First nursing job in med-surg, not the right fit?

[Krither]

Alright so I have been on a med-surg unit for several months now just right out of nursing school. I had been having issues with time management since my original orientation, but it seems as though I did not get the type of specific feedback that I needed that would have been helpful to me. So a few months after my first orientation I have been put back on orientation to strengthen my time management skills. I very much appreciate this second chance to improve (I feel it is a blessing to even get another chance), however the conditions are that improvement must be made for me to continue working in my current position.

What I am getting concerned about is that I am doing all I can and giving my best efforts (giving 100%/giving my all) to improve now that I have gotten the feedback that I really need. I understand the feedback, tips, and advice that I have received now, but with my best efforts to follow through, work hard, and meet the goals for improvement it has been determined that not enough progress has been made yet during the two weeks that I have been back on orientation and so additional time has been given.

I have been seriously thinking about the time I have spent so far in med-surg and I am starting to feel that perhaps a med-surg floor is not the area for me. I can stick it out to the end with my best efforts which is what I have already been doing, but again I am concerned about whether med-surg is for me.

Any advice, suggestions, or words of wisdom would be very much appreciated.

[turnforthenurse, MSN, NP]

Are you with a preceptor again? Is it the same preceptor or a different one? I would definitely ask for some feedback from them.

Time management is a skill that is learned over time and probably one of the hardest things for a new nurse to grasp, aside from learning how to be a nurse, lol. Don't sweat it.

Do you have a brain sheet? This can really help you organize your day. You can do a search here on AN, or I'm sure Esme will chime in and post some *cue Esme*

It sounds funny, but I get lost without my brain. Aside from having all of the pertinent information that I need to fill out, there is also a list of times on my sheet, going from 19 to 06 (I work nights) in a straight line. I briefly look each of my patient's MARs and circle whatever times I have meds....this usually means 21, 22, 23 and 06. If the patient is diabetic and needs their blood sugar checked, I usually write "AC/HS_______" so I can write the value on that line. I highlight it. If the patient has an order to check their blood sugars Q4H, I write "20 _____ 00 ______ 04 ______" or if Q6H I write "00 _____ 06 ______" and this helps remind myself. If a patient needs a urine or guaiac I make sure to write that on my sheet and highlight it.

Everything else just depends on the patient. Say I have a patient with a PEG tube and there is an order to flush with tap water Q6H. I will make a little box next to each time so I can check it off when I complete it. If a patient has ordered neuro checks Q4H, I do the same thing. I hope this isn't confusing you!

Try to cluster your care as much as possible, and cluster your meds. If you have meds due at 20, 21 and 22 and there are no contraindications, give them all at 2100 instead of giving one at 2000, coming back with the 2100 meds and again with the 2200 meds. Save your "talkers" for last. If you have to do a dressing change during your med pass, save that for last, too.

[salvadordolly]

It hurts me to see these kinds of posts. It really takes 6 months to a year to get your groove on the floor and a lot of employers are just not giving their new grads the time they need. It sounds like your employer is giving you some time of help. If you're precepting again, ask for specific help with time management. Try to get many preceptors and pick up tips from all of them. Time management is the toughest skill to learn. Try to get a routine at the beginning of your shift. Get your report. Then gather meds and supplies that you'll need and bring them in the room to do your assessment. It's often to hard to chart right after doing assessments, so I save that for when I'm eating my lunch. I used to have the CNA accompany me at the beginning of the shift, so we could do turns, moves, VS, blood sugars so I knew them right away. You're on top of the game this way, and very few call lights go off when you have all their needs taken care of right away.

[%63theend]

I think it is bothersome how some managers expect new grads to hit the ground running. You're new. Give the new nurses slightly lighter loads and let them get their bearings!

Anyway, take this as a blessing that you have a longer orientation. Do get samples from other people on what they do but mostly develop what works FOR YOU... Things worked MUCH better for me when I tossed what everyone else was doing and figured out what worked for my brain. Nurses can be very critical, too. The more you ask for help the more critical they become and can become insulting. Just try and not take it to heart. Give yourself kudos for making it this far. You CAN DO IT. No one who has ever survived is any better than you are. You are capable.

[wannabecnl]

Just want to encourage you not to give up yet. (I'm not saying med-surg is for you, though--read on)

I went into the PACU with basically no experience after school. Even having completed my clinical immersion in the same unit, I had so much to learn and slogged through my first 3 months of orientation. At the end of 3 months, I was not yet independent enough, so they gave me an additional month with a different preceptor.

That month almost did me in. Different teaching style, different schedule, different emphasis on much more acute patients--all of this had me convinced after a week and a half that I needed to quit and do hospice nursing or work in an office! ANYthing but PACU! I couldn't sleep, I couldn't let go, I couldn't get organized, and I was a wreck.

A particular case forced me to come to terms with some of my issues; I talked very frankly with my preceptor and told her not to give up on me and that I would also not give up, and decided that I was going to give 110% to my next 3 weeks with her. Then it would be up to the manager.

I am so glad I did not give up; it is now 3 months later, and I'm on my own. I survived those last 3 weeks on orientation and even thrived as I focused on the patient rather than on what my preceptor seemed to want (because a good preceptor wants you to become a good nurse!). I still ask questions, and I get help with the sickest patients (it's common to have help with ICU patients in the PACU, even for the more experienced nurses), and I learn new things every single day. Just over a week ago I had my first "nursing instinct" experience: I had a patient whose pain was very strange and disproportionate to the procedure. It just didn't feel right to me, so I called the surgeon (which we almost never do). Turned out she did have a complication beyond the usual PACU stuff, and it was a good call. After 6 months of feeling like the paranoid newbie, it was so gratifying to have made a good judgment that may have ended up helping someone (not just reducing my anxiety!).

I tell you this to encourage you to stick it out and learn all you can. Your job right now may seem like it is to please your preceptor, but you can't look at it that way. You are there to learn how to take care of patients and how to function within your unit. Get the help you need, focus your questions for your preceptor and colleagues, and take those tough patients while you still have help! Then you can make a better decision about staying that is based on what you actually like doing rather than how your orientation is going. I wish you all the luck in the world!