New Grad - can't keep it together.

bargainhound, RN · Nov 30, 2006

Lighten up on yourself.

Ask coworkers for time-saving tips.......or pick out someone who you

see getting it all done and copy them. You can also take tidbits from

different nurses' organization skills........whatever works for you.

It will take you time to see what works best for you.

What you are doing would be overwhelming for most people.

AuntieRN · Nov 30, 2006

PinkAurora..I can sympathize with you as I am sure just about any other nurse here as we all start out as new grads. I am a new grad myself. I have been orienting on a busy med/surg floor days for about 4 weeks now. I am up to 6 pts with my preceptor just overshadowing me reminding me things I need to do like my care plans etc. She is awesome totally awesome. Yesterday was my first good day. I actually stayed caught up with everything and got out at 1905 instead of the 2015 or later like I have been getting done at. They keep telling me it will get better with time. Good luck to you. May we both prosper in our new careers.

P_RN, ADN, RN · Nov 30, 2006

IS this a hospital? Frankly I don't think 4 weeks is long enough of an orientation to be set out totally on your own. That plus it's really only been 2 weeks on the unit you are currently assigned to.

There's no way you can assess 7 patients between 7a and 8a. That's a ridiculous assumption on the preceptor system.

You can Look in on them, do a hello, make sure they're breathing and their IV is OK. That a basic information gathering. Eyeball them from the top of their head to the tip of their toes......everything still percolating......say

"OK can I get you any thing before I see my next patient? OK I will be back within the hour, but call me before if you need me."

How do you know they are scheduled for tests? If the night shift knew it, then perhaps they could have given/held/notified about meds?

If the patient is off the floor during med rounds....you can't give meds. If they want to call that a med error they're wrong. It is a justifiable variance. If they want an incident report give it to them. State just the fact. "9 AM Lasix not given until 10 AM as pt was off the floor from 0730 to 10 AM."

If you need to give blood, unless the patient is exsanguating at the moment can be delayed for a short time. And if they are exsanguating then you might have to ask some one to give your meds. NO shame in that. PS if another nurse is drowning, offer to do something, anything, she will remember your kindness.

We were all new, we all drowned for several months up to a year. After 22 years I was still treading water some days. And some days I did a little mitzvah for a drowning friend. What goes around.......

jjjoy, LPN · Nov 30, 2006

Experienced nurses, please chime in here... do you REALLY get all that done that PinkAurora describes? Are you able to assess those patients before they go down for tests? If so, is it more of a once-over-glance where you can tell from experience whether or not you're comfortable with them leaving the floor or is something a newbie can truly emulate without the experience (and thus be able to be timely)? Do you manage to check if patients going off floor can get their AM meds and pass them and take care of any insulin needs without holding the transfer too long? Or do you just accept that the other departments will be annoyed but they will just have to wait? How often do you get ALL of your meds passed and charted within the one hour time frame allotted (and not start passing them earlier than the allotted time either)? How often do actually chart on EVERY patient every two hours?

Bargainhunter advises "pick out someone who you see getting it all done and copy them." When I was working, it didn't look like anyone was getting it all done. They were all running around, not available to help much and often snappy because any interruption would throw them off the rest of the shift. During preceptorship/orientation, they generally only let you shadow one day and it's fine and right to jump in right away, but as a newbie, you barely know half of what you are watching on your day of shadowing. After that, you never get the chance to see how (or if) others manage to "get it all done."

When I'd ask about how or why someone did something a certain way, the answer was almost always snappy and/or defensive - making one wonder how a newbie supposed to get it down when experienced nurse are just barely scrapping by or what shortcuts they weren't willing to admit they took to "get it all done." Is this kind of cynicism and hopelessness unfounded?

jjjoy, LPN · Nov 30, 2006

Thanks P_RN for your practical feedback. It's unfortunately not common to hear a nurse say something as reasonable "if the patient's off the floor, you can't give them their med" instead of "you should've anticipated that and figured out how to avoid it." Sure, you want to try to avoid it, but to admit that sometimes you just can't is so valuable to a newbie. Not an excuse for not doing something better, but we've got to learn how to cope in less than ideal situations.

It's reassuring to hear you say that it's ridiculous to expect to assess 7 patients from 7-8a along with all the other responsibilities and just starting on shift. Some nurses do imply that that's what expected. They know how to eyeball it and to zone in on relevant symptoms, but don't seem to realize that it would be unsafe for a newbie to copy their methods because they don't have the experience to back it up yet.

The problem is, if you work "by the book" you'll never get everything done and always be criticized about poor time management. So many newbies flounder for a long time because they need to take more time but it's not available for them (how many hospitals SAY "if you need more time on orientation, just ask" but then brush off your concerns when you ask for it and say you'll be just fine... or terminate the preceptee).

Many preceptors also can't stand to watch how slowly the newbie proceeds and just jumps in and does what needs to be done or disappears to help someone else (always needed). And since their license is also on the line, if the newbie gets behind on orientation, they are obligated to pick up the slack. And god forbid if the newbie and preceptor take LESS than a full load so that the preceptor has the extra time to explain everything he/she is doing!!

P_RN, ADN, RN · Nov 30, 2006

Thanks for the kind words jjoy. One of the best things I found was the team/pod system( and NO this is not your grandmas team-nursing).

Ten patients in our case.......same rooms on a team (no matter who is on the team) of an RN-LPN/RN (or new nurse) and a nurse tech. That would make 4 RNs (charge and 3 teams) . On my precepting tours one day would be for the newbie to be checked off on meds. Either one of the Clin Specs or one of the BSN educators would take them around and explain the system etc and then make sure they are safe. Then I'd give her/him a whole day of meds and I'd do the assessments.....it's only one day, I can do it.

I dearly LOVE teaching new nurses.......

dbihl, BSN, RN · Nov 30, 2006

One thing you can do is in each spot your at do everything you can do, dont leave things undone. touch each piece of paper once!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:rotfl: and Lighten up on youyrself, everyonehas trouble at first. And listen to all the advice of these talented ladies above~

SmilingBluEyes · Nov 30, 2006

I agree with PRN and the others before me. You have hardly had enough orientation to learn anything, let alone how to get along on a med-surg floor on your own. I am continually dismayed and angered by the lack of proper orientation of new nurses. Sadly, many just dont' know the disservice they are being done, until the poop hits the fan. And then they do like you are, berate and put themselves down, thinking they are incompetent! Grrrrrr... How unfortunate. YOU are not the problem. This hospital IS.

You need more orientation and learning time before being set on your own. 4 weeks is nothing. Demand more time or consider this is probably not the job for you. What they are asking of you is ridiculously unsafe.

AuntieRN · Nov 30, 2006

My preceptor and I started with only getting 4 patients the first week. The first day I shadowed her the second day I took one pt then picked up one each day until I hit 4 pts. I stayed with four pts for 2 days then we went up to 5 pts. I took all 5 for 2 days then we went up to 6 and thats where we have stayed and I have had all 6 pts. She is there for me not to help everyone else out and everyone on the floor knows that. We are supposed to get our assessments done by 0800 but I have yet to figure this one out. Some pts have 0730 meds then some have 0800 etc....we have one hour before and one hour after to give meds by hospital policy...I have to say for the most part I can keep up with that 2 hour window however...I have had 2 days where I got so far behind due to the acuity of our pts that I had to ask my preceptor to please help me with 0900 meds and it was almost 1030. I felt like I could not handle nursing that day and came home in tears swearing I would never go back. But I did. You need a good support system when you first start out. I have to admit I have thus far had a wonderful orientation. Not only has my preceptor been awesome but so have the other nurses on my floor. From the first day they have tried to recruit me to stay on days and as of 2 days ago they won. I feel like they are very supportive and will be there to support me in my days to come on my own. I wish you had this kind of support system as well. I do not think I would go back if I did not have this support system. If I was you I would talk to your NM and ask for more orientation. Good luck to you!!

General E. Speaking, RN, RN · Nov 30, 2006

I have to agree that 4 weeks doesn't seem like enough time. It is just difficult to get everything done somedays. When all your doctors come at one time and write STAT and NOW orders, it can throw off everything. I agree with the poster who said you should try and briefly see your patients prior to going for tests. Forget trying to to a head-to-toe assessment on everyone in that hour.

Unfortunately, some days meds just get given late. I know this seems like a cardinal sin, but it is reality. If this happens, I try and adjust the times so all the doses are given. Usually I call pharmacy and get their input. Our hospital decided that BID is 0900 and 1700. So, if something doesn't get given until 1100 or 1200, I don't beat myself up. The next dose can be given at 2000 or 2100. It is being given twice per day as ordered. Of course, things like Vanc or time released meds require more careful planning. Vital signs should be monitored so BP meds are given. I guess if you work for a facility that writes nurses up for being occasionally late with meds, it would difficult. Don't get me wrong, I don't make a habit out of rearranging all my meds. Most of the time all my meds are given on time. I'm just saying that I refuse to beat myself up because their 0900 Protonix was given at 1100 because my other patient had chest pain and needed careful bedside monitoring.

I know you have heard this before, but it does get better. Things will start to fall into place. Med-Surg is hectic and chaotic. It is difficult (if not impossible) to control a hectic enviroment- usually I hope for manageable.

SmilingBluEyes · Dec 1, 2006

I can honestly say that first few months out of school I was so disorganized and stressed, I swore I had no place in nursing. You just have to hang in there, do your best and really be sure you ask for help when you feel you are going under. There is not one single experienced nurse who can't get what you are feeling. All of were there, believe me. The biggest mistakes you can make are to blame yourself and to pretend to know what you don't. Know your limitations and ask for help whenever you feel you need it! You spend the first year learning-----allow that and go easy on yourself.