First job in Med-Surg and it might not be a good fit...

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Hi everyone, sorry this is such a long post. I feel like typing everything out has been therapeutic for me :'D. Thanks for reading!

I just graduated nursing school in June and landed a job in a residency program on a Med-Renal floor. Most of our patients are in End-Stage Renal Failure and are on dialysis. We also see a fair amount of liver failure, CHF, GI bleeds and COPD exacerbations. We also have telemetry. (And of course pretty much everyone has diabetes and chronic hypertension!)

The residency program consisted of 6 weeks on day shift and 2 weeks on nights with a preceptor, then on my own. Day shift I didn't really have too many issues besides time management (which i feel most new nurses struggle with) and just in general staying organized on my shift. Once I moved to night shift, it's like I'm all the sudden horribly unprepared to go on my own. I have a new preceptor which I feel slightly intimidated by... and feel like I can't think straight in front of her. I forgot to scan a med a couple times before giving to a patient (she caught me doing this, so the med was never administered), and I'm struggling with accurately charting and prioritizing my most critical patients.

My manager decided to put me on 3 more weeks of training. I finally felt like I was safely administering all my meds, but was letting my anxiety get to me since I felt embarrassed about needing more time. My preceptor on night shift like I said is very diligent and watches me like a hawk, but I feel is really supportive and gives great feedback.

I had a meeting with her and my manager last week and they decided to give me 5 more shifts, 2 with my usual night shift preceptor and 3 with another person since my usual preceptor has to be charge nurse. I went home, spent time looking up patho, made lists for myself, read all of my feedback, created a new "brain" for myself and did a bunch of self reflection. I had two more shifts with my usual preceptor this week which I really felt was my time to prove myself so I could be on my own, but I was failing left and right. I almost gave a medication too early, I pulled the wrong medication under someone else's name, I pocketed a med and lost it, I almost didn't flush an IV medication... on top of that I struggled with accurately charting, communicating with my preceptor my plan for the shift and prioritizing my most critical patients. I feel like an absolute failure and once my manager sees my preceptor's evaluation of me last night I feel like they are going to let me go. My manager said If I can't "meet expectations" on all my evals for these shifts, I can't be moved to another floor, and the hospital setting "may not be a good fit for me."

I still have 3 more shifts with a new preceptor. I want to say that part of the reason I've been struggling is because my usual preceptor is constantly watching me and all I can think about is her watching and not actually think about what I'm doing. Part of me also thinks.. what if this floor isn't really a good fit? Several nurses that have floated to my unit told me they can't believe I work on this floor, "it's so hard" and they hate when they have to float to this unit. All of the other residents were nursing students on this unit, I'm the only one that is completely new. I love all of the staff on this unit, I feel they are extremely supportive and always help when I ask. I'll admit the patients are very overwhelming at times... But I feel like I really could do this if I just push through and get over this learning curve.

I have a meeting after my 3 shifts with my new preceptor... I feel like if I keep messing up it will confirm that this floor is just too much for me and I need to go somewhere else.... but where!?!?!?

I apologize for rambling... Any advice is appreciated. Never thought my first job would be this difficult... I want to strive to be the safest and best nurse I can be, whatever setting I am in... (don't we all! :) )

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You are not alone my friend! I cannot explain to you the perfect timing of this post. It seems that we are BOTH going through the same experience. I’m currently in a medsurg residency program as well, and have extended my residency another week before I am on my own.
I do not believe you will fail. You are essentially failing your way to success, and this is allowed since we are still BRAND NEW and have MUCH MUCH MORE to learn.

The “mistakes” you mentioned are part of the process. Without making those silly mistakes (all of which I have made PLUS more by the way), we wouldn’t leave room for improvement.
You are not perfect, and neither am I. We are bound to make more mistakes , but this is part of the process.

Do you take notes through out the shift? I suggest you buy a pocket sized notebook and write ANYTHING that your preceptor or other nurses mention. I usually review these notes the next day and make an effort to memorize/understand them.

As far as the charting goes, what type of charting system do you use? My preceptor is very anal about correct charting. I have been yelled at by my preceptor for incorrect and incomplete charting. I’m sure this is a struggle every new grad faces, YOU ARE NOT ALONE.

Before every shift I become very diaphoretic, tachycardiac, and are so distracted by the fear of failing that I forget to think of the GROWTH that’s happened during previous shifts on the floor. Are you better than you were last week? Last two weeks? Last MONTH? I’m positive you are a better nurse than you were before.

We can do this! One shift at a time! One patient at a time! I look forward to hearing any updates on your journey!

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18 hours ago, Ronnie96 said:

You are not alone my friend! I cannot explain to you the perfect timing of this post. It seems that we are BOTH going through the same experience. I’m currently in a medsurg residency program as well, and have extended my residency another week before I am on my own.
I do not believe you will fail. You are essentially failing your way to success, and this is allowed since we are still BRAND NEW and have MUCH MUCH MORE to learn.

The “mistakes” you mentioned are part of the process. Without making those silly mistakes (all of which I have made PLUS more by the way), we wouldn’t leave room for improvement.
You are not perfect, and neither am I. We are bound to make more mistakes , but this is part of the process.

Do you take notes through out the shift? I suggest you buy a pocket sized notebook and write ANYTHING that your preceptor or other nurses mention. I usually review these notes the next day and make an effort to memorize/understand them.

As far as the charting goes, what type of charting system do you use? My preceptor is very anal about correct charting. I have been yelled at by my preceptor for incorrect and incomplete charting. I’m sure this is a struggle every new grad faces, YOU ARE NOT ALONE.

Before every shift I become very diaphoretic, tachycardiac, and are so distracted by the fear of failing that I forget to think of the GROWTH that’s happened during previous shifts on the floor. Are you better than you were last week? Last two weeks? Last MONTH? I’m positive you are a better nurse than you were before.

We can do this! One shift at a time! One patient at a time! I look forward to hearing any updates on your journey!

Thanks so much, Ronnie96! Glad to hear someone is going through the same! ?

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2 minutes ago, NurseC1193 said:

Thanks so much, Ronnie96! Glad to hear someone is going through the same! ?

And we use Epic

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Specializes in Med/Surg, PCU,.
On 11/15/2019 at 5:01 AM, NurseC1193 said:

Hi everyone, sorry this is such a long post. I feel like typing everything out has been therapeutic for me :'D. Thanks for reading!

I just graduated nursing school in June and landed a job in a residency program on a Med-Renal floor. Most of our patients are in End-Stage Renal Failure and are on dialysis. We also see a fair amount of liver failure, CHF, GI bleeds and COPD exacerbations. We also have telemetry. (And of course pretty much everyone has diabetes and chronic hypertension!)

The residency program consisted of 6 weeks on day shift and 2 weeks on nights with a preceptor, then on my own. Day shift I didn't really have too many issues besides time management (which i feel most new nurses struggle with) and just in general staying organized on my shift. Once I moved to night shift, it's like I'm all the sudden horribly unprepared to go on my own. I have a new preceptor which I feel slightly intimidated by... and feel like I can't think straight in front of her. I forgot to scan a med a couple times before giving to a patient (she caught me doing this, so the med was never administered), and I'm struggling with accurately charting and prioritizing my most critical patients.

My manager decided to put me on 3 more weeks of training. I finally felt like I was safely administering all my meds, but was letting my anxiety get to me since I felt embarrassed about needing more time. My preceptor on night shift like I said is very diligent and watches me like a hawk, but I feel is really supportive and gives great feedback.

I had a meeting with her and my manager last week and they decided to give me 5 more shifts, 2 with my usual night shift preceptor and 3 with another person since my usual preceptor has to be charge nurse. I went home, spent time looking up patho, made lists for myself, read all of my feedback, created a new "brain" for myself and did a bunch of self reflection. I had two more shifts with my usual preceptor this week which I really felt was my time to prove myself so I could be on my own, but I was failing left and right. I almost gave a medication too early, I pulled the wrong medication under someone else's name, I pocketed a med and lost it, I almost didn't flush an IV medication... on top of that I struggled with accurately charting, communicating with my preceptor my plan for the shift and prioritizing my most critical patients. I feel like an absolute failure and once my manager sees my preceptor's evaluation of me last night I feel like they are going to let me go. My manager said If I can't "meet expectations" on all my evals for these shifts, I can't be moved to another floor, and the hospital setting "may not be a good fit for me."

I still have 3 more shifts with a new preceptor. I want to say that part of the reason I've been struggling is because my usual preceptor is constantly watching me and all I can think about is her watching and not actually think about what I'm doing. Part of me also thinks.. what if this floor isn't really a good fit? Several nurses that have floated to my unit told me they can't believe I work on this floor, "it's so hard" and they hate when they have to float to this unit. All of the other residents were nursing students on this unit, I'm the only one that is completely new. I love all of the staff on this unit, I feel they are extremely supportive and always help when I ask. I'll admit the patients are very overwhelming at times... But I feel like I really could do this if I just push through and get over this learning curve.

I have a meeting after my 3 shifts with my new preceptor... I feel like if I keep messing up it will confirm that this floor is just too much for me and I need to go somewhere else.... but where!?!?!?

I apologize for rambling... Any advice is appreciated. Never thought my first job would be this difficult... I want to strive to be the safest and best nurse I can be, whatever setting I am in... (don't we all! ? )

Hi there! I was recently offered a med-surg night position but I haven’t accepted yet. Any updates on your progress? Did you improve & you’re now working on the floor, or did you change settings?

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