I need some advice

Published

I'm a very new, very green graduate nurse. I graduated back in May 2005 and accepted a position on a step-down unit. I've been on the floor for roughly 4 weeks.

I'm a fast learner, and I can make it look like I know what I'm doing...but sometimes that's the problem. Sometimes I dread going to work or I can't sleep the night before because I feel like I don't know what I'm doing, but everything thinks I do.

The worse thing is, it's not even the nursing care that's confusing me. It's the communication with the doctors and the clerical work. The patients on our floor have multiple teams working with them, and I never know which one to call or if the other teams need to know about certain things. Sometimes I feel like a secretary bouncing around between internal medicine, cardiology, surgery, etc.

Everyone says I'll learn all the doctors in time, which I'm sure I will. But it's frustrating when they're already expecting me to be collaborating with people I can't identify. I have to literally stand by my patient's door and wait for someone unfamiliar to come up and try to enter so I can find a certain doctor to get an order.

I also got chewed out by a doctor who was attending for a patient's neurologist because internal medicine said she was ok to be discharged, but the attending had no clue about the patient or the history. He asked me to explain it to him, which I did but then he asked me to read the neurologist's latest progress note. The note was a few days old, irrelevant, and illegible. He got frustrated because I couldn't read it, and I decided to not discharge the patient because no one knew what the hell was going on.

Honestly I feel so relieved every time I get off the floor, it's scaring me. I find myself reading more and more into PA programs. I really like nursing, and I'm pretty good at the nursing care, but I can't stand being treated like a dog. It's different if a patient is upset and taking it out on me, but I would expect other healthcare providers to be somewhat humane. I feel bad for the poor MD who makes me explode...:uhoh3:

So what's your advice? I know I'm probably telling an old tale, but I need to know how to handle this. Or I need to know what I can do to proactively move forward. I watch the other nurses and they just seem to know what to do or who to talk to. :confused:

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

First, I'm going to move this over to the "First Year After Nursing Licensure" forum, which I think is more suited to your post -- lots of people will be able to offer advice regarding acclimation to your new work environment. Second, I'm confused ... did you really graduate in May 2005, and only started working now?

Up Vote Up Vote ×
Specializes in Critical Care, Education.

Don't feel bad - Communication with physicians is one of the most difficult skills to master. From what you have described, there are actually a three issues at work here: 1)Your own ability to communicate relevant facts; 2) understanding the physicians' pecking order; and 3) getting caught up in physician-to-physician conflict.

I would advise you to adopt the SBAR communication technique with physicians. If you are not familiar with it, there are a ton of resources on this site for you. Using a structured approach will ensure that you are well prepared & able to clearly communicate in order to achieve your goals. Physician heirarchies may differ, but you always need to understand that the admitting (attending) physician rules the roost. They make all final decisions about patient discharge. If you're in a teaching hospital, you can easily get information about how each department is structured - who is chief resident, who are the newbies, etc. In private hospitals, there is always a medical staff roster and you should have access to this. Take the time to introduce yourself to each new physician - "Hello, we haven't met - I am Jane Doe, and you are. . . . "?

However - there is nothing you can do about physician-to-physician conflict except to step aside. Simply refuse to put yourself in the middle. It is not your fault if the consulting physician's notes are illegible... you could offer to give the attending physician his/her phone number so he can do so directly. It is their responsiblity to communicate with their colleagues, including getting a 'report' on patients when they cover for a colleague. Don't let them aim their frustration at you and don't let it affect your own confidence and self esteem.

Up Vote Up Vote ×

Thank you to both of you who responded. I started working in June, so a little over a month after graduation. I took a month to take the Kaplan review course and study for the NCLEX.

I am familiar with SBAR, I just need to really apply it. I had a much more positive experience today with the physician communication. I actually knew to call the attending regarding a order modification I wanted to make.

I'm still learning this hierarchy...I hope familiarity will kick in and help soon...

I'm trying to stay positive though. I'm just not used to not knowing so much, if that makes any sense.:cool:

Up Vote Up Vote ×
Specializes in med surg/cardiac.

I just wanted to add that you probably could have pulled up a dictated consult from the neuro doc rather than trying to read that page! You could have given the doctor the info and saved yourself the embarassment of him being a jerk!

When you are waiting for a specific doc ask a seasoned employee what he looks like so you can be on the look out. Then when you meet the doc introduce yourself and explain you are new to the company (you dont have to say new nurse!) and next time I bet he/she remembers you. I can honestly say the majority of ourr doctors recognize, know thier names, and he personal lives of our 3 male nurses. So you have an advantage there. Even saying hello to them gives them a second to notice you and reminds you to notice them. Some nurses are so task oriented they run up to the doc ask for orders and thats it. They are your co-workers, so treat them as such.

Another tip is to befriend you unit secretary. If you are courteous to him/her, offer to watch her phones while she runs for coffee or stop that family member who keeps bugging her because shes the only one sitting there; and I guarantee she would have spoke up and read that page for you or pulled up the consult if she overheard what was going on. It is hard to learn all the new staff but that is what they do 8 hours/day read and identify docs.

Hope that helps!

Up Vote Up Vote ×

I find that sounding confident when speaking to the docs, though I may be shaking in my clogs, helps tremendously. As a new grad there were a few who initially did not trust my judgment, and went as far as bypassing me, the pt's RN, to get another RN's opinion. In time they bean to trust me, and I found that standing firm in my beliefs and assessments helped a lot. When time allows, I like to listen to docs talk amongst themselves. This way, when a new doc signs on and asks me about the pt I can regurgitate the info, add a little of my own assessment, and sound super knowledgeable.

Good Luck!

Up Vote Up Vote ×
I just wanted to add that you probably could have pulled up a dictated consult from the neuro doc rather than trying to read that page! You could have given the doctor the info and saved yourself the embarassment of him being a jerk!

When you are waiting for a specific doc ask a seasoned employee what he looks like so you can be on the look out. Then when you meet the doc introduce yourself and explain you are new to the company (you dont have to say new nurse!) and next time I bet he/she remembers you. I can honestly say the majority of ourr doctors recognize, know thier names, and he personal lives of our 3 male nurses. So you have an advantage there. Even saying hello to them gives them a second to notice you and reminds you to notice them. Some nurses are so task oriented they run up to the doc ask for orders and thats it. They are your co-workers, so treat them as such.

Another tip is to befriend you unit secretary. If you are courteous to him/her, offer to watch her phones while she runs for coffee or stop that family member who keeps bugging her because shes the only one sitting there; and I guarantee she would have spoke up and read that page for you or pulled up the consult if she overheard what was going on. It is hard to learn all the new staff but that is what they do 8 hours/day read and identify docs.

Hope that helps!

I would definitely agree with you on getting the dictation, but unfortunately the results had no been read yet. The EEG tech told us unofficially that there was nothing remarkable about the exam, and the internal medicine doctor ran with it and decided to discharge.

Up Vote Up Vote ×
Specializes in med surg/cardiac.
I would definitely agree with you on getting the dictation, but unfortunately the results had no been read yet. The EEG tech told us unofficially that there was nothing remarkable about the exam, and the internal medicine doctor ran with it and decided to discharge.

"I just wanted to add that you probably could have pulled up a dictated consult from the neuro doc"

Not test result. Consult report. Consultants will record a consult usually the first time they see a patient. Thats what I was talking about. = )

Up Vote Up Vote ×
"I just wanted to add that you probably could have pulled up a dictated consult from the neuro doc"

Not test result. Consult report. Consultants will record a consult usually the first time they see a patient. Thats what I was talking about. = )

Now that sounds like something I really need to find pronto!

Up Vote Up Vote ×
First, I'm going to move this over to the "First Year After Nursing Licensure" forum, which I think is more suited to your post -- lots of people will be able to offer advice regarding acclimation to your new work environment. Second, I'm confused ... did you really graduate in May 2005, and only started working now?

Sorry just read the last line! Nope I graduated in May 2010...

Up Vote Up Vote ×
+ Join the Discussion