Scared.....No Nursing?

[Name9335]

Hello All,

I have posted on here several times before, but in short, I am a relative new grad. Only a little over a year out of school. I have failed out of two med-surg orientations. I am currently working at a nursing home and it was going fairly well, up until recently, where again, I am being told I'm not good enough/my assessments are not up to par, I'm basically incompetent. I'm scared and angry..... Everywhere I turn, I am being told apparently nursing isn't for me. This is all I have ever wanted to do. So now I have a nursing degree and very little clinical experience to get into anything like informatics or..... So now I'm stuck. I don't really know what else I have an interest in. I don't know where to go next. I really don't want to be stuck at a desk job or sitting in front of a computer all day. I have a nice nest egg (financially) and I still have my job at the nursing home, (so I don't need to make a decision in the next couple of days) but I don't know if I will be staying. Any other suggestions on where I can turn to? I LOVE nursing. It hurts and breaks my heart to even consider walking away, but no matter what I try, I'm told that i can't do the job.

[Name9335, BSN, RN]

Essentially I am calling providers with lab results and haven't done an assessment. In my mind, I'm just calling to give a heads up. I think I would do ok with the actual assessment if I actually slowed down and did one?

But then some labs we call on to give a heads up and providers aren't asking for a full assessment...

[Accolay]

I'm with Davey- it takes a lot of guts to come on here and say this stuff about yourself.

Can you go into the details of what kind of "full assessment" is being asked for?

What are you missing? What can you work on? What are you slow with? The process of being great has a lot of pitfalls and will take a lot of hard work, feedback from your supervisor and coworkers and self reflection to get better. Keep at it.

When you reach for the stars, you might not quite get them, but you wont come up with a handfull of mud either. -Leo Burnett

[Daisy4RN]

But then some labs we call on to give a heads up and providers aren't asking for a full assessment...

I am a little confused by what you are calling an assessment. Do you possibly mean assessing a given situation, when to call MD re: labs, knowing what is important and what needs to be done etc. If this is what you mean this will come with time and experience, but you can also look things up and/or look into nursing apps.

[Name9335, BSN, RN]

I'm with Davey- it takes a lot of guts to come on here and say this stuff about yourself.

Can you go into the details of what kind of "full assessment" is being asked for?

What are you missing? What can you work on? What are you slow with? The process of being great has a lot of pitfalls and will take a lot of hard work, feedback from your supervisor and coworkers and self reflection to get better. Keep at it.

Trying to not give too much information.... I called on a lab result. Provider asked about the residents breathing. I was not familiar with this resident or their baseline at all. So I mentioned what the aides said...... she took that as me not doing a full assessment. I agree that I could have probably done more to assess, but it's hard when you don't even know residents baseline

[Daisy4RN]

Trying to not give too much information.... I called on a lab result. Provider asked about the residents breathing. I was not familiar with this resident or their baseline at all. So I mentioned what the aides said...... she took that as me not doing a full assessment. I agree that I could have probably done more to assess, but it's hard when you don't even know residents baseline

Yea, MD's are busy and will expect you to have info ready when you contact them. You will learn to anticipate and know the appropriate info to have on hand. Maybe start a notebook with labs and important info needed. This will get easier.

[Davey Do]

I mentioned what the aides said...... she took that as me not doing a full assessment. I agree that I could have probably done more to assess

I can identify with your situation two fold, Name.

When I was a new nurse, I sometimes lacked at full knowledge and when put on the spot, I gave what information I could. For example, I remember a Doc asking me what dose of digoxin a patient was on. I said, "I think 0.125". He replied, "Don't think! Get the chart and find out!"

Ew.

So, I got better and for years did good assessments and gave sound reports.

Now, in my professional twilight years, I sometimes forget things. No big deals- just things that make me go "Like, duh!"

These days, I gotta keep reminding myself to focus and try not to multitask.

We just gotta keep working at staying good or getting better.

[LovingLife123]

If you have an abnormal lab result, yes, you should assess that patient before calling the MD. That is kind of important.

When calling abnormal labs, have a set of vitals and an assessment of your patient ready to give.

Assessments should not take you very long. Once you get it down on how to do it, you should be able to do one in less than 5 minutes.

Keep working at it. You will get there.

[Davey Do]

Maybe start a notebook with labs and important info needed.

I say "AMEN!" on writing things down and try to do it all the time. When I don't, I do tend to forget.

Yet another case in point: Just last week on geriatric psych, we had this guy who had urinary retention and a uti along with a firm mass on the RLQ of his abdomen along with being psychotic and acting out.

The patient had been Rx Bactrim from the referring facility and a nurse contacted me with the u/a c&s report that the causative organism was resistant to the antibiotic.

I did everything right: Thanked the nurse for good continuity of care, communicated with involved parties, got a radiological order and report, bladder scan, Rx for po Macrobid, dealt with the patient whose perception was definitely not grounded in reality and fulfilled with my other responsibilities.

Pretty good job for an old burned out psych nurse, right?

Nope. At 0400 in the morning I realized that I hadn't started the Macrobid when the order was received at 2130.

Like I said, "Duh!"

[Triddin]

But then some labs we call on to give a heads up and providers aren't asking for a full assessment...

Before I call the doc, I've learned to have done an assessment for the pertinen details and I've written down what I think I'd important for them to know (I swear I have the memory of a goldfish sometimes) so I have my pertinent points. Some doc's want all the details, some dont but it's always better to have the information available of its requested.you don't necessarily need to do a full assesebt. Often focussed ones will work.

I feel like being able to give the pertinent data (and know what is pertinent) comes as you develop critical thinking, which is an ongoing process in all nurses.

I also think we've all been there, having a doctor call us out on not having all pieces of information they want. I ever calling a doctor about a high k and they asked me about urine output and I honestly couldn't tell them. I had to put them on hold to check.

It sounds like you've done some good reflection. Could you take this information and present it to your work in form of a learning plan? It shows them you are taking this deficit seriously and are being proactive to find solutions. Might help. Also writing down valid strategies to help you improve can help you direct your own practice. Best of luck.

[BAY AREA RN, BSN]

good luck

[Kooky Korky, BSN, RN]

Trying to not give too much information.... I called on a lab result. Provider asked about the residents breathing. I was not familiar with this resident or their baseline at all. So I mentioned what the aides said...... she took that as me not doing a full assessment. I agree that I could have probably done more to assess, but it's hard when you don't even know residents baseline

I think you have solved your own problem.

Always stop to think about what information YOU would want to get from the person reporting a lab to YOU, if YOU were the doctor.

It is not enough to just tell a doctor that a pt is having trouble breathing or has a low potassium or a high CO2 level.

The doctor has a million patients, many of whom he can't even picture, let alone know each one's history.

I'm not saying that's good or proper, it just is how things are.

Always have a fresh set of VS and the list of the pt's diagnoses, along with the labs that are concerning you. Have the labs preceding the current ones, too.

Also, you must SEE the pt before calling the doc. Is breathing labored? Is the skin warm and dry? Clammy? Is pt having orthopnea? Using accessory muscles to breathe? Is pt alert and coherent? Oriented x how many spheres? Is pt at baseline neurologically? Is there a standing order for an EKG or whatever and have you done these things before calling a doc about a specific situation? What is the pt doing right now?

Your employer should give you some very specific examples of what you need to change, of what you have done wrong up til now.

You know this stuff, now just do it!

[Name9335, BSN, RN]

I think you have solved your own problem.

Always stop to think about what information YOU would want to get from the person reporting a lab to YOU, if YOU were the doctor.

It is not enough to just tell a doctor that a pt is having trouble breathing or has a low potassium or a high CO2 level.

The doctor has a million patients, many of whom he can't even picture, let alone know each one's history.

I'm not saying that's good or proper, it just is how things are.

Always have a fresh set of VS and the list of the pt's diagnoses, along with the labs that are concerning you. Have the labs preceding the current ones, too.

Also, you must SEE the pt before calling the doc. Is breathing labored? Is the skin warm and dry? Clammy? Is pt having orthopnea? Using accessory muscles to breathe? Is pt alert and coherent? Oriented x how many spheres? Is pt at baseline neurologically? Is there a standing order for an EKG or whatever and have you done these things before calling a doc about a specific situation? What is the pt doing right now?

Your employer should give you some very specific examples of what you need to change, of what you have done wrong up til now.

You know this stuff, now just do it!

Thanks. I'm in a nursing home, so my standing orders and such are pretty limited, but I'll keep that in mind