new grad blues

Happy Wombat · Mar 18, 2014

I understand the feeling of dragging your feet to work and feeling stressed throughout the journey and your situation does seems 'normal'. I have been through these negative emotions when I first started out too! I also have many friends that did free overtime everyday when they started to learn the ropes of the workplace. Some managed to cope well after a month or 2 and stopped working free overtime, some felt totally burnt out and dread going to work everyday and eventually gave up.

Have you ever tried going earlier like 20-30 mins to work everyday to assess the 'situation' on the ground and plan out your day? Write out your plan and keep it with you, so you do not miss out the things you have to do. Plan some 'luxury time' in between for toilet and meal breaks, but it is perfectly 'normal' to use those time for unplanned urgent tasks. The 'luxury time' helps buffer the impact of those unexpected task on your timetable and allow lesser deviation from the original plan. Again, don't be surprise you do not have time for a meal or toilet break for the entire shift even if you planned them. (Welcome to nursing!!)

Delegate your helpers (ENs/AINs) if you have any and try to teach the students and delegate task to them. The students are an asset once they are properly instructed and assessed, please do not view them as burden. It might disrupt 1-2 shifts to teach them the basic routine of what the wards normally have to do. Once they learnt it, they can help buy some breathing space for you and your colleagues for the rest of their placement~~!

Do more self studies at home, so you will have lesser trouble planning the needs of your patient and lesser issues understanding the medications that are prescribed for the patients. (Lower the chance of medication error.)

Have a short meet up with some of your uni mates/colleagues. It can help you unwind the stress that is building up and sometimes offers tips/solutions to your troubles.

Remember, graduating from uni and stepping into the nursing world is the beginning of your career. Hang in there!!

leekiss · Mar 20, 2014

Which hospital is this if you don't mind sharing? I worry about this as well, what are the main nursing tasks on the stroke unit?

ceridwyn · Mar 20, 2014

There are no tasks in nursing in Australia, every patient,client, consumer, is assessed and given care according to their needs.

Skills should be known or developed to give the best care. Difference between some overseas nurses and Australian nursing philosophy. If you are from overseas do not attack an interview with how good your task busters are, shows you are task orientated assessment skills not used or poor, and will not give wholistic care.

As a new graduate nurse you are expected to have sound basic assessment skills and basic skills. For a stroke unit you would not have experienced skills, but would be expected to be able to think about the skills and assessments you would need and medications. Ie, conscious state, neuro obs, blood thinners, clot busters, research emergency care of a stroke victim. It's all out there if your nursing education has taught you to think and research.

ceridwyn · Mar 20, 2014

Dear Kasey,

I will not give you a plan as Happy Wombat has kindly done, more so some thoughts, you are not alone in this, is there any times in the day when you feel in control and like your work. If you were a complete dud at this and a worry, believe me the experienced nurses would let you know. How many shifts till next rotation. It may take the whole next 12 months until you feel 'in control.' Took me 2 years before I really felt I had experience and had the confidence to be relaxed enough at work and you never stop learning and needing to ask or research check policies, procedures even with 20 years up and I was a mature age graduate.

Just recently I have figured out, many nurses that have 20-30 years all round experience when going to new areas, often do not ask, check policies, question their practise, and often plough straight in and unlike a new graduate that checks double checks things, these nurses often make mistakes.

So the moral of the story is you are probably doing much better than you realise, other nurses no much how much experience are probably being pushed to the limits in your area as well. Have confidence in yourself.

Hang in there we need Australian educated nurses in our profession! You guys are the best.

Happy Wombat · Mar 21, 2014

Hi Ceridwyn,

I disagree on not having 'tasks' in nursing in Australia. The nurses' duty (in general) is to take care of the patient and plan out the needs of the patient. Tasks such as keeping the patient safe and up-keeping their hygiene are needed to fulfil the duty of care. (However, please do not shave/cut the patient's beard/hair/nails no matter how messy they are. It can be considered a tort and can lead to court cases.)

Having the skill to complete certain tasks is good, but nurses cannot be too task orientated and needs to have the ability to assess the situations/orders. Things such as doctors ordering too much medication for a patient. Eg. A doctor ordered 2L of N/S IV over 2 hours for a patient with CCF. Eg. An elderly patient had a fall. The nurse needs to do the necessary assessment for the patient, inform the people involved (next of kins and allied health), and book things such as x-ray. These are all considered tasks.

In short, Australia needs nurses that can complete their duties and tasks with understanding on what they are doing. Not nurses that can complete tasks within the allocated time and not plan and think for the patients.

@leekis: New graduate nurses will not have the skills required to handle the workload given to them within the allocated time during the initial few shifts. (At least not within the 1st month if you have no experience.) However, the graduate needs to have the ability to assess, prioritize and plan out their daily tasks. The initiative to do self-learning and research. Not just following a set routine everyday and neglect the care of individual patient.

leekiss · Mar 21, 2014

@Ceridwyn i'm not from overseas and btw every job has tasks that need to be completed otherwise you will never leave work.

leekiss · Mar 21, 2014

yes next time I'm emptying a catheter bag I will refer to it as a skill rather than task that needs to be done lol

Happy Wombat · Mar 21, 2014

Hey Leekiss,

Pretty sure emptying catheter bag is not part of your 'skills'. Not to mention it is normally done by the ENs/AINs. However, you still need to have the skills to do catheterization.

An ECG can be done by an experienced RN within 2min (Including printing and interpretating the results), but can a new RN do it within the time frame?

Skills such as taking of blood pressure and pulse manually. (Not all hospitals have the luxury of automatic BP machines.) Then the knowledge to interpret the results and think through what is wrong and make decisions accordingly. Other things such as physical/mental assessment, drugs knowledge and preparation, ability to transfer patients without putting yourself or the patient at risk, wound dressings, communications, time-management are all considered skills.

If possible, get the ward/hospital to send you for IV and blood taking course. It will save you alot of time.

And Leekis, you make it sounds as if wards have fixed things to do. I can share with you 1 of my more traumatic experience during my grad year that was thrown at me. Call me jinxed or incompetence if you want and pray it doesn't happen to you.

I was giving out medication during that time and was behind schedule. I was informed by my experienced EN that a patient under my care collapsed. I set everything aside and push the Emergency trolley to the side of the patient and have no idea what to do next. A 100 things went through my mind, things such as 'I need to seek help, but where and how?', 'patient needs cannula access, but I'm not trained in it!' 'I have never done a CPR on a person before!' 'What do we need to resus a patient?' - I was in panic mode as he was the 1st person that ever collapsed on me and I was truly freaking out.

I have no idea how long I stood there and did nothing for. But what I do know, is that my experienced EN called the resus team and asked for help in my stead. The team arrived, but I still need to assist in resus of the patient as there was more than 1 code blue in the hospital and the resus team had a shortage of staff. After 3 hours of none stop actions, the patient was sent off to ICU. I learnt quite a few things from this experience.

1) ENs are a valuable source of knowledge and help, please show the appropriate respect to them. You learn heaps from them and will never know when you need them to cover your back. It is also times like this that you can see which one of your colleagues are the knowledgeable and skilful ones.

2) Being familiar with protocols is important, but keeping calm and thinking straight in situations like this is even more important.

3) Check and understanding the situation of your patient is important. It allows you to do the make the appropriate decision and take the necessary actions.

4) Breaking peoples ribs in theory and in practical is a totally different feeling. And CPR is tiring...

An experienced and well versed RN would have taken better control of the situation than what an inexperienced RN like me during that time. You can ask yourself, what would you do if you faced a situation like this.

So unexpected task like these do happen every now and then. So good luck for your placement!! ^_^

Mopples · Mar 22, 2014

Kasey, do you have grad coordinators that can help? Where I work we have 3 and are just a page away.

It is hard. I have just started my second rotation & the new ward seems so much more hectic then the previous one.

Just remember, nursing is a 24 hour job, you can hand things over. I personally don't like to, but it was pointed out to me early on by senior staff and sometimes you just have to.

If you feel you are having trouble coping, speak to your NUM or ward educator and see what extra support you can get.

Another thing, does your ward have a shift planner? I found them extremely useful at the start and still use them.

Happy wombat: not sure about where you work, but where I am, they won't allow us to do the cannulation course during our new grad as we have enough to focus on and our allocated study days are taken up by other mandatory training.

K+MgSO4, BSN · Mar 22, 2014

Have you spoken to your educator and NUM. If they don't know they cannot help you.

Happy Wombat · Mar 23, 2014

Hey Mopples,

I know certain specialities such as ED allows new grads to do so. (If they are able to cope.) However, I understand not all departments allows that and that is also why I said 'if possible'.