end-of-orientation anxiety

Published

Specializes in hospice.

I've been working on a cardiac floor since November, 7a-7p, at a 500+ bed, L2 trauma center that does everything except transplants. I have two weeks (6 days) left on orientation, and I am wondering if this job is in my/the patients' best interest. There is SO much to know, that I don't know. I learn at least 100 things every day. This is REALLY a RN job. I was an LPN honors grad, and have taken all RN prereqs, so I'm reasonably educated, but it feels like this job requires a boatload more knowledge than I have. I haven't killed/coded anyone, but I have made mistakes that are stupid. I set up a piggyback med with the wrong IV set, I forgot to give a pt a 1800 med, I gave PO meds to a pt with a PEG (though she swallowed them just fine, and thanked me for the glass of water, as she was very thirsty)(I didn't see anything that said she was NPO), and I never seem to have my assessments in the computer early enough to suit my preceptor. I've been working on my speed, developed a "one-page-brain" to help me stay organized, and I really am faster, but I'm not nearly up to hyperspeed. My pt load is usually 4, maybe 5. (Yesterday I started with 5, had two d/c's and one admit, but the d/c's were EXTREMELY needy before I got orders to send them home. Oh, and one pt was isolation, total care and = 2.5 pts.) I am doing all the normal stuff, plus admission assessments (which are very time consuming). I'm just feeling woefully inadequate. My co-workers are terrific and supportive, but I've had some "communication issues" with my preceptor, which have been very distressing to me. We've worked through this, I think (yesterday she seemed to treat me as an equal), but I could be completely wrong about this. Are my mistakes forgiveable? Am I experiencing usual and customary new nurse anxiety?? I am not a crisis-oriented person, so I'm not intending to create drama. I just want to know if I'll be invited to leave after the next 6 days, or if my experiences are normal. No one has said, "you're really screwing up here," but I'm feeling really awful. I'm losing sleep. I'm second-guessing myself. Will I "outgrow" this?

Thanks.

Up Vote Up Vote ×

Hi,

I'm a new RN and I have about 4 days left of my orientation. I feel for you cuz I'm starting to get nervous about being on my own. I had a really hard shift a couple days ago. Five patients, three very needy and two of those confused and getting out of bed. I had a patient fall and I was mortified. I ran into the room with everyone else, but my mind went completely blank and I just stood there looking like an idiot while the other nurses took care of my patient! I've never had a patient fall before and I didn't know what to do! I would've stayed with that patient the rest of the night if I wasn't already behind. I talked to my manager about it and she said that it was just one of those days and everyone has them.

It worries me that you are working in an RN position as an LPN. At my facility the LPNs (LVNs here) can't give IV medications (they can hang fluids though) and can't do the admission physical assessment or risk assessment. I would want to be sure that the duites you are assigned to do are in your scope of practice since being an RN student is very different from being an RN. As far as your mistakes, I would need more details to tell you how bad they were. Did your preceptor catch them? Did you report them to her as soon as you caught them?

I started out in Peds with a 3 month orientation. My experience there sounds a lot like your post. I learned 100 things a day, but I knew I wasn't ready to be on my own. I was transfered to the medical floor about two weeks before my orientation ended. It's been the best thing for me, even though I work my butt off on this floor.

I would try to arrange a time to sit down with your preceptor and manager and let them know how you feel and find out how your preceptor has been rating your performance. They might be able to extend your orientation. If you really don't feel ready, I would ask to be transferred and they will probably welcome you back when you have your RN license and a bit of experience (that's what I'm hoping to do with peds).

Jessica

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

Sounds to me like you're right on course. It gets better, I promise. All new nurses go through these mistakes and anxieties.

Up Vote Up Vote ×
Specializes in Behavioral Health.

Take it a shift at a time...:wink2:

Up Vote Up Vote ×

None of the mistakes sound very odd. Some are typical new grad stuff, and one you mentioned sounds as if ti came from being in a hurry.

If you like the job, stick with it. If you weren't cutting it, for sure they would be telling you in a lot of ways by now.

Up Vote Up Vote ×
I've been working on a cardiac floor since November, 7a-7p, at a 500+ bed, L2 trauma center that does everything except transplants. I have two weeks (6 days) left on orientation, and I am wondering if this job is in my/the patients' best interest. There is SO much to know, that I don't know. I learn at least 100 things every day. This is REALLY a RN job. I was an LPN honors grad, and have taken all RN prereqs, so I'm reasonably educated, but it feels like this job requires a boatload more knowledge than I have. I haven't killed/coded anyone, but I have made mistakes that are stupid. I set up a piggyback med with the wrong IV set, I forgot to give a pt a 1800 med, I gave PO meds to a pt with a PEG (though she swallowed them just fine, and thanked me for the glass of water, as she was very thirsty)(I didn't see anything that said she was NPO), and I never seem to have my assessments in the computer early enough to suit my preceptor. I've been working on my speed, developed a "one-page-brain" to help me stay organized, and I really am faster, but I'm not nearly up to hyperspeed. My pt load is usually 4, maybe 5. (Yesterday I started with 5, had two d/c's and one admit, but the d/c's were EXTREMELY needy before I got orders to send them home. Oh, and one pt was isolation, total care and = 2.5 pts.) I am doing all the normal stuff, plus admission assessments (which are very time consuming). I'm just feeling woefully inadequate. My co-workers are terrific and supportive, but I've had some "communication issues" with my preceptor, which have been very distressing to me. We've worked through this, I think (yesterday she seemed to treat me as an equal), but I could be completely wrong about this. Are my mistakes forgiveable? Am I experiencing usual and customary new nurse anxiety?? I am not a crisis-oriented person, so I'm not intending to create drama. I just want to know if I'll be invited to leave after the next 6 days, or if my experiences are normal. No one has said, "you're really screwing up here," but I'm feeling really awful. I'm losing sleep. I'm second-guessing myself. Will I "outgrow" this?

Thanks.

I am coming off orientation at what sounds like exactly the same time as you. Yesterday I was allowed to work for someone, which meant I had no preceptor. My manager ok'd this last week. What I am noticing is that things seem to go downhill for me when I get a late admission (5:30 or 6pm). This seems to be because when the admission comes, so does everything else. I am having a hard time dealing with that. I have the same concerns as you. Yesterday I forgot to do some things, among them was to give a pneumonia vaccine.

Up Vote Up Vote ×
Specializes in hospice.

Thank you for all the moral support. I'm back on the floor tomorrow, and intend to try my best to do my job faster, with fewer mistakes. I'm also going to try to talk to the educator, or manager, re "what happens next."

Thanks again for your support and advice.

Up Vote Up Vote ×
Specializes in hospice.
At my facility the LPNs (LVNs here) can't give IV medications (they can hang fluids though) and can't do the admission physical assessment or risk assessment. I would want to be sure that the duites you are assigned to do are in your scope of practice since being an RN student is very different from being an RN.

I'm doing ENTIRE admissions, physical assessments and history. I thought this was odd, too. It was a question I asked my manger when I interviewed for this position. She said it's a hospital policy that LPNs do admissions. In addition, I've been trained to hang blood, with a RN, and had to be checked off on doing this three times. It's my understanding that my state nurse practice act says LPNs can't give blood transfusions, but my facility has trained me to do it, so who am I to question??? I'll also be able to give IV meds after I take another class in 2 weeks. This is no little podunk hospital, it's a MAJOR facility, with an excellent reputation, that's been around for 75 years. It just very confusing when something is drilled into your head in school, then the "facility policy" is completely different.

I really like my job. I like my floor. I guess I've just got the "new nurse panic attack" thing right now.

Up Vote Up Vote ×
Specializes in hospice.
What I am noticing is that things seem to go downhill for me when I get a late admission (5:30 or 6pm). This seems to be because when the admission comes, so does everything else. I am having a hard time dealing with that. I have the same concerns as you. Yesterday I forgot to do some things, among them was to give a pneumonia vaccine.

Our floor policy is to not process new admissions after 6pm. We'll do vitals and hook them up on tele, but the next shfit does the assessment and admission. It's just too hectic at end of shift to do an admission. I did have one come from the cardiac cath lab right at 6:45, in the middle of shift change. That was a real treat. The oncoming nurse didn't want to take the pt (pts from cath lab or post-op are "signed for" by a nurse, assuring they are breathing, beating and not bleeding) because she'd not taken report. In the future, I will make sure to tell whoever gives me report on the phone to NOT send the pt to the floor until 7:15!!

Up Vote Up Vote ×
In addition, I've been trained to hang blood, with a RN, and had to be checked off on doing this three times. It's my understanding that my state nurse practice act says LPNs can't give blood transfusions, but my facility has trained me to do it, so who am I to question???

It's in your best interest to check into your Nurse Practice Act. This document outlines the legal boundaries of your practice. It doesn't matter what facility policy is, they cannot force you to perform a skill or procedure that it outside your scope of practice.

Up Vote Up Vote ×

I had the same issues, and went to the clinical manager. She agreed to make sure I had a maximum of 3 patients for my first couple of weeks (4 is a max for everyone on my floor), and that I had an assigned "resource person" to call with questions. I still felt really nervous, but it did make things somewhat better. Maybe you could ask for the same.

Up Vote Up Vote ×
+ Join the Discussion