4 months orientation and STILL struggling, help!

HappyWife77, BSN, RN · Mar 26, 2014

At 4 Months.... its time to swim.

jennycRN · Mar 26, 2014

It is normal to feel all of those things--- self-doubt, anxiety, being overwhelmed-- especially at the point of coming off orientation. It takes time, much more than four months, to grow in confidence, build relationships with your team, and learn the time management skills.

I think that most nurses can empathize with what it feels like to be a new grad wondering whether or not we can be successful as a nurse. However, we don't work with you so we can't answer for you whether you are just having the 'normal' new nurse anxiety or whether you actually have a problem providing safe care to patients.

Hang in there, remember that safety always comes first, and be open to constructive feedback from your coworkers.

CrunchRN, ADN, RN · Mar 26, 2014

Ask your doctor about taking Propanalol. It is great for "fight or flight" performance anxiety without impacting your intellectual capacity.

HouTx, BSN, MSN, EdD · Mar 27, 2014

Take a breath. Your fear and anxiety are palpable. I'm going to veer off on a (possibly unpopular) different direction here and outline something for your consideration.

In order to successfully function in a hospital environment, you need to be able to multi-task on a continuous basis. There is an increasing amount of evidence that this (multi-tasking) is not something that everyone can do. It has nothing to do with intelligence - it is all down to biochemical & neurological differences. As a nurse educator, I can assure you that this is not an uncommon situation. Ironically, these individuals are very hard workers who are highly motivated to do their very best. Frequently, they were very high-achieving students. But rather than becoming more comfortable and confident in the transition from student to practice, they lose confidence as time goes on and it gets harder and harder to cope while they see other new grads doing well.

If this is your underlying issue, no matter how many different checklists, paper 'brains' or organization tools you use.... it won't decrease the stress because it is just not 'natural' for you. Trying to dull your reactions with medication will not address the fundamental cause. A better solution would be to work in a more predictable, more structured setting. This could be a very specialized acute care setting that serves a fairly homogenous patient population, so that you would not have to deal with a continuous barrage of "new" stuff to process... but this might be difficult to find.

A non-acute setting usually has less 'stuff' to deal with in terms of the volume & variety of tasks/responsibilities to deal with. It would allow you to enjoy your work rather than struggling to cope with an environment that will never be comfortable for you.

Just my $0.02.

Curious1alwys, BSN, RN · Mar 30, 2014

Thank you all very much for the replies. I just don't know what I am going to do. On one hand I know the first year or nursing is hell and you feel very uncomfortable but I have a very high anxiety/high strung personality to begin with and I have those closest to me who know me well telling me this may not be the environment for me. I didn't know until I tried. I am trying to work on what I am telling myself and stress management but I will say that changing your core personality and the way you think under intense pressure and in a very short time so you can succeed at a job is proving difficult.

I am so exhausted mentally and physically between the long shifts and the "brain fatigue" I feel from thinking all day and all the education they are piling on me. Just feels like my brain is not receptive and sending out the "no more input!!!" message. LOL. First time in my life I have ever felt OLD.

It does not help that I am actually more of a float nurse, hired at "staffing" so I don't even know that I will for sure stay on this floor. That is disheartening too because I question whether I am a strong enough nurse to be moved around from floor to floor and facility to facility.

I will ask about Propofol...sounds promising but my HR is less than 50 so not sure they will give it to me.....taken anti-anxiety meds before with poor results and too much sedation. How do I fix this FAST?

When do you decide this is really not for you rather than just the crap of the first year of nursing?

I had a crisis situation the other day at work and I just panic. I'm a panicker and that bothers me. I see all these things I don't know how to do (cuz I've never done them), orders I don't know how to put in, tasks piling up, other patients I can't get to, and I PANIC. I use "brains" but they don't seem to help a whole lot other than keeping me informed about my patient... Staying calm is not my forte. Maybe I am in the wrong specialty? I am a mother of two small children who bicker and fight alot so I feel like I am going from one battlefield to another so that doesn't help the stress levels either, LOL

Should I just give it more time and see what being "on my own" brings? I just don't want to kill anyone because either I was too slow and panicking.

Thank you all for your help, your input means a lot to me!

AmyRN303, BSN, RN · Mar 30, 2014

Definitely ask about propranolol and not propofol though

Being in a float position as a new grad would concern me too. I'd want to get solid rooting on a floor where I can get comfortable with the "tasks" (such as the computer system and order imput you described) and learn as much as possible about the assessment of the population of patients seen. Neuro tele may not be for you, but only you can determine that. It sounds like you have some trusted friends who are giving you advice.

I know from experience the negative effects anxiety can have. I cried my first day of clinical thinking I'd never be able to do it. I've had anxiety since I can remember as a child but had never taken meds or been in therapy for it....truth is, I could compensate well with it until I hit nursing school. I chose both, and I have found them both beneficial. Taking the opportunity to take charge of that aspect of my health was critical to my performance. There are meds which do not impart long term drowsiness (though there may be a period of adjustment at first)

I haven't started work yet as a new grad, and I'm sure it will at times be difficult, but I feel confident that implementing new strategies for handling my anxiety while I was in school was essential. But, like previous poster said, not everyone handles the multi-tasking high intensity situation well. Do you have a relationship with one of your preceptorship in which you can discuss what the best fit for you would be? What shift are you working?

Curious1alwys, BSN, RN · Mar 30, 2014

Hey Amy,

Yes, I meant propanolol, LOL, propofol might work a little too good.

I didn't develop relationships with any preceptor since I have had so many. I am working day shift so I don't have the flip flop thing going on at least but it is super hectic I guess. Which meds do you think do NOT impart long term drowsiness? ALL SSRI's have done that to me and I have been dubbed "medication resistant". Like you, if I am not in a stressful job or school I can manage fine through diet and exercise but once the stress hits a toxic level I have a hard time keeping a hold on it. Just hope I can get this under control soon enough to be of any help to me...

Esme12, ASN, BSN, RN · Mar 30, 2014

We cannot give medical advice as per the Terms of Service.....follow up with your PCP. Propofol...killed Micheal Jackson. You'll be relaxed alright....LOL Propranolol is more appropriate :up: . But you need to ask your PCP

Curious1alwys, BSN, RN · Mar 31, 2014

I understand Esme, not looking for medical advice anyway...just trying to find my way..... Thank you

Gabby-RN · Apr 3, 2014

The 1st year is tough. Take it one day at a time, one hour at a time, one task at a time. Take report in a specific color pen then use a different color pen for your shift. If the night nurse tells you yesterday's INR or that labs were drawn, write down "INR" with a little box next to it. Do the same if they tell you patient had a fever, pain, or any thing else you want to follow up with. At the start of my shift I quickly go through the emar and write down med times for each patient in the bottom right corner. Just a simple 8/9/12/2, which I later cross out after I complete.

At the start of your shift:

•Do your rounds, say hello to your patients, introduce yourself, if the night nurse mentioned pain ask them how they feel. If they have a gtube or IV fluids running, check the rate. "Im just going to take a quick look at your IV site/gtube site, it looks great, thank you" Look over the patient on this quick encounter. How is their skin color, their breathing, mentation. Do they have edema, are their extremities warm? Do they have a foley, glance in the bag, how much is there, what color is it? I use therapeutic touch a lot when I can to get assessment info and make a patient feel comfortable. If the patient asks you to get them something or do something time consuming, let them know you just need to check on your other patients and you will either be back or will let their pct know. Check in with your pct quickly let them know any info that is important. If a patient had loose stools or nausea a simple "did the night pct let you know x patient was up all night with loose stools? Let me know if it continues or if she develops a fever. Thank you! "Mrs B has a wound on her coccyx that I need to change a dressing on. I plan do that after I pass morning meds, I will need your help turning her". Most PCT's appreciate knowing when you will do wound care and if you will need help with that.

•Pass am meds, write down issues you want to discuss with the doctor or other staff along the way in a different color pen on your report sheet. You already said hello to patients so if anyone asked for prn meds, start with them first. If a patient asks for a prn while you are bringing them their daily meds, let them know you will be back with that after you help another patient you promised. If they ask you to get them water, a snack, or anything else, write it down. Ask them if there is anything else you can get for them when you return. Finish passing daily meds then go back to the patient that you promised a prn to or the water pitcher if you didn't see the pct to delegate it. Most patients don't mind waiting 10-20 minutes if they know you will actually come back. If it takes a little longer say you are so sorry it took longer than expected with sincerity.

• At this point did anything come up that you want to talk to the doctor about? Any orders you need? Are there any new orders for you to execute? If there are new orders, are they written stat? Write them down. As you get to completing these tasks you have written down, check them off. If you wrote down that a patient had am labs, know when results are typically back. At my hospital, 6am labs have results around 10am so I plan to check labs then give report to the docs around that time. Look up the labs, scan them, write down abnormal values that are pertinent. Anyone that is on Coumadin I make a point to write down the INR and pass that on to the next nurse.

•Move on to wound care or other tasks. Finish your head to toe assessments. You already did a lot of it earlier when you said hello and administered meds if you checked their skin, listened to their lungs, looked at their legs for edema and felt for pulses etc.

• Take a break. Even if only 5 minutes to drink some water or go to the bathroom.

• If something comes up that you don't know, ask another nurse if she can help you when she gets a moment.

• Check your sheet for notes you made to yourself for other things you need to do. Can you do anything at the same time? If you need to go in to a patients room for one task, is there another task you can complete at the same time? Does your patient always ask for water when you see them? Bring in a cup of water as you deliver the urine specimen cup for the UA the doctor just ordered.

This is just an example of how I planned my day when I worked on a step down unit. Of course not every day went as planned, most days did not actually lol. But I had a plan to stay organized and keep track of what I have done and what I need to do. At the end of my shift if a patient still needed a stool sample I would pass it on in report and chart accordingly. It sounds like you have yourself stressed out about the day before it even starts. I think if you can find a way to break down your day and organize it, a huge weight will be lifted. You are still new. You will have questions. You will need help. It will get easier. Eventually you wont have to write every little thing down and you will be better at multitasking but until you get to that point take one task at a time and complete it before letting yourself get pulled in another direction in non-emergent situations. If a patient crashes, call for help, you are never alone. If a patient just doesn't look right, ask for help. When you get help, listen and learn. Everything will come together. Good luck!

(Sorry if there are typos or bad paragraphs, I wrote this on my phone while relaxing outside)

Curious1alwys, BSN, RN · Apr 3, 2014

Gabby,

Thank you for that informative post! I actually already do a lot of that, albeit not perfectly of course. I have that four color pen and so far I've been using one sheet of paper for all four of my patients. I found that when I used a whole page for each I got them all jumbled all the time and I couldn't remember what rooms I had quick enough when the docs would ask. Now it is one glance but def a lot of info crammed on there LOL.

Thank you everyone for the advice. Not sure the environment of the hospital is a good suite for my personality type but trying to give it more time to be sure. :up:

4 months orientation and STILL struggling, help!

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