need help

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Hi all,

For background I am a new grad, as in haven't yet written the NCLEX, but I am working as a new grad RN. I am just off orientation one shift in and I already feel as though I can't do it anymore. My coworkers are nice enough, but I feel like I am having trouble connecting with them partly due to me being intimidated, and also major social anxiety. Aside from that I have the typical new grad issues of being insecure, unsure, and generally hopeless about ever being able to do this job well. I feel so incompetent at times that I wonder how I ever got through nursing school in the first place. So far I haven't made any errors (that I know of) but it is all becoming too much to handle. I am currently feeling guilty over calling in sick for my second day of being on my own, as I was having major anxiety the night before and couldn't get a blink of sleep in. I know that being extremely fatigued isn't safe for coming to work, but I feel as though my co-workers will judge me for not coming in. On my days off I feel so fatigued and *** that I can't get out of bed till the afternoon. Maybe its the shift work that is messing up my sleep schedule, but no matter how many alarms I set I can't bring myself to get up and have a productive day off. I don't really know what I'm asking, but maybe just looking for reassurance that I'll eventually get to the point where I feel like I can do this job, and enjoy it. I feel the urge to quit often, but I don't have any other options or anything else I can do, and I can't tell if I want to quit due to the job itself or other reasons. I hope this will pass.

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How are you orientation working as an RN when you are not an RN yet? There are still limitations you have even as a nurse graduate. What kind of facility is this and how much orientation did you get?

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Specializes in Nurse Leader specializing in Labor & Delivery.
2 hours ago, newbienurse97 said:

For background I am a new grad, as in haven't yet written the NCLEX, but I am working as a new grad RN. I am just off orientation one shift in

Wait, what? How does that work?

8
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Specializes in Critical Care; Cardiac; Professional Development.

If you don't have a license you should not be off orientation and cannot legally work independently. I am sure someone will correct me if I am wrong but I don't really think I am.

Your emotions sound a little extreme. I would strongly suggest you find someone to talk to about it. Anxiety is pretty normal, but crippling anxiety that keeps you from resting and makes you call in sick isn't.

I hope you feel better and please, for all that is holy, check your nurse practice act.

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I can relate to what you are saying. I take it you are bedside nursing in a hospital?? Today, that kind of job is extremely stressful for those who care. If you feel that the situation is unsafe then I would leave there, or try to work a shift that is not as demanding.

It is hard for anyone in a new job, not just new nurses. They should give you a smaller load while you are still learning. They knew you were a beginner when they hired you. In addition, you can't practice as a nurse till you are one. Are they having you do teching or something?

I have resigned a job that was causing a lot of fear because I felt the care and staffing wasn't safe 90% of the time. Mistakes were way too easy to make and this scared me too. The pace was so fast that no one could really do for the patients what they needed. I never saw one nurse do an assessment, not one, not once in the months I was there. They didn't have time. I was totally exhausted all the time because I gave and gave and gave and it wasn't enough. It was an impossible job for someone with a certain personal standard of care.

One thing to think about, are your anxieties based on reality or do you think you might be over responsive? Do you think your emotional reaction suits the situation? In any case, it doesn't sound like you should be there. You better talk to your manager.

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Your Board has authorized you to begin training with a licensed nurse by issuing you a graduate nurse permit. You do not have the authority to practice independently because you are not a nurse; you don't have a license.

What kind of setting are you working in? It's probably safe to assume that your orientation was inadequate since it's finished before you've even had time to sit for the test.

"Patient abandonment" gets thrown around too much, but your employer has RNs abandoning patients each time they report to you alone and leave. Nurses must hand off care to nurses - not nurses-to-be. You need to bring this to your manager's attention immediately. You also need to make sure the nurses giving you report are aware you aren't licensed. You need a licensed preceptor to accept a patient load.

I would encourage you to contact your manager with your concerns immediately instead of calling in to avoid the issues. Let them know you need more orientation (for practical reasons in addition to the legal reason). Let them know when you'll be taking NCLEX so they can schedule staff accordingly. I know that it can be uncomfortable speaking up to a manager, especially if you are younger and new to the workforce in general, but it's an essential skill.

Ask questions of the nurses you work with... rationales for things that aren't clear, where to access policies, where to find things you need, etc. Be a proactive learner. Some might grumble, but don't take it personally. You're learning to safely care for patients, and if anyone acts bothered by you learning, that's their own problem.

It's common to feel anxiety as a new grad. In fact, the new grads who think they've got everything figured out scare me much more than the ones who are nervous. However, if your anxiety is debilitating, seek help - private counseling, EAP at work, etc. You've got to take care of yourself to take care of others.

Working 12 hour shifts is a big adjustment. Rest when you can, enjoy downtime, and take care of your body. You will adjust, but it takes time. Try not to call in for fatigue; it leaves your fatigued coworkers to pick up the slack. If you truly didn't sleep at all and can't safely function, calling in is a good choice. If you're just really tired, go to work.

Hang in there! You can do this. It just takes time.

1
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Several states offer a one time license to students who have graduated from an accredited school of nursing and are eligible to test for the NCLEX. The length of license depends on the state - I’ve seen up to 90 days. Students can actually accept an RN job and start work.

I didn’t use this option so don’t know much about it except that apparently it is an option in some states.

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Hi!

For clarification, in Ontario I can legally apply for a temporary licence as long as I have met all requirements aside from the NCLEX examination and I have a job offer. This licence permits me to do everything as a general class RN, but I must write my NCLEX within 6 months. I had 3 in-class orientation days and 12 days on the floor orientation, which I would have maybe liked to be longer but is typical for my hospital.

1
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Specializes in Critical Care; Cardiac; Professional Development.

Do you work 12 hour shifts? That would give you roughly one week of classroom orientation and four weeks of orientation on the floor. A bit skimpy for a new grad.

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2 hours ago, kp2016 said:

Several states offer a one time license to students who have graduated from an accredited school of nursing and are eligible to test for the NCLEX. The length of license depends on the state - I’ve seen up to 90 days. Students can actually accept an RN job and start work.

They offer temporary graduate nurse permits, but they aren't the same as independent nursing licenses. GNs can practice within an RN's scope under direct supervision. I began my first nursing job 2 days after graduation with a GN permit, and I want to say the only restrictions I had were administering chemo or blood... That was a long time ago! (And at least in my state, if a GN fails the NCLEX, the permit to practice is also revoked until they're officially licensed.)

The OP offered clarification that she's in Canada though, so they must not have the same restrictions on graduate nurses that we have in US. Makes much better sense!

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To confirm, yes, things work differently here in Canada. ? GNs are permitted to work independently with an interim license for up to three years in some provinces (though that is obviously discouraged, and most new grads write the NCLEX ASAP, usually within a few weeks or a month or two of graduating). We also, to the best of my knowledge, do not have the same kind of new nurse preceptorship that is common in the US. At the most, we have around 6 weeks of floor orientation in which we are randomly co-assigned to various nurses on our floor (usually the most-experienced, though there were times when I personally was co-assigned to a nurse with a year of experience or less, as the senior nurses had students and couldn’t take a new grad under their wing). There’s usually no consistency. It’s very much a sink-or-swim approach that’s taken here across the country. I could remember being quite envious of other posters on this site who were expressing concern about being on their own as an RN after six months of preceptorship, while I was on my own after a month and a half in an area where I’d had no prior experience as a student! Having six months of preceptorship with the same preceptor sounded like a dream! My lack of experience resulted in many a panic attack during those first few months. ?

Sigh... It will get better, OP. ❤️ It’s baptism by fire, as much as we wish it wasn’t. I wanted to quit every single day, but I kept plodding forward and it all eventually came together. Don’t be afraid to tell your new co-workers what you’re feeling — they all went through the same thing, and most will admit to it. You’ll learn very quickly who to avoid, and who’s got your back. Don’t be afraid to remind anyone who ever gives you grief over anything that you’re new, and that you’re still learning. Heck, I’m still learning new stuff one year in! You can’t know it all right from the get-go, even though it feels like you’re expected to. Be kind to yourself and make time for yourself on your days off. Vent when you need to vent (venting is important!) Ultimately, you’ll get through it. ❤️ Hold on to the positive moments that remind you why you decided you wanted to be a nurse in the first place.

Feel free to reach out at any time.

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On 6/24/2019 at 11:04 AM, FacultyRN said:

Your Board has authorized you to begin training with a licensed nurse by issuing you a graduate nurse permit. You do not have the authority to practice independently because you are not a nurse; you don't have a license.

What kind of setting are you working in? It's probably safe to assume that your orientation was inadequate since it's finished before you've even had time to sit for the test.

"Patient abandonment" gets thrown around too much, but your employer has RNs abandoning patients each time they report to you alone and leave. Nurses must hand off care to nurses - not nurses-to-be. You need to bring this to your manager's attention immediately. You also need to make sure the nurses giving you report are aware you aren't licensed. You need a licensed preceptor to accept a patient load.

I would encourage you to contact your manager with your concerns immediately instead of calling in to avoid the issues. Let them know you need more orientation (for practical reasons in addition to the legal reason). Let them know when you'll be taking NCLEX so they can schedule staff accordingly. I know that it can be uncomfortable speaking up to a manager, especially if you are younger and new to the workforce in general, but it's an essential skill.

Ask questions of the nurses you work with... rationales for things that aren't clear, where to access policies, where to find things you need, etc. Be a proactive learner. Some might grumble, but don't take it personally. You're learning to safely care for patients, and if anyone acts bothered by you learning, that's their own problem.

It's common to feel anxiety as a new grad. In fact, the new grads who think they've got everything figured out scare me much more than the ones who are nervous. However, if your anxiety is debilitating, seek help - private counseling, EAP at work, etc. You've got to take care of yourself to take care of others.

Working 12 hour shifts is a big adjustment. Rest when you can, enjoy downtime, and take care of your body. You will adjust, but it takes time. Try not to call in for fatigue; it leaves your fatigued coworkers to pick up the slack. If you truly didn't sleep at all and can't safely function, calling in is a good choice. If you're just really tired, go to work.

Hang in there! You can do this. It just takes time.

That was spoken like a True Queen

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