Drowning at new job!!

nicu4me · Mar 4, 2009

My first job was ortho. It is hard, the patients are hard and seem to forget that they can move the other parts of their bodies that they didn't get operated on. I felt like this too and ended up being able to care for 7 on the noc shift with only 2 techs on the floor. On days you have the benefit of Physical therapy being around and hopefully that will help with the bathroom walks. They can literally tie you up in the room for a good half hour by the time you push the iv pole and keep them from falling. All in semi private rooms no less. Our was a ortho/neuro/med tele trash hole. However, I often ended up liking the ortho and when someone floated to our unit, I would take all the ortho because they were scared of them. They took the gi bleeds, medical overflow, etc. You are also working with a lot of older folks too, that makes everything seem like it goes in slow motion, especially the elderly that fall with hip fx from nursing homes, etc. What I would say to you is that you will find that the ortho becomes a specialty as it is, as you know. Get into a system of doing assessments, etc. I used to go in there with a list, pain, pedal pulses, dressing, iv, etc.. Then I realized that the trip to the bathroom (usually when I first came onto the floor) was a time to look at the dressing, assess the ambulation, skin, IV, etc. Say how is your pain today, any numbness or tingling when you are walking, etc., etc. The only thing that you haven't done is listen to LS and BS. Feel their pedal pulses when you are getting the slippers on. If they are on the pot then you know they have BS because of the bm. It is hard to get organized. The surgicals come in and it throws you out, the blood transfusions, etc. all take a huge amount of time. Ask them right away do you need pain meds, are you having any nausea, etc. That way you have assessed and asked them adn they are less likely to put the light on for everything. Also the aides are usually busy, it takes a long time to pass trays, get total joints up and down, etc. Are you letting them help you? You can get to the point where you will feel safe enough to turn someone by yourself (within reason) and you know, the patient often does better than when three people go in. Lots of positive conversation! Also, one of my biggest hang ups in the beginning was I felt like I was responsible for everyone's pain. Everyone was hurting and it just really drug me down inside. Yes there are those accidents and gun shot wounds and drug seekers that claim to have back pain. I don't have a cheat sheet for you but try to stay organized and flexible and be able to use those moments in the room to do your assessments. By the way I left because I was a new grad with a horrible orientation and terrible managment and coworkers but at least they knew that I wasn't a bum. Turn your patients, make them move and be encouraging, you may feel that you like ortho more than you think because they soon all become horses instead of zebras. Look at my username, that's where I am now and as I write this I realized how far I came and how far I have to go. I switched jobs last fall and am now feeling just like you are. Give yourself some time. It will get better.

Boston-RN, RN · Mar 4, 2009

Welcome to your first year as a nurse. Don't be too hard on yourself it's like this for EVERYONE. Your first year will be the one of the toughest of your career and you will here this over and over again. Time management is a very difficult aspect for a new nurse and that is very common and normal. Just a couple bits of advice is take your time and think about things before you do it so you know that you are bringing everything you need to do what you need to do while you're with the pt. Set limits with difficult patients....this is delicate but you'll come up with your own way. I take the time to make sure that I have addressed all their needs while I'm there and specifically ask/tell them...."Do you need anything else while I am here? I want to make sure you have what you need from me because I will not be able to come back in for x mins to 1hr because I have to see my other patients" If it is an emergency feel free to call but otherwise I will be back to check on you in 1 hr....(but make sure either you or someone else go back as scheduled). Most of the time this works.....sometimes it still doesn't and that conversation gets a little more firm. If they are anxious and that is why they are calling for little things address that...say "I sense the reason you're call is not for more water(or tissues or whatever) but that you're anxious about xx, is there something I can do to make that anxienty more bearable?"

Some other pointers are:

- make yourself a cheat sheet if you haven't already or at least a to do list

- ask you preceptor for her advise...what has worked for her or for other new grads she has oriented (because what works for 1 may not work for another)

- What I did when I was done with orientation and with people I have oriented is have a mini briefing at the end of every shift...what you did good / what needs work....is it flat out time mgmt or is there something else. As a new grad you you have a lot to learn....are you needing to look a lot of things up during your shift....if so maybe you need to spend some time outside of work brushing up on these things if at all possible instead of during your shift....

Sorry for the length of the reply

Oh and don't forget.....delegate whatever you can...don't be afraid to utilize your resources.....and from what the other poster wrote, gently remind people that they NEED to do as much for themselves as possible. I have have patients expect a bedbath when all they needed was to be set up and maybe some help with the nooks and crannies

- try and anticipate what the pt will need.....like prn meds, water, tissues and bring those in with you to min the back and forths

neurobabe · May 13, 2009

I have no advice at this time, because I too am in your position. I just completed my 8th week on a neuro/ortho unit. Just about everything you described I have experienced. Orientation is not what I envisioned. I know it's been two months since your posting, I can only hope that it has gotten better for you as I hope it will get better for me. Good luck to you!!!

P_RN, ADN, RN · May 13, 2009

All us ortho Nurses have been there. I carried my cheat cheat -my brain- the entire 20+ years I was in ortho.

Look for posts by Daytonite she has some great "brains" for all kinds of Nursing.

artist-rn · May 13, 2009

Dear Keira and all new nurses,

You have all our empathy from us experienced and seasoned nurses...we know what you're going through...we've been there too. Remember, it's NOT you, it's that you're new to the workforce and in one of the most demanding, rewarding and versatile professions. There's a reason why you pursued nursing - you have the heart AND strength to be a nurse, so don't give up to pursue another line of work.

Don't be hard on yourself in needing additional perceptor time - every nurse has different needs and different timetables. You have nursing and non-nursing skills that no one else has. Thank your perceptor and nurse manager to recommending the extra time rather than think you're 'not good enough'. I don't want to sound redundant, but you have the heart and STRENGTH to be a nurse.

As for those demanding patients, place some limits with them-give them timeframes when you will check back with them...tell them you have other patients who may need more of your time due to their conditions. Many times, when you are honest with the situation, patients understand and realize 'it's not all about them.'

Boston-RN gave some very good pointers about promoting self-care and self-responsibility with patients, because that is what nursing is about. But self-care also applies to nurses as well - be CAREful about what you think of your performance...don't feel guilty about needing a break or lunch - it's the body way of telling you "Listen, I need a break"...ask your colleagues for help...delegate non-RN tasks to CNAs and techs.

Hang in there because it does get easier. Remember, you're new to everything and it can be scary and overwhelming, but it will pass. In-the-mean time, schedule something that entails doing something for you on a regular basis...self-care for the spirit/soul, such as a creative activity or any activity you really enjoy.

alngela2 · May 28, 2009

I know how you feel. I started on nights as a new grad on ortho unit with med overflow. I think this helped alot. I learned a good schedule (which often got out of kink) but had a flow I learned on my own. You learn how to handle pain and help your pts with ice, distraction, visitors and sleep. This is a demanding field but heartwarming when that special pt comes along that makes you smile inside. Don't be hard on yourself. Remember: Pain try to get on schedule if not working speak to doc about not adequate pain control. Uncontrollable crying could be a cry of despair/depression that you as a nurse can help identify for pt while on unit. You have your typical pain pts that no matter how much morphine or phenergan they are never satisfied, that you will share with all of us. I agree, put boundaries on the pt that calls constantly for tissues, water, and god forbid ice cream but is nauseated.

Take a breath, it will get better. Good Luck!

llg, PhD, RN · May 28, 2009

I wish all of you who are struggling all the best of luck. For most of you, it WILL get easier as you get some experience.

I am curious ... and I hope you don't mind answering a question. How much clinical experience did you get as a student? Did you get the opportunity to provide total care to at least 2 or 3 patients in the last semester of school? Did you have a senior year preceptorship during which you cared for a full load of patients with the help of a preceptor? How long was your nursing program?

Perhaps we should be considering lengthening nursing programs rather than accelerating them or minimizing the required clinical experiences so that new grads would be better-prepared to function in the real world on their own.

NRSNFL · Jun 27, 2009

You'll get there....I wish I could watch you in motion for like 2-3 hours because I BET as a new nurse there are things time management that you could improve upon. I will say, chances are, no matter what specialty you went into....you'd feel this way. The nice thing is if you are on a total ortho floor....once you have one procedure, your assessments will get tighter because you'll know exactly what to focus on, like niceunewbie said. You have to piece your assessment together. The only time you ever need to do a total head to toe like they taught you in nursing school in one sitting is when you get a new admission and there is NO documentation on it, (or hell, even if there is documentation on it...I don't trust anyone else's assessments anymore). Regardless....if you have them for at least 4 hours, by the end of that time, you'll have seen all that you need to. You also may need to find some destressing time OUTSIDE of work and try to shirk any feelings when you get high strung at all....when you know your winding up tight, be congnicent of it and acknowledge that it will only hinder your goals. You'll get there...you've come this far....and once you are in a rhythm and are spotting "issues" in your assessment skills and the paperwork becomes a LITTLE less cumbersome (most of it is ridiculous, but it is really there to protect you and the hospital)....you'll start feeling better. Good luck to you, we are here for you to vent if needed.....