First year in nursing really that hard???

Sterren, BSN, RN · Jan 6, 2009

I'm halfway through my 1st year and I think there are several things that make it so hard. First of all, nursing school does not teach you about nursing. Nursing school teaches you to pass the NCLEX. After you pass the NCLEX and start working as a nurse, you get hit by the reality of the work load - anywhere between 2 to 6 to 8 or more patients, depending on what area you work in, and it's a ton of work. My first week as a nurse, I felt like I got hit by a semi every day just from the shock of how much there was to do and know and remember and learn. Everything from simple procedures like foleys and IVs, to charting properly, to when and how and why to call the doctor, and so on. Eventually, you get comfortable with the patient load, usually just in enough time to go off of orientation and realize that your preceptor was doing 1/4 to 1/2 of the work for you a lot of the time, so you have to re-learn all of your time management and duties in order to be efficient and capable all by yourself. I'm not there yet, I've been off of orientation for a while but I still find myself scrambling around trying to get everything done a lot of the time! There's just a lot to learn, and a lot of responsibility to adjust to, and a lot of habits to make and break.

sunray12 · Jan 7, 2009

Follow up to OP's question.

Did anyone finish nursing school, get their license, get a job, and although new job jitters are normal for everyone no matter what field, and obviously you would not know everything just starting out on any job did you feel reasonably calm and able to do your job on a day to day basis ... and just maybe excited about learning something new each day?

I've read a lot here about people who vent about having a hard time, but is there any other side to the story? Does anyone ever go on to the floor thinking - wow - I made it! This is me?!

I ask because some here say they have wanted to be nurses for as long as they can remember. Others - like myself didn't always know but had a light bulb moment where we realized - I want to be a nurse!

So how does that all go away and get to the point where someone is crying before/after work, thinking about leaving a field that you cost you so much time, money, effort to get into?

Hopefully that does not rub anyone the wrong way but I'm just wondering about all this. (And I'm sure at least other prenursing students reading this board wonder this as well).

Sterren, BSN, RN · Jan 7, 2009

Did anyone finish nursing school, get their license, get a job, and although new job jitters are normal for everyone no matter what field, and obviously you would not know everything just starting out on any job did you feel reasonably calm and able to do your job on a day to day basis ... and just maybe excited about learning something new each day?
I've read a lot here about people who vent about having a hard time, but is there any other side to the story? Does anyone ever go on to the floor thinking - wow - I made it! This is me?!
I ask because some here say they have wanted to be nurses for as long as they can remember. Others - like myself didn't always know but had a light bulb moment where we realized - I want to be a nurse!
Hopefully that does not rub anyone the wrong way but I'm just wondering about all this. (And I'm sure at least other prenursing students reading this board wonder this as well).

Sure, but it's still really hard. I love my job. LOVE LOVE LOVE. I'm thrilled that I'm working where I am, I enjoy the work, I adore my coworkers, and I can't see myself leaving this unit any time in the near or fairly distant future. I love it. But it is still really, really hard and overwhelming. The two are not mutually exclusive. You can love what you're doing and feel just a little bit panicked that you're not doing it well enough. You can be excited about learning a job you love and still feel a little overwhelmed by the sheer volume of things you didn't know and now need to learn. You can want to be a nurse all your life and still discover on your first day as a nurse that you didn't realize exactly how much a nurse does.

If it wasn't worth it, nobody would make it through the 1st year. It's worth it and there are a lot of great and exciting and rewarding moments, but even with the most perfect job in the universe there is a period of learning and adjustment, and in nursing that period can be (and IMO, usually is) incredibly difficult.

Morettia2, BSN, RN · Feb 18, 2009

what makes it hard as a first year nurse is learning the nursing culture and hospital culture and physician culture. Nursing school and clinical prepares you to BE a nurse in the world of nursing, with respect to education, clinical skills and knowledge. It dosen't prepare you for all the "extras" that come along with being a nurse.

The first year of nursing is finding who you are as a nurse. You start out at the bottom of the barell...YOU ARE NEW. As with any organization or group, you have to find your niche. YOU have to FIND your NURSING VOICE. Which can take a while. Dealing with other nurses, doctors, staff ect..it can be very stressful and discouraging.

If you have exp. working in the hosp. setting before you actually become an RN or LPN it helps and I wish I would have had that exp. before I became an RN almost 2 years ago.

But that first year is a learning and building exp. People walk all over you, constantly question you, ignore you, ect...it's a breaking in period. YOu may get the most horrible pt. assignments, feel like crap and want to quit, cry, rant, and question why you ever became a nurse, BUT you end up having that epiphany one day that changes your life.

Usually by the end of that first year or longer you find your voice as a nurse. You become assertive with people, espically MD's, which feels great when it actually happens. You begin to become more aggressive with nurses who bully you, which they begin to back off and respect that you grew a backbone. Also asking questions is OK!! All nurses no matter how many years exp. ask eachother quetions. We bounce ideas and questions off of eachother all the time. And most of the time some of the senior nurses are asking the new nurses things b/c the new nurses are fresh out of school with new nursing knowledge. And new nurses more so then normal ask quesrtions. That is a good thing. But as a new nurse don't act like you know everything b/c you don't.

If you don't know what you are doing as a new nurse tell someone, that's the only way you will learn.

Example...I have been an R.N. for almost 2 years. Lastnight I had to give liquid dilantin via peg..ok I know IV dilantin can only be given with NSS. I asked 2 other nurses that when I give it via peg can I give it with water or do I have to give it with NSS...they both said since it is peg it can be given with water but warm water b/c it is so thick..cool...another thing is as I was going to give the peg tube meds the peg wouldn't flush to gravity with just a water flush. I repositioned the pt, tried a push top toomby, nothing would work. I grabbed one of the other nurses and said I think the peg is clogged but I have't even given meds yet..my girlfriend said, you have to milk the PEG to get the gunk and sludge out of it. She showed me how to do it...GROSS we both flinched but she said now you know how to do it, almost 2 years as an RN and I am always learning, she also asked how they heck the day shiftRN gve meds via peg if it was this clogged..I said, no clue, but at least we can give the pt his PM meds. So we both realized a brand new RN had the pt. during the day and most likely didn't give the pt his meds b/c the tube was clogged and she didn't ask for help.

Always ask for help, DO NOT try and do everything yourself. Even if you are ignored juust keep aksing. Someone will help you.

There is a barrier that nurses have to break through. It's like being the new kid in school. Some of the poeple you meet at first you may hate and thnink what a witch, and no matter how nice you are those people may just be down right rude or mean to you for no reason or just be indifirent to you. Others you might think are lazifair and just don't care...don't ever judge a book by it's cover.

Some of those rudemean witchy, lazifaire labels you initially have about people can be completely wrong. Infact 99% of the nurses I work with at night are the best nurses I have ever seen. There is only one who I can honestly say needs to not be a nurse. Recently a nurse I work with at night, who I thought for the last 2 years was burntout totally blew me away with her ICU knowledge and skills. She def. is a nurse that if I was an ICU pt. on my floor would want her to be the one calling the shots, but as a regular bedside tele nurse, I would not want her. Her ICU skills are amazing, maybe it's the 30+ years exp. she has as an ICU nurse, but her bedside tele skills and manor are burnout.

But finding that blance as a new nurse is horrible. MD's yell at you, not all MD's, but you are barked at, you run in circles, you learn your delegation skills, you also HAVE to learn to SPEAK up for yourself. If you can't defend yourself or be Aggressive or assertive then you will have a problem. You can be both aggressive and assertive and still be nice, and at times you can be both with out being nice when the situation calls for it.

If you have tried the nice aggressive and assertive with MD's and they don't want to eval. a pt. at 2am b/c they don't cover the pt's attending MD, and the pt. is havig a problem and you need an MD there NOW, you drop the NICE and BECOME VERY aggressive and assertive, b/c it's your resp. to your pt. if there is a problem for an MD to eval. the pt. You may get the run around quite a few times as a new nurse and not know what t do..but once you grow the nurse backbone which takes time, and say I need an MD here NOW to eval. this pt., someone will come, they may not be happy but they will come.

Nursing is being compassionate, learning how to deal with people, doctors are people too and may be intimidating but they have the same resp. as you, tey are there are the pt., they may make you feel like a peion but they know with out nurses that there would be a major problem and they do apprecitate you. Nurses eat their young for a reason, to make you a nurse, and it's usually to make you a good or a great nurse, you need to learn ad exp. difficult assignments for prioritizatrion and delegation and just to have knowledge.

If we were all babied as new nurses and given easy assignments and didn't learn how to become a voice then nurses would not be who we are. I have seen new nurses that were babied and given easy assignments and a year later those nurses go crazy when they have multiple probles going on at once, and I help them out. but I ask my ANM at night why they were coddled and given easy assignemts and why I wasn't treated like that my first year of being a new nurse. They tell me well, we saw strength and we knew you could handle the hard assignments, HUH? I was a new nurse like them when I first started what made me different? They saw, what both of my ANM's at night have said over and over, "We saw a brand new nurse that was good and is going to have the potential to become a great nurse, and well now we made you a great nurse and you still have even more potential." After more abuse and crap that any new nurse on night shift has ever endured, I was told, I survived, and for that I actually thank them that I wasn't babied.

We are strong, we are the pt's voice, we spend more time with the pt. than a MD ever will. Nursing takes a type of person that has a heart, a really good sense of humor, patience at important times hahaha, can't take what others say to heart and let it offend us, although we do, we cry with our pt's, we cry when we get frustrated, we don't sleep, we hold a pt's hand when we see the desperation in their eyes no matter how busy we are, we make people smile, we run in circles our entire shift, we save MD's butts hahaha, we teach and educate, we become a family, we become our family's personal doctor ahaha, we deal with alot of stress, we have people talk down to us and belittle us, we have pt's bite kick spit and punch us, people think we are glorified maids and gofergetters, people think we know less then we actually do untill we answer their questions that the MD's couldn't answer, we are medical McGyvers when it comes to patient care, we are ingenious and can figure oiut how to fix most anything with tape and other things. We are guardian angels, we are nurses.

Faeriewand, ASN, RN · Feb 21, 2009

:twocents: i will be happy to give a different opinion on the first year of nursing.

i started in med/surg 6 months ago and have been very happy. there have been maybe 3x i have cried and that is all. i feel competent in my skills and in my interactions with the patients and the docs. i'm fine with asking for help or just getting advice from other nurses on the floor. i work with a great team of nurses who all help each other out. i feel it is my duty to complete all tasks and be up to date at the end of each shift so i can give a good report and i mostly accomplish that without having to pass along work but it does happen.

as a new nurse i want to celebrate at the end of my day not because i lived thru another shift or my pt's did too lol but because i was in the groove and surmounted every challenge that came my way and learned more about myself and my abilities and made a positive difference in someone's life.

you know that tom hanks movie about him on an island and when he makes fire how he dances around and says, "i have made fire!" or that move freaky friday and the young boy is dancing on the table waving his arms in the air yelling "woooooo! wooooo!" that's how i feel.

i have made fire! i am a nurse.

.

Winnie04 · Feb 22, 2009

Nice post Faeriewand, I am sure the OP appreciates hearing something positive!

I tend to agree with Sterren, in that I usually like my job, but that at the same time, I find it VERY stressful. I am unfortunately not at the point of loving my job yet, but I remain hopeful that that day will come. As far as what makes being a new grad (or just being a nurse!) difficult, here are three things I want to add to the list (sorry if I am repeating some things that have already been said):

1) being held accountable for things that someone else promised and being stuck with the mess when the promise can't be kept....ie. Today when my patient (who was just about to be discharged) informed me that his attending told him that the hospital would send him home with a 30 day supply of his meds, since he has trouble getting his prescriptions filled at a pharmacy in a timely manner (long story). Well, that is something our hospital just cannot do (IF we had 24 hrs notice, we could have supplied him with a 3 day supply). So, it took a call to the attending physician, two to the resident physician, and two outside pharmacies to get this situation clarified and squared away. It might not sound like that much, but it took up a lot of my time.

2) On a related note, communication in general can be a challenge. I am not sure if this is particulary problematic in a teaching hospital, where there are so many members of the medical team. For example, it took me a while just to figure out who was covering my above-mentioned patient...our on-call directory led me to the wrong number, I got the right number but then that person never paged me back, so I ended up paging the chief resident who didn't hide his disdain at being paged, but, to his credit, did help me get a hold of the right person. Also, for example, members of the medical team might tell an NPO patient early in the morning "alright we are going to let you eat today" so the patient expects to eat breakfast, but what he doesn't understand is that he can eat only after his abdominal ultrasound, barium swallow study etc and after he has tolerated clear liquids (or whatever the case may be). The team left out those specific details, so the patient is not too happy when I have explain to explain it to him!

3) Most of my charge nurses are very helpful, but there is one in particular who looks angry every time I ask a question. I have also been told by co-workers that although this charge nurse will help you if you need it, she "will hold it against you." Yikes! (Although I suppose this situation could happen at any type of job, and is not necessarily nursing-specific)...

Alright, that is enough for now. I don't want to sound like a whiner- I had a long frustrating day and typing this felt very therapeutic : ) thanks allnurses for always lending a listening ear!

southernbelle08 · Feb 23, 2009

I've seen better days, but I've made it so far, lol.

The first year is hard, but I did start getting more comfortable around 6 months.

Good luck!!

anbreen · Feb 25, 2009

I have never forgotten something a nurse told me, "Your new license is your quarter to buy a clue. " :-)

I'm 2nd career, and my other profession did not teach me my job in school, either. I don't think many academic programs prepare one for the actual JOB. They give one the concepts and the vocabulary.

FA to CRNA2b · Feb 25, 2009

lazifaire labels

C'est laissez-faire, ma cherie :redpinkhe

carbaminohemoglobin · Mar 3, 2009

nursing is hard. it's emotional, stressful, crazy! i work in ltc and the full weight of 35 lives rests on my shoulders. i've had my license since jan 27, 09 but i've been working as a charge nurse since dec 25, 08.

you see the nurses around you taking the heavy loads in stride, but every thing takes just a little bit longer for a new nurse. my shift ends at 10:30p, sometimes i stay until after 1:00a just finishing up my work.

you don't know what all the meds are. you don't know what all of the lab results mean. lots of rules and procedures to learn. but these are things that you are expected to know.

you work under a microscope and many people have little to no patience with new nurses. the patients, families, physicians, and other nurses are watching your every move. you're not comfortable with your skills yet and you realize just how very important it is to know your stuff. people's lives can hang in the balance.

you thought you were going to school to be a nurse, but you're a waitress, a teacher, a counselor, a plumber, a janitor, a maid, an electrician, a secretary, etc..

you'll be pulled in 5 different directions like one of those torture devices!

you'll come close to peeing your pants on many occasions, because you just don't have the time to pull yourself away from tasks.

you'll learn to love coffee and vending machines. mmmmm chocolate donuts.

most new nurses i know (including myself) are way too hard on themselves. beat themselves up over the smallest mistakes or oversights. feel like complete failures over things that are out of your hands. all in one day you could feel stupid, small, helpless, blessed, confused, rushed, lost, elated, amazed, happy, depressed, worthless, important, lucky, smart, proud, etc. the roller coaster of emotions is enough to make anyone run for the hills.

buut don't let me scare you off yet.. those on-top-of-the-world days are amazing and totally worth all the crappy stuff. you get warm and fuzzy feelings from something as miniscule as a 'thanks' or as substantial as that moment when you first realize you just saved someone's life!! i can also promise there'll be plenty of laughs!

there's so much to learn in the medical field and in the first year they say you soak it up like a sponge. but you don't only learn meds, labs, and procedures.. you also learn a lot about yourself and develop loads of useful skills. how to be resourceful! how to manage your time! how to prioritize!

nursing is not at all what i thought it would be; it's better. :redpinkhe:redbeathe:redpinkhe

OrthoRN09 · Mar 8, 2009

Yes, it is that hard.

SummerGarden, BSN, MSN, RN · Mar 9, 2009

yes it is hard!!! i am 3 months into it and i cannot believe how hard it is!! i was and am an "a" student (i do the rn-bsn program part-time). adn nursing school is easier then the first year of nursing because many experienced nurses try to eat you! btw, my adn program was hard! i have many posts on the tortures of which i survived, so the comparison is a big deal.

your really bad days will feel like quicksand ... no matter how much you work and how hard you try to be on top of things, you will sink deeper and deeper!! 5-6 patients and everything you can imagine or not imagine goes wrong! :banghead:

ok ... enough venting ...gl!

-new grad rn who knows that someday she will be an excellent nurse. the problem is surviving being a new grad to see that "someday"!

ps. some shifts are very good and you leave work on cloud nine! :nurse: