First day as an official RN: Reflection

[_littlemissBSN, BSN, RN]

Warning: tl;dr

Hello nurses! I'm a new grad RN and today was my first day on the floor by myself. I would just like to write this post to reflect on my day and share my experience.

I work in a busy acute rehabilitation hospital and had 17 days/6 weeks of orientation. I had a total of 8 patients. I thought my run wasn't something that my co-workers would say is a difficult one -- at least not compared to what is considered a hard run when I was still orienting. Yet, I felt swamped throughout the day, I kept running around, did not pee at all during the shift (I actually never had the urge to), only had 15 minutes of lunch, and even went over 2 hours my schedule to document and finish tasks.

After finally walking out the door at 9:30pm, I sighed and said to myself that I need to be more organized and work on my time-management next time. I try not to be too hard on myself considering that this is just my first day. I say to myself that it's still overwhelming for me since I'm still very new to this, but I still couldn't help but feel quite upset and incompetent that I was so behind. I am even more upset by the fact that I missed an ACHS glucose check on one patient. She does not have any insulin order and her previous blood sugar are within normal level. It is my fault that I'm depending on my MAR and not looking at my tasks or orders. I might have also missed it during report. I don't even remember anymore.

The acuity of my patients definitely isn't as high as the ones in acute care (although I maintain that some of the patients that the hospital has, including a patient of mine, are not stable enough to be in a rehab, even if it's an acute one). A lot of my classmates work in acute care and I doubt they had to stay 2 hours over their shift, so that is even more dejecting to me. As much as I do not want to compare myself to others and that doing so will do no good, I could not help it. My tasks are doable, it's just the patient load that needs getting more used to.

Here's an overview of the things that I dealt with today:

- A total of 8 med-pass morning, lunch, and afternoon.

- Upset patient who was complaining and cursing because no one was answering his call light first thing in the morning and couldn't get more pain medications. He'll be fine for a moment and gets upset again.

- A patient who kept pressing the call light because she was constantly having visual hallucinations and she was being agitated by it.

- A fall-risk patient who has a history of stroke and has expressive aphasia who kept getting up.

- 2-3 patients who are asking for pain medications, round the clock.

- 2 patients with ACHS accuchecks

- 2 patients whose urostomy and pleural vac kept leaking, so I had to change and reinforce them like twice

All that and repeat throughout the day plus reviewing labs and orders, communicating to doctors and other professionals, dealing with unavailable meds, getting supplies, etc. One of my patient also had a really low blood sugar of 58 shortly before lunch, so I had to monitor that patient, offered orange juice, and fed him myself to make sure he eats since he was very drowsy and almost difficult to arouse.

Now, I was asking myself why was I so behind and I was able to boil it down to these:

1. I tried so hard to please my patients (especially the upset and the hallucinating ones) that I had to constantly go to their rooms and reassure them, talk to them for a while, and tend to their needs.

2. I am still not familiar with some procedures and wounds that I had to frequently ask stuff and/or grab another experienced nurse to go with me to do some wound care, who thankfully was very willing to help me.

3. I get intimidated by call lights. Whenever I try to sit down and do my chart, there will be a call light alarming and I would quickly get up as if it were a reflex. I was prioritizing answering call lights over documentation.

4. CNA work. The client whose blood sugar crashed earlier is 1:1 feed and since I usually could not find my CNA, I had to do it myself, as well as tending to my other patients' requests - which were mostly what the call lights were for.

It was tough for me. I had a rough day and sometime during the day, I was questioning my competence. Whatever honors or As I had in nursing school is insignificant as they mean nothing when you are on the actual job. I tried my best to be calm, but anxiety took over that may have affected my organization. But still, I refuse to complain nor let this negatively affect my self-esteem and confidence. I want to reflect on this day and see it as a significant learning experience, which I truly hope will help me grow as a nurse who can thrive when the going gets even tougher.

I need to be tough and if I had to ignore a stable client's call light to document an important assessment and just stiffly, but respectfully ask my CNA to answer, I'll do it. If I can see myself talking to a patient for a while to appease them, I might as well bring my WoW with me and document while chatting.

Thank you for reading. I very much welcome any type of advice or criticism.

[Ella26, BSN, RN]

Congrats on completing your first day off orientation! I think you are already on the track to succeed as evidenced by self reflection in this post. The only way to learn what does work is to analyze what doesn't. So bravo for taking the initiative, that shows critical thinking.

Each day just reflect upon what did and did not work, make the necessary changes and repeat.

Good luck out there comrade!

Thanks for sharing your experience.

[guest52816]

Congratulations on making it through your first shift on your own. Be proud of yourself.

I think you did a great job of summarizing your shift, and identifying the areas where you can improve with time management skills. No, don't beat yourself up, or feel badly about staying late. You are on the right track!

Use the tech as much as you can. Remember, you can do their job, but they can't do your job.

Each shift, you will learn more and it will get better.

[Edina]

Great post! I'll be starting my first nursing job on a rehab unit and will definitely use reflection to help me grow and improve.

[_littlemissBSN, BSN, RN]

Thank you everyone for your words of encouragement! I'm not gonna lie and say I'm not anxious about my next day on the floor, but I will do my best!

[guest52816]

_littlemissBSN said:

Thank you everyone for your words of encouragement! I'm not gonna lie and say I'm not anxious about my next day on the floor, but I will do my best!

I think you will be fine. So long as you are willing to be open and engage in self-analysis (which you obviously are). Let us know how you are doing.

You are going to be great!

[purplegal]

Sounds like my workday everyday, although with 20 patients versus 8 (at one time I had that number though). I've been at it for 19 months. Sorry to say, but none of the issues you talked about really ever get better. It does sound like you handled the situations well, especially when the patients were unstable and that's the most important part; recognizing who needs attention the most, and that may not be the person who is constantly on the call light (in fact, it rarely is).

I agree that in rehab we get a lot of patients who really are not stable enough to be there. Unfortunately this means quite frequently we have to take the time to send them back to a more appropriate level of care.

As for forgetting a blood sugar, it happens. It's not really acceptable but I've done it and I think others have done it as well. Sometimes more critical patients demand our attention and the time to get the blood sugar flies by before we get it. Really try to make it a rare occurrence though because you never know when the stable diabetic will become unstable.

As for staying hours late for charting, that happens all the time. Sometimes you have to decide which really needs to be charted today and which can be completed on another day. Otherwise you'll never get out of there.

I feel like I also get behind for many of the same reasons. I also like to please my patients but some people are not going to be happy no matter what you do, so you just have to leave the room once you realize they don't really have an immediate medical need.

I also have to ask for help with skills that I am not proficient in. As a new nurse, it's going to happen so not really a big deal. Better to ask for help and do it properly than assume you know what you're doing and possibly causing patient harm or not doing the task at all.

I also feel the need to answer call lights, although a lot of it has to do with the stares visitors and other non-staff members will give you when they perceive you to be ignoring a call light. However I think it's a good idea to keep continuing to answer call lights since it is part of our duties, not just the CNAs. Most documentation can wait. At the same time, if there is a CNA doing nothing and you're charting, they should be answering the lights.

Also, it is actually a good thing to do some of the cna work if you're available and they're busy. It's also part of our jobs and the CNAs will appreciate it as well as the patients. Sometimes nurses simply cannot avoid doing CNA work. The amount of charting is daunting but remember that caring for the patient comes first.

From what it sounds like, you're doing great. There's not much I would change since yours sounds like a pretty typical day in this type of setting. Good work!

[_littlemissBSN, BSN, RN]

Thank you for your post, purplegal. Very insightful. And once again thank you everyone for your all your thoughtful advice. I'm about to begin my second week as a solo nurse and here's to hoping it will run smoother! I promise to myself that I'm never going 2 hours past my shift again.

[nurse_flo_marie, MSN, RN]

Congrats on completing & reflecting on your first day alone as a new grad RN! And definitely glad you found time during your shift to eat.

I'm a Staff Development Nurse at a skilled nursing/rehab/sub-acute facility & your reflection is refreshing. It's important to think about ways to improve your nursing practice and your team. Healthcare is changing and patients will be transitioned out of hospitals faster. Acuity will continue to increase. Triage & delegation is truly a skill.

Does your facility use electronic records? Time management also includes knowing where to locate & document patient information. Some programs allow you to sort the eMAR based on time or for example, blood sugar checks.

Do you have a person in the staff development role who you can discuss your reflections & provide you with tips?

For the patients who were on the call lights, required pain meds, etc, I have some suggestions or ideas:

- During change of shift or rounds, ask the patient if they need a PRN but let them know you have to finish rounds. This can have two possible results - patient loves when you're working, symptom is managed & they are content the rest of your shift or they will continue to be on the call light. It's important to gauge EACH patient for effectiveness of this method;

- Get to know the patient and use distraction. If there is an area where patients can go so they aren't spending their days in the room hoping for interaction, that would take a lot of weight off of you and the CNAs. I used to even send my patients down to rehab;

- For the agitated patient having hallucinations, do you have a psych service? Patient recovery can be hindered if they are not comfortable or anxious; and

- Take time while you're documenting to review the patient chart, especially the care plan. If others have identified interventions to address things you've assessed, it should be in the care plan.

The other things come with experience. Do a huddle with the CNAs at the start and end of your shift. Let them know if you'll need patients for treatments, labs, or specimens.

Great job! You will be a great nurse and pass on your knowledge & skills to new nurses.

[blackberry74]

it has been my first day at work as a solo nurse myself Christmas day, which wasn't bad, but the day after was horrible. All the surgeries had been on hold for the Christmas weekend and so Tuesday was a nightmare. I was being nurse, tech, and "fireman" as tempers were high with family members and patients who had to stay with us over the weekend and who wanted to be sent home.

Today is day three, my Friday, and I look forward to sleeping in tomorrow. It's tough, hang in there. But wow, 8 patients? that is a heavy workload, we have six on the Med/Surg floor.

[_littlemissBSN, BSN, RN]

Almost an entire month went by since I wrote this (wow). Ever since that day, I noticed a slight improvement in my time management and I'm able to clear out my tasks before my shift ends. The latest I've stayed over was until 9pm, but it was understandable as I had a pretty heavy run. I just need to learn how to be a nurse more, but sometimes, I just couldn't help but feel quite envious of my experienced co-workers who know what they were doing all the time and get everything done on time. I understand that that is something that do come with experience.

[guest52816]

_littlemissBSN said:

Almost an entire month went passed by since I wrote this (wow). Ever since that day, I noticed a slight improvement in my time management and I'm able to clear out my tasks before my shift ends. The latest I've stayed over was until 9pm, but it was understandable as I had a pretty heavy run. I just need to learn how to be a nurse more, but sometimes, I just couldn't help but feel quite envious of my experienced co-workers who know what they were doing all the time and get everything done on time. I understand that that is something that do come with experience.

Glad you feel as though you are making progress and moving in the right direction!

Good to hear back from you.