New Grad off Orientation

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So I just wanted an outside opinion, I am a new grad who just finished orientation today. I am on a med surg unit in a large hospital ratio is 1:5. Every float that comes to our unit says how heavy our unit is and our patient load based on the types of patients we often get. I read all these things about how new grads struggle so much and feel overwhelmed for a really long time. I am scared to say it, but I honestly do not at all. There were some moments my first maybe 3 weeks where I definitely felt overwhelmed (I just finished 12 weeks of orientation), but overall I do not at all. I know I still have plenty of questions and things will always come up that I need to ask or clarify or get another opinion, but overall I feel confident. Don't get me wrong, there are days when I am running around completely crazy, but I never feel like I am going to panic or that it is impossible-I always feel like I know I can get it done. I have had 2 preceptors, both are really great. One who precepts almost all of the new grads on my unit specifically told me that she thinks I caught on really fast and that I must have had a good nursing school preceptorship (I was in the OR though-not on the floor), but I just want to know is there ANYONE that felt this way as a new grad? Aware that you are a new nurse, but feel pretty confident? All I read are things about how new grads struggle so much for awhile and I am just wondering if this is normal or if I am missing something.

Wow, a nurse comes on not totally miserable, admits she/he might be missing something and will continue to have questions but so far isn't feeling panicked or that the work is impossible. And says she/he had great preceptors. And she/he must be over confident and cocky, dangerous even?

Maybe she/he is all of the above, or maybe this new grad is well cut out for the job and so far has had a positive experience.

What I dislike about this board is nearly everyone who is evidently and cringe worthy not cut out for the job is encouraged to keep trying but someone who comes on feeling good so far is struck down as being dangerous.

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Wow, a nurse comes on not totally miserable, admits she/he might be missing something and will continue to have questions but so far isn't feeling panicked or that the work is impossible. And says she/he had great preceptors. And she/he must be over confident and cocky, dangerous even?

Maybe she/he is all of the above, or maybe this new grad is well cut out for the job and so far has had a positive experience.

What I dislike about this board is nearly everyone who is evidently and cringe worthy not cut out for the job is encouraged to keep trying but someone who comes on feeling good so far is struck down as being dangerous.

I agree with your last paragraph, but for what it's worth I suggested that she may not realize what she doesn't know - not that she's dangerous.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Some new grads adjust to the real world of nursing remarkably well. They don't become overwhelmed with their work loads. They react to new and novel situations with calmness rather than anxiety.

It seems as if the OP is one of the lucky ones. After all, nobody is doing his/her patient a favor by freaking out. Good luck to you.

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I felt that way as a new grad, too. I went from school right into home health. I had the benefit of a long and excellent orientation with a preceptor that was a wonderful teacher and I was surrounded by supportive colleagues. I was also the only new grad in the group. I was very aware that there were lots of things I didn't know, and I was very aware that I was more likely to make mistakes, and bigger ones, than the other nurses I worked with. You can bet I consulted a LOT with my coworkers both by phone while at visits and back in the office. And truthfully, a year and a half later, I haven't yet made a mistake that's caused any damage to a client.

I felt confident because I had a great orientation, yes, but also, that's just how I deal with stress. Truly, I'm fortunate to cope very well with anxiety and rarely, if ever, feel nervous. That doesn't mean I'm dangerous or cocky or overconfident (come on, guys). It just means that I feel well-prepared for my current work and am better at managing nerves than your average new grad.

OP, be aware that you don't know what you don't know, but don't think that it's normal or helpful or indicative of being a good nurse to be crying and vomiting before every shift. Be cautious, but learn and do all you can in this early phase.

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Specializes in Critical care.

I am a new grad and I just got off orientation too, in the ICU. There are things I know and things I don't and things I don't even know that I don't know yet. I don't panic on a daily basis and I too feel and have been told that I caught on quickly, however I am almost constantly asking questions and I never assume I know anything- if I am even slightly uncertain, I ask. Certain patients make me more nervous than others... I can handle "stable" vent patients but there are others who make me feel like I know absolutely nothing. I'm still learning and I know that.

I had a guy Friday morning who was a new admit and made me very, very nervous. I couldn't figure out why I was so nervous and I was calling doctors left and right... then he coded. Learned a lot from that situation- he was my first to code while I was on my own AND he coded while I was down in CT with him, not up on the unit surrounded by coworkers. Terrifying does not begin to cut it and this situation specifically, taught me a whole lot about "gaps" in my knowledge. I've talked a lot with my precptors about what happened and learned a lot from the processing.

I'm sure I have many more learning opportunities in my future. Everyone I've talked to says it can take a year to get comfortable but my one preceptor has been there five years and says there are still days she questions everything. I am sure that will be me as well.

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Congratulations to you, OP, if you are off orientation and feeling ready to start working without your preceptor. I think that's a good thing! My floor was very good about assigning new grads the most stable and least complicated patients initially. This helped us ease into working on the floor. So some of your assignments may be the relatively "stable" patients on your floor and it may not reflect the everyday acuity other nurses on your same floor experience. Not saying for sure they do that, but just keep it in mind. In the meantime, I would just make sure that you are getting everything done charting wise. At another job I worked with a tech who maintained everything was "easy" and she knew how to do it all. But she never charted Is and Os and routinely left batteries unchanged in monitors, etc. So just make sure your charting is complete.

I think it is great you are feeling confident coming off orientation! Welcome! :)

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Medium. I had a 4 month orientation on Mental Health, and I felt confident in the general day-to-day stuff, but totally terrified about the emergent situations. I had about 6 days orienting to Med Surg which felt woe-fully inadequate, and after a month or two I felt fairly confident in the general day-to-day stuff, but fairly terrified about emergent situations. On both units, though, I had great resources to go to for help. I've also worked in places with pretty great staffing. I'm good at time management and a speedy charter and both of those things help a lot.

I do recognize that I've got a lot to learn still. After feeling confident with completing the basic tasks ordered, I have moved on to trying to anticipate unexpected changes, have a better understanding of disease process/treatments/meds, provide better patient teaching, initiate health-promotion interventions for patients without an order or being told to, research evidence based practice, promote better practice among peers, give better reports, etc. If your facility has a clinical ladder, take a look at the different categories/levels of nursing. It is interesting to see what is expected of a new nurse, versus a slightly less new nurse, versus a more experienced nurse. It's good to feel confident in your skills. It's good to recognize that you've still got a lot to learn.

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Specializes in Med-Surg.

Thank you everyone for the helpful insight. No, I did not post this to get my ego stroked as some have suggested, but on an anonymous message board because I was genuinely curious if this was normal and if there may have been something big going on that I'm missing. I am definitely aware that I am a new graduate completely new to healthcare and that there are a million things I do not know and that I will never know everything. The reason I say I feel confident even though I have not yet worked a day without my preceptor is because the last week I was on orientation my preceptor had me pretend I was on my own, did not come into rooms unless I had ended up needing to ask her, did not check my charting anymore, etc. Yes, there may have been a mental component knowing she was there, but I feel I was able to perform my job with minimal stress. I know there is definitely a fine line between cocky and confident and I do not ever plan on becoming cocky, like I said I know I am a new graduate with a ton to learn. To the poster who asked where I am working it is in NC at one of the big teaching hospitals (not sure if it's ok to say which one on here) and to the poster who asked if all 12 weeks were on the floor, 11 of them were. Thank you for the comments though everyone, it is nice to hear stories from new graduates that did not involve feeling like they were going to throw up or crying all the time. I am sure I will probably have moments or even days like that, but the point was it is just not a normal occurrence for me. The reply that especially got me thinking was the part about possibly being too task oriented and not thinking critically enough; I am definitely going to try to pay a lot more attention to that.

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Specializes in Critical Care, Education.

KUDOS TO YOU OP!!!

I have the unique perspective of having been 'in the trenches' for 30+ years.... and I can assure you that the "horrible experience; constantly overwhelmed; stressed to the max" expectation for new nurses is a fairly recent phenomenon. I find it very sad that newbies such as OP who do not fit this mold are viewed with suspicion and the belief that they must be doing something wrong.

Back when the Earth's crust was still cooling - my first nursing gig was in Neuro-Trauma ICU. I had ~ 2 weeks of orientation before being turned loose with my 2 patients. I enjoyed going to work and volunteered for OT on a regular basis. I worked with wonderful veteran nurses who were always there when I needed them. My fellow graduates recounted similar experiences. When did miserable become the norm? Not being snarky here... just curious. Is our educational process destroying confidence and completely removing the joy of nursing?

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Specializes in Pediatric Hematology/Oncology.
KUDOS TO YOU OP!!!

I have the unique perspective of having been 'in the trenches' for 30+ years.... and I can assure you that the "horrible experience; constantly overwhelmed; stressed to the max" expectation for new nurses is a fairly recent phenomenon. I find it very sad that newbies such as OP who do not fit this mold are viewed with suspicion and the belief that they must be doing something wrong.

Back when the Earth's crust was still cooling - my first nursing gig was in Neuro-Trauma ICU. I had ~ 2 weeks of orientation before being turned loose with my 2 patients. I enjoyed going to work and volunteered for OT on a regular basis. I worked with wonderful veteran nurses who were always there when I needed them. My fellow graduates recounted similar experiences. When did miserable become the norm? Not being snarky here... just curious. Is our educational process destroying confidence and completely removing the joy of nursing?

I am still a student but I have been working for 15 years (nursing is a career switch for me) and, in my previous work, I noticed a huge switch in the workforce. I come from a place where we had classes in high school on how to do interviews and write resumes. People took getting a job at the one place where the majority of us worked in high school seriously (and many, including myself though it was entirely not in the plan, continued to stay into college and beyond). Through the years, I noticed a sharp decline in the quality of applicants coming in to the various locations I worked at, even at the higher end places where, when I was in these peoples' shoes, I was too intimidated to even apply at. Resumes misspelled and frequently stained (or, "What's that?" or, "Ugh, do I really need one?"), people bringing in their family members, shopping around before asking for an application, people wearing casual clothes in a suit store, etc. etc. it all got to be the hottest mess eventually. Hiring people became painful because, even in retail, people would be experiencing the stress and misery that it seems a lot of newbie nurses go through, too. It's everywhere.

I don't know if it's the "Facebook culture" that has promoted being casual and reinforced being "smart/hardworking is uncool" or what but it seems like people have just stopped trying. I see a lot of this in many (not all, thank god) cohorts -- an attitude of entitlement, everything must be posted on social media (cuz, I need ATTENTION, plz!!!), and no accountability whatsoever. One would hope that people with this mentality would not get into nursing because there is something inherently lacking when someone is stricken with entitlement and an inability to be held accountable: resiliency. Things definitely will get miserable fast when someone comes in with the inability to adapt, be flexible, and dig deep into their inner resources (not to mention behave appropriately in a work setting and develop a strong rapport with one's coworkers without alienating ALL people because of an utter lack of self-awareness).

Kids these days. :sniff:

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I understand where you are coming from. I had six days (yes that's days, not weeks) orientation on a med-surg floor and hit the ground running with a ratio usually around 1:7 or 1:8. While I felt overwhelmed with the amount of things I had to do each day, I never lost my composure or cried on my way home like some nurses say they do.

However, like others have said it takes a while to see the big picture and that takes time. I'm still working on it. Make sure the reason you feel confident isn't because you're missing things that would be stressing out a more experienced nurse who was aware of them. I hope you're on a floor where the other nurses will continue to be supportive and receptive to questions. My worst days came when my preceptors were no where to be found and the other nurses were too busy or couldn't be bothered to help me.

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Specializes in Med-Surg.

Yes most of the other nurses are really nice and I think I'll be comfortable asking them for help, but it will definitely be different not just having my preceptor completely at my disposal

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