New grad; need advice

[BigA14]

Hello everyone,

i am am a new nurse on a telemetry/IMU floor. I had six weeks orientation on days and I have been on my own at nights for 7-8 weeks (no orientation on nights). I feel like I am not making much progress in my nursing ability; I feel like I am just going through the motions a lot and not using good critical thinking. I am also getting mixed ideas from my coworkers about what to do in situations.

Example: patient was running sinus rhythm and I noticed he was in a.fib but he was sleeping and his last vital signs were normal. He was admitted for Pneumonia and rhabdo with no history of a.fib. I asked the charge nurse and another nurse if I should call rapid or his cardiologist consult to report it and they both said no because it's stable but just pass the info along to day shift. So the day shift nurse gets report from me and goes off on me about how I should have called to get a 12 lead because it's a change in rhythm, etc. I understand her point, but the patient was on blood thinners and asymptomatic. The same nurse got mad at me because a patient I gave report on was admitted for allergic reaction and difficulty breathing... her problem was that the patient didn't have NC and I said it's because she has been clear and her O2 has been good on room air.

I could give a million other examples but those are the most recent. I am so timid/insecure in nature I feel like that's part of what brings me down too. I did well on tests in nursing school but being able to function and perform as a nurse is so much different. I am always overwhelmed even during my off days. I want to improve but sometimes I am just so busy during my shift that I can't sit down with the charts and or really even think. We just got a nurse manager for our unit so I will try to make an appointment with her soon. Any other advice or resources would be greatly appreciated

[SaltySarcasticSally, LPN, RN]

Well feeling like your going through the motions right now just to stay above water is 100% normal. I was an LPN for 8 years before my RN and I felt that way for a few months.

The night charge nurse was wrong. If the patient has no hx of a fib and suddenly develops it, that absolutely warrants a 12 lead and a call to the MD. It doesn't matter what they are doing at the time or if they are symptomatic. You did the right thing by asking, your charge just gave you the wrong answer. I wouldn't put O2 on someone if their sats were good and they were breathing normally without a lot of effort either so that seems like a weird thing to pick a bone with you about.

If you feel like you are not getting clear direction from your charge -- talk to the charge first. If she doesn't respond to that then I think it would be appropriate to speak with your manager about it. GL!