Feeling like a failure most days

wish_me_luck, BSN, RN · Sep 5, 2012

Hey, I am a new grad too (taking boards soon). The UA stuff being collected and such needs to be given in report. You shouldn't have to search through a chart to find that out.

Here's how I figure I might work it. Get there, get pt assignment, get report (you should be going into the pt's room to do this and making sure the oxygen is what it's supposed to be, IVs running at the correct rate/no infiltration/redness, note whether they have drains or foley and other quick assessments; step outside to give code status), then do your blood sugars unless there is something very urgent that needs to be done (pt having airway issue or something emergency wise), then write down all your med times (i.e. rm 200: 800, 1000, 1200, 1400, etc.); and do your assessments when you are in the room giving the meds; and ask them if they need anything while you are in there to prevent going back in there right after; chart right when you get out of the room; then check your orders and such after pt assessments are done. If you have an emergency or something, that's out of your control. I can see why you get frantic. It's unexpected.

Delegate some things; but please don't be the nurse that the pt needs to use the bathroom bad and you say "I'll call your tech to take you" when you have nothing better to do or you have a moment to do it.

Well, airway and breathing is first, so the desat. one you do need to stay with, then take care of the high BP. If you need something hung immediately (i.e. antibiotic), see if the charge nurse can help. Here, the charge nurse has a lighter load, so they can be charge and take care of things.

I, too, am scared out of my mind. But being new, you can only try and learn from your mistakes. Take time out at the end of your day to evaluate how it went. What worked, what didn't work, and how you can make it better.

Ruby Vee, BSN · Sep 5, 2012

I am a new grad at a hospital med/surg floor and I work rotating shifts a month. I can manage a full assignment on most shifts and have been performing at a very rudimentary level. I am having trouble in a few areas though:
1- Time Management: When everything goes mostly as expected and is an uneventful or mostly uneventful shift, I can handle myself and feel confident. When something goes wrong or a patient's condition changes, I start to feel myself get anxious and panic, and run around like a headless chicken. When it's 7:15am and I'm coming off nights and I'm running around like crazy while trying to give report, I feel like a hot mess! One night I had to pass on a bunch of stuff to the next shift and I felt sooo bad, and like they will judge me as a bad nurse

Time management is the curse of all new grads. If you can manage a full assignment on mosts shifts, you're on your way to being able to conquer time management. It's the unexpected stuff that trips us all up . . . even sometimes when you're decades into the job.

We've all had to pass stuff on to the next shift, too. That's why nursing is a 24/7 kind of job. The goal is to improve, so that you're passing on less stuff as time goes on.

Brain sheets help with both of these issues. Another thing that helps is seeking out someone whose time management skills you admire and asking her how she manages. This accomplishes two things: it's flattering to the person being asked and may gain you an ally, and you might get some tips that help out enormously.

2 - Being too task orientated: I am so scared about missing a medication, or being too late on vitals or assessments, or forgetting to chart this that I'm often more focused on checking off boxes on my report sheet rather then seeing the whole picture of the patient's condition. For example, my charge will ask for updates and I will have no idea what the patient's plan for discharge is. When we start shift, the nurses pick their patients, which takes up a lot of time (10-15 minutes). Once I get my assignment I need to look through charts and then get report, if I took all the time I needed, by the time I even see my first patient it would be an hour into the shift! So I often skim through the charts and miss minor things (like patient A needs a UA/UC collected).

Are you working two or three days in a row? The second and third days cannot help but be better as you'll already know your patient. Once you've picked your patient, scan the chart quickly for meds or treatments due within the first two hours of your shift. Report should cover the basics of history, abnormal labs and plan. Eyeball your patients quickly to make sure they're pink and not blue, and that no one is bleeding out, falling or trying to die. Again, seek out someone who you admire and ask them how they get their day started.

3 - Prioritization: I know how to prioritize but in the real world it's so hard. For example, although I've got a new post-operative patient I need to assess, the patient in room 6's family keeps calling and calling for pain meds for the patient and getting angry at me. It makes me feel so stressed. Or, my patient is desatting into the low 70's-80's when simply speaking, is on CPAP, respiratory is on the way, but I can't leave the room. But the PCA tells me that my patient in room 8 has a blood pressure of 180/95. Or the patient in room 7 needs an antibiotic hung, 8 needs insulin ...

Again, prioritization is a bugaboo of new grads. You'll get it. When you start feeling stressed, just take a few good, deep breaths and remind yourself that you can do this. If you're only a month into the job and you can already manage a full assignment on a good day, you're well on your way to being able to manage a full assignment on most days.

4 - Just being nervous in general: Nervous about an unsteady patient falling, nervous about making a medication error, nervous about missing something significant, not sure what to do when weird situation X happens ...
I have a good brain sheet that has helped a lot, but I am often sick to my stomach and so nervous when I go home that I missed something or made a mistake. I try to avoid obsessing about it, and I can calm myself down soon after the shift is over. But I can't help but feel a lack of confidence and like I'm not sure this was a good career for me, or if I can really do it and be a safe nurse.

All of these complaints sound like the first year of nursing blues. The first year of nursing is really, really rough. The only way to get through it is to GO through it. Trust me, we've all been there. We got through it and you will too.

nursemike, ASN, RN · Sep 5, 2012

A thing that helps a little with prioritizing that might sound wrong right out of school is considering how long a task may take. I can pass a pain pill pretty quickly, but assessing a new patient takes some time. So, I might help transfer the new arrival to bed, take a quick look, then go pass a pain pill. I can come back and do my full assessment with less pressure. It also helps to think about which jobs will save me work, later. One pt needs pain med, one needs bedpan. Doing the bedpan now saves a bath/bed change a few minutes from now. I don't like to keep people waiting for pain meds. I try to be proactive and ask before they call out--saves me time, saves them pain. But if it comes down to it, waiting 10 minutes for a pain pill isn't the end of the world (just remember it can feel like it, if you're the one in pain, so do the best you can.)

The comment about calling a tech/aide to toilet a patient has some validity. The aides I work with don't think a lot of a nurse who assesses a patient, then calls them to toilet that patient while they move on. The poster's phrase, "when you have nothing better to do," is key. At this point in your career, when do you not have something "better," (more important, that only a nurse can do) to do? Support personnel are not doing you, or the patient, a favor when they do the work they're paid to do. I'm not a bit too posh to wash, but if I'm having to choose whether to do a bedpan or a pain pill, my aide better not be reading a magazine. I've seen a few new nurses since I was one, and most, like I was, are prone not to delegate enough. We're control freaks, and I'd still rather get my own manual BP when the machine isn't good enough. But when I do need to delegate, I look at it this way: most of my aides work hard. I work harder. That's just the way it is (and yes, I get paid accordingly, so I'm not trying to be a jerk about it).

*4!#6 · Sep 5, 2012

I feel that my delegation skills are okay, but go hand in hand with my time management. Sometimes I try to do too much and end up behind, but I can definitely tell when I am drowning and need help. For example, on nights where I was working with a reduced patient load, I got all of my own blood sugars. However another day, my patient needed his AM insulin and of course his blood sugar checked before, but I was dealing with a clogged tube as well as needing to give report (again envision me running around like a chicken with it's head cut off at 7am). So I asked the PCA to check the patient's blood sugar, and thankfully no insulin was needed (saves time as some of my other patient's needed 7am meds). It is also hard when they schedule a lot of treatments and meds half an hour before shift is over, and you also have blood draws, and to give report. I think I might start getting my labs and medications early.

wish_me_luck, BSN, RN · Sep 6, 2012

Sorry, nurse mike. I didn't mean it that way. I've teched before and I have had times where I was with a pt and there would be another one of my pts needing the bathroom and the nurse would be in the room and say "well, your tech will be here in a minute to take you to the bathroom" and they leave the room and they had extra time to get them to the bathroom. I have worked with nurses that were fabulous about helping and others that thought once they got that RN or LPN after their name; they thought they never have to toilet a pt again.

I know the facility I was at, they had a time frame that was okay to give it (like if they did it 30 minutes ahead of time, it wasn't bad or they didn't have to write themselves up); know your facility's policy though. They didn't do their own blood draws though but they had to do their own blood sugars.

amoLucia · Sep 6, 2012

Just know that once in a while even we senior nurses have to leave something undone/unfinished. Not a problem in my opinion because I know that we all do so (and that means the nurse after has done so also. If she said she hasn't, I'd know she's a big fibber).

Having said that, it is a 24/7 job as RubyVee posts - the facility ran OK before I arrived, and it will run OK after I leave. NO facility is 100% dependent on 1 person to run. You do the best you can. You give report and just tell them. If you remember something after you leave, give them a call (don't we all have our work # programmed ?).

I want to believe that many of us really do cut newbies some slack even if we don't toot-toot it. It's tough to be new, as a graduate OR as a seasoned new hire. And many seasoned nurses aren't perfect even being experienced - there's always room to improve for us all.

So, take a deep breath and keep on --- :hug:

sapphire18 · Sep 6, 2012

I guarantee you, 95% of new grads feel like this for the first 6-18 months. It WILL get better!!! Hopefully you have supportive coworkers, use any resources you can without feeling guilty! A plus on your side is that you are able to identify your weaknesses...work on one specific area at a time, and you will get it!

BluntForceTrauma · Sep 6, 2012

Sounds like the normal new grad to me...heck, some nurses that have been doing it for years may still feel the same way. You have to figure out what works for you. Don't be ashamed to ask people for help. If you're assessing your new patient, it's ok to ask another RN to administer pain meds. However, like the above poster stated, sometimes it;s quicker to give the pain meds ten come back to do your detailed assessment.

nursemike, ASN, RN · Sep 6, 2012

I've seen the same thing, from time to time, so no apology needed. I've also had patients who've said they would rather "hold it" until the female aide could get to them--although most are more than happy to let the male who is there do it now than to wait for one of the gals. I've also experienced, and seen with others, that some of our aides will test a new nurse. Most are looking to see if you are the sort of nurse they can respect, who will roll up your sleeves and do whatever needs done. If you are "too good" to toilet a patient, you won't have their respect, and to me, that's fair. A small minority will test you to see if they can let you do your work and theirs, too. Fortunately, it isn't that common--lazy aides tend not to last long. But it happens.

I mostly meant to emphasize that a new nurse may feel a strong desire not to seem too full of herself/himself for the dirty work. But new nurses are typically busier than experienced nurses, and there should be no shame in that. It takes time to find a rhythm. After seven years, I still have an occasional shift where it seems all I get done is running around putting out fires. But there are others where I have time to toilet another nurse's patient, or bathe my own, because little things like getting the pills out of their packets don't slow me down like they once did. Time was, placing an IV was a minor disaster, now it's just another chore. But a new nurse, learning the ropes, needs to be able to lean a bit on the other staff, and realize that nearly all of us have been in the same position. New aides go through it, too.

nurseladybug12 · Dec 17, 2012

I am also a new grad RN and I sympathize with everything you are saying. I always feel like I am running around like a chicken with my head cut off. I especially hate the morning from 7-10a when I am passing morning meds. I just feel like a pill pusher and barely like a RN. I feel like I am not doing what I went into nursing to do, which is to be there to teach pts to care for themselves, to offer them help emotionally in any way. I also have no time to delegate and supervise, and recently I was approached by my preceptor telling me that many of the aides are telling her that I am not helpful enough. I am barely hanging in there trying to take care of 6 patients and now I have to add in helping the aides. They will not approach me during the shift to ask for help, so up until now I assumed they had everything under control. So to say the least, I feel completely blindsided by all these comments it is starting to become so overwhelming I am starting to hate nursing all together honestly. I am constantly anxious as well,especially when I give anything IV push, and BP meds. Many times their BPs are under 120/80 and they will be on 4 different BP meds. Some have different parameters but it just makes me nervous. I also have an issue with giving all these meds, many I havent heard of and not having a second to look them up so I know interactions, nursing implications, etc. Even IV compatibilities, I cant look up no time so I pause everything, heplock and push everything like that unless its NS hanging. One time I had a patient vomiting wanting phenergan, another was being discharged and being pushy about leaving NOW they were in a wheelchair and their family member was waiting in the car for them, and I had 3 ppl calling for pain meds, etc etc. I got flustered, so I went to my preceptor for help, at least to take the pt downstairs to discharge. She tells me no, I need to prioritize, and then she continues to sit and chit chat with other RNs. That flustered me even more! I am also new to inserting IVs, and I tried twice on my pt, so I asked the charge RN, she says no I dont feel good, I ask the manager who is breaking down boxes after stocking and he says " im not doing those today" so I had to beg 2 other RNs who were sitting around talking before I could get help. This was when I was not even halfway through orientation and they all knew this. There is definitely a lack of teamwork on my floor and I know walking in everyday I will never have less than 6 patients, I might even have 7 or 8 plus LPN assessments to do and chart, plus doing aid work if we are short. I dread going to work, for the past 2 weeks I have had no appetite feeling so stressed. I almost walked out one day when I heard I had 7 patients, I had to do 4 LPN assessments, and I had to be the aide for half of them. I feel like my license is almost in danger at this point so I did myself a favor and I am out of their asap. I got another job already at a much better hospital and I am just going to hang in there another 2 weeks with 4 weeks of orientation to go so I dont miss a paycheck. Oh well.

Bedilia · Dec 19, 2012

I feel the same as the OP, everything that she has said reflects how I am feeling right now. I hate that feeling, when you are dealing with a clogged Gtube, trying to feed the meds in, while transport is waiting to take the patient down to CT, asking you if you had the forms done, meanwhile I don't know how to print the forms, or at least its not working the same way as it did when you did it for the first and last time a week ago, and you are already behind and the more flustered you get the more difficult every task seems. Oh yea and new orders are coming in for blood cultures and a type and screen ASAP bc your other pt needs a blood transfusion and patient 3 who is covered in Stage IV sacral pressure ulcers is laying in a puddle of feces and needs both cleaning and dressing changes. You find out that bit of information from the family member! Ahh, that was yesterday for me. Pt 4 is doing well, is your last priority, but you havent seen them in too long and have to make hourly rounds?!?!

This job is meant for like 10 people, not 1. When I come home and SHOULD feel accomplished because I did learn. However, I just feel incompetent, stressed out and anxious for my next day at work. I hope it gets better.

One other complaint is that I absolutely love dealing with my patients and their families. I have had nothing but good experiences and they come by and thank me for being so caring and helping their family members out. That also made me cry in a good way yesterday. But what makes me sad is that as I go through this orientation period, I will be getting more and more responsibility with less and less time to properly talk to, teach and update my patients and their families. I love doing that so much, and should be at the core of nursing. But now it puts me behind. I have to learn to make it short and quick I guess. My floor is trying to make it routine for us to sit with our patients for 2-3 minutes in the morning to cover goals and cover and concerns for the day. And even that is proving to be difficult for the experienced and non experienced nurses alike. 2-3 min!!!! Thats how busy we all are! I just dont know....I will tough it through for 18 months and reevaluate then I guess. Until then, keep my head down, plow through and try to get rest on my days off.