First year nurse. Thinking about leaving field altogether.

LibraNurse27, BSN, RN · May 17, 2020

6 hours ago, TriciaJ said:
All I can think when reading this was that you were in a bad staffing situation. A patient who has a history of going ballistic and injuring staff, and a unit staffed by one nurse and one CNA. Was there anyone you could have called to help you get the situation under control? Otherwise, this wasn't your error. This one falls squarely on the shoulders of management and their staffing practices.

Oh yes, terrible staffing situation! Even here in CA with our magic ratios, LOL. My shift was almost entirely new grads. 5 patients each (Med/Surg) but no charge, no resource/break nurse, no CNAs, no clerk. pts who were supposed to be on 1:1 no staff for that, pts eloping, falling, even though we worked so hard and literally ran around all shift with no breaks. Even with legal ratios a unit can be short if management cuts all support staff.

When we had to do incontinent care on a combative pt or give an I'm it was hard to recruit enough people, and we had multiple pts like this every shift. It would have been impossible to gather a team every time this pt needed an I'm. I still blame myself for the error because I was rushing but I do agree staffing contributed to it. Thank God I am on a different unit! Thank you for your comment, it really makes me feel better.

BlessYourHeartt · May 17, 2020

MSW programs accepts applicants with Bachelor's degrees in other fields. You may be able to get free tuition if you land a graduate assistantship at the university or work for the university in any staff capacity. If you decide to stick with nursing, you may benefit from a job with a solid, 6 week orientation and a supportive team (like a hospital floor job where you always have other nurses to turn to). It doesn't need to be psych, but rather any work as a nurse where you can grow and get comfortable and proficient before venturing into contexts where you're largely on your own.

K. Everly, BSN, RN · May 18, 2020

If you heart isn’t in this, there is nothing that can be said to make you want to stay.

But, if your heart is in this and you are just too afraid to say so and are protecting your own psyche by telling yourself you don’t want to do this anymore because you worry you will be a failure, then there is some work to be done.

nursing.com has a course for new nurses that is WAY helpful and can give you really great tips for being an safer, more efficient, more proficient nurse. I would really recommend checking that out if you want to do better because you want to stay in nursing. Don’t just quit your job and don’t just quit the professional until you’ve really done the work or deciding what your reasons are for wanting to get out and doing everything you can to eliminate the barrier.

And also, as a new grad with a BSN and a BA in psychology, take it from me, psych is NOT all it’s cracked up to be. Check out the work of Dr. Peter Breggin to learn more about toxic psychiatry and prior MSW Daniel Mackler for more info about the fallacy that is modern psychology. Both can be found on Youtube.

Feel free to PM if you need some empathetic support.

Marc Goodman, BSN · May 18, 2020

I am an experienced Psychiatric RN with over 10 years of experience, so I'd like to offer some thoughts.

It sounds like it would be helpful to break some of your thoughts and member responses into categories. From a brief perspective it looks like its important to look at your mental health specifically, how most novice RNs cope, system issues that are effecting you, and your relationship with coworkers and opportunities for mentorship.

Your mental health

A few members have recommended some strategies to cope with stress. Distract, self soothe, utilize self care, mindfulness techniques. These are components of DBT therapy. Learning a bit about DBT will be helpful for you as well as your practice. Behavior tech has a great online training if you can have it paid for as a conference. It is a bit pricey. A DBT workbook I used to use might also be very helpful (and less expensive) ISBN-13: 978-1684034581.

If you're taking medications for anxiety I would be very careful to be working with a skilled psychopharmacologist. I've seen so many hodge podge inappropriate med regimens over the years that are doing the opposite of helping.

It sounds like you're self flagellating over giving the wrong formulation of the same medication (zydis vs regular tablet). Yes, its technically a med error, but not harmful to the patient and a mistake easily made. Is it possible that you're depressed and only able to see the glass as half full?

I would be reasonably depressed and anxious in your shoes.

How other novice RNs cope

So, you've been through from two other jobs after nursing school?

I think most people would feel self defeated. I know I would. In fact, I'd be a basket case.

I had a few errors starting out because I was anxious and rushing. Others members have responded with similar advice, slow down. Although, I remember having angry psych patients lined up for their meds so they can go out to smoke. Think of having them wait as them building their distress tolerance skills. If they're upset now, they'll really be upset when they get 150 of seroquel instead of wellbutrin.

System Issues

Other members have identified that you do not have a bar code scanning system.

Prior to starting to use the scanner I was always very careful with the "5 rights", but after we switched over to scanning we realized that we were probably all having med errors in the past that we didn't even know about. You're realizing your med errors. I bet your coworkers are doing the same thing and have no clue that they make mistakes all the time.

It sounds like what you're doing is called Team Nursing. I've never done it, but medicating 50 patients sounds ridiculous. I've always done what I think is called Primary Nursing. I have my 4-6 patients and handle their meds, behavior, medical issues, supportive psychotherapy, etc. I know their medications and what to look out for (emerging mania, sedation, orthostasis, clinical improvement). If they're being uptitrated on seroquel or starting on trazodone, I'm looking out for orthostasis and reminding them to change positions slowly/staying hydrated, ringing a bell and waiting for me to avoid falls. Its madness to uncouple the care of the patient from medication administration. So, this way I more or less remember what they're on which reduces the chance for a med error.

With coronavirus we've had to cancel groups, close all public rooms, and ask the patients to stay in their rooms as much as possible. Having patients line up in the hallway for medication would also be unfeasible and dangerous at this time.

Perhaps if rates go up in your area you can be a leader in change management and help launch a primary nursing model.

Relationships with coworkers

This is the keystone.

If your coworkers feel you're providing unsafe care, they're going to run to your boss. You're medicating their patients and they have to deal with the consequences of your actions (either patient behavior or poor health outcomes). They might focus on their own risk for assault given what they think your actions are. This is serious business.

See if you can engage your colleagues in professional conversations about providing excellent patient care. This will increase their feelings of clinical competence towards you. If appropriate, engage in non clinical conversation when the opportunity presents itself. Everyone appreciates some levity. Grab a drink with someone after work..If your coworkers like you, they won't run to your boss as easily. This will also give you the ability to develop a mentoring relationship.

Just some thoughts. Feel free to reach out.

Marc

futrnursenickii, BSN, CNA, RN · May 18, 2020

So to be making these kinds of mistakes you really must not be paying attention or you’re getting overwhelmed and trying to move too fast. I’m a nursing student but I passed meds for 10 years before going to nursing school. You keep repeating the same mistakes at every job so at what point do you take accountability for your actions? You’re lucky you haven’t killed someone. Med errors are very serious. Maybe you need to take a break and reevaluate your situation before you lose your nursing license

louanna · May 18, 2020

On 5/12/2020 at 9:58 PM, mhadvrn34 said:
Hey y'all. I've been a nurse for almost 9 months now and I'm seriously considering leaving the profession altogether. I graduated in December of 2018 and was ecstatic when I got a position as a new grad RN in a med surg residency program starting July of 2019. Packed up all my things and moved three hours away to a very rural community knowing no one.
From the moment I started, I struggled heavily, mostly due to anxiety which I was clinically diagnosed with two years ago and take meds for. I made a lot of mistakes and was constantly on the radar of my nurse educator and supervisor. Two months later, I got called in to my boss's office and she let me go over lying to my preceptor over charting something which I didn't. They felt as if they couldn't trust me anymore.
My options were get fired or be forced to resign. I was devastated. Moved back home to my parent's house and began looking for a new position.
Luckily, I landed another job in a psychiatric rehabilitation facility. Even before starting nursing school, mental health was my passion. I knew I wanted to work psych in the long term. I started this position late October of 2019 and lasted 3 1/2 months until Valentines day. I worked NOC's and was the only licensed staff for that shift. I was overwhelmed, had virtually no support and had to deal with toxic coworkers.
On February 12th, I made the mistake of covering an AM shift and was responsible for pulling meds from a med cart in sheets the old fashioned way and giving them to 50 patients. The next day my boss found out I made a ton of med errors and I seriously thought I was going to be fired on the spot. He gave me another chance to my surprise, but I had had enough and decided to quit.
My current position is in an acute psych facility which I started per diem in January of 2020. Here I feel like I have tons of support, charge nurses who are constantly checking up on me. I've only been called into my boss's office once in 5 months over messing up charting. I feel as if this is less hectic than my last job but I am very unhappy with it.
Psych nursing is not what I glorified it to be. What I thought psych nursing was vs what it really is is not what I expected it to be. What I feel like I really want to do is more in the line of social work or clinical psychology.
On top of all this I screw up constantly and have this fear of getting fired every time I step into the hospital. Today, I made a med error and sort of freaked out and stormed outside the patient's room after realizing I gave meds to the wrong patient. My coworkers tried to comfort me but now I feel like they feel like I can't be trusted.
I'm starting to think nursing is just not for me.
I'm fed up, burned out and I've come to the point where I just don't care anymore and I feel numb. I've had 3 jobs in 9 months which says a lot.
Opinions?

subee, MSN, CRNA · May 18, 2020

Meds in little cups? Sounds very antiqated to me and not safe. All nurses have more tasks to do and sounds like the institution needs to flash forward a couple of decades..

Meiel58 · May 19, 2020

Hey, don’t give up just yet. Do you have a gazillion thoughts in your head at all times? Have trouble sleeping? Really, really can’t focus? Have trouble staying organized? I raised 2 kids with ADD & you sound like that kind of person. Please get that checked out....it might be the root of your anxiety. It breaks my heart to know a young nurse is having so much trouble. Hang in there & talk to your doctor. There is medicine that’s not Ritalin you know for ADD. Good luck my dear.....

TeeLo · May 19, 2020

?‍♀️ Run for the hills as fast as you can, literally

yourgoodneighbor · May 19, 2020

What about pmhnp ?

RatchedAfterMidnight, MSN, APRN · May 19, 2020

A lot of hospitals have positions for RNs as Case Managers or Utilization Review Specialists. You would be advocating for patients in a different way without the constant anxiety of giving the wrong medication. There is a need for clinical staff in Utilization Review positions to advocate for more "days" covered with the insurance companies and you are in a perfect position to know that with your clinical background when you read a chart and go to rounds. Psychiatric Hospitals love hiring nurses in Utilization Review positions. Good luck.

Nurseunite · May 19, 2020

Having being a nurse for a little of two years I feel the same as you sorta.

I’ve had my share of jobs already. Now I’m starting to feel nursing isn’t for me. Sigh

one thing my instructors told me in nursing school and I hold true to, if unsure seek help. Ask a colleague, pharmacist or call the supervisor it have be it because these are ppls lives and practice the five rights religiously. If a order doesn’t seem right- question it. I’d rather be wrong then hurt someone. But I know how an anxiety disorder can cloud your judgement.
I think you should find something that fits your pace and work on asking tons of questions before accepting a job. During orientation ask to actually visit the floor and talk to some of the nurses that works there. I too, have had a dream job then it turns out not that way. Find a non bedside job like case management.

All the best,