HELP! New Grad on Med-Surg / Telemetry Floor

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Specializes in Psych.

Hi,

I graduated in May 2011, and got a job at a community hospital in December 2011 on a med-surg/tele floor. I have had 12 weeks orientation, had 2 different preceptors, 10 weeks days 2 weeks nights, took an EKG class, and an ACLS class, and i STILL feel unprepared to be by myself. My unit is crazy, it's crazy busy all the time, they are trying to get it so we only have 4 primary patients with 2 LPN coverage, but we can have as many as 6 with an additional 2 LPN coverage.

I don't know how to prioritize, I'm not good with getting admissions, and I haven't had anyone die on me, so i don't know what to do for that. I've asked for 3-4 additional weeks, and my manager seems cool about it, but I truly am freaking out. I don't know how to deal with the difficult patients, you know, the ones that are half-crazy to begin with? Also I don't know how to deal with a confused patient, or the patient going through alcohol withdraw? I can deal just fine with the ones that are pretty much stable and that's it!

I come home crying almost every day. And before each shift I pace around my living room, nervous and anxious for what the next shift has in store. I suck at just about everything, and I am asking questions constantly, to the point where it's probably getting insane. I don't know what to do? And I'm worried their patience will wear thin soon. When something happens with one of my patients the whole day is thrown off schedule!

I am just freaking out and looking for advice. Other nurses seem to think that I'm just feeling this way because I am new at everything. But I'm not so sure. I don't even know what I need to call the doctor about all the time, or even which one of the 583926 doctors any one of the patients has on consult at the time. God help me!

Did I make the wrong choice in job? My good friend works in a nursing home, she says nights are a lot less hectic than that, and that hardly anyone gets IV meds or bedside procedures. People are generally stable there.

What should I do? I feel so overwhelmed I'm worried it's going to give me a stomach ulcer. I suck at prioritizing and I generally suck. I feel as though I love the medical field, but I'm not sure this is right for me! What do I tell them after 12-16 weeks of training if this isn't for me? They've been all so nice to me, but what if it's too overwhelming? What if I suck? I'm being serious here, I'm not looking for someone to hold my hand and tell me it's going to be ok if it's not! Help!

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Specializes in Med Surg.

I'm a new nurse, too. Graduated in May, started working in July. I can totally relate to your post. Being a new anything is hard. Anyone starting a new job sucks at it. After a few months you suck less. Maybe by 6 months or a year you're sucking even less. After a couple of years (or however long), you actually start to get good at what you're doing. It takes time to get the hang of prioritizing, figuring out which doctors to call, etc. Use your fellow nurses and CNAs, ask for help when you need it and be sure to help them when you can.

Are you working days or nights now? I work nights and I think that's helped me tremendously. The pace is different, the coworkers/atmosphere is a bit different (much less type A, which I am not). It's crazy busy but still has allowed me to get my bearings.

Keep going, it will come together eventually. It has to, right? :)

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Specializes in Certified Med/Surg tele, and other stuff.

First of take a really deep breath! I know you feel completely overwhelmed, but it really does get easier. With that being said, you will have some days that just make you feel that you can't keep up.

When you say 'they' want to decrease the pt load, who are 'they?' It sounds like the ratio might be part of your problem?

For now, do you use a 'brain' for you to help organize yourself? Make one that works for you. It will help you organize your thoughts and day.

As you get report, start prioritizing as you go. Look at your patients. Who needs to be seen right away, and who can wait? Think about your pt load. Usually there will be a few that will stand out as your problem child, lol. Those pt's are going to be the time suckers of your day. Who is going home? Probably your least time consuming pt.

Some nurses like to start their rounds with pt's that are the least sick. That way, they can get through them quickly and focus on those that are more needy. Others do it the opposite way.

If you have trouble forgetting to give meds, hang IV's, use your cell or watch to remind you to hang something. That will give you a bit of a back up for now and you won't have to file yet another thought in your head. :)

Ask your preceptor what you can do to multi task better. She has worked with you long enough and should know your style.

She should be able to help you decide which dr to call for a problem. Write her answer down and keep notes in a small notebook for future reference.

There is more to probably add, but I'm soooo tired, lol.

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Specializes in Psych.

I am thinking of switching specialties. I'm thinking of going to psych. I can't do med surg anymore!! I don't think it's for me.

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Hmm, psych? I am going to go out on a limb here and guess that psych nursing will be even harder for you than med-surg. If you can stick it out for a year or so, med-surg gives you a good foundation for the rest of your nursing career. I am a relatively new nurse myself (1.5 years) and the only thing that throws me off short of a patient trying to die on me is a crazy patient (and I mean "crazy" in the least offensive way possible but when they are aggressive, paranoid, obsessive, or just plain mean and/or abusive). Even if you are having a tough time accomplishing your tasks, a calm/understanding/cooperative patient can help you survive the shift. I understand your pain because I really, really don't like med-surg.

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Specializes in Certified Med/Surg tele, and other stuff.

I agree here, I think getting that foundation will be good for you. Psych is no cake walk either. It can be a complete zoo, BTDT.

It really is too bad that Med/surg gets such a bad wrap. It comes down to hospital staffing. Any floor can suck if not staffed safely.

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Specializes in Psych.

Well I think I owe it to myself to at least shadow a psych nurse. I'm so upset about everything right now!

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Specializes in Certified Med/Surg tele, and other stuff.

It makes me sad to hear how stressed you are. Go shadow a psych nurse. Just remember, it's different shadowing than being on your own. :hug:

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Specializes in Psych.

I'm going to shadow a psych nurse for a couple of nights. I have to see what it's like. I just remember being in school and loving psych a lot. I think there are certain people who are pulled to psych specialty and I was. So I owe it to myself to at least do some shadowing to see what it's like.

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Specializes in Cardiac.

I just have to interject here. I am also a new nurse, I graduated in June with my BSN, started on a step-down cardiac floor in July. Have been on my own for almost 5 months, I am type A! My floor is like an ICU, we do all cardiac drips and we have med-surg overflow. Let me say after 7 of months of being exactly how you are feeling I am slowly becoming more competent and far more organized. I have learned the flow of the unit. I usually have 6 pts. by myself, some are not doing well, I have had to call RRT's, Code 1's, you name it. I have bounced many things off of other nurses, they are your best resource. Trust me they would rather have you ask tons of questions then be helping you in a code, or picking up your pt off the floor because you waited too long to ask a question, or get some help. I completely relate to you, I can't even count how many times I had the exact same conversation with my manager and team leader that maybe this field just isn't for me, or maybe this floor isn't for me. The fact that you care this much tells me it is right where you should be. I know it's intimidating to have so much to do and watch the clock tick away only to think, OMG I am never getting out of here. Being on a med-surg floor for the first year is your best foundation, you will learn so much. I have learned so many new things everyday. Trust me it will all come together. One day you'll think, holy cow i'm starting to get this. BTW I also have a bachelor's degree in psychology, I felt that I'd be better off on my floor for at least the first year. I am really starting to love my job, I'm going to go back to school and obtain my Psychiatric nurse practitioner degree, but for now i'm staying put. There are many nurses that feel your way, know you are not alone EVER. Hang in there it does get better. Big hugs to you :)

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Specializes in ED/ICU/TELEMETRY/LTC.

Breathe, now breathe again. Priority.......A.....B.......C, everybody pooping? Every body peeing?

Then meds, then orders, then chart.

Try your best not to get distracted. It won't work but it will help.

It all depends on how much you want it.

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Specializes in Psych.

Thanks for posting this, I'll take it into consideration. I am going to shadow with psych still though just to see! I can't shake to feeling that I may be in the wrong spot. I get so depressed when I get home!!

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