation. You have so many tasks, demands, interruptions, changes in the course of your day and prioritization that your mind is swirling and you simply move from one task to another forgetting to prioritize appropriately and are often finding yourself sidetracked and doing the work someone else should/could be doing. I think the thing that finally made things click and made me feel much more calm and capable was the advice of a lovely doctor "remove yourself from as much as you can and know that this is not your illness to manage alone and that I have seen patients survive things I didn't know the human body could endure." Meaning....if it's not your job ie: lab calling to ask if the doctor meant to order these two labs...well that's an excellent question for the doctor here is his number, pharmacy tech calling to ask if the patient in room 101 is paying cash or credit care...well that's a great question to ask the patient, here is their room extension and so on. Also realizing that you are working in a team and you yourself are not the one that is ill, so it's not your job to take responsibility for the illness, merely the job of assisting the patient to get well and educating them on how to take the responsibility of managing it...TALK TO ALL THE CARE PROVIDERS...ask lots of questions even if people get impatient or make you feel stupid, ask for another set of eyes, or learn phrases like "I really feel like I need another set of eyes in here" and you'll start to learn all the things you are wanting to learn, assessment, labs, etc. I always made it a point as much as possible to follow the doctors into my patients rooms and to ask the more senior nurses advice, opinions, help. And take notes, lots of notes, like when you notice a change in a patient, write down the time and your assessment, because you might not have the time to chart it at the exact moment. Make use of your printer...I print a lot of the patient summary so I always have it to look at if needed. Also no one can remember everything, take a breath and say, "you know I'm not positive on that, let me badge into the computer and I can let you know". And lastly...just know that you are doing your absolute best to take care of this other human and that if something goes wrong, it's not your fault, there are lots of other hands and eyes involved and you do your job and you let them do theirs. You've got this and soon you'll lift your head up and be able to look around with more clarity and even start to wonder why you were running around so overwhelmed and stressed.

@mermer_rn I saw your post before my shift last week, and it made me feel so much better going into work! I'm relieved to know that what I'm experiencing is common. I'll have to look into the stages of nursing. Is that from the concept of Novice to Expert?

Thank you so much for your response. I took your advice and applied it to my last few shifts, and it has been very helpful! ?

[Nurse SMS, MSN, RN]

Always remember it is PERFECTLY okay to say "Let's look it up to be sure I am right" when someone is asking about things like medical history. You can pull up the chart, you look together and often it helps the other person put the clinical picture together too and make it a conversation rather than feeling like a pop quiz.

It sounds like you are in a very supportive environment and have really good ratios for M/S on nights. You are going to be fine. Being patient with the learning curve is very humbling. It will make you a good preceptor one day. You will have new grads starting there soon and it will become dramatically apparent to you how far you have come already once they do.