New grad sinking fast - page 2
Hi, im a new grad nurse and am in terrible need in of some advice. Please any advice is welcome! I just started orienting on my floor 2 nights ago. & I have to say I am already bombing it. My... Read More
Jul 31Joined: Jan '12; Posts: 734; Likes: 1,676Did you receive any orientation on the equipment? During my new grad residency during the week of computer training we also had half days where we went over the hospital-specific equipment. We were also shown the policy and procedure for that hospital. I was glad they did that because I did not end up working at the hospital where I did my preceptorship during nursing school because it was over an hour away. Both hospitals had different equipment, different charting (like you stated), and different policies and procedures. If you haven't had this, I'd suggest asking about this. Also get in contact with your unit's nurse educator as he/she will be a great resource.
Jul 31Joined: Dec '09; Posts: 1,083; Likes: 2,885"Has anyone else been in this situation?". Yeah. Probably the majority of us.
Jul 31From: AL, US ; Joined: Jul '18; Posts: 16; Likes: 8Thanks for the advice and support! I just felt down because all my other classmates and friends were handling at least one pt by themselves within 3 days of orientation while I'm not even doing that... it just hurts because I want to do this and be good at it. There's even an objective for orientee's stating that we should be able to handle one pt load at the end of 1 week. & i don't want the pt to suffer because they can't have their primary nurse's full attention. & I guess to clarify on my statement about "is anyone in this situation?"
i ask because I often feel like I have to be shown how to work the pumps and some things more than once. & that's why I'm worried about my pace being to slow.
& we did go over the pump and charting system in orientation but i couldn't remember everything.
I just also felt like there's a lot I haven't even seen & wondering did everyone else get to do these things in clinicals. In my clinical experience I did a tube feeding change probably once. So I couldn't exactly remember how the machines worked. & I'm just scared after reading some posts that once they see I'm struggling they will have this preconceived notion about me. & already count me out. Like I said my preceptor is fine but I know she's been talking bout me because I have her so behind. That's why I'm questioning this.Last edit by Sheika34 on Jul 31 : Reason: Didn’t finish
Aug 1From: AL, US ; Joined: Jul '18; Posts: 16; Likes: 8Thanks so much for your response. I do feel somewhat better. I'm just afraid I'm going to be the one fire after or before orientation is over because I'm doing so bad. We have an orientee objective where they expect us to be able to handle one pt load in a week and I'm just really worried because within my first week I haven't even progressed to handling one pt load. So by week two I will basically still be working on trying to handle one pt load. And thank you for the advice about having a check list. That will help to organize me. I think I need to work on talking with my preceptor more as well. The pace is fast & I am not as quick so I like to have a minute to get situated. Which to my preceptor's credit she did do but I just take to long. I think maybe I should just suggest focusing on one person. At times I feel like I am trying to focus on everyone at once which would be me gettin ahead of myself. & I did improve on charting a little. But as far as imputting the pump settings, and how to work the medicines I feel like I'm not making a fast enough improvement on that due to the fact that I have to be shown how to set the pump multiple times. I even had a another nurse to come in a room and look after our pt because I somehow missed the pt in distress while charting. & when suctioning her I didn't even have the yankuer hooked up correctly to the suction. It's like I get so nervous & do stupid stuff without thinking which is dangerous. That's why I'm wondering is this level of screw ups is normal?
Aug 1Joined: Feb '11; Posts: 622; Likes: 743Darling ,at least they did not put you in charge!!!
You are new ,that is how new people feel,you will learn,stop listening to those that tell you it is the hardest floor,you can have a miserable day on an "easy floor "too.
The panic will subside and you will find your wings and fly like a butterfly.
Aug 1Joined: Aug '09; Posts: 6,323; Likes: 26,006"all my other classmates and friends were handling at least one pt by themselves within 3 days of orientation while I'm not even doing that."
No, not all your classmates . Have you discussed your feelings with any of them?
" it just hurts" Nurses don't get to hurt. Nurses get tough. You can do this.
Aug 1From: AL, US ; Joined: Jul '18; Posts: 16; Likes: 8Quote from Miss.LeoRNThank you for the advice! I feel somewhat better now. I just felt down because I just feel like this level of screwing up is not normal for a new grad. I feel like I miss a lot of vital things. There was even one point in the night where another nurse had to help with our pt while my preceptor was off the floor. She was in distress & I had somehow missed it while charting. She had been vomiting a lot & needed suctioning to. I couldn't even hook up the yankaur correctly. It wasnt working properly so I had hook it up to the vacuum directly because she needed help right then. Silly mistakes such as these is why I think I should rethink things. I am improving with charting but I have to ask on multiple occasions how to set the pump, run the meds or set up a feeding tube change. & the other new grads don't appear to struggle like I do. They're practically on their own while I'm hand holdingYou sound just like a new grad. Welcome to being a new grad. You'll mess up. You'll forget things in the charting system. You'll slow your preceptor down. You'll have your hand held. Don't take that personally. You're supposed to. You'll forget how to hang something or what settings to turn the pump to. You'll be unsure of what meds you can give, how to give it, and ask countless questions that any other nurse should know. My preceptor told me "better safe than sorry". Question everything and anything, don't feel stupid. If she had a question and I couldn't answer it (like, what a med we spent two seconds on in school was for or how it would help a particular patient) she went over it with me. I was lucky to have a wonderful preceptor and when she wasn't on those who filled in were equally as great. I hope you do as well. My Educational Outcomes Director was constantly on me asking me how things were going with my preceptor. Now, that wasn't to say there weren't some days where I stepped on my preceptor's toes or made her eye twitch. Of course I did. There's a fair amount of "I want you to develop your own methods and ways of doing things, while at the same time, doing exactly as I show you and tell you". And I understood this. My screw up isn't just my screw up, it's hers too. My first week was pretty much shadowing and learning the system (we have Cerner), that next week I had two of our 4/5 patients. No one ever said to me "wow, you've been here two days, you can't handle your own patient load yet". If I felt like the patient was giving me a strange look all I said was "Hi I am Miss.Leo, I'm new to (facility name) and orienting with (preceptor name) today."
The third week I was doing all the charting and most of the care, as well as (trying to) give report (she'd had way more time to look through the chart and even pin down doctors for questions than I did and would help out), though my Preceptor was over my shoulder the entire way and she still made sure to be right there when I gave meds. Some days were seriously hard. I was expected to hit the ground running and get right to it, sometimes without a full picture of the patient. Some days I went home and my mind was blank because I wasn't even sure what I accomplished that day. It wasn't until Week 5 that she was letting me go my own and then following up afterwards.
By the time she said goodbye to me and passed me onto my night shift preceptor, I could hold down a full patient load, had no issues with charting, was skilled in tracking down doctors to ask questions (it was important to the floor that new grads felt comfortable paging, calling or talking to doctors, especially if they were gonna be night shift), and managed report easily.
It all comes with time. As long as you are improving... you're doing fine. So you're first few shifts or even your first two weeks felt like a disaster. Are you repeating the same mistakes or did you learn from them? If you're struggling, let your preceptor know exactly what you are struggling with. "I'm not too familiar with this charting system, can you double check to make sure I've covered everything". Make a check off list for charting if you need to. Carry a clip board with notes of things you need reminders of. Mine had IV times, pump settings, important extension numbers, charting reminders, whatever I needed.
So, in short... take a breath. You're doing just fine.
Aug 1Occupation: RN-Emergency Services Specialty: ED, Cardiac-step down, tele, med surg ; From: CA ; Joined: Feb '07; Posts: 1,114; Likes: 1,230I would try to just roll with it and learn as much as you can and ask as many questions as you feel are necessary for you to learn. It doesn't matter how you look, what matters is that you keep your patients safe. Rushing won't help you. You need to know how to do things, why and when and in what order. Your preceptor is there to help develop you into a safe independent RN capable of safe patient care. You won't know how to do everything and there will be lots of things you don't know but you should know how to get the answers you need. Knowing where to find information is also important. Emergency procedures, where important equipment is kept, who to ask if you don't know something, are all important. Keep a notebook and write things down so you aren't asking the same question over and over. Everyone started where you are now and there's no shame in that. The shame would be in not asking for help and pretending you know things that you don't or rushing to get things done and overlooking safety. Good luck and try to remember again that we were all in the boat you're in when we first began.
Aug 1Joined: Feb '08; Posts: 5,564; Likes: 15,679I think one of the hardest parts of being a new grad nurse is the giant heaping helping of humility that smacks you in the face. You are a new grad. You know next to nothing. You aren't unusual in this and nobody experienced in nursing would reasonably expect otherwise. Now is when your real education begins.
Try to stop freaking out. This will be hard for the next year to two years. The sooner you wrap your head around that and settle in, the less difficult it will be. Hang in there.
Aug 1Joined: Feb '08; Posts: 5,564; Likes: 15,679Quote from Sheika34Try to realize that a lack of experience and training is not a "mistake". It is a lack of experience and training. To be honest, I think you are a little wound up in not wanting to look stupid. Its okay. We were all there. ALL OF US. Ask questions. Ask for help. Focus on learning time management. There is no way you ever should be alone with an unstable patient that is vomiting and needing suction at this point, so don't question that another nurse stepped in. You aren't qualified to handle that on your own yet. It is okay. You will get there.Thank you for the advice! I feel somewhat better now. I just felt down because I just feel like this level of screwing up is not normal for a new grad. I feel like I miss a lot of vital things. There was even one point in the night where another nurse had to help with our pt while my preceptor was off the floor. She was in distress & I had somehow missed it while charting. She had been vomiting a lot & needed suctioning to. I couldn't even hook up the yankaur correctly. It wasnt working properly so I had hook it up to the vacuum directly because she needed help right then. Silly mistakes such as these is why I think I should rethink things. I am improving with charting but I have to ask on multiple occasions how to set the pump, run the meds or set up a feeding tube change. & the other new grads don't appear to struggle like I do. They're practically on their own while I'm hand holding
Aug 1Joined: Jul '18; Posts: 13; Likes: 16Sister, take a deep breath! We all have gone thru those feelings. Try to give yourself a break. The 'learning' actually starts when we hit the floor. Be honest, and request another Nurse show you the ropes. We as Nurses training other Nurses sometimes forget...realizing you want to make sure you do their machines and procedures correctly, is an admirable trait. Believing you know 'all', will result in a not so good outcome. I would rather someone ask...then do, without understanding. Hang tight!
Aug 1Joined: Jun '18; Posts: 182; Likes: 265I'm new myself. The one take away from every interview I had is that there is an orientation and some individuals take longer than others. I'm sure your preceptor has seen nerves before. It's only day 2. It took a lot to get you on board. You've been given a lot of wonderful advice. I thank you for your post because I'm going to be in your shoes in a few weeks and my nerves are getting to me too. You're not alone. I beat myself up too. Breathe... In a few months you'll be looking at this post in a new light.
Aug 1Joined: Aug '18; Posts: 5; Likes: 9First of all, you are new grad!!! It is expected you have to learn a ton of things. Almost all nurses started like that. Do not panic!!! True is that nursing is getting more and more overwhelming and it must be understandably harder for new people to flow in. Try to create some system in the madness. One thing at the time. I also started as a nightshifter at the similar type of floor. I feel your gasps for air as you sinking. Calm down. Grab a coffee, eat well, sleep well, do not stress, get yourself a uniform with at least 5 pockets on (will explain), so calm down you have a preceptor. Try to learn as much as you can. I am not saying this is best approach but I tell you how I did it, if it works for you great. I came, (like half hour earlier at least) look at assignment (it usually changed anyway as the seniority nurses quarrel about who is going to have easy patients, so be ready to be flexible) and I take large sheet of paper, (here is where the routine part starts to make it a bit easier) patients sticker and log in the pc and look up all info and write on my paper - as I divided patient by patient (horizontally) each had their own column (with status - you do not want to pump chest of the patient who is DNR or call code blue on them), I would write who is the family plus contact (in the night they tend to do the pc maintnance an you wont have an access), where they came from and where they will go back eventually if known, what is there going on now, history, orders, VS (and frequency), I looked up their labs and checked what labs were ordered and noted it (sometimes I had a plastic bag for all supplies for each patient ready, I divided it also by time (vertically) - so I knew that at 2000 I have to make an assessment and address all what is going on with pt now, I knew what meds needs to be given at that time (and I pulled usually the PRN meds too - sleeping pills, pain pills if allowed, quifaneisin etc. as it is time saving - patients tends to ask you for them so then it takes you lot of time to lock everything, go back pull it, go back to patients room...yadayada yada), so when I walked in the room and assess patient I would scan them and pass the meds right away, (check mark, one man down) I would note things as BS checks - what time (midnight) other had it at 0400 or at 0600, restrains, I had noted which patient had folley - so I would do UO at 12:00, 04:00 or hourly if order says, who was intubated and needed oral care, what is their tely status - so you know the step down you need to do every two hours, the tely every four...but you still round in between... So you go by table and address all tasks at the given time, rounding patient one by one. I carried the sheet on me, and noted there everything what was going on with patient what they wanted. Don't be shy to tell your tech, you needed pillow, water, or BS on some patients. Try to call doctors after you assess patients if you need any order so you spare yourself some nasty yelling if you got to call at 0200. At the same time keep and eye on the strips even if you have a tely tech. Now the pockets on the uniform - yes, people laugh at me, but then trust me they learn to appreciate it. So in one pocket you put several flushes (as you come at 2000 or whenever your shift starts and you round on patients - flush IV as you flashing it check also when you need to change it or dressing on piccs, or start new IV if your IV can't be flushed as no one did it for past few days - you know you need new one rather sooner than later there is nothing worse than patient coding with no access...), that means you can have at least one IV starter kit, the needle and J tube on you in another pocket, one pocket for an extra gloves, stickers for tely box (damn those patients love to pull them off), tape, 2x2 and 4x4 sterile gauze, few blood draw ampules (rainbow - each of all colors) and butterfly and other things you learn to be useful and time saving to carry on. So when the surprise arise - you can just act right away, no need to run around looking for the supplies, finding they run out and you need to go to another floor... and other pleasures of nursing. Be nice to yourself and carry the basics on you. Now that was for detangling the jungle of orders. For the PC - just come one day you are off and just practice searching your patients, orders, meds. Soon you will be pro in meds administration - it is just practice, carrying out the orders as folleys, dressings, and this all takes time and through experience you will find out how things works, you will learn on your own how to get this or that or how to page on your own. (EACH time write it down, so you can look it up and don't have to slow down your preceptor). When it comes to meds error - yikes, but it happens to everyone, just concentrate when you do meds and rather recount it twice or take your time, pay attention, you do not want to kill someone, really really pay attention what you passing, why, and how much and what time and if you have the right patient. Everything will work out. And if you are not seeing any progress after few months then you can look for rehab floor or something less overwhelming. Good luck