First Year as a New Grad

[rey190]

I'm a new graduate nurse in the SICU and I've been feeling really incompetent lately to a point where I feel my heart racing and can't sleep at night. I started orientation with a preceptor for 10 weeks prior and she was extremely helpful. She gave me advice, showed me the ins & outs, and helped me with time management. I had more confidence toward the end of my orientation and felt ready to be on my own. I'm now going on one month of being on my own and I feel even worse than I did during orientation. I keep making mistakes that I can see are frustrating the charge nurse, and during rounds I have a hard time keeping up while also answering the physicians' questions. I've had a patient fall (fortunately he was okay) and had to fill out an incident report; the staff was not happy with me and I still feel terrible about it. I'm always late to give meds (or at times they are not loaded in the pyxis, so when I call pharmacy for that med they take FOREVER and it ends up being missed), I ask for help A LOT (even with little things that I should be doing independently), I miss major details to give in report to the change of shift nurse and the charge. I feel like my coworkers think I'm the worst and I can't disagree with that. There are times where I just want to cry during the shift and have no idea how I'm going to finish the day. I get so consumed with getting everything finished that I forget how task-oriented I can be and don't even remember WHY I'm doing what I'm doing. I can't interact with my patients or family members because I'm too busy getting everything finished. When I try to slow down and take a breather, I end up falling behind even more. By the time I get home, I think of everything I did wrong/forget to tell the change of shift so I can't sleep at night. I have minor anxiety attacks and catch myself trying to gasp for air at times. Sometimes I think I took on too much starting off in the ICU as a brand new nurse. I'm learning a lot and I do love this job, but I definitely feel like I'm not enough. Any time-management tips or general advice for new nurses would be greatly appreciated.

[BSNerves]

I'm a new grad as well, and I wanted to say that you're not alone, and I've been feeling the exact same on an ICU stepdown floor. My nurse manager had some really good advice and told me that in the first six months, it's important to build resiliency. New grad nurses are focused more on tasks than anything for the first 6 months and real critical thinking skills don't come in fully until after that. She also let me know that the first year is going to be really hard and you're going to feel like an idiot most of the time.

As far as report goes, what I've done to improve mine is to take note of the details I was given by the last shift, and try to expand on that. So if they told me a specific lab, I would keep an eye on that lab and try to figure out why it was important, and pass along any updates to the next shift. Same with recent procedures and consults. I also tend to look at the labs that are ordered for the next morning (me being a night shifter) and use those to determine what information to pass on. Writing down any unusual orders and having a schedule for the shift for meds/assessments/turns/vitals/weights also helps me to check everything off and know that I'm keeping an eye on everything, too! I hope this helps in any way :) Remember that you have this, and you're going to see yourself grow so much with these growing pains.