extremly nervous new nurse starting nights

[mulbc55653]

Well, I am about to start on the night shift, fresh out of orientation on days. I am working at a LTAC with some pretty sick patients. I will have a mix of med/surg and telemetry pts. I am sooo nervous about not having the preceptor to fall back on. It is really starting to have an effect on me. My wife is a R.N. as well that just went into home health from a telemetry unit. She assures me that everybody goes through it and to ask questions when I am unsure. I have even gone so far as to get her to promise to answer the phone in the middle of the night if I call for advice. One of the things that troubles me is when to call a doctor especially at night. For example a pt. with a b/p of 86/54 that is sleeping in bed and states they feel ok when I awaken them to ask. Also if a pt. runs a temp at 3 am and I give the prn tylenol and it doesn't respond but I can give it q 4 does that warren a call to a Dr especially if the Dr on call is not the pt's Dr? Sometimes I feel like I have forgotten everything from school. I did fairly well in nursing school but feel like my nerves prevent me from applying it. Any tips for me are greatly appreciated. Thanks to all for letting me vent.

[AZO49008]

I'd tell you to calm down but it won't do any good. There's no way you can start as a new nurse and not be a huge bundle of nerves. Just know it gets better.

I just completed my third full week on my own on a busy cardiology floor and just within this short time frame I am MUCH more comfortable and relaxed than I was three weeks ago. This past week I even had my first rapid response which I handled well. Three weeks ago anxiety was literally oozing out of my pores and I wouldn't have predicted I would be this confident at this point.

I think it has a lot to do with the culture of the unit you'll be working on. I literally hit the jackpot with my unit and shift. I have been encouraged to ask questions and every night I have worked I have had veteran nurses asking me if I needed any help with anything. I feel very empowered to ask lots of questions and I have been doing that. I don't just ask the questions, though. I think through the question and arrive at what I think the answers are and offer that up when asking the question. I don't want someone to always just give me the answer. Some of the times I have been off track, but surprisingly I have been on the right track which has boosted my confidence.

I am also very honest about the fact that I know what I know and I know what I DON'T know. I'm not going to fake it because I fear others will think I should know something already. If I don't know, I ASK.

As for calling doctors in the middle of the night, you'll get a feel for how to deal with that. It's nerve wracking the first couple of times but if you use the SBAR format first before you call you should have no problem.

I hope that in a few weeks you'll be feeling more confident like I am. You'll get through it okay. Hang in there and welcome to the profession!

[PMFB-RN, RN]

At this point before you call a physician about a patient problem you should probaly run it past your charge nurse or another experienced nurse you work with.

I woulnd't call about either of the problems you mentioned but I don't work where you work. Is the patient with a temp a post surgical or a medical patient? It would make a difference as to weather or not I called the doc.

I am sure you won't be left all alone, you will be working with other nurses. Use them as a sounding board. Everybody expects new nurses to have lots of questions.