I really don't think I'm cut out for med-surg....

[HippieHealer]

I'm a new grad, got my RN in June and started working on a med-surg unit Aug 14. I'm in the final weeks of my preceptorship and I can tell my manager wants me to start weaning off.

I like nursing a lot, esp when I get great patients, but I've been feeling incredibly overwhelmed lately. I understand I'm new at this and no one expects me to be perfect, but I can't help but compare myself to my other classmates that have already finished their preceptorship weeks ago, and one of my friends even works on a cardiac unit with codes on a weekly basis, and she's still handling it fine. My unit is more low-key, we get about 2 or 3 codes a year, but I'm still struggling on how to balance everything.

My biggest problem is my complete lack of short-term memory. I recently moved up to 5 patients, and there's ALWAYS at least one med that I completely forget to give until my preceptor reminds me 2 hrs later, I'm ALWAYS behind on charting, even when I try to chart at the bedside I'll get 3 done and then somebody gets discharged or admitted and my brain goes off on that train of thought and I forget about the other charting. I just can't keep track of the needs of 5 different people. Inevitably, whoever's the least-acute patient ends up being neglected by me, which I hate doing because what if they only seem less acute and they code and I'm not there and my charting hasn't been done??

I hate feeling so scatterbrained. I've always wanted to work with more high-acuity patients, like ICU or NICU, particularly because then you only have to worry about 1 or 2 patients. But I don't know how much of my scatterbrained-ness is because of the number of patients or how much of it is just me. It's really cut into my confidence and I don't know if I'll ever be able to handle that level of acuity, but I also don't want to be stuck in med-surg with 5, 6 or 7 patients the rest of my career. I've tried all kinds of memory tricks, highlighting the medsheets, sticky note after sticky note, and I still forget everything. It's like my brain is at a minimal low-level of panic mode all the time and I can't concentrate, but until I start being able to concentrate I don't see how I'll get out of panic mode. It's a vicious cycle.

My only hope is that I start precepting on nights in a few weeks, and I did nights for a few days in nursing school and loved it. It was much more laid back (generally) and I didn't have meds on the hour every hour like it sometimes is here.

I'm really itching to specialize one day, although it's still too early to do it now, and I'm not sure I'll ever be able to figure out my niche in nursing, I'm interested in so many different areas. I'm just worried I might find I don't like the specialty I go into, and I know if my heart's not into it it's just going to make my concentration even worse. I don't want to be intimidated from high-acuity care for the rest of my life, nor do I want to end up at a doctors office (no offense to those at doctor's offices).

Would an ICU type setting really be that much better for someone like me, or should I just accept that I'm going to be a scatterbrain and should stick with people less likely to die?

[Sun0408, ASN, RN]

You need one brain sheet to help you keep track of all your pts, needs, meds, dressing changes etc.. Mark them off as you do them. Charting is a must also but once you get the hang of multi-tasking, it should get easier. In the search box type "brain sheets" and many different treads will pop up. Just take a look and find one that best fits your needs.One sheet is best, easier and it will help you get organized.

ICU maybe only 2 pts but trust me, it is busy and you are expected to know everything about your pts and q1h vitals, neuro checks,pts crashing, several gtts, turning, mouth care, families etc is just as stressful. I've done both. Hone your skills, learn your priorities, delegation, meds, assessment skills etc then move on.

It is a very difficult transition from school to actual nursing, so give yourself some time but it will get easier. Also don't compare yourself to other nurses or old classmates; they are dealing with the same things. They are just not as honest or vocal as you. Being a new grad sucks :) We have all been there and had issues with one thing or another. It takes months to become comfortable..

I hope Esme12 chimes in, she has great brain sheets !!!

[Good Morning, Gil]

If you want to be an ICU nurse just so you can have 2 patients, that is not a good idea. If you really want to be an ICU nurse, then that's something to look forward to, but it's not any easier as far as having to remember things. On really critical nights, I have to remember things about my patient without having time to write them down, and I know everything about both of my patients, labs, etc, because even when you don't have a super critical patient, you want to prevent your patient from going downhill.

You could be traveling down for a stat CT, only to go to the OR as soon as you get back, but you still have your other patient to take care of, as well, and there have been times when I've had 2 patients not doing well at the same time, and need to hold my own.

So, in short, get your experience in m/s first since you're already there, and then look for another nursing area after a year of being there once you're more comfortable. You should start to feel more comfortable every week that you're there as you gain experience. Working on the general medical floor you will learn what kinds of patients you enjoy caring for, and you might be able to figure out your specialty that way. Maybe you'll get lots of patients with diabetes, and you enjoy educating; well, then you can work towards being a diabetes educator, for instance.

[HippieHealer]

Yeah, I wasn't trying to imply that ICU would be a cake walk. I just have a hard time when, say, the other week I had 2 pts that had both came in with abd pain and gastroparesis and they're right next door to each other and I have to keep them straight in my head. I'm def giving myself at least a year in med surg before I specialize. I'm just anxious to feel like I belong.

[Born_2BRN]

Please don't feel discouraged! I am almost the same exact way. Write down what you need to get done during your shift. For instance, labs that need to be collected. Do the best you can. Try to give medication early. In my hospital you can give an hour early or late but if you late make a decision base on what type of medication and how frequently patient receiving this med. If medication was not available I would call pharmacy to deliver it or go get the meds myself. Ask for help if you need to. Your coworker and charge nurse should help you especially you are new. Good luck and try to stay above water. We all understand what you are going through. It's tough!