New grad needs advice

[Neaner22]

I graduated in September and began working in October on a med/surg floor that has tele, ortho, and trauma....I am extremely overwhelmed. I oriented on days for a few weeks but now am on nights. Me and my preceptor are not hitting it off- she asks if I am ok and I say yes, but I think she views me as incompetent. I am always anxious and rushed, and from what I can put together I must ask stupid questions? I dont know, but one of the issues we have had is that she does not want me to do a full assessment at night (only what the condition warrants), I have tried to explain that I am more comfortable with doing the full assessment, since my intuition is not adequate and I may not be able to eyeball certain problems. She keeps making remarks like, you dont need to listen to their BS, or reminding me that shes not a big fan of waking patients up unless necessary. I agree with that aspect, but this is my license, and it is my responsibility to give the best care I can...why is it such a huge issue? Any advice would be helpful!

[Eirene, ASN, RN]

I had a similar issue on nights (being discouraged from waking patients for their 0400 assessment). I began to not give an option and asking if I could do their assessments-- I just went ahead and did it.

It works for me... but I didn't have a preceptor. Bottom line-- it's your license. I feel that it's better safe than sorry-- especially if they are post-op.

[I_love_my_job]

You are right to do a thorough assessment. Pt's condition can change dramatically over a shift. It has happened to me already and I have been on my own for only a month. I had a patient whose BP was okay and then a few hours later dropped a lot. I called the docs, reassessed him frequently and he was later transferred to ICU. It seems your preceptor may be taking short cuts to save time. It is necessary to do an assessment rather than just eyeballing someone while they sleep. You never know...they might not be breathing!

Talk with your manager. I bet the manager would be shocked this nurse is teaching you not to assess completely.

[Quilter0225]

I think you are right to do a full assessment. You can do a good head-to-toe in 3 minutes once you get your system down. I would look at it this way: They are sick enough to be in the hospital, and everyone with experience tells me that acuities are higher than they ever were in the past. They wouldn't be there if they didn't need 24 hour nursing care. You are doing your job, providing the care they are paying for. Besides, if you don't do an assessment, what can you chart? We had to do a full assessment (whole new section of the assessment form) for each shift, no exceptions. I think your gut is telling you the right thing to do. Go with it!