New Grad Nurse, already feeling the burn

Baubo516, RN · Mar 27, 2014

If you have tried to contact your manager, and she is not getting back to you, I would suggest going up the chain of command. Maybe a first step would be to talk to someone who is in the "employee education" area, and approach it like you feel that you need more orientation, etc. That way it would not be like you were trying to get someone in trouble, but just that you are actively seeking a solution for yourself.

For the badge issue, I would go directly to the human resources office in person. Just tell them you still don't have a badge and that you need one, and then stay there physically until they make one and give it to you. I got my ID badge on the day I signed paperwork, but I guess my security "chip" that gets me into doors came from the "security" office. So maybe that is another place you can go for results. But the main thing is, go there yourself and don't leave until you get some action. It sounds like your manager is not going to get this accomplished for you, and I don't see any reason why she would be the only person who can do it.

I am sorry to hear about your situation. I hope some assertive action on your part will at least solve the badge problem. The staffing and unit culture sounds like it will take a lot longer to improve...

I also think it is legit for you to tell the charge nurse that you are not willing to work on your own without your own badge. Explain that you don't want to create work for others by having them accompany you into the med room, etc.

(BTW - I am a nursing student who works as a CNA at a hospital, so not working as a nurse yet. I am sure others will have different perspectives.)

nynursey_ · Mar 27, 2014

I had the exact same issue starting out as a new graduate. I was on a busy medical floor, had a 12-week preceptorship experience (which, from what I can tell from other newly licensed nurses, 12-weeks is generous), and started taking 6-patient assignments, regardless of acuity level. From my 3rd month to about my 5th month, I wanted to cry when I left the floor every single day. I felt like an absolute wreck. I felt all over the place. Every organizational skill I developed during orientation fell apart because I didn't have a more experienced nurse to point out the nuances to me, and often times, I'd forget details that were important in either my patient care or documentation. I often left work an hour after most of my colleagues. I quit getting compliments on my efficiency and my care. I just felt, as you put it, low.

Then something happened: I got into my own routine. I prioritized. I started knowing when to delegate care to the PCA's, when to delegate phone calls to the resource nurse, when to take messages of family members wanting an update, and when to say to a patient, "I'm sorry. I have to give medication to another patient. I will be with you shortly." And while not all of my feelings of inferiority diminished, a lot of them did. I learned to chart my assessments in my patient's room: spending time listening to their needs/assessment of the situation, and lessening the chances that I'd be interrupted. I started my med passes on the hour prior. I just … got smarter. And you will too.

I was told that it takes a year to develop competence. I fully believe this. Some of us are quicker than others in that we are able to go through the motions, navigate the computer, and make it out on time, but there are other factors that just take time, like the nurses' instinct. Or gut feelings. Or being able to notice a deterioration quickly and anticipate what a physician will order. I'm not there yet, and I'm fully comfortable admitting that.

Be comfortable with being uncomfortable. This is my #1 advice. If you're constantly upset by the level of your inexperience, it will impede your ability to learn, and accept criticisms that may help you in the long run. Keep your head held high. You're *learning* and this is all part of the process.

canigraduate · Mar 27, 2014

First, take a deep breath. Try to be calm and assess your situation objectively in a problem solving way. You sound flustered in your post.

Take the things that are bothering you one at a time and try to work out solutions on your own.

Here are the things I would suggest:

1) I second nynursey_. Do a lateral around your obviously new and so far useless manager. Go to HR in person and have your badge taken care of. Go to the unit educator or hospital education staff. Go to the Director of Nursing if you have to.

2) Develop relationships with the more experienced nurses. Ask, ask, ask, and ask some more. If you are uncomfortable doing something, have the charge nurse or another experienced nurse talk you through it. Don't do things on your own if you don't know how. That's dangerous. If they give you guff, just smile and say things like, "I am only trying to keep the hospital from being sued. That would be bad, right?" Don't forget you are not a doormat and you are not stupid, you are just new.

3) Delegate, delegate, delegate!!! It took me forever to get comfortable with this. If you see another nurse and they don't look swamped, get them to pass meds for you. If you have a CNA, don't do any CNA work until AFTER you finish your own (including charting). You can always help a CNA if they get behind, they can rarely return the favor.

4) Go home at night and consciously go over the day, looking for ways to improve. Problem solve! Do not be afraid to try new strategies to help get you through the day.

5) Time management is key. I know everybody says this, but that's because it's true. Go ahead and get started with your day as soon as you hit the floor. If no one is available for report yet, check your labs. If you are finished with report, pick your easiest patient and knock out your first assessment. Give your meds on a two hour schedule. I give my 7s and 8s together (sometimes my 9s, too), my 11s and 12s together, etc. Don't wait until your meds are due to start giving them. I try to have my med pass done by the time it's due, which gives me time to chart. Don't let little interruptions slow you down. If a family member calls, have the secretary or whoever get a number and call them back on your terms. If a CNA asks you for help and it will make your meds late, don't do it. Use time shortcuts as much as you can. If a doctor is rounding and needs you right there in the room, try to do some charting or check your lab/diagnostic results, or even give your meds. Set time limits for yourself. For example, if you are going in to give a medication and reassess pain, it should take 2 minutes or less. For a full assessment and morning meds on a med/surg patient, 10-15 minutes. (Obviously, if they are PEGed, have a leaking colostomy, have a medication given by every route possible, and require 5 people to turn, you can give yourself longer.)

6) This is the big one. If you do not feel you are ready to be on your own, DON'T DO IT. Do another lateral around your manager and get the help you need. From your post, I wasn't sure whether you have a preceptor, or already on your own, or both. If you are already on your own and feel like you're dangerous to your patients, ask your manager (or whoever will get it done) to put you back on orientation until you feel like you can handle it.

Also, you can try to transfer out of this unit or look for another job. Good luck to you! It DOES get better.

Deepinthegame · Mar 27, 2014

Just get use to it -no matter the place it's going to be the same in a clinical setting.

sistaAfua · Mar 28, 2014

I got a very good advice for myself. your post is very detailed. thks

mermer_rn, BSN · Apr 2, 2014

Thanks so much for the advice. This particular hospital offers 6 week orientation....so I'm on my own already; I decided to take control and got the things I absolutely needed....worked on getting into a routine and found that it is working better. By far the best thing I learned is that kind of like you said, I don't know everything, but no one really expects me to and that is ok....that's just where I am.

Thanks!