Feel like I don't know anything

[mindiianajones]

I didn't see a specific new grad forum, so I'm posting this here.

I start my first job in two weeks, and I'm absolutely terrified. My first month of orientation is going to be on the same floor I worked on as a CNA, and I'm scared they're all going to think I'm a terrible nurse. I'm scared I'm not going to know what to do. I'm scared I'm going to somehow kill someone or not recognize something vital.

I've been in school for two years, and I feel like I don't know a damn thing. I'm pretty sure you could ask me a nursing related question, right now, and I'd tell you I don't know. Two years of school that I managed to graduate from, managed to pass the NCLEX exam, and I feel like my brain is full of nothing but 90s song lyrics and every line in Robin Hood: Men in Tights.

Should I keep studying while I'm waiting to start? Go through my Saunders book? I keep envisioning showing up to my first day of on the floor training and winding up fired or my preceptor hates me because I don't know something I should know.

[brownbook]

Perhaps just a different perception. The "voice" in my head as I was reading was not a pleasant one especially when she said the bit about these being dumb questions. To each their own, but yes, maybe I was being a bit sensitive

Now I understand. I only meant "dumb" questions in the sense of I always thought my questions were dumb until I found out experienced nurses didn't know the answer either. I didn't mean her questions she asked here were dumb.

The only dumb question is the one you don't ask is something I struggle with to this day!

I can ask my "dumb" questions here anonymously

[JKL33]

( in response to brownbook ) Why so hateful? These are valid questions from someone who perhaps needs a little boost of confidence or reassurance, not for you to be confounded and invalidate these concerns merely because you did not have access to such a tool as this forum. Shame on you; I hope you never precept new RNs.

Sometimes, if in doubt, you can get a bit of an understanding of a poster you don't "know" by taking a look at other things they've posted.

I love your username (truly)...but on that note, the "I hope you never..." sort of comments are "anti-dontbetachy" i.e., "tachy." They are a special sort of very cliche nursing umbrage. Right up there with "You shouldn't even be a nurse!"

Based on Brownbook's other participation here, I read the comment in question as..."it'll be okay." The statement that upset you so much was actually sort of light-hearted self-deprecation, you know? We all have asked questions that we worried were dumb...

TBH I think an apology would be appropriate, but as you say, "to each their own...."

[Dani_Mila, ADN, BSN, RN]

I am in the same position as you. I start this week and I am freaking out!! I've been trying to review some things but can't focus because of anxiety. First day If class orientation I barely slept the night before only 3 hours of sleep because I was so worried. Now I will be hitting the floor this week and I just couldn't sit still. My mind just won't stop thinking.

[Susie2310]

First of all it's really, really, REALLY, hard to kill someone. One IV, or IM, or PO medication cannot kill a person.

Missing something vital.....unless you're working in a critical care unit patients are going to let you know by what they say or what their vital signs are that they are critically ill.

I understand your good intentions, but I respectfully disagree, and I think it is important not to encourage a false sense of security in regard to giving medications safely. A single medication can definitely kill a patient depending on their current clinical condition, co-morbidities, allergies, age, etc., if it is contraindicated for that patient or incorrectly administered, or sometimes even if it appears to be indicated. Also, elderly patients and very young patients have much less physiological reserves and are more likely to be unable to withstand a medication error that a younger, healthier person, could. To give just a few examples: A single IV medication that is contraindicated for the patient or incorrectly administered can kill a patient. One example is IV Heparin, which can result in fatal hemorrhage. Giving a PO antibiotic that the patient is allergic to could result in anaphylaxis. An overdose of subq insulin can kill a patient in a single administration.

I have to also disagree with your statement in regard to missing something vital that unless you are working in a critical care unit patients will let you know by their vital signs or what they say that they're critically ill. This is not necessarily true, by a long shot. Patients are often very sick and have no knowledge of correct nursing/medical practice; just to give one example, it is not hard if you are not paying attention to make an error such as allowing the patient's IV fluids that are running at 125 cc/hour when they return from a procedure to continue to run at that rate for hours more, without even noticing that the patient is putting out a very large volume of urine (the patient has a history of significant chronic renal failure plus a cardiac history).

[TriciaJ, RN]

No, do not spend the next 2 weeks studying Saunders or anything else. You'll only drive yourself crazy and still feel empty-headed when you start your new job. You do need to spend the next 2 weeks fixing your "relax button" because you're going to need it during your career.

You graduated from nursing school and passed the NCLEX. Time to celebrate. You deserve a bit of relaxation and I have a feeling you will be a perfectly fine nurse. Congratulations!

[Triddin]

Nursing school essentially gives you the background information,action about how to do the job. You don't really start learning/ growing as a nurse until you're in your own. It's perfectly normal to feel this way when you first start. It will get better but even nurses who have been working 20+ years will still encounter situations in which they are unsure. Good luck

[DowntheRiver]

Sometimes, if in doubt, you can get a bit of an understanding of a poster you don't "know" by taking a look at other things they've posted.

I don't know, I think it is strange that you'd expect somebody to go back and look at the commenter's other posts to decipher what they mean. The first time I read her comment I was kinda astounded. I check this board daily and recognize names but I don't know if I'd say that I can recognize response styles.

[cayenne06, MSN, CNM]

Well, I'm glad even the seasoned pros still have questions about things. It's hard for me to let go of the notion that I spent all this time in school so I should theoretically know things? Note taking, though! I'll remember to do that for sure. And try not to care about feeling or looking stupid when asking questions.

There is *never* a time when you stop having questions! Being comfortable with this reality is what comes with experience. Gods help me if there comes a day when I have the hubris to think i've learned it all.

[brownbook]

I understand your good intentions, but I respectfully disagree, and I think it is important not to encourage a false sense of security in regard to giving medications safely. A single medication can definitely kill a patient depending on their current clinical condition, co-morbidities, allergies, age, etc., if it is contraindicated for that patient or incorrectly administered, or sometimes even if it appears to be indicated. Also, elderly patients and very young patients have much less physiological reserves and are more likely to be unable to withstand a medication error that a younger, healthier person, could. To give just a few examples: A single IV medication that is contraindicated for the patient or incorrectly administered can kill a patient. One example is IV Heparin, which can result in fatal hemorrhage. Giving a PO antibiotic that the patient is allergic to could result in anaphylaxis. An overdose of subq insulin can kill a patient in a single administration.

I have to also disagree with your statement in regard to missing something vital that unless you are working in a critical care unit patients will let you know by their vital signs or what they say that they're critically ill. This is not necessarily true, by a long shot. Patients are often very sick and have no knowledge of correct nursing/medical practice; just to give one example, it is not hard if you are not paying attention to make an error such as allowing the patient's IV fluids that are running at 125 cc/hour when they return from a procedure to continue to run at that rate for hours more, without even noticing that the patient is putting out a very large volume of urine (the patient has a history of significant chronic renal failure plus a cardiac history).

I was posting from my personal experience as a new grad. I was so freaking scared my first few years as a floor nurse I could not, did not, grow, learn, barely functioned, barely survived emotionally, I was so freaking scared and nervous. Yet I didn't harm or kill anybody.

I guess failed badly, I was just trying to ease mindiianajones's fears. Can you understand the difference between going to work with the mind set that "I'm doing okay, I am new but learning, It's really hard to kill a patient, . That somehow as a new mom (not yet a nurse) my children survived their first years with me. (Laughter is a great stress reliever.) Versus "I'm so scared I'm going to kill a patient I think I'm having a panic attack."

[Susie2310]

I think it is very important to be very aware that our actions and inactions as nurses can seriously harm or kill patients, and to make our best effort to practice safely. This awareness shouldn't induce panic, but should be enough to instill great caution and vigilance, which is necessary to practice safely. For example, using the five rights (or however many it is now) when administering medications, knowing the action of the medication, normal dosage, indications for giving, contraindications, assessment before and after giving, relevant lab values, drug interactions, necessary monitoring, expected effects, normal side effects, adverse effects and action to take, are very important. Being aware of the patient's medical history and co-morbidities are important, as all of this is relevant when a patient is admitted for a particular diagnosis; a patient can be admitted for a cardiac problem yet can have a history of hypoglycemia, which while it may not be an immediate problem can certainly cause big problems for the patient if they become hypoglycemic and this goes unrecognized by nurses/physicians. Intake and output/fluid balance is another very important area - is the patient's urine output appropriate/sufficient and is their IV rate as ordered appropriate, and is their IV infusing correctly at the ordered rate, and so on. Doing a good assessment is very important. Prioritization of care, with the sickest, most unstable patient first, is very important. Be aware of lab values and diagnostic test results. Be aware of trends: Vital signs, I&O, labs, assessment data.

[Workitinurfava, BSN, RN]

Clinical's aren't long enough. You would need more time to feel competent as a new nurse. You will build your confidence and competence as you work.

[Ruby Vee, BSN]

( in response to brownbook ) Why so hateful? These are valid questions from someone who perhaps needs a little boost of confidence or reassurance, not for you to be confounded and invalidate these concerns merely because you did not have access to such a tool as this forum. Shame on you; I hope you never precept new RNs.

Brownbook wasn't hateful but you are. Shame on you!