New grad in need of help!

BecomingNursey · Feb 23, 2015

It's going to take time and experience. Every new nurse feels this way. We all get behind. Ask for help and don't feel bad about it. Just give it time. You'll make it :) I've only been a nurse for 9 months. Around the 4-6 month mark I started feeling like I knew what I was doing. It's a different story and time frame for every single nurse. Just be patient with yourself and don't beat yourself up.

allnurses Guide · Feb 23, 2015

Let me give you a big, big hug, sit down to a cup of coffee with you (shot of Bailey's? Yes?) and tell you a few things.

I started out as a new grad on PCU just like you. Like you, I was a non-confrontational person and, like you, my brain went into a scramble when directly questioned about stuff. I had a LOT of stammering, stuttering sessions with MDs and other nurses and ancillary staff in the beginning.

I too struggled with time management skills, late meds, late charting and feeling like all I did was run from task to task.

Want to know something? So did EVERYONE when they first started.

Of COURSE you aren't really critically thinking yet! That skill doesn't just happen magically upon graduation...it comes from experience and experience only comes from time. During the time that gains you experience, you learn. Learning comes from embarrassment, mistakes, misjudged situations, skewed priorities etc. It is humbling and it feels icky and its uncomfortable but you have to go through it. Everyone has to. Those who don't, don't make it.

Around month three I started telling docs with questions "I am not sure, let's look it up" and pulling up the answer to their question on the computer. Think about it. If THEY had the chart memorized they would not be asking you, right? You aren't expected to either! It is perfectly ok to review results together!

Around month seven I stopped being terrified at work. I was most days getting out on time. I knew my coworkers and had started on a regular routine.

Around the first year I started being able to tweak my routine better for priorities. I also started to notice I never once got in trouble for giving a medication late, particularly if I documented why when I did.

Around year 2 I started critically thinking more. Students started wanting me to be their nurse to follow for the day.

Around 2.5-3 years I had moments of Aha! and actually saved some lives BEFORE I ever had to call a rapid response. The docs knew me and the questions no longer felt like a pop quiz in a class I didn't study for. Some of them even had a sense of humor that I could not see when I was so worried about looking stupid.

All of this is to simply reassure you that, though you feel absolutely incompetent, you are RIGHT where you should be. Work on the time management, learning the drugs you give most often, making sure they are safe to give and work on learning to chart more as you go so that you aren't in so much overtime. That is literally ALL you have to do right now. Work on those things and know when to ask for help. That last one is a doozy and I still am working on that one. Oh, and start praticing delegation. It is a skill just like any other and the more you do of it, the more comfortable you will get. Just never forget that the CNA/PCT is your partner in caring for the patient, not just your "assistant". Be respectful and polite and appreciative and communicative and most of them will respond in kind. They know you are new. They know you will need help. And they know it is their job to do so. Delegating is the magic key to time management. You HAVE to make time to chart.

Welcome to the world of nursing. It is trial by fire but at the end of the day, you are in the club. It will be ok. So many of us survived and you will too.

allnurses Guide · Feb 23, 2015

Here is what I did in the beginning and still do when I know it is going to be a doozy of a day.

-Take a piece of paper, turning it landscape view. Make a column for each of your patients and label them at the top with their room number or name. Five patients = five columns.

-Write the times of your shift by military hours down the left side. ie: Day shift will have 0700, 0800, 0900 etc etc etc down to 1900

-For each of your patients, take a moment after report and before morning med pass to review the EMAR. Make a note in the appropriate time slot for each patient when they have meds due, blood sugar, etc. For 0900, I always just wrote "meds" because there were too many to list, but if they had an antibiotic also do at 1400 I wrote the name of it there by the 1400 time. Blood sugar checks were noted in the appropriate slots at 0730, 1230 and 1630. I put in electrolyte replacements as well so that I would not forget to do them (something I still struggle with remembering if I don't have a reminder).

-Cross off each hour for each patient as you complete the tasks.

What this does for you is gives you an overall view of the tasks for your day. In it, you can see clearly where you may have some openings to get your charting done and when you can do the dressing change or ambulate the patient or what have you. It also shows you where you can cluster care together. Med due at 1300 with blood sugar at 1130 and a med at 1200? Do all of them around 1215. When you get the panicked "Did I do this???" moments, you can just glance at it and see you did or did not. When your brain is in hyperactive mode trying to figure out what needs to be done next, you just look at this paper and you can see it.It is this "hyperactive thinking" that makes your thoughts feel so distressingly scrambled when you try to answer questions or think about your day and your priorities. As you get better at this little "brain sheet" of sorts, you can start to prioritize what comes first.

Is this task oriented? Yes. But it REALLY REALLY helps with time management. In fact, it never fails. You HAVE to learn time management before you can even begin to learn critical thinking. One comes before the other. Time management is, in a sense, the prerequisite class for the critical thinking class. You didn't beat yourself up for not knowing the A&P II stuff before you had finished A&PI, right? Same thing here.

Try the above next shift. It is what I teach every student I precept and they come out shining.

soneutral · Feb 23, 2015

@ BecomingNursey, ADN, RN: Thank you! I am looing forward to month 4 :)

@ not.done.yetThank you so, so much for your inspiring post. I feel so much better after reading it. I am going to be more patient with myself, practice, repeat, and then get better. You are beyond awesome :)

BecomingNursey · Feb 24, 2015

Glad to be of service :) Chin up. And like one of my nursing role models says #dealwithit

firstinfamily, RN · Feb 24, 2015

You are going through what any new grad goes through known as "Reality Shock" and just like any type of physiological shock, it takes a little time to rebound and become fully functional!! All of us have been there, you will graduate from this just as the rest of us did. It does take time to develop critical thinking skills, learning to put all the "pieces of the puzzle" together takes practice. You can always refer back to your resources, and remember that all of us are learning all the time, it does not end with graduation. AS far as using your paper "brain" learn how to streamline and put what is the most pertinent information that applies to your patients, instead of everything, select a few categories such as if they are on oxygen, what their EKG is, their finger stick results etc. There were some cheat sheets posted here on this site at one time and may still be available. Everyone has their own tool that helps them, ask your co workers what works for them, perhaps borrow from their ideas and design your own paper brain. I have found that even though everything is on the computer most of us still use a paper brain or format or resource to keep us on task. You will eventually learn how to prioritize things, and with the constant interruptions of acute care, it is very difficult to develop a routine. I have found that looking at my watch and knowing when my medications are due, I usually start about an hour before they are due, this allows for the extra time it takes for resolving discrepancies, establishing IV lines, some patients take a long time taking multiple oral meds. It also allows for the unforseen little occurances that happen all the time. Give yourself time to grow. Concentrate on the basics such as perfecting your physical assessment skills, treat the patient, not the machines, learn to correlate all the information and whala it will become much clearer for you and you will have learned a great deal!!! It takes time and experience, and the ability to know when you need to ask questions. Do not ever be afraid to ask questions, there is no such thing as a stupid question, it is the unasked question that is stupid. Learn what co workers are good resources, learn how to correlate lab values with physical symptoms and diagnosis, ask the MD questions---they really love to teach and they will admire you more for asking instead of assuming. Welcome to the dynamic field of nursing!!!

soneutral · Feb 24, 2015

@firstinfamily: Thank you so much for your words of wisdom!