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New grad in need of some more advice

NP Students   (2,257 Views 17 Comments)
by Sheika34 Sheika34, BSN (Member)

600 Visitors; 17 Posts

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Hi, so I've been on this forum earlier last week.

im currently a new grad on my second week of orientation. & I think I'm not cut out for this. I am on a busy Tele floor on night shift. 3 out of my 5 shifts I spent on the PCU. Now I had trouble getting started in the beginning. So around my 3rd and 4th shift my preceptor finally felt comfortable with giving me 1 pt to handle independently. After taking everyone's advice I made improvements. But then today on my 5th shift it was my first time holding my own 1 pt load on the med-surge/Tele unit. My preceptor was around when I needed her, but was charge nurse with 7 pts, technically 8 if you count the one I was handling. So down to where things to the wayside...

i was basically no help at all. The one pt I had, I basically took the whole shift to chart on. & then I had to stay an extra hour to make sure I charted everything. This pt never went to sleep. She was constantly crying out the entire shift & I literally mean crying out. Some of it was because of pain & Given her condition I could understand that she was in pain, so I did what I could when it seem like the meds weren't working.

Anyways whole shift, she needed something. Then she started complaining about pressure and tingling under her arm cast, said it was a new symptom. So I paged the ortho doctor. He came & when he was asking me questions about the pt I had no answer to a lot of the questions. I felt silly because how am I the nurse & not know these answers. I hadn't had time to thoroughly review the reports & history & the shift report wasn't that great.

Throughout the night I made various mistakes. I sent an EKG chart of a pt who was having chest pain to the wrong place.( it was already determined it wasn't an MI or PE by then thankfully), I called the wrong doctor when I need a decrease on vancomycin. He got mad of course but still went in to see my pt. Apparently I kept paging him but I only paged him once or thought I did. I was so flustered I'm not even sure.

The nurses were irritated because they had this extra person on board and of no help. One nurse expressed her disbelief that I was still charting one pt throughout the night & I quote "well did she just start orientation"

I also like to run things by my preceptor, maybe too many things. Even if it's just PRN meds. I have this fear that I'll administer a drug & make a med error because I missed some important lab or some other contraindication to giving the med. I think this also exasperates her as well since I shouldn't need to run every little thing by her.

Anyways should I just sit down & see if I can transfer to another unit or should I just look for another job elsewhere, maybe outside the hospital setting all together? Everyone keeps saying this is normal but I think you know when your really not doing good. & I could understand everyone's exasperation. I would be too if I had this other person of no help. So any advice is welcome really. Were there any other new grads in this position? What did you do?

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Been there,done that has 33 years experience and works as a case manager.

263 Likes; 4 Followers; 68,498 Visitors; 6,203 Posts

"well did she just start orientation" BINGO. You Do need to run every thing by your preceptor. You are in the learning phase. You do not have a preceptor with time to teach you.

Take that concern to your manager and nursing education. You deserve decent training.. you're not getting it.

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153 Likes; 6,128 Visitors; 509 Posts

Do you know how to look up policies and procedures? Med information? If not, ask someone. As a new grad, no one expects you to know everything (or really anything), but you are expected to try to figure it out. Once you do that, you can confirm with your preceptor.

When you come across a new situation (which right now is everything), review it when you get home. Yup, pull out those books from nursing school or google it. What was potentially causing that pressure and tingling in her cast? Based on the possible diagnoses, what do you need to assess? Color, motion, sensation, distal pulse, pain, swelling? Anything else? The questions the doctor asked you are probably the answer to that! File that experience away and use it next time you have something similar.

On a telemetry floor, you will see certain diagnoses frequently. Start researching those. Learn the signs and symptoms, labs, medications, procedures, and what you should expect to find in your assessment. Heart failure? Maybe a S3 heart sound, crackles at the bases of the lungs, peripheral edema, shortness of breath, activity intolerance, etc. You'd expect an EKG, ECHO, BNP, TSH, BMP, etc. You'd also expect an order for a diuretic. What else?

One of the advantages of the night shift is that you don't typically give as many scheduled meds. One way to get more comfortable with the meds is to look them up, just like you did in nursing school. For PRN medications, you have a couple categories that you'll see over and over, such as pain meds, bowel meds, GI meds, etc. Take note of which ones are commonly ordered and make flashcards if you have to. Then, when a patient tells you they are nauseous, you are able to identify which PRN would be appropriate to give. On a telemetry floor, you will also see a lot of PRN meds for rate control and blood pressure. Learn those too. For instance, if a patient has a HR of 125 and beta blocker is ordered PRN for a HR>120 and the patient has a second degree heart block, would you give it? Get comfortable with those common PRNs. And don't forget not everything needs a med. Sometimes, crackers and ginger ale work for nausea; prune juice for constipation; Ice pack or warm blanket for pain; chamomile tea for insomnia.

Being a new nurse is hard. Really hard. I think it was unfair to you to have a preceptor that was charge and had 7 patients. Don't give up yet. I promise you, if you leave, the next job will suck too. Not because all nursing jobs suck, but because the first year is just hard. Your defeatist attitude isn't going to help you. Go in with the attitude that you CAN do this. You WILL make mistakes. The goal is to learn from these mistakes and get a little bit better every day.

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232 Likes; 3 Followers; 95,218 Visitors; 36,400 Posts

Beekee said it in her post. Homework. Pick one situation from your day and treat it as a take home exam, every day after work. Even if you only spend half an hour looking things up or writing down the steps to a protocol or writing down pertinent questions to ask your preceptor the next day, do it. You will feel better about your efforts to improve yourself.

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37 Likes; 10,227 Visitors; 1,371 Posts

Ditto what previous posters have said.

Also, if I would quit after one rough day, or a day I felt like I didn't know what I was doing, I would have had A LOT of nursing jobs. No. You stick with it and learn.

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600 Visitors; 17 Posts

That's just it. It's not just one bad day. It's multiple and the only two decent days I've had is because we've had 3 pts and they really didn't require much besides meds. I think you know when your sinking. & you may be right, I should persevere. But at the rate I am going, I definitely won't make it past orientation. That's why I've been hoping to move to a floor with a slower pace. ( & yes I know no unit is really slower than the other especially for a new grad ) but the floor I am currently on is one of those "monster" units. At one point it was normal for the nurses on that floor to have 8 pts. I think if not by tomorrow then by sometime next week I'll talk to the NM about trying to transfer elsewhere. I just don't what to wait and wait and wait till I'm out the door and then can't do anything. & ive been asking my preceptor for honest feedback but I haven't really gotten any because I was in the PCU most of the time. Like I said, she's nice as far as answering questions and such. Would it be wise of me to warn my preceptor ahead of time about my thoughts?? I don't want to blind side her but at the same time I don't want my plans or my thoughts to get back to the floor or to the NM before I'm ready.

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37 Likes; 10,227 Visitors; 1,371 Posts

That's kind of my point, though. You're going to have several bad days, particularly when you're new. You don't know what you're doing--you've only been at it for 2 weeks (and I bet not all of that on the floor). You will even still have days that you feel in over your head as a seasoned nurse, but you'll have more confidence in your problem solving ability

Your expectations are unrealistic.

But it also sounds like your mind is made up. Quit/transfer, if that's what you want.

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That's just it. It's not just one bad day. It's multiple and the only two decent days I've had is because we've had 3 pts and they really didn't require much besides meds. I think you know when your sinking. & you may be right, I should persevere. But at the rate I am going, I definitely won't make it past orientation. That's why I've been hoping to move to a floor with a slower pace. ( & yes I know no unit is really slower than the other especially for a new grad ) but the floor I am currently on is one of those "monster" units. At one point it was normal for the nurses on that floor to have 8 pts. I think if not by tomorrow then by sometime next week I'll talk to the NM about trying to transfer elsewhere. I just don't what to wait and wait and wait till I'm out the door and then can't do anything. & ive been asking my preceptor for honest feedback but I haven't really gotten any because I was in the PCU most of the time. Like I said, she's nice as far as answering questions and such. Would it be wise of me to warn my preceptor ahead of time about my thoughts?? I don't want to blind side her but at the same time I don't want my plans or my thoughts to get back to the floor or to the NM before I'm ready.

I think its crazy that a nurse has 8 patients, never mind eight patients and charge. How are you supposed to be trained by someone who is that busy. I'm orientating on a telemetry floor and each nurse has 4 patients, if they are charge its 2-3. Its unfortunate that this hospital's way of doing things is killing your confidence. You should bring it up to the manager...you need more of your preceptor's time and that's not possible with the load she has.

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600 Visitors; 17 Posts

That's kind of my point, though. You're going to have several bad days, particularly when you're new. You don't know what you're doing--you've only been at it for 2 weeks (and I bet not all of that on the floor). You will even still have days that you feel in over your head as a seasoned nurse, but you'll have more confidence in your problem solving ability

Your expectations are unrealistic.

But it also sounds like your mind is made up. Quit/transfer, if that's what you want.

A part of me knows that you are right. & I do want to stick it out. But I also don't want to risk hurting anyone either. I've been making a lot of mistakes and I know I'm not where I'm supposed be. For example, I sent a pts ekg reading to the wrong place to preceptor's chargrain, I took the whole night to chart on one pt and still ended getting out late. I don't Want to transfer but I'm not sure if I'm a right fit for the floor I'm on.

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A part of me knows that you are right. & I do want to stick it out. But I also don't want to risk hurting anyone either. I've been making a lot of mistakes and I know I'm not where I'm supposed be. For example, I sent a pts ekg reading to the wrong place to preceptor's chargrain, I took the whole night to chart on one pt and still ended getting out late. I don't Want to transfer but I'm not sure if I'm a right fit for the floor I'm on.

I've been at my job for about 2 years and I still sometimes call the wrong doctor or do other stupid stuff. I did it all the time when I started. I am pretty sure no one expects me to quit over that. At most, I get a call saying "hey, not me" and I go try again. No biggie. The charting system is the same throughout the hospital. How is transferring to another floor going to make you better at charting? If these are the most pressing issues you have, I'd say things are going pretty well.

I'm debating between telling you to talk with your manager to check in with how you are doing or to go to your PCP to deal with your crippling anxiety and perfectionism. Perhaps both are in order.

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232 Likes; 3 Followers; 95,218 Visitors; 36,400 Posts

I'm debating between telling you to talk with your manager to check in with how you are doing or to go to your PCP to deal with your crippling anxiety and perfectionism. Perhaps both are in order.

If you keep running away from opportunities to learn how to do your job, you will never be able to overcome your lack of experience or knowledge. That next job, especially for someone just starting out, is not guaranteed. This may be the only chance you have for quite some time. Make the most of it before throwing in the towel.

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nurse.j. has 5 years experience as a ADN.

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You need to speak up about your training! I work on an incredibly busy Med-Tele floor with a 4:1 ratio (sometimes 5 if we are short) and the charge almost NEVER takes pts. Your preceptor should not be charging also, the days they charge, they need to assign you a different preceptor. CN is entirely different role and one that you won't be needing to know how to do yet, as a new nurse. The first couple years as a new nurse, are really tough, no matter what unit you work on. It sounds like you have a particularly challenging situation, because you aren't getting the training you deserve. Speak up to your managers and know, you're going to make mistakes and things aren't always going to go well. I remember feeling the same way as a new nurse, I thought another hospital or unit, was my answer...it's not, it just time. Time to learn and hone in on your craft. You'll get there, even 5 years into nursing, I still have questions, I still forget things and still make mistakes; we are all human after all. But please talk with your unit managers and tell them, you need more education, direction and training. This is a very unfair and unsafe situation to be starting out in.

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