Miserable New Grad!

yellow finch, BSN, RN · Mar 10, 2008

You're not alone feeling this way. It sounds like you got used to the pace and atmosphere of the ER. Now that you're on the floor things are waaaayyy different. The transition can be awful. I remember the days of giving report and having to explain myself to the experienced nurse that I was new and to give me a little leeway. Unfortunately, barring any massive emergencies you are expected to get all your work done by the end of your shift. You'll get used to the routine and iron out your own rhythm and system. In the meantime, turn to your resource/charge nurse. They are there to help you out. Be ready to delegate as much as professionally reasonable to allow you to get your work done in a timely manner.

But enough of that... since you already have a job, can you switch to part-time or prn and apply for a part-time position within the other ER? That way, you have a job that you already know (despite the transitional struggle) and can orient in the ER to see if you like it. Imagine if you quit your current job and find out the ER isn't your ideal job either. Where would you be? I wouldn't go around quitting jobs after a couple of months of work. Just a thought to allow you some time to learn and compare.

Hope you find a good solution!

Best of luck.

:paw:

emergencyRN757 · Mar 10, 2008

Thanks! That sounds like a good idea.....

Sometimes I let my emotions make my decisions....going PRN to see if I like it sounds like a great idea.

They do tell me it gets better....just wish it was "better" already.

yellow finch, BSN, RN · Mar 10, 2008

Yeah, it can get better, but it doesn't mean you'll always be happy. I spent my senior precptorship in a Neuro ICU and spent some time on the floor at a different hospital until the Neuro ICU opened up (2 years later!) Not the best time of my life... yet I survived and have an appreciation of floor nurses now. And sometimes no sympathy because they can't tell me anything I don't already know from experience.

nurseby07 · Mar 11, 2008

Yuck! Hey! You're okay, and just like the rest of us new grads. I personally prefer the bathroom, I lock the door, sit down, have a good cry. Clean up, go back out. It is really stressful. I am learning to anticipate what dayshift will ask, although the other night we were making great fun of them and their sometimes STUPID questions that have nothing pertaining to the pt, but more to how they can make their day easier (and that's ok too, we all do it) Now when I get report and a nurse says "I'm sorry, I didn't get this done" I look her/him in the eye and ask "Can you do that before you leave?" Then I wait and they realize it's a joke. It's good for a tension breaking laugh, which we all desperately need! Another favorite is to tell dayshift that I just gave that suppository 10 minutes ago. It's also good for a laugh and I think makes people realize that what they do/don't do affects all of us. Good luck! Oh yeah, go where you want to go and where you would be most happy. The ER sounds very stressful to me, but I have never worked there! (Speaking of ER that show was what made me really want to go back and finish school to be a nurse)

elkpark · Mar 11, 2008

Well, if it's any comfort, you sound right on track for a new grad. Realistically, there is a big difference between being a tech in the ER and an RN in the ER, and you would probably be feeling just as swamped and inadequate if you were working in the ER. The transition from student to practicing, licensed RN is famously, notoriously difficult and stressful -- check out some of the other threads here on this topic.

I remember back, when I graduated and got my first job (back in the Dark Ages), I used to have to stay late every night (worked 2nd shift) to finish up, and would, literally, cry all the way home, thinking I had worked so hard for all that time in school, and now I was a complete failure and couldn't hack it ... :crying2: What I did, at the time, was look at all the "new" grads in the hospital who were six months or a year farther along than me, and see that they had survived and were functioning, and kept telling myself that, if they could do it, I could do it, too. I know that sounds really dorky, but you use whatever you can! (And it worked ...) And I kept working hard at getting better at my job!

Try not to be so hard on yourself (as you've seen, there are plenty of folks happy to do that for you :)), and give yourself some time. It's widely recognized that it takes new grads six months to a year to start feeling comfortable in their new role.

PMFB-RN, RN · Mar 11, 2008

GET OUT OF THERE! It is certainly NOT your fault. The management of your unit has chosen to provide you as a new grad inadequate training and resources. Failures of management and administration are not our responsibility. Either try to get a job in a hospital that train you properly or better yet got to work in an ICU or ER that provides training.

At my hospital new grads go through a 5 month training period for med/surg and 9 months for ICU. After that they are given reduced patient loads and/ or acuity and a real resource RN until they get their feet under them.

I don't know where you live but I work at St.Josephs hospital in Marshfield Wisconsin. Other large Wisconsin hospitals do the same. Have a look at this.

http://www.uwhealth.org/internships/nurseresidencyprogrampostbaccalaureate/10799

They have a similar (but shorter) program for new grad ADN nurses.

valkyria, BSN, RN · Mar 12, 2008

hello, i wish there were something i could tell you or wave a magic wand or just make it go away but i cannot. you are working with folks that have forgotten what it is like to be new, to be fresh, to want to learn and to please patients. those are the folks that coined the phrase,"nurses eat their young." med-surg is where we all we supposed to start and grow and learn and mold our experience and not have it mold us. at least, that is what my professors told me. i had a situation like that. i came out of nursing school, i was in graduate school at the same time, (studying education), and having infertility treatments to get pregnant. i applied for a med surg position and ended up in icu. once the recruiter heard the story about my being in a mva and 9 days in a coma and a gcs of 3 at the scene and now having accomplished what i had, she wanted me to be in icu as an inspiration to my patients and i thought, to the other staff. well, neither the staff or my nurse manager saw things that way. this hospital did not have a formal internship/training program and as i found out much later, the nurse who wanted to be my preceptor, who himself had been a surgeon in the phillipines, was going on vacation that week and i got stuck with a woman whose life work it became to make my life miserable and try to break my spirit. "i do not know who you think you are," she would tell me, "but, you are not impressing anyone with your education here." "you have not earned the right to be here and ...there is no shame in knowing when you are in over your head." then when i asked for a different preceptor, i got moved to nights with another woman who made me feel beyond stupid and inadequate," oh, i thought you knew how to zero out an arterial line," " you do not know how to do that?' not only would i cry every night but i had to drive this woman home every day. we car pooled together, i never thought she could be so callous and hateful. when i was asked by my nurse manager how things were doing and she told me that my preceptors told her i was not advancing as quickly as they thought i should be. i told her the truth, objective data and then my subjective impression. she told me that i was beginning to become difficult and i had to get a "thicker" skin. i went to talk to the nurse manager of another unit who felt for me because she saw and heard how i was. i transferred to her unit and stayed there, on both day and night shift for the rest of the year. things were not perfect and i had hard nights and i learned not to say that i was new, because everyone knew. i asked for help. remember, no one is born a nurse. we are born with the qualities that will make us a good one but they too have to be nurtured. i knew plenty of nurses that did not finish their charting till late. eventually no one said anything. prioritize. who needs you more? what comes first. charting is not nursing. it is not the end all and be all. it is important but the patient is first. you are one woman, with two hands and we need you. stop, take a deep breath, and then, focus. turn off all the noise in your head: the other nurses complaining, the doctors, your charge nurse, focus on your patients. organize your report sheet, system by system from the top down and then have a section for pending. clean up the clutter in your report and in your day. just the facts maam. you can do this. i have faith in you. then when you are calm and get yourself organized, learn to say no. and stop and i got it! then, when time allows, visit other units, talk to other nurses and patients and when your little voice says, "this is it", go to the nurse manager and see how he/she is. night shifts are usually more tightly knit of a group but closer and harder to get in, though you can do it, i did. be outgoing, offer help, ask questions. smile. be real. the good ones will see the light. you will learn the difference between a leader and a manager. one motivates and supports and the other worries about appearances and numbers. when the nurses get too much say,"are you going to help me defend my license?" it is rarely that drastic but if you do not want to say it another way that may offend someone, that usually backs them off. no one is going to stand beside you and help you defend your actions as a nurse to your boss or the boards and they know it. if i can help you more, let me know. :yeah:

imanedrn · Mar 13, 2008

GET OUT OF THERE! It is certainly NOT your fault. The management of your unit has chosen to provide you as a new grad inadequate training and resources. Failures of management and administration are not our responsibility. Either try to get a job in a hospital that train you properly or better yet got to work in an ICU or ER that provides training.
At my hospital new grads go through a 5 month training period for med/surg and 9 months for ICU. After that they are given reduced patient loads and/ or acuity and a real resource RN until they get their feet under them.
I don't know where you live but I work at St.Josephs hospital in Marshfield Wisconsin. Other large Wisconsin hospitals do the same. Have a look at this.
http://www.uwhealth.org/internships/nurseresidencyprogrampostbaccalaureate/10799
They have a similar (but shorter) program for new grad ADN nurses.

Damn, I feel TOTALLY screwed. My training period was 8 weeks. I was started on days and told I could go longer (like 10) if needed. When I asked for it, my manager "suggested" I try going on my own, and then we can revisit the issue.

I just started on my own this week, and I realized just how messed up I really am! While I was orienting with my preceptor, she would pick up my slack. Well, instead of telling me what she was doing, why, how, etc., she would just do it. Most of the time, she wouldn't even tell me until report! Now that I'm on my own, and half of this stuff isn't getting done, I'm getting reamed by the night nurse. My answer is the same every time. "I didn't know how to / that I was supposed to do that." Last night, I even got reamed by her charge. When I told her I was new and didn't know I was supposed to do this one thing (and that even my preceptor didn't tell me to!), she repeatedly asked me, "What, were you too swamped?" *****! I felt like such a jerk. I'm a 2 month old being expected to walk already!

:crying2:

TX_Engr2RN · Mar 21, 2008

I just graduated in December- It's been about a month that I have been off orientation, and I feel miserable. Even the thought of going to work makes me depressed. I am currently on a med-surg unit. Before I became a nurse I worked in an emergency room at a different hospital as an ER tech. However, I wanted to start off in med-surg before going to the ER....and now I'm miserable!
What makes it so miserable?
I feel soooo stupid at times when nurses ask me questions during report...and I don't have an answer. I have to tell them, I apologize, I didn't do that. Some get all mad, and tell me to do it before I leave....and it's already late as it is.
The charge nurses keep pressuring me to leave "on time" (supposed to get off at 7pm and leave by at the latest 730) but I never do! I haven't gotten the time mgmt down, usually I'm running around all day that sometimes I just can't get my charting in until late.
When I was hired, the charge nurses explained to me that I would have someone I could use as resource, but usually that nurse is too busy to help me, or we are so understaffed, that I don't even have a resource person.
Those are the main reasons why....but mostly because I just feel so, inadequate. I'm tired of saying sorry...I'm tired of looking like the lost little puppy crying for help...
I usually have six patients...and some days the entire group is just....difficult.
I'm great doing skills from my experience in the ER, but I really haven't developed my critical thinking skills yet!
It's not that I don't want to, I do. It just seems so busy at times that I just can't sit down and think everything out.
One day I just broke down to the charge nurse b/c I was drowning with things that needed to get done.....
I'm really thinking about going back "home" to the ER as an RN...I know everyone there, and I KNOW people won't treat me like they do on this floor.
Just a couple of questions?
Do you guys think this would be a good idea? And what can I do...until I do leave to maybe, hopefully, get rid of this feeling of "misery"? And are there any resources that I can read/use/practice to develop my critical thinking skills?
Thanks so much!!!:)

I am a new grad too with almost one year of experience on a telemetry unit. It IS hectic, especially on day shift. My internship lasted about 3 months and I went on my own around then end of it. It's still troubling and I often feel miserable leaving work past 8pm (sometimes as late as 9:30pm) AND having to return the following day for more. As a new nurse, you're expected to be slower, and I call it "on time" if I can get out by 7:45pm.! Sooo... DON'T BEAT YOURSELF UP TOO HARD!

To help with time management, I often asked other nurses about their routines. I would take 1-2 weeks trying out their way to see if & what worked for me to help me manage my time better. So far, I've been picking what works from various RNs and incorporating it into my own system. Granted I am not perfect and I still leave late, but I have been improving on getting out NLT 8pm. I still need some work though...

I also know of nurses who would chart off the clock, and I remember one nurse telling me that I should do that. My work ethic does not allow me to work without being paid, especially when I am not the type who goofs off during my work hours. If I'm lucky, I get to take a full 30 minutes for lunch and I have yet been able to take a morning break.

I too have had moments feeling same as you about wanting to go elsewhere. My contract requires me to be there for 2 years from date of hire so I'm doing my best to maximize my learning experience and avoiding lazy and/or negative people. Perhaps talk to your NM, charge RN, or another trusted RN about your qualms to see how you can improve. But don't let this reflection upon yourself as an opportunity to beat yourself up. Remember... You are NEW, and if necessary, remind them that YOU ARE NEW! Good luck!

Piki · Mar 21, 2008

Sorry you are so miserable Newnurse. FWIW I too am a recent grad (last June 07). I have a feeling that you are so miserable and overwhelmed due to your relatively short orientation!! Where I work (med-surg post surgical unit), our manager gives all new grads 12 weeks orientation (there were also a few other RNs with experience starting around the same time, and they also got up to 12 weeks if they felt they needed it). And taking 6 patients already by yourself??? I'd want to cry too. That's too much for such a newbie.

There is no harm in asking for help. Everyone on our unit is really good about asking us newbies if we are needing their help (and I always make sure if/when I have some downtime to do the same). And if I am really drowning, go ask your charge to help in - that's their job.

I am coming up to my 6 month mark on my own past orientation, and feeling more comfortable each day. It does get better. You really have to learn to prioritize and group your tasks to make your day more efficiently. It's hard to do that when you are feeling swamped and overwhelmed. And no matter how hectic my days are (really hectic day shift for me the other day, I had 5 patients and literally spent 4-5 hours out my shift of 8 hours in one double room due to the high acuity of both occupants of that room) - I make sure I take time to go to the bathroom, get hydrated, etc. You can't take care of others if you're not taking care of yourself, kwim?

As far as not leaving until "late" to chart, we have several exp RNs who never leave on time due to charting. I try my best to chart as much as possible, as I go, b/c it does save time in the long run. We have 2 computer systems we chart on, one you can access from the pt's room so if it's something I can jot down real quick in that system, I put it in while it's fresh in my head. I think the thing that I can say I have gotten infinitely faster at since being a new grad is doing the computer charting. At first it takes much longer but now I have it down to a science and normally I can chart on all 5 of my patients in approx. 30 minutes (that is if I don't get interrupted which of course rarely happens!)

I find having a good organizational cheat sheet helps. I have a report sheet for each pt that I jot down their H-T assessments, their labs, vitals, any procedures, fluids, diet, activity, etc. Then I have a master sheet I made (suggested by one of my main preceptors) -- it is basically two grids - I list my patients in rows, and then columns across - one grid for charting (we have to chart q 4 hours, at minimum) - Iv site charting, activitiy charting, diet, etc. I tick each square off when done. If I get interrupted (invariably) I stop and mark where I am so I know when I get back to charting which patient I've finished with and where. The second grid again I list patients in rows, and put hours across in columns. Then each hour I list the meds or treatments needed for each patient. Again I tick them off when I complete. It keeps me very organized and streamlined, and then when I give report, I can just read off my report sheet for each pt.

Good luck. I would hang in there a while longer... take a deep breath. I have a friend that started in the ED and it is way more stressful than what the typical floor or step-down (or even ICU) floor is. Somedays she is dealing with 2-3 ICU type patients/traumas AND others not as serious. No way I could deal with that right out of school! (She was a paramedic for 10 years previous).

SoundofMusic · Mar 22, 2008

As a new grad not yet off orientation, I am getting the feeling that i"m just basically going to have to go back and review lots of concepts in my patho books and other resources at home. I will be on the floor and will just go blank about a lot of things that I used to know well. The learning curve as an RN is just so straight UP, I'm not even sure the brain can really do what it is asked to do as a beginning nurse.

Do you have a good organization system down? I take no more than 30 minutes to listen to report and get the handoff, and I'm off to the races by 7:30 a.m. to get vitals. It's back to the computer by 8 a.m. to get in all my assessments and write notes, check labs and charts. The more I get done early the better the day goes.

So far it's working, but i'm not sure how it will be once I increase my pt load.

I also agree that 6 pts is way too much to have just off orientation. I'd be crying too!!!