First year nurse. Thinking about leaving field altogether.

kdkout, BSN, RN · May 31, 2020

I think a lot of people going into nursing think it’s easier than it is. When I was in school in the early 90s we were weeded out. If we couldn’t hack it, we didn’t make it. Now a lot of colleges do stuff online, seem to be in it more for the money, no longer “vetting” nurses, etc. I am not sure the quality of the programs are at all the same as they used to be.

Littleblackdog, ADN, BSN, RN · May 31, 2020

Oh, honey (hope you don't find that demeaning at all, but I just feel so badly for you), I am so sorry for all this. What you are describing is to some degree what so many nurses go through to some degree. First of all, packing up and moving 3 hours away from home to a rural area where you know no one is incredibly challenging and stressful! I could not have done this! I have now been a nurse for 35 years, and I still would not be able to do this, so kudos to you for being brave enough to give it a try.

Nursing, especially when you are new, is SO hard. It just is. I made a med error when I was a nurse for only 6 months and then several months later, I took a phone order for a blood transfusion, gave it uneventfully, and about a week later my manager said that I had written the order on the wrong chart and had therefore given it to the wrong person! The person's counts were a bit low (and back then, people got blood when their HCT dipped below 29 or 30!) so getting that order for her did not strike me as odd and to this day, I know I took the order on that person and not the one that they said really needed the blood, LOL, but I could just be wrong about that!

But I digress.....it is hard to be a med surg nurse (or any kind of nurse ) and especially when you are new. And especially when you have toxic co-workers and believe me, there are SO many of them out there. Your anxiety is no doubt making it harder than usual for you to perform in a calm manner ( I take anti anxiety meds, too). You are being so hard on yourself right now. I am certainly not saying that meds errors aren't serious - they are, and they can be deadly, but still, you need to take a breath and give yourself a break for a minute. Is there a therapist you are seeing or that you can make an appointment to see? I think maybe that would help right now. And yes, social work does kind of sound like it might be right for you, but first, get some professional assistance with the anxiety and just "stay the course" for a bit, just to stabilize things. Cut down your work hours if you have to, maybe two shifts a week or something. Get plenty of sleep and make sure you find the right therapist. I found the one I used to see (she was great) by googling for therapist in my town and making a few calls and checking out (if they had them) some websites. And!! Having to oversee 50 patients??? And give meds to them??? No, no, and no. That is unbelievable. NO ONE can do that. Please keep us update, and best of luck to you - you certainly deserve it!'

Littleblackdog, ADN, BSN, RN · May 31, 2020

47 minutes ago, kdkout said:
I think a lot of people going into nursing think it’s easier than it is. When I was in school in the early 90s we were weeded out. If we couldn’t hack it, we didn’t make it. Now a lot of colleges do stuff online, seem to be in it more for the money, no longer “vetting” nurses, etc. I am not sure the quality of the programs are at all the same as they used to be.

Good point you make. I went to school in the early 80's and they weeded folks out (or people often weeded themselves out) and monitored how well or not we were doing and did not hesitate to jump in and intervene if need be. I don't see how anyone can become a nurse just online, but I know people do it (except they go somewhere in person for their clinicals of course).

Littleblackdog, ADN, BSN, RN · May 31, 2020

On 5/24/2020 at 10:05 AM, lregister said:
Who in the world thought that loading cups for 50 freakin patients at a time was a good idea? That’s insane! Damn, I can’t imagine thinking that I’m going to do that EVER! Not one supervisor owns the rights to my nursing license.
nurses should be able to load beds 1- 7 (typical med surge load) at the most and go reload, without higher ups saying a word.
I can’t believe this whole mess.

And whoever thought that one nurse having to give meds to 50 patients was a good idea?

Littleblackdog, ADN, BSN, RN · May 31, 2020

On 5/27/2020 at 2:55 PM, thinbluelineRN said:
Right! I don't know why people think this. I am a NP all week long and pull in some ED shifts as RN some weekends and OMG I'm on autopilot at my RN job.........can't say the same thing abut being a NP!!

With all due respect for you as an accomplished NP, who still works some as an RN, I can't be on autopilot at my RN job, either. One example: being in a room with a gentleman recovering from total hip, about to transfer to a LTC facility for rehab, just as ambulance for transport arrives, he stops breathing, he is a DNR (made himself one two years before for no medical reason, just said he
"didn't want to linger if anything bad happened) - doctor happened to be on the floor and came right in - patient opened his eyes and started breathing again - ICU was full so he remained with me for 45 minutes till a patient could be dc'd in ICU and room cleaned, meanwhile, he of course was on tele by that time and kept going in and out - Dr talked him into allowing heart meds IV and revoked his DNR right there - I was not allowed to push heart drugs so calling and calling for super or ICU nurse to come do so asap - he continued to "go in and out" every few minutes - meanwhile, I had 5 other patients calling me for various needs, could not get charge nurse to take them over for me...no, not an everyday thing,but an example of all the stuff that DOES happen on the floor at times. I don't think many RNs or LPNs have jobs where they can "be on autopilot." I mean, it must be entirely different from you NP job, of course, and I understand that ( after all, I am now working LTC in the twilight of my career and I have to call or text our two great NPS often!) But I have to oversee 27 people who can at any minute have a serious problem. Not on autopilot! ?

On 5/25/2020 at 9:40 AM, Genevalj said:
Check out clinical nursing. I work in a urology, OB/GYN office and I love it. I get paid well. I only give meds as ordered per patient as seen. Monday-Friday. Holidays and weekends off. I realized early in my nursing career that I didn’t like bedside nursing so I stayed away from it. With nursing you have so many options. There are outpatient psych clinic. Try to find one. All you do are assessments, education and give long acting medication injections.

That sounds nice.....

Littleblackdog, ADN, BSN, RN · May 31, 2020

On 5/18/2020 at 4:58 PM, louanna said:
My dear I do understand and feel your pain. I was a sing parent and went back to school things were very hard for me I didn’t have any Help from anyone. My entire time as a student nurse was very difficult and depressing not being able to reach to clas on time because I had to drop my kids to school very early n leave them there alone and I would get locked out of the class because my coordinator said to me one day it’s either your a nurse or a mother make up your mind and with tears in my eyes I said I’m a mother first and always because that was the reason for me being there. Trust me I know what it feels like to want to give up because ppl in this profession can be cruel but my faith in God and my desire to make a better life for my kids pushed me. I promised myself that I won’t be that wicked nurse to students I’ll make a difference and I did now I’m living in the states and studying again after that long journey to be a nurse here and continue to do Gods work. Believe me when I say the tears will turn into strength that no one can break the harder the journey make sure you use that pain to be a better person and a great nurse. No nurse knows everything we all had to come from zero to reach to a hundreds and we are learning everyday. Stay humble don’t be rude and don’t let no one intimidate you. God chose you for this profession. Nursing is a calling from God it’s a very rewarding job to do yr best and help others. Just have faith in yourself and let your patients be your best friend. That’s what I do and I don’t see the negativity even if it’s thrown in my face. Focus and don’t give up the race is not for the fast runners but for the ones who endure to the end. May god guide your footsteps and your hands you will be a good nurse you have a good hart.

You sound like such a kind, caring person! I am glad you became a nurse! You are just the type person that nursing needs, thank you for being kind and caring about others! Glad you are here now, from where did you move when you came here?

Littleblackdog, ADN, BSN, RN · May 31, 2020

On 5/21/2020 at 12:20 PM, Link648099 said:
I didn't read all five pages of posts, so maybe this was already covered, but I'd recommend a careful assessment of your situation.
Your anxiety is expected, especially as a new nurse. It will take you several years of nursing to get to a point where you're comfortable as a nurse. Think of it like when you first started driving at 16. Lots of nervousness and anxiety, but hopefully by now you drive well and relatively safely without much thought. Nursing is the same way. It takes time.
Regarding your medication error problem, that's a big thing to start working on. I would recommend, aside from slowing down, is create a list you can look at that lists the five "Rights" so you can go through them for each and every patient. Do that for a week and it'll be second nature and you will get better as long as you stick to those five Rs.
Finally, have you considered different fields of nursing? I don't like giving medications. Nor do I like having more than one patient at a time. I also like doctor's close by, and my patients asleep and family far away. So I'm an Operating Room nurse. The only things I insert in patients are Foley catheters. I don't worry about meds or patient vitals or potty breaks or baths or nagging family members or all the stuff that goes on on the floors.
Maybe something like that would be a better fit for you. You have to look at your own strengths, weaknesses, and desires and go from there. Maybe you can find something that's a better fit for your strengths?
Think about that before you torch your entire career.

I love this! It actually made me laugh outloud, because, though I have worked a floor for 35 years, I recognized some of my own feelings in what you had to say. I had a chance to enter a program for new-ish RNs who wanted to train to be surgical nurses many years ago, when I was out of school just 2 1\.2 years. I allowed myself to be talked out of it and have regretted it ever since. Glad you didn't make the mistake I did!

Littleblackdog, ADN, BSN, RN · May 31, 2020

On 5/18/2020 at 12:16 PM, Marc Goodman said:
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. Behaviortech 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 basketcase.
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

All very good advice you have given, here. And you are so right: if you can develop an occasional relationship outside work with some co-workers, they are likely to be kinder to you and less likely to report you to the manager for every little thing....

Michelle Pendergrass · May 31, 2020

I would like to suggest medically intensive pediatric homecare. You get 1 client at a time, and if it's a good agency, you get trained well.

Phoebe123 · May 31, 2020

Oooo this is a great idea! I recall even as a student nurse I did a lot of home care — as an RN, you can work for a home health agency — pediatric, elderly, like that — you get super familiar with a specific person and can really make a difference and get close to your charge! Super great idea!

Lizardqueen13 · Jun 5, 2020

I am only a PCA currently so my screw ups generally aren’t as dangerous as the nurse’s can be, but I want to share something. I collect labs and just last week somehow screwed them up. I truly cannot tell you what went wrong, but the fact is something did and I’m responsible for it. I had gone into a patient’s room to get their labs, scanned them and printed out the labels, then the patient refused. So I moved onto the next patient, who did allow me to get their labs. Same procedure.
I still had that past patient’s labels on my computer and I “made sure” (I put this in air quotes because I must not have really made sure despite looking) that I had the correct person’s labels. Well, I’m sure you can guess how this ended. I had two tubes of blood for the second patient. One was sent with their label, one was sent with the first patient’s label. I have no clue how this was even possible given that if you scan the wrong person’s label, the computer is supposed to reject it and tell you that you have the wrong label. Maybe I DID scan the right labels, but put the wrong ones on the tubes. Probably. I had 4 labels altogether.
It’s not a med error. But it can lead to further complications if the incorrect lab is received and indicates something crucial and then the patient is treated for an issue they do not have, or rejected a surgery due to it, etc.

You NEED to slow down. You need to go through the motions every single time. Do not take a chance because you’re confident. I knew I should have shredded the first patient’s labels to avoid any possibility of a mix up, yet I didn’t. Just be smart. You know how bad it feels to mess up like that and only you can change it.

Guest505077 · Jun 7, 2020

It's time for you to leave the profession. It's clear this is not for you.

I wish you well..