Is this normal??

[NurseOhmy]

Hi everyone! First of all, thanks for taking the time to read this, sorry so long, I think writing it has been cathartic. I think I've read every "help, new grad" post I could find but am still in need of advice.

I know the first year is expected to be hell and I'm up for the challenge because I want to be the best nurse I can be for my patients. I know that no setting is perfect but I have some concerns and need to be sure that I'm protecting my patients and my license. I do whatever I can to do my part. I come home and study all the new things I come across and I let the other nurses know that I'm new and open to any guidance.

Fresh out of school with no prior hospital experience, I was hired to my first RN position on a neuro progressive unit. I made it clear to my supervisor that all my experience was limited to clinicals or lab, I had never even cath'ed a patient or started IV. She said that was great because she wanted to mold me for the unit.

Just a little background...I've been off orientation about 2 months now. I am a smart person and my ego doesn't come into play in my nursing, I know my limits and make it clear that I am open to advice. On orientation, I never did anything without running it by my preceptor. Orientation was difficult because my preceptor did so much that I never found my own groove, she just snapped that I needed to learn time management. When I asked for advice, she said she couldn't teach it, I'd have to learn. Other preceptors have done confidence building things like yelling across the room "what are you giving him??" as I started the IVP of morphine we just discussed. Or yelling at me in front of a patient that meds were due 2 hours ago (forgetting that I had been with another high-need patient all morning and let her know I was running behind).

Anyway, I've had some troubling things happen since I've been on my own and I am questioning if I should be on this floor at all because I'm new?

More than once I have spent most of my shift with a needy patient (BP over parameters, Cleviprex titration, lumbar drain, MD phone calls, new neuro deficits, pulling out cortrak, restraints, etc) and I'd let charge know my situation and another nurse would do meds and check on the other patients but at the end of the day, I was responsible for the assessments and overall well-being of the patient. Often all I had done was a neuro check or 2 and then a fast total assessment at end of shift. What do I really know about my patient at that point?? So I remain responsible, even though I cant leave the more acute patient AND the other patients got minimal care and attention?? NOT OK with this nurse but what could I have done differently? When I asked, I was told "that's just the way it is, you did good". Is that really the way it is?

Also, since I started, close to 10 of the seasoned nurses have quit and about 7 brand new nurses are coming on board which is setting off my red-flag sensor.

On more "normal" shifts, I hit the ground running, rarely pee, never eat and I don't leave until 9:30-10:30pm (shift ends at 7:30). Let me remind you, I aint complaining but I am concerned. We are not only short nurses, but are short aids so I am doing alot of aid work. Not a problem for me but I'm also brand new and learning an intense specialty so I get very little charting done because I never stop. I'm trying to delegate, bundle and prioritize but I never stop. (the seasoned nurses have the same pace, some leave on time, some late, I cant figure it out).

Because of my hour commute, that gives me about 5 hours to sleep until next shift and I'm so tired that I'm afraid I'll make a stupid mistake. I told my boss my concerns and she set me up with a mentor, but we're too busy to catch up. She said I need to have "more authority" with my aids who are spread 8:1 with high needs patients. I spend my days off trying to sleep but my anxiety wont let me so it's snowballing. I'm considering a med for the anxiety but I dont want to need that for my job!

Obviously I have a decision to make and I'd really appreciate your opinions, as I don't really know what normal is or how to protect myself or my patients.

Thank you again for your time.

[Daisy4RN]

Unfortunately this does sound pretty normal for most hospital jobs. But, you do have to keep in mind that you are still new (only 2 months on your own) and most nurses take about 1-2 years to feel comfortable. You need to learn how to prioritize while at the same time caring for your other patients, meaning take care of the most acute care needs first but at the same time see the other patient (example: while on your way to call MD, gets meds etc. physically look at the other patients and either make a mental or physical note re: what you know you need to chart later (assessment info, on less acute patients this should not take long) so even if you have to wait until the end of the day (to chart) you will "know" your patient, you need to "know" all your patients anyway even if the less acute ones don't need your immediate attention. This is just the way it works, the more acute/urgent needs get the care first and sometimes you don't do everything you would like to do for your patients. You need to know what is important and what is not, sometimes things do have to wait (until next shift, until CNA available etc) especially when you are new but it will get easier with time and I am sure your unit doesn't expect you to be on the same level as a nurse with experience. I would try to get on top of the charting so you are not there late, learn what works for you. I have seen many new nurse try to do everything/anything for the patient, including things they don't need to do, which takes a lot of time throughout the day and then try to do all the charting at the end of the day, you need to do it throughout the day. If you were told to have "more authority" with the aids then I would take that advice, tell them what needs to be done and let them do it, there is a reason you have aids. Bottom line for protecting yourself and your patients is to learn to prioritize and let the other things wait (if nursing) or let if go completely (if non-nursing). Also, for now I would ask your mentor and any other staff if you are not sure about what should be done first but you will learn with time. Good luck!

[KelRN215, BSN, RN]

I worked on a neuroscience unit for 5 years and sometimes, yes, it's unavoidable that one patient takes up the bulk of your day and that you need to rely on your colleagues to help with other patients. That shouldn't be an every day occurrence though.

I once took care of a baby with hydrocephalus (aqueductal stenosis) on the night shift the night after Neurosurgery decided to make her their little science experiment and pull her EVD (despite the fact that she'd failed every clamp trial they did on her and had hemorrhaged the first time they pulled her EVD without placing a shunt). To this day, almost 10 years later, I'm still convinced the case would have gone to court had the parents not been 16 years old. Before midnight VS, it was clear that she was in trouble- her O2 sat was dipping to the low 90s, her RR was in the teens, her blood pressure was creeping up, her HR was slowing down, her fontanelle was bulging, her pupils were sluggish and she wouldn't spontaneously wake to feed. On our way to CT, actually, she didn't even wake when we pushed her crib over a giant bump that should have startled any baby. A stat CT showed exactly what I expected- vents were up and the Resident made her NPO in anticipation of her going to the OR. The Attending on-call didn't want to come in overnight, however, she thought the baby could wait till morning since she had an open fontanelle and just sent the Chief Resident over to tap her fontanelle. I don't think I left that baby's room the rest of the night until I wheeled her down to pre-op at 6am. My colleagues fed my other baby patient, who didn't have parents with him, and checked on my other patients.