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.
