Expectations vs Reality

peacelover · Feb 4, 2014

It is hard when expectation does not match up with reality. I have never been scared, I think that my pre-nursing life experience helped me with confidence. I was shocked at the gaps though..you know there was just so much that school cannot possibly prepare you to face. I felt like I had slept through a lot of theory class on some days.I waited 20 years to get to be a nurse too, so I get that part.

I think it is good that you have identified what is going on for you instead of just having a general yucky feeling about your job. Now that you know what is going on I think you can create a plan for it, don't you?

Where do you feel the biggest fear? Patients crashing? Medications? Lab work? Missing something critical that harms your patient? Time Mgmt? Not understanding the disease processes that are showing up on your floor?

You can name it, you can fix it. You got this one lock!

dprevish · Feb 4, 2014

I worry about being able to recognize symptoms of patients who deteriorate, I worry about connecting the dots between lab results and conditions, and don't feel like I know enough about the disease processes. I never got a chance to draw blood in nursing school and have to do it every night now...I just stink at it! I have always been so good at every job up until now and feel like a dummy most of the time. That is not a fun feeling when people's lives are at stake. I know some of this will be fixed with experience and I have only been at this on the floor full time for a little over a month, but when the patient care techs know how to do things better than you do, it doesn't inspire confidence. I'm looking into resources to help me be a better phlebotomist and I come home and research things I do not know, but it's just agonizing right now. I also know in my heart that I need to let up on myself a little, but that has not yet become reality either. I just wanted to know if others have felt like I do so that I know "this too shall pass". Does that make sense?

peacelover · Feb 4, 2014

I am glad you see that you are being a bit hard on yourself. I will say though, thank you for actually caring that you do a great job and take give great care, lots of new nurses do not really even know that they do not know something. Which is an even worse spot to be in-so you are doing something right! :)

Maybe it is the hit-or-miss nature of patient assignments is adding to your frustration. It is hard on a med-surg floor because you may get a hip tonight and a CHF tomorrow followed by an ETOH withdrawal mixed with a demented patient. All those difference can overload your brain when it is trying to learn.

I am not sure what kind of floor you work on however; maybe it would be possible to chat with the charge nurse and tell them-'Hey, I need to get really good at CHF with complications or I really need to learn more about insulins and timings(or whatever you feel)-can you throw these all of these types of patients my way for a while so I can gain proficiency with their care please?' So your brain can focus...

Maybe that gives you a chance to 'live' in the world of CHF for a few weeks straight so you can fully immerse yourself in the meds/labs/interventions/complications.

If that is not possible maybe pick a particular lab value to focus on for the month. BUN/Creatinine and the ratio, when it means AKF or CKF or when it is just dehydration. What would you expect the doc to do with each, to prove each. Look at the meds that would change the ratios, that may harm the kidneys. Sometimes coming at it from the back side-lab or med first could be a better way to cover all your patients. You know, compare the same lab across your patients. Why does one have a high BUN and the other no?

Just some suggestions. I think you will find that if you come at things from a slightly different angle it will get easier, faster. Focus on one thing and get good at it, instead of trying to be good at everything right now.

I am sending great thoughts your way-I know you will be awesome once you get through this first few months!

loriangel14, RN · Feb 4, 2014

How long have you been working as a nurse? It does take time to get over that "OMG I know nothing" feeling.

dprevish · Feb 4, 2014

I work on a surgical stepdown unit that focuses on Gastric surgeries, but we get some Oncology patients with very specific protocols and a WIDE variety of other things. We also do bariatrics. We are considered a critical care unit which is overwhelming given the limited experience I have. Our population is very fragile and can turn quickly. I appreciate your kind words and advise. I have only been off of orientation since the 19th of January, so I am REALLY new. Thankfully, I work nights where the pace is slightly slower and the other staff is really supportive and helpful. I am my own worst critic but I am trying to give myself credit where credit is due. I just wish I had been required to do an internship so I would have had a better base to practice from. I am looking forward to the day that I actually start to feel like a nurse with good critical thinking skills rather that a nurse who slept at the Holiday Inn Express last night! lol

dprevish · Feb 4, 2014

Hired in late October with limited patient care experience until early December. Yes, that's exactly it; I think, OMG, I know nothing every day! lol

loriangel14, RN · Feb 4, 2014

Oh my yes you will need to give yourself time. It sounds like you are ona very busy floor.Use the resources that are available and don't be afraid to ask for help.There is no shame in saying you feel overwhelmed or unsure. It is better to ask questions and get help. Hang in there.

dprevish · Feb 4, 2014

I made myself a really good brain sheet that has helped tremendously. I just want to be able to put it all together. You are all wonderful! I also commute over an hour and that makes it hard to want to walk out the door. My husband and I worked together side by side for over 15 years and I miss him, miss my puppies and hate it when I have to spend the night out of town so that I can get enough sleep to be able to stay up all night. Once we feel more able to do my job well, that will make it easier; but I am just struggling with reality shock I think. I knew my skills were limited; I just didn't anticipate how much I would hate feeling like the weak link on the floor. Thanks for your encouragement!

Ruby Vee, BSN · Feb 5, 2014

dprevish said:

I worry about being able to recognize symptoms of patients who deteriorate, I worry about connecting the dots between lab results and conditions, and don't feel like I know enough about the disease processes. I never got a chance to draw blood in nursing school and have to do it every night now...I just stink at it! I have always been so good at every job up until now and feel like a dummy most of the time. That is not a fun feeling when people's lives are at stake. I know some of this will be fixed with experience and I have only been at this on the floor full time for a little over a month, but when the patient care techs know how to do things better than you do, it doesn't inspire confidence. I'm looking into resources to help me be a better phlebotomist and I come home and research things I do not know, but it's just agonizing right now. I also know in my heart that I need to let up on myself a little, but that has not yet become reality either. I just wanted to know if others have felt like I do so that I know "this too shall pass". Does that make sense?

Of course the techs are better at phlebotomy than you are -- they've been doing it longer! Rather than being intimidated by that, use them as a resource. I'm sure they have tips and pointers that can help you learn to be a top notch phlebotomist.

The first year of nursing is difficult -- school does not adequately prepare you for the reality of being a nurse. It didn't forty years ago when I was a student, and it doesn't now. The good news is, you can learn an awful lot from the patient care techs you work with -- and while you're doing so you can forge good working relationships with them. I got most of my "orientation" in my first job from the NAs and LPNs I worked with -- the RNs didn't have the time for me.

You're only a month into your nursing career -- it's expected that you'll stink at it right now. The learning curve is steep, but you're climbing it. As the months progress, you'll learn more than you thought possible, and one day you'll realize that you feel absolutely competent and confident. (And then five minutes later that feeling will pass and you'll feel ignorant and incompetent again -- but that too will pass.) It takes about two years for a new nurse to become competent, but the worst of it is in the first year. Unfortunately, the only way to GET through that is to GO through that. We've all been through it and gotten through it. You will, too.

nurseprnRN, BSN, RN · Feb 5, 2014

^^^^^THIS

Of course it's hard being new. In your spare time, if you haven't read it already, get a copy of the classic Benner From Novice to Expert. It will help you.

You will probably not believe me at all, but I would much rather have a new grad working with me who feels as you do than someone who waltzes in sure as shootin' that she knows it all, will take no constructive criticism unless she cries, "Nurses eat their young! Bully! Bully!" and takes pains to tell me just what she won't do.

You have the good sense to know you have a lot to learn, and you want to learn it.

It does get easier, of course it does. And every single nurse with the sense the goddess gave geese felt the same way you did when s/he started out. You are not alone. Stay in touch!