New Grad Just Want to Throw Up: Should I quit?

[Quinn_Le]

Should I quit?

When I was in nursing school I couldn't wait to graduate and become a nurse. Now ,as a new grad nurse working on a med surge-oncology floor I feel so overwhelmed. I just want to go back to school. Because in school at least the amount of tears I had is much less than when I'm at work. 

I feel so overwhelmed. 

Initially management gave me 6 weeks, now they added 2 more. I guessed the unit manager talked to my preceptor and they might have determined that I'm not ready yet to be on my own. And that's the truth, I just can't,seriously. More than 10 occasions during a shift I questioned my intelligence. The more I know the more I don't know. I can't even recall what they taught me in the beginning. I've gone to be bathroom countless times and shedded more tears than a bag of vancomycin. Some days I get easy assignment yet still behind on the charting, and don't get me started on the days I have the heavy ones. Trying to chart my MS assess, LDA, education, care plan, IVPB, pain meds, while one opioid dependent pts keeps pressing the call light demanding to have their dilaudid. One GIP pt passed away waiting to be pronounced and bagged while I have no freaking clue who to call and what to do. The other is freshly post op with frequent VS and is due to void within 6 hours. The ER called and questioned why it took me so long to get the new admission because charge nurse dropped the bed already. The other day one Whipple pt is in so much pain and high maintenance he calls me every 15 minutes, while the lady next door refused to be positioned yet have 3 fleet enema due. A guy in the end of the hallway had BP of 182/101 unresolved with hydralazine PRN, one more across the room is so anemic she tried to stand up, passed out, and nearly fell I had to call code blue. Then, what happened is I'm behind with my charting, can't read all the notes from their file, and can't even give a proper shift change report to the next nurse without them questioning what have I been doing all night.

The worst thing is: all of the things above, I can't even do myself. I have to be directed by my preceptor, how and when. How to handle an opioid dependent patient? What if her VS tank from the dilaudid? What do I do if a patient passed away? What if the GIP family demanded to increase the oxygen? Do I call respiratory? What do I ask when the ER give report? What if I don't know what to ask and ER send the pt up with missing orders? How to properly do admission? How to care for a patient with Whipple surgery? What is even PEG tube J tube G tube Wound vac? My nursing school knowledge was completed thrown out of the windows. How do I do the fleet enema with a pt in so much pain? How long will that process take? How much time do I have left until shift end? What if my anemic pt tried to stand up? I can't remember even the simplest thing my preceptor taught me. She looks upset. Is she mad? Does she think I'm stupid? I'm already on my 6th week. Maybe I am. Maybe I am not smart enough to be a nurse. I still have 4 BSN classes this semester. Anything due this week? Did I do that assignment? How's my grade right now?

IT'S KILLING ME

I can't do this anymore ?

I had to call off today. I'm scared to death to go back to work. I feel so incompetent. Maybe this is not for me. 

Do you guys think I should quit and do outpatient instead? I have started to have panic attacks. I'm so stressed out, I've even thought about going to a specialist and asked for medication for this reason. I'm literally shaking once I clock in to work. Am I stupid? Will I kill somebody? Is this even normal? Please share your story

Thanks all

[londonflo]

It sounds like a very rough 6 weeks of orientation. That amount of time is no where near to you having 'repeat' experiences with similar diagnoses and needed tasks. Cut your self some slack. You are very conscientious and kind, it sounds like. You will get there.  

41 minutes ago, Quinn_Le said:

The ER called and questioned why it took me so long to get the new admission because charge nurse dropped the bed already.

This happens all the time. At least it wasn't at end of shift....or was it?

42 minutes ago, Quinn_Le said:

I still have 4 BSN classes this semester. Anything due this week? Did I do that assignment? How's my grade right now?
IT'S KILLING ME

Can you 'pause' your BSN classes until you have comfortable at your new job? Try to control something in your life and give yourself some 'me' time.

[JKL33]

On 10/28/2022 at 5:39 PM, Quinn_Le said:

Initially management gave me 6 weeks, now they added 2 more.

That is not enough time. And are you getting any instruction in your specialty? What kind of supports and education are in place on this unit?

On 10/28/2022 at 5:39 PM, Quinn_Le said:

The more I know the more I don't know.

Yes, that's a very common feeling.

One thing from reading your post - it sounds like it might be helpful to re-focus on prioritization. I do understand how all of the items you mentioned kind of coalesce into one big weight on your shoulders, but the only way any of us get through the reality of what you are describing is by quickly prioritizing according to the principles we were taught in nursing school. We put the smaller stuff on the back burner and start addressing the rest in the order of urgency.

I realize that prioritizing is not easy at first. It comes quite easily after years of experience but that is because along the way we have learned what is important and what isn't. But everyone had to start somewhere, and you did learn some things in school that can help you. What you describe is basically the real-life version of an NCLEX question. ? 

Ask your preceptor for help re-focusing on prioritization. Every time you are ready to go do the next thing you need to perform a quick reassessment of priorities. This is what we do all day long. ALL DAY, over and over and over. It eventually becomes second nature.

On 10/28/2022 at 5:39 PM, Quinn_Le said:

I still have 4 BSN classes this semester. Anything due this week? Did I do that assignment? How's my grade right now?

Recommend putting this on hold as mentioned above. It seems like it would be a major additional stressor. You need time in the day for rest and a break from thinking about nursing.

[Quota, BSN, RN]

6 weeks isn’t even close to enough orientation for a new grad on any floor let alone an oncology medsurg unit.  I think I had 12 weeks, now new grads have a fellowship and 15 weeks.  It also sounds like your preceptor isn’t doing a lot to support you, you shouldn’t feel like you’re on your own at 6 weeks.  Oncology is a hard unit, and I’d never have a brand new post whipple on my floor.  Deep breaths and take things one day at a time.  You shouldn’t be expected to be on your own after 6 weeks…

[RatherBHiking, BSN, RN]

Six weeks is common around here unfortunately. I’m glad they want to give you a couple more at least. The first thing I’d do is talk to the manager and be honest that you’re feeling overwhelmed and maybe in addition to extra time they could give you a different preceptor or try a different way of teaching you. 

Carry a small notebook. All those things you have questions on write them down. Then later when it’s less crazy ask questions. Things like enemas, new meds, diagnoses, etc look up on your off time in depth. Read why this diagnosis would cause this lab value and the treatments, what to look for, etc. 

Also write down things like how long this med takes with an IV push, what number to call if the med isn’t on the floor, heck even visiting hours or cafe hours. Just every little thing because you won’t remember it all but you’ll have a quick reference until it eventually sticks or someone asks you. Even write yourself a basic routine of the day, steps for an admission, discharge, surgery etc. 

I would definitely postpone the BSN for at least six months until you aren’t feeling so overwhelmed. Try to relax on your days off and get lots of rest. Explore counseling to help you cope. It WILL get easier. It just takes time. 

 

 

[Jill Squire BSN RN OCN]

First, let yourself of the hook. You are a new grad! You are not supposed to know everything! Don't quit nursing... your patients need someone as caring as you. You articulated your thoughts quite well - you know more than you think.

Your manager may be under pressure to get get you up and running, but that is not going to help you learn any faster.

I agree with so much being said here... 

Carrying a notebook/journal is a fantastic idea for questions and for when you understand things - writing helps with memory.

See your manager, be honest and forthright. You are advocating for yourself and ultimately your patients. You have articulated your challenges and fears very well, here. You could use your post for your talking points. Consider telling  (yes, telling) your manager that you need smaller assignments in order to successfully learn. You can't learn what you need to in the current state,  but you are very capable of doing so, you need time to feel meet your care plan goals for the shift and understand why you are doing what you are doing. I agree that your preceptor could be lending more assistance. 

I have an inkling that your preceptor may be new at precepting or burned out, and your manager may be on the newer side, as well. 

I wish you the best. I am betting you will be a fantastic nurse. 

[kkbb, MSN, RN]

First, big hugs Quinn_Le!  New grad me would agree with everything you wrote, feeling exactly like you do.  

I agree with seeing if you can postpone school for a little while to focus your attention on work and self-care when not at work.  I struggled when I started on my oncology med-surg unit.  I did use a journal, and what helped me was writing out what went well for any shift.  Then I would think about what was beyond my control and make a note of that.  Finally, I would think about what didn't go as well as I wanted and what I could have done differently.  Time management was a huge issue for me, so thinking about what could have been different helped when I came back the next day and had the same patients or at least some of the same patients.  This allowed me to put into practice what I had thought about.  But you need to also focus on what went well and know that things are outside your control.   

The next bit of advice is easier said than done, but try...don't think about work when you are not there.  Or perhaps, take a little time to look over a patient's diagnosis that you recently had to start putting things together.  But don't spend too long doing this.  Your time off is your time to recharge and do what you need/want to do.  Take some time for yourself.    

Are there other nurses on the unit that you feel comfortable talking with?  If there are, go to them and ask them how they would approach the same situations.  

Hang in there.  My dad always said, it takes 6 months to learn how to do a job.  And it takes a year to learn how to do it well.  He wasn't wrong.