Not sure if I should post here or general nursing, but here goes..I am a new RN on a med/surg floor after working 8 months at a rehab. I have been on orientation for 4 weeks and have asked for more time b/c I feel like I am not getting certain things. Any suggestions/feedback would be helpful.
1) pt's come in with all different problems and some stay longer than others. at times I don't feel I am grasping their disease process and feel incompetent.
2) Medical jargon in report (paraspinal mass...lacuna infarct, etc.). I don't know what these things are and don't have time for research..I feel like I should know these things before caring for pt. and so I feel incompetent.
3) medical tests. CT scans, bone scans, MRI's. Why are they ordered...if someone has no evidence of a fx with a CT scan, then why 2 bone scans? When do we get results?
4) I really suck at lung sounds!
I have spoken w/my manager and she is aware of how I am feeling and have asked for assistance but I would like to know if others have felt the same way and what has helped.
Thank you all for your support...to daytonite..I appreciate the message and maybe I wsn't as clear as I needed to be, but while I am at work I don't have much time for research..I do take the time when I get home so that I have a better understanding. I was simply looking for some support and suggestions...I feel your response is rude and condescending and really not helpful when I am simply trying to become more proficient in my position.
Please understand that it's pretty much impossible to evaluate what level of help you need over the internet. The problems you described are not unfamiliar ones, and I guess it's pretty evident that you recognize that they are problems. Still, if you ask for advice, it seems just a bit ungrateful to be offended at being offered advice. If you don't agree with the advice, you're certainly free not to take it, and if you have already implemented some of it on your own, you're free to continue to do so (and you must not think it's a bad idea, if you're already doing it.)
IMHO, jjjoy and Daytonite have laid out about as good a plan as possible. Learn everything you can, whenever you can, and be prepared to "wing it" a little, when you have to. I frequently get pts with diagnoses like "Altered Mental Status," or "Visual Defect," or "L-Sided Weakness." In other words, the docs aren't entirely sure what's going on, either. I don't know that it's possible to write an A+ nursing school careplan for a Dx like "Chest Pain." But there are a number of commonsense nursing interventions that will likely apply to just about every admission, and just knowing the patient is on neuro, or cardio, or whatever service, will suggest other pretty nearly automatic measures. Similarly, even if you have a clear diagnosis, but one you aren't familiar with, you already know some things you need to do, and your more experienced co-workers probably know others, and if you can cover the basics until you're able to look up more info, you'll be better prepared when you come back for the next shift, and probably even moreso by the time you see another, similar patient again.
It's a major source of angst for every new nurse--including the one writing this post--that we aren't going to be as good as nurses with more experience and knowledge. Just can't be done. Great nurses, like Daytonite, have decades of experience behind them, and are still learning every day. So the only way to catch up is for them to retire. But we can learn to become great nurses in our own right, if we're willing to listen and learn from those who've been there, done that. As beginning nurses, we are in a position that requires a fair amount of humility. But I've been lucky enough to work with and talk with some truly great nurses, and I have yet to meet one who had lost that sense of humility. In fact, some of the best nurses I know have, from time to time, asked for my opinion, and I'm here to tell ya, you just can't get much more open-minded than that!
I feel your pain.. i too am a new nurse, but i tell you what, the posts on this forum are so true. You must be honest with yourself and with ohters. You are NEVER going to learn everything about nursing... that's why nursing is so great there is something new to learn everyday. Before i finished nursing school, i worked as a CNA for over 13 years and learned something new everyday. Now as a nurse i'm just building on that base. Hay hold your head up, i feel the way you do often at work, checking, doublechecking,triplechecking,but i had a nurse tell me that the day you stop worrying as a nurse is the day you become unsafe to your pt. Good luck.
Specializes in Medical-Surgical-Ortho-Neuro-Agency.
I too do not know all the medical terms, I just ask during report, they tell me pt has **whatever** and I just say "oh I dont know what that is". I always believe honesty is the best policy and if you dont know, ask. Hopefully as time goes on the pieces will click together. It is pretty overwhelming being a new nurse.
Yes, it is better to admit that you do not know a patient's condition. Doctors do not know everything, no one does, it's better to ask, I used the internet at work, when in doubt!!! Also, on the units try to familiarize yourself with the common diseases patients are admitted with and their treatments. That is a great learning, and training. Nursing is about learning new things everyday!!! That's why it is so interesting, and demanding at times. :)
My preceptor last night had some good advice. She said that she does her best to know that patient "now" as he/she is, based on her assessment, and labs, and all the current things going on at the time and doesn't stress over trying to get the entire past history from the first second the pt. was born or came in through the ER doors, or wherever. It's sort of about the "now" as well, and what you can do NOW to keep moving the care forward.
That made a lot of sense to me and takes off some of the pressure -- unless it's dayshift and I have the families breathing down my necks to provide every single last detail. Sometimes at that point, I remind them I'm just the nurse and they may have to talk w/ the doc to get all the info they need. Or, I tell them I'll try to research as much as I can in the time I've got.
You can quickly scan the H& P to get the doctor's plan/impression and that helps me a lot.
Sometimes it also takes digging through progress notes to find out who has seen the pt, and what their plans/impressions are.
I'm just now getting to where I can "see" what tests have been done, what is planned, and what i need to help them get done with the rest. Yeah, I'd like to know "why" we're doing all the tests, but sometimes it's just enough to get the pt. off the toilet, off the monitor, on/off the right meds for a test/NPO, whatever -- to GET them there and get things accomplished. That is our role also, as I understand it -- and it seems we're just as accountable, if not more for THAT, than to have grasped the entire picture of a pt's stay/history.
Of course, if tests are routine on your unit, you probably need to do some reading about them and grasp why they're done. We work on neuro and there are a TON of various tests and I'm still learning what they're all about, believe me.
My preceptor last night had some good advice. She said that she does her best to know that patient "now" as he/she is, based on her assessment, and labs, and all the current things going on at the time and doesn't stress over trying to get the entire past history from the first second the pt. was born or came in through the ER doors, or wherever. It's sort of about the "now" as well, and what you can do NOW to keep moving the care forward.
I'm just now getting to where I can "see" what tests have been done, what is planned, and what i need to help them get done with the rest. Yeah, I'd like to know "why" we're doing all the tests, but sometimes it's just enough to get the pt. off the toilet, off the monitor, on/off the right meds for a test/NPO, whatever -- to GET them there and get things accomplished. That is our role also, as I understand it -- and it seems we're just as accountable, if not more for THAT, than to have grasped the entire picture of a pt's stay/history.
That's an area that where I think clinical nursing education could do well to improve upon. Not to dismiss the "big picture" or patient history or all that good stuff, but to give students assurance that part of that all important skill of prioritizing is that you at times will have to prioritize immediate needs over "ideal world" holistic nursing goals. In school, they seemed to imply that the nurse HAS TO know everything to be safe, that anything less = incompetence. And thus, the gap between school and reality is that much bigger.
JJoy that is so true...can't speak for anyone else,but i think that when you are in school the big emphesis is on"don't make a mistake or i will give you a unsat"!At the school i can from three in one area put you out of the nursing program. Instead i feel as though instructors should "help" the student to understand that you are still human and although safety is always number one, students should not have to feel as though they are a failure .I learned my most from the instructors i had that shared with us the mistakes that they have made. That made me feel as though okay now if a nurse that has been a nurse for 40 years can make a mistake then so can i!
nursemike, ASN, RN
1 Article; 2,362 Posts
Please understand that it's pretty much impossible to evaluate what level of help you need over the internet. The problems you described are not unfamiliar ones, and I guess it's pretty evident that you recognize that they are problems. Still, if you ask for advice, it seems just a bit ungrateful to be offended at being offered advice. If you don't agree with the advice, you're certainly free not to take it, and if you have already implemented some of it on your own, you're free to continue to do so (and you must not think it's a bad idea, if you're already doing it.)
IMHO, jjjoy and Daytonite have laid out about as good a plan as possible. Learn everything you can, whenever you can, and be prepared to "wing it" a little, when you have to. I frequently get pts with diagnoses like "Altered Mental Status," or "Visual Defect," or "L-Sided Weakness." In other words, the docs aren't entirely sure what's going on, either. I don't know that it's possible to write an A+ nursing school careplan for a Dx like "Chest Pain." But there are a number of commonsense nursing interventions that will likely apply to just about every admission, and just knowing the patient is on neuro, or cardio, or whatever service, will suggest other pretty nearly automatic measures. Similarly, even if you have a clear diagnosis, but one you aren't familiar with, you already know some things you need to do, and your more experienced co-workers probably know others, and if you can cover the basics until you're able to look up more info, you'll be better prepared when you come back for the next shift, and probably even moreso by the time you see another, similar patient again.
It's a major source of angst for every new nurse--including the one writing this post--that we aren't going to be as good as nurses with more experience and knowledge. Just can't be done. Great nurses, like Daytonite, have decades of experience behind them, and are still learning every day. So the only way to catch up is for them to retire. But we can learn to become great nurses in our own right, if we're willing to listen and learn from those who've been there, done that. As beginning nurses, we are in a position that requires a fair amount of humility. But I've been lucky enough to work with and talk with some truly great nurses, and I have yet to meet one who had lost that sense of humility. In fact, some of the best nurses I know have, from time to time, asked for my opinion, and I'm here to tell ya, you just can't get much more open-minded than that!