I need some advice

[mphilomena]

Hey nurses! I am in need of some advice. Here is my situation.

I graduated nursing school with BSN in May 2013. Passed my NCLEX in June 2013, immediately started working in a nursing home after passing because that was the only place I could find a job at. I worked there for about nine months, and very recently, was offered a hospital job on a hematology/oncology unit. I have been working on the floor for a total of 3 days, still on orientation. My co-workers are all very experienced and very understanding.

I guess coming back into a hospital environment was more of a shock to me than I anticipated..working in LTC, things can be so much more laid back, and in the hospital, you're really crunched for time and always have to be on top of your game because you don't get to see the exact same patients every single day you go to work. Since it still was super busy at my first job (even though working in the nursing home is a very different environment from working in the hospital), I had really hoped that my adjustment to this new job wouldn't have been such a shock to my system.

I understand that no matter what job you start in, you will be overhwhelmed initially and there is a learning curve. I had just hoped that it would be easier since I've technically worked as a nurse for 9 months now. Instead, I honestly don't feel any less anxious about this job than I would had I been hired to work at the hospital immediately after graduating nursing school with zero nursing experience. I know I just have to suck it up and learn, but it just really hurt my pride to realize that despite the fact that I've been a nurse for 9 months, I still need a lot more practice with certain skills (especially IVs, PICC site cares) that I wasn't exposed to in the nursing home.

Another thing that has really bothered me is the fact that family members don't seem to trust me as much as they do my preceptor, even when I know what I'm talking about. (They would ask me questions, I would answer their questions, and then they turn around and ask my preceptor the same questions they asked me and my preceptor gives them the SAME answer I gave them). It was just really discouraging to know that no matter how well I did, these people still weren't going to treat me like a full-fledged nurse.

What do you guys think? Is it normal for me to feel like a nursing student all over again in this new job? What can I do to pump myself up instead of just getting all discouraged? What can I do to show family members that even though I'm new to this particular nursing unit, I am still an awesome person/good nurse?

[Jory, MSN, APRN, CNM]

The first question you need to ask yourself...where do you want to spend your career?

Yes, you hear about these amazing skills that hospital RN's have, all the technical skills they get to learn, etc. However, what makes you happy and where you can earn a living, is much more important.

RN's in both working environments have very much needed skills and nursing homes are not going anywhere..you will always have a job. One is not better than the other.

If you are truly happier in a nursing home, then there is nothing wrong with going back. I think that is what you feel in your heart and you have not FAILED ANYONE, not even yourself, if you decide hospital work is not for you.

I am getting ready to move away from patient care altogether....this is a second career for me and I have discovered I like the management and the planning, hand holding, education, much better than starting IV's and participating in codes. It's also where I am more skilled.

[roser13, ASN, RN]

You are still a new grad. Nine months does not an experienced nurse make. Of course you should still feel underwater. Your experience in LTC gave you (by your own admission) very little experience that is relevant to your current hospital position. My only question is, why are you even questioning that you need to learn more and practice more skills?

You may be "awesome" as all get-out as a person, but as long as you are an orientee and your patients/families realize this, it is only natural that they gravitate toward your preceptor as the ultimate go-to for answers. That will change as you are gradually able to take on more patient care and your preceptor fades into the background.

i personally don't feel that you need to "pump" yourself up more. I think you need to buckle down, accept that you have A LOT to learn, and be very very grateful and happy that you scored this hospital position.

[schnookimz]

Totally normal. Give it 6 months.

I also feel like orientation makes me feel dumber bc I am not forced to figure things out on my own. I really believe I learned as much the first week out on my own as I did in 3 months with my preceptor.

[jadelpn, LPN, EMT-B]

There are usually those of us who think that LTC is overwhelming!!

It is natural to feel like a fish out of water whenever you do something new in nursing. Especially in a specialty that is complex.

What you may find similar is that in LTC you have the same patients daily, and you get to "know" them. And if you think about it, a family member in LTC may ask a new face a question, however, they would probably then go to a familiar face (you) and ask again, "just to be sure".

Oncology can be much the same. The patients are usually known, as are the nurses. Once you have been established as a familiar face in the unit, then you may find that they will seek you out as well. Often, the patients are in a race for some sort of control--so they can be complex in their emotional support needs. Much like LTC. As you show empathy, support and encouragement then the patients WILL realize that you are a good person. But be mindful that you want to be known as a good nurse in practice that is emotionally but theraputically supportive.

So the similarities are there. And know that there are a bunch of seasoned nurses who have had IV teams in their careers, so don't usually do IV's, so it IS a learning curve. I know that you must be really good at skin assessments, as that is a huge thing in LTC, so be sure that you assess the PICC site, the IV site--the same type of thing applies. And watch and learn the dressing changes--as I am also sure that there were some complex ones in LTC as well.

Finally, be sure to have conversation with your preceptor on where your resources are. If you don't know, then you do need to know where to find the answer. That will help you greatly going forward.

And you know, you may want to do a once a month per diem at your old stomping grounds. It just may be what you need, and if you decide, after giving it some time, that acute care nursing is not for you, then you will have your foot in to go back to where your passion is. But give it time to make sure that this is just not overwhelming because it is new.

[Here.I.Stand, BSN, RN]

I agree w/ the other posters that it is COMPLETELY normal to feel overwhelmed! I know for myself, caring for the same pt's for a second day makes my night go so much easier...and you're used to REALLY knowing your residents.

Also, try not to take the family members' actions personally. They are facing cancer with their loved ones. It's a scary and confusing time, and it's obvious that you are new b/c you are working w/ a preceptor. They were seeking out your preceptor's experience. Keep giving pt's and families that good education, and be willing to find out when you don't know the answer (not if, but when.) Soon they will have that same confidence in you too.

[klone, MSN, RN]

Oh, dear - you've only been at this job for 3 days! Of course you are going to be overwhelmed, and of course families are not going to have a lot of faith in you at first. It will take at least 1-2 years at THIS job before you will competent and confident. Unless you are going to a job that's exactly the same type of nursing as your last job, you should be prepared to feel like a new grad every time you start a new job.

I think you've had some unrealistic expectations of yourself. Let go of those - accept that you are a complete newbie, and absorb all the knowledge you can from your preceptors (as well as the unit's P&Ps - that's one of the first things I read when I start at a new job). Soon enough you will feel confident and competent. It's just not realistic to expect that you would or should feel that way right now.

[RunBabyRN]

I agree- I think what you're feeling is quite normal.

As far as families asking your preceptor the same things they're asking you, think about how you'd be if it was YOUR family member being care for- wouldn't you want to ask the preceptor, especially if the nurse seemed unsure of her/himself?

Be patient with yourself, and soak up as much as you can from your preceptor. Take advantage of opportunities as they come!

[alrighThen]

I started on a medsurg floor after 7 years in LTC/subacute rehab/hospice (CNA-RN) and I was startled by the pace of things. I also had a hardcore preceptor and it was torture. Just buckle down, stay humble, and confidence will come. Fake it till you make it. Don't let families ruffle you. I still struggle with that as I feel I am surrounded by idiots at times but it's really not their fault. When you are out of your element you tend to reach for reassurance.