How Behind Do You Get?

nursemike, ASN, RN · Nov 1, 2005

Don't give up! I'm coming up on six months, and it's s-o-o-o much better than 4 months. I'm literally amazed. Not to say I'm even close to Supernurse, but I'm feeling like my nightmare shifts would be pretty tough ones even for the more experienced nurses.

I did actually finish on time Sunday morning. Having two shots at my 2o'clocks was pretty handy. Generally, my 12 hr shifts have been running close to 13 hrs more often than not, but this morning I was out by eight (4 patients all night--woo-hoo!)

One thing I do pretty consistently is just what they told me not to do in school--I tend to leave most of my charting for last. Our flowsheets have boxes for Glasgow, strength of extremities, and stuff like that. I fill those immediately after each assessment and try to keep up with whatever can be checked or initialled, but I tend to right most of my notes during downtime or when my successor is listening to report, or after my shift, if necessary. I take comfort that a couple of my mentors--best nurses I've ever seen--do much the same thing. Patient care first, paperwork last. But I've learned the hard way that you can't remember things like pupil size, grip strength, or 02 sats more than three minutes.

None of which is much help when all heck breaks loose. One night I told my charge that my assessments were done by checking one system per patient as I put them back to bed, then tying them all together. He laughed and said I'm sounding more and more like a nurse. I was a couple of hours late, that night, which sucks when you're back the next night. But while I was charting, I overheard the 20+ yr nurse who followed me telling the charge nurse it would be cruel to give me the same assignment again, and the CN replied that she had no choice, since the other two nurses that night would be newbies.

Anyway, don't let it get you down. Self-evaluation is just about impossible at this point in our careers. I still feel pretty inadequate on a regular basis, but nurses I respect tell me I'm doing okay, so I try to take their word for it. I hope you have some people like that to work with--if not, there are lots of other places.

PS Second night with that same crew was much better--they didn't have the element of surprise!

Altalorraine · Nov 1, 2005

Can anyone relate? I can't imagine things getting better. Hearing the first six to 12 months is the toughest isn't making it any better. Any suggestions?

Remember all those prioritization questions on NCLEX... the ones where you come out saying, "There was no right answer; they were all important!"....?

Try to use the same thinking in the care of your patients. No one is going to care that you've got a full plate; everyone will want things done RIGHT NOW. It's your job as the nurse to decide what you really need to do RIGHT NOW and what can wait. A doctor calling with new orders on a stable patient can wait while you hang blood. A patient who is due for his Colace can wait while you take orders from a doctor.

It's really hard to be the heavy and tell people to wait when you truly want to help everyone and please everyone. Just remember that prioritizing is very much a part of your job.

Altalorraine

Fairemaid · Nov 1, 2005

I did actually finish on time Sunday morning. Having two shots at my 2o'clocks was pretty handy.
:rotfl:
I stayed an extra half hour tonight to finish charting. Why does it seem that the nights that should go quietly are the ones that go right down the toilet? just when I thought everything would finally be done, two of my patients had critical lab values and as a result one of them needed a unit of blood hung. Tonight on my 8 hour shift, there was no CNA, so I spent probably 2 hours doing vitals and handling toileting issues. Then the other patient with the critical 4.73 Gentamycin trough level needed a call to her MD and I got a covering MD at 11 pm who knew nothing about the patient and nearly bit my head off.:chair:
Despite all of this, I still love my job. When things go right, I feel like I've really accomplished something. My advice to new grads who aren't happy yet is to try different floors or try working only 8 hour shifts if the 12's are too stressful. You've come this far, surely there's some kind of nursing that will appeal to you. Don't give up hope.
Rebecca RN

Tweety, BSN, RN · Nov 1, 2005

Good luck to you. I'm 14 years in and still feel that way. I stayed 45 minutes late both days this weekend, it was just that tough. I touched base with the charge nurse on nights, and said "you'll probably here from the next shift, but I'm leaving them 2 units of blood to hang and an adminission to do." They all were gracious, but I could not be bothered with their grouchiness if they weren't gracious. If I worked my butt off all day, have to stay late to finish my work, I'm not going to feel guilty for not being able to do it all.

I don't have any words of wisdom. It's a tough life, but it definately gets better as time goes on past that first year. Good luck.

DutchgirlRN, ASN, RN · Nov 1, 2005

Good luck to you. I'm 14 years in and still feel that way. I stayed 45 minutes late both days this weekend, it was just that tough. I touched base with the charge nurse on nights, and said "you'll probably here from the next shift, but I'm leaving them 2 units of blood to hang and an adminission to do." They all were gracious, but I could not be bothered with their grouchiness if they weren't gracious. If I worked my butt off all day, have to stay late to finish my work, I'm not going to feel guilty for not being able to do it all.
I don't have any words of wisdom. It's a tough life, but it definately gets better as time goes on past that first year. Good luck.

I'm with you all the way Tweety. This is why hospitals have 2 shifts. I had a really bad day yesterday and left an admission history for the night shift to do. I don't feel one bit bad about it. I ran for 12 hours, woolfed down lunch in 10 minutes, other than that the only time I sat was when I managed to get to the bathroom. Woo nursing is tough, eh? I'm in with 30 years.

student4ever · Nov 1, 2005

I'm so sorry you're going through such a rough time! But don't give up! You've come this far - finished school, passed the NCLEX, you just need to pass another "test" yet - unfortunately, this is a test of fire, but you will make it through! I know it's discouraging when it feels like you just don't get the hang of how to do things as well as you feel you should. Just keep your head up, and know that it will get better!

Bijou-Spice · Nov 2, 2005

lisaRn41 :bluecry1: That's me crying along with you! I started writing this to you yesterday, but I was so wiped out and upset I had to stop.

I am about the same age you are and I am 2.5 months into this new exhausting and frustrating career! I also wanted to make it one year, but I hope to make it 6 months. I have never felt STUPID and slow until this time! Yesterday was awful..I had a pt getting Mg, KCL, 2 Antibiotics, plasmanate, NS, and morphine through a PCA (which the pt couldn't push). I was just struggling to figure out where to hook everything up to her saline locks. What can run with what, what goes primary what goes secondary..ahhh! Today was a little better since I had done all the figuring yesterday.

To add to my frustration I have a preceptor that will say to me "what did you learn in school", I ask myself this everyday!

I have read from other posts the best thing to do is a the end of the day reflect on what you did well along with what needs improving and journal it. I haven't started this yet but plan to....tonight (?).

This is a second career for me where I knew what I was doing, now I am at the bottom and clueless.

I know this is not the encouragment you where seeking, but know you are not alone, in fact you are surviving better than me! :rolleyes:

My plan is to get some hospital experience and if it does not get better move to something different and also go for my masters.

I wish you the best and I guess each day should get better with some dips inbetween.

porterwoman · Nov 2, 2005

Sigh...it's not at all unusual for me to be finishing up charting my assessments at 5:30, 6:00--checking all those stinkin' little boxes on the flow sheet makes me cuckoo :lol_hitti --and I've given 2200 meds at 2400--would be happy to ask charge nurse or somebody for help, if I could find them--but, the last two nights I worked the census was low, so it made for a very very slow night. Everyone was complaining, but I was grateful for it. I try to at least check the abnormals off on the flow sheet assessment, and I try to keep up with my notes. I try to do what I can to stay ahead of the game, but, geez, it's so impossible sometimes, isn't it though?

Year of med-surg, year of med-surg, then I can do something different...Not that I'm not learning a ton...

Biker RN · Nov 2, 2005

Staying late and charting gave me time for some reflection on my day, some closure; finally sitting down wasn't bad either. If I was falling behind and HAD TO bother another RN for some help during a very busy shift I would help them later. If I was on my way to the medroom I would ask if they needed anything, if I heard a pt's. IV beeping I would check it out and report to that pt's. nurse if he/she was busy doing a dressing change, etc.

lisa41rn · Nov 2, 2005

Hey thanks everyone!! I always feel I'm venting too much, but as usual I get so much support and feel so much better!! Get this.....it's now almost 1:00 am. I got up about 24 hours ago to do some work for my husband before going to work. Because of my terrible day the day before, I was thinking about calling out because I needed a mental health day, but I didn't. I had the same patients and ended up working a double and just got home. By doing a double, I was able to get an extra day off this week. Of course, I'll never want to go back with four days off now!! I have to say, my nurse mgr is wonderful. She did tell me one doctor was upset a unit of blood didn't get hung yesterday, but couldn't understand it as the patient had a fever and we NEEDED to check with her first. This doctor is generally nice and we both figured she was having a bad day like I was. Another real mean doctor was upset about something that got missed by me, but also others from the previous shift missed things as well. She fights with all the doctors and is known to be a bit crazy, but still the nurse mgr doesn't want to hear any complaints. I admitted I made mistakes and really worked out ways to improve. I think she liked that and said not to beat myself up over it. The only thing I didn't like was she said she could put me on other shifts if I found days too tough. Was she doing this because she didn't want to lose a good worker or was she doing this because she didn't want the headaches with me? Hmmmm

While today went better, I have to say just the fact they asked me to work extra made me feel they still had SOME faith in me. Of course others say if you have that RN after your name, they'll ask anyone to work. I can't imagine them doing this with a total goof!! Anyway, the night is over, I'm happy I have a few days off and I left tonight realizing just how demanding each and every one of my patients were these last two days. You know the type, you can't please them because you never do enough or move fast enough!!

The clincher tonight was I was working with some of the nurses who really made me feel bad because I left them work to do last night. One especially was nasty and all she did tonight was complain about HER tough night and how behind SHE was. What goes around, comes around I guess.

Thanks again everyone!! You've all really made me feel so much better (but I'm still praying I get through a year!!).

grinnurse, RN · Nov 2, 2005

Hi there Lisa41rn-

If you have only had one really rough day in four months of nursing girlfriend you are doing great!! I have now hit almost 5 mos and can't tell you how many really crappy days I have had so far. I keep going back because I am probably too stupid to know any better LOL!!! I think Nursemike said that the only saving grace that he finds is that the nurses that he respects tells him that he is doing ok and that he tries to remember that in times of real stress!! That is kind of how I have survived so far too is keeping that in mind.

Seriously, yesterday was one of those days that went to hell in a handbasket and it had all intentions of being a very tolerable day for me as well. Just keep pluggin and don't give up!! I find that every week continues to improve as far as what I know and can do. I think every nurse, even well seasoned nurses have days when they are treadin water just like us newbies seem to be doing!! At least in my hospital that's what I see!! Good luck and don't give up!!