New Grad who doesn't feel ready....

TheCommuter, BSN, RN · Mar 30, 2011

Is these just s/s of a person who should not take the responsability of being a nurse?

In this day and age, many nursing programs merely prepare students to pass NCLEX. However, it is the on-the-job training that teaches a person how to really be a nurse. You will learn more during your first year of nursing than you did during all of your time spent in school, so do not give up the good fight yet. Good luck to you!

Been there,done that, ASN, RN · Mar 30, 2011

You are way ahead of where I was 30 years ago.. You have a great handle on medications, side effects,etc.

I feel scattered all the time, there are simply too many tasks to accomplish. Prioritize, do the most important things first.

BTW, that nurse was wrong! Of course you need to hold beta blockers with that BP.

Holding one dose is NOT a sudden withdrawal.

Always check the parameters for holding meds, hospital protocols that are in place, and notify the doctor when you do so.

You will be FINE!

rkitty198, BSN, RN · Mar 30, 2011

Hi!

I graduated 5 years ago and nursing is a profession in which you truly learn something new everyday.

Would I have asked another nurse for some advice with a blood pressure drug as you did, you bet! I consult my co-workers on a daily basis as they do me.

I remember it took me an entire year to feel somewhat comfortable. I say somewhat because I feel that if you feel totally comfortable in what we do as a profession it is then where we are apt to make a mistake.

No one is ever 100% ready in this arena, but if you are ready 50% the other 50% will come in the form of experience and knowledge that is only found when having an open mind to learning.

Altra, BSN, RN · Mar 30, 2011

As others have said, you will learn more in your first 6-8 months as a nurse than you have in the entirety of nursing school.

And if I were precepting you, I would expect you to do exactly what you did - correctly ascertain that it is appropriate to hold Atenolol for a BP of 85/39. :)

NurseHopefulInOH · Mar 30, 2011

I am a fairly new nurse as well. I am just about to my first yr anniversary. I felt and feel the same as you do. I guess the main things I have learned is you are never alone. If you are uncertain about ANYTHING there is a more experienced nurse around the corner or a phone call away at any given moment. Asking for help does not make you look stupid. Always inform the Dr or consult him/her if you have any doubt. I used to worry about them getting mad at me or wasting their time but you know what...who cares??? That's what they get paid big bucks for. Always take time to step away and look at the big picture. I feel like as a new grad I am overwhelmed by all the "tasks" I needed to complete ie; change the IV bags, putting in orders. I had a little checklist in my head and let it run my day. Time management is important but taking the time to critically think is more important! You don't learn everything in nursing school but you will learn as you go and that's ok. It's good that your worried and you realize what a big responsibility it is to be a nurse.

curiousrainbowfan · Mar 30, 2011

Wow, I am a new grad and I feel EXACTLY the way you do, OP.

"- I feel like a scatterbrain on the floor sometimes and I fear it will lead to a mistake

- I don't have the basic confidence that I feel I should have for even entry level nursing practice

- I don't know if I have the critical thinking skills I need for this job"

These thoughts swam through my mind during the last semester of nursing school, and they still do. My main concern is critical thinking. I worry that I will not recognize s/s which require further intervention by the MD. I worry about my assessment skills. I worry that everything I've studied in school won't "come back to me" when I'm in a tight situation. But I also know that I am going to give it my all when I do start my first job. I guess that's all I can ask of myself. And I totally agree with NurseHopefulInOH: I'm going to ask for help!

jeeptj · Mar 30, 2011

I'm also a new nurse and I can relate to the way you feel. There are some days that I feel really together and organized, and other days when I feel like it's my first day. You should always be comfortable asking questions. It's unfortunate that some nurses forget what it's like to be a new nurse, and can make you feel like your asking a stupid question, or even worse that you are stupid because you have to ask. The majority of the nurses I work with are great and very helpful, but there are a handful of nurses that seem to enjoy watching you struggle or enjoy telling you when you are doing something wrong. Those same nurses can be very mean and rude. I'm still trying to learn the best way to deal with nurses that seem very unhappy and miserable and that don't seem to want to help you succeed. If anyone else has had this experience, I'd love to know how you dealt with these difficult nurses.

Do-over, ASN, RN · Mar 30, 2011

- I feel like a scatterbrain on the floor sometimes and I fear it will lead to a mistake
- I don't have the basic confidence that I feel I should have for even entry level nursing practice
- I don't know if I have the critical thinking skills I need for this job

First, of course you hold beta blockers with a SBP less than 90 or 100 - but check for parameters or notify the doc and go from there. Sounds to me like you did exactly right.

As for the things I quoted above - I think that is universal to all new grads and completely normal. I am 7 months in, and still don't feel up to the job, but I learn every shift. I'd be way more concerned if you DID feel confident right out of school. I didn't feel ready when I graduated, I didn't feel ready when my orientation ended, but somehow I am making it. :)

chubby40 · Mar 30, 2011

Well... I am three more weeks away from being a new grad!
Okay... I coming here looking for some advice or support from people who are going through what I am going through. I am about ready to graduate and I don't feel I have what it takes to be a nurse. I like many aspects of nursing and I want to be a nurse but I feel like it is too easy to make a mistake and I worry that I have the mental capabilities to do it. I've been struggling with fatigue for years and I have always been a little absent minded but I've been having what I can only describe as a "brain fog" going on for a while now. I bring this up because I have put up with it up to this point but now that I will have people's lives in my hands I'm starting to grow concerned.
I know that all new grads have everything to learn after school but I lack the confidence in my skills as a nurse up this point. I feel like I am bound to make a mistake at some point and it's a little scary. It's like today: I had a pt with a low BP; so I trended her VS and she had been running low most of the day before. Still, she was 85/38 so I took her apical of 79 and decided to hold her BP meds including Atenelol. The nurse informed me that this is extreamly dangerous since a pt can have a serious arrhythmia due to the sudden cessation of beta blocks. This scarred the shiznit out of me because it is just an example of how much there is to know and how easy it can be to make a mistake.
Did I learn? Absolutely! Did I provide safe care by properly assessing before I gave the med? Sure. Was my judgment sound for holding the meds? Yes but the whole experience was a real eye opener.
Okay, I'm rambling here and I don't know if anyone can relate to what I am saying but it boils down to this:
- I feel like a scatterbrain on the floor sometimes and I fear it will lead to a mistake
- I don't have the basic confidence that I feel I should have for even entry level nursing practice
- I don't know if I have the critical thinking skills I need for this job
Anyone else go through this? Is these just s/s of a person who should not take the responsability of being a nurse?

I have been a nurse for 8 years and somedays, i still have the same feelings. I would like to tell you that these feelings will go away eventrully but i can't. The truth of the matter is whether you're a nurse for 1 year or 30 years these feelings will always be present because every patient is different, you're always going to come accross situations that you have not dealt with before no matter how experience you're, especially when you move form one speciality to the next or change hospital. You may find being the new nurse that sometimes nurses that are more experience than you are, can make you feel totally incompetant especially when they sense that you're not sure of yourself. Please, please, do not give into this!!!

The decision to hold the bp is what any good nurse would have done. However, what that nurse should have also mention that sometimes beta blockers are given not so much to control the bp but also the heart rate especially on cardiac floors, if this was what it is used for she should instruct you to not only hold the med but to also contact the physican however, since the apical pulse was 79 and i assume regular you did the right thing.

Part of professional practise is self evaluation, the fact that you're able to reflect on your day and identify your own strength and weakness tells me you're already a great nurse; eventhough, these feelings will not go away it will diminish with time and experience. Your confidence will come with time and experience, keep the faith!!!

mh56700 · Mar 30, 2011

I know exactly how you feel. That "brain fog" feeling.. I could not have described it better myself. I am a senior nursing student doing my capstone and am graduating in 2 months. For a while I feel like I've had sorta cloudy thinking (it's worse when I'm tried) and it seems like it's significantly worse when I'm at clinical. It worries me more than anything in the world because as you said, people lives are in my hands. I constantly compare myself to other RNs (and even students) and seem to notice that everyone else has sharper memory and ability to recall little tasks and various things to do throughout the shift (without really writing anything down, etc.) I feel like I lack that basic cognitive function and I almost feel stupid. Although I have a nearly perfect GPA, I feel so incompetent when on the floor. So much to the point where I am wondering whether or not nursing is even for me. It's almost like I'm not "sharp" enough for it. This pains me to admit, because I really do enjoy helping people and love being around patients. Sorry for the ramble. It feels nice just writing this out because I feel like my fellow students can't really relate to my level of anxiety and... fear I guess.

ann4997 · Mar 30, 2011

hi morningland, i too am a recent grad and have started a new job and totally understand where you are coming from. as a new grad, i feel that it is doing yourself a disservice to be overly confident to the point where you don't ask for help when you probably should -- that will definitely lead to a mistake. have confidence that you want to do the best job for your patients. in your scenario you demonstrated sound clinical judgment -- questioning giving a med when the clinical picture is out of focus. i have high expectations of myself and can be hard on myself and honestly have been a bit frustrated with myself because i thought i would be able to get up to speed a little quicker than how things are progressing, but my preceptor has helped to put things into some nice perspective for me and maybe it will make sense to you too. your first year of floor nursing is like your 3rd (plug in whatever value fits according to whatever program you did) year of nursing school. given the right environment, (and ignoring those rude, competitive crab-apples that tend to "eat their young") and hopefully you will find a job that offers a good new grad internship-type program where they know you are new and provide training - not just for "this is how you get meds out of the pyxis...how you dilute this med...how to pack this wound...etc. but also how to organize yourself, track your tasks - time management, see the "big picture". they encourage you to anticipate what is coming next (given a set of circumstances), critically think, plan and prioritize -- create habits that minimize opportunities for error. no one is expected to be completely self-sufficient as a new grad. i am definitely using this time to get a solid foundation of how best to time manage and stay organized. for example i am still trying out a report (brain) sheet. i have been utilizing my preceptor's sheet, but i am finding that i write down way more than she does (you mentioned brain fog, there are certain things i don't even try to remember because if a doc asked me for a value i would want to give an accurate one and at this point i still get a little flustered) so i saw another nurse (newer hire) use a different sheet and i asked her for a copy and i am going to test that one out next shift. it's a work in progress that i am sure i will find a grove with.

to jeeptj: in general i feel like i work with a great team of people -- from the nursing assistants to my fellow rns, the nps and even most of the mds are very helpful and willing to answer questions. there is one particular nurse and asst. that are a bit tough to work with; downright unapproachable, rude and you are right -- they don't want you to succeed. they frustrate me, but i still have to work with them and i refuse to let them ruin my day or morale. if the situation allows, i will go a little out of my way to stay out of their paths and ask others my questions or for help. when i have no choice, i put a smile on my face and deal with them plainly and matter-of-factly. it's not my nature to "kiss up" to people, but i do believe that kindness and manners go a long way. i know it's not the key to the universe, but don't let others bring you down. try to find a few people you have a good rapport with and when it allows just stick with them (like minded people kind of thing) and when you have to deal with the crabs, know that you can do anything for a short period of time. a quote that i like and try to live is: be the change you want to see in the world. (mahatma gandhi). i hope this helps.

lastly, while i am trying to go easy on myself because i am new, i summed up my new job to my dad like this today: i really, really, really love my new job (tons to learn but i just love it) -- such a variety of diagnoses and conditions -- totally exercising that old gray matter!! i used to think that i would make a good nurse; i learn fast and thought i would be able to get up to speed relatively quickly -- now i wonder when i will really feel like i am an actual nurse and not just playing "dress up"!! lol

so, be fair to yourself and look for a position that provides good training -- i hope this helps! good luck and congratulations on your impending graduation!