New Grad Overwhelmed

ONC-RN · Jun 12, 2008

I'm a med/surg nurse educator and believe me when I say you know more than you think you do. We don't float our new grads for 6 months so maybe your manager can consider something like that? If not, trust that your assessment skills will develop over time and you will worry a little less over your patients as that happens. Confidence comes with time and experience.

Prioritize and delegate!! Not everthing is number one priority, you will drive yourself mad trying to be everything to everyone at the same time. Treating pain comes first for example, watering and repositioning patients can be delegated to a CNA when you are busy.

Pin a timer to your uniform--when you tell a patient you will be back in 15 minutes to address their request or answer questions, let them see you set your timer and return when it goes off. When patients know you are true to your word, they will sit on that call light less often. Patients who are anxious and doubt their nurses are often needy patients. You can buy yourself some time to do more critical things in that 15 minutes with another patient.

Until you get faster at charting, chart the important things first..assessments. Care plan updates can wait. Though they are important in charting, assessment documentation comes first.

Organize your area, stuff your pockets with flushes and alcohol pads if you don't already. Little things but it's one less trip out of the room.

As a new grad, I did up a template on WORD with a time frame and an acronym for charting things (P for PIE, O for orders, A for assessment and R for report). I jotted down what I had to do at each time from meds to things I wanted to assess specifically and it has been a life saver. No double checking and triple checking to see if I did this or that; it's been checked off my list. A lot of other nurses have adopted it too so if you want, I can send it to you as an attachment and you can adopt or discard if you already have something similiar.

Hope this helps!! Remember, you are going through what we all have gone through!! This too shall pass!

suzy253, RN · Jun 12, 2008

It will get better. Sounds like you are doing fine!

casperx875x · Jun 13, 2008

I'm a med/surg nurse educator and believe me when I say you know more than you think you do. We don't float our new grads for 6 months so maybe your manager can consider something like that? If not, trust that your assessment skills will develop over time and you will worry a little less over your patients as that happens. Confidence comes with time and experience.
Prioritize and delegate!! Not everthing is number one priority, you will drive yourself mad trying to be everything to everyone at the same time. Treating pain comes first for example, watering and repositioning patients can be delegated to a CNA when you are busy.
Pin a timer to your uniform--when you tell a patient you will be back in 15 minutes to address their request or answer questions, let them see you set your timer and return when it goes off. When patients know you are true to your word, they will sit on that call light less often. Patients who are anxious and doubt their nurses are often needy patients. You can buy yourself some time to do more critical things in that 15 minutes with another patient.
Until you get faster at charting, chart the important things first..assessments. Care plan updates can wait. Though they are important in charting, assessment documentation comes first.
Organize your area, stuff your pockets with flushes and alcohol pads if you don't already. Little things but it's one less trip out of the room.
As a new grad, I did up a template on WORD with a time frame and an acronym for charting things (P for PIE, O for orders, A for assessment and R for report). I jotted down what I had to do at each time from meds to things I wanted to assess specifically and it has been a life saver. No double checking and triple checking to see if I did this or that; it's been checked off my list. A lot of other nurses have adopted it too so if you want, I can send it to you as an attachment and you can adopt or discard if you already have something similiar.
Hope this helps!! Remember, you are going through what we all have gone through!! This too shall pass!

I am looking for a document that may be helpful as I begin orienting soon. You've peaked my interest with the mention of the one you created... would you be willing to send it to me as an attachment? It would be greatly appreciated! TY.

Tweety, BSN, RN · Jun 13, 2008

I have been told I am doing well, a good critical thinker, but.........

Take out the "but" and that's all you need to know.

You're right where you should be right now. We've all been there and done that.

roziepig · Jun 13, 2008

I can't thank you all enough for your time and inspirational words. I would certainly love a copy of your template, and any other tips you have to offer.

I have made a conscious decision to go in each day with a positive mindset, looking at difficult times and situations as a learning experience.

wanna-be-nurse · Jun 13, 2008

Can I please get a copy of that too, I think that would be very helpful. Thanks.

imanedrn · Jun 13, 2008

Here's the form I use as "my brain" while working. (Feel free to make any changes you like to suit your needs.)

On the first page, right side, I document the previous shift's findings in one color. During my assessment, I either circle them (to confirm I found the same) or re-write/circle another item in a different color to indicate that's what I found.

On the left: abnormal labs & notes throughout the day of things that are scheduled (i.e., procedures) or other items (i.e., PICC or dressing changes).

I don't use the 2nd page as much any more, but it's mostly for VS & pain assessments. In the past, when I did NOT chart as I went along, I would write notes in the grid at the top (i.e., 0830 - left for CXR, 0900 - returned from CXR, etc.) as a reminder to chart these items.

I know so many nurses who jot down everything all over their Kardexes. I have never been able to make that work and have no clue how they do it. I'm so ridiculously anally retentive that I literally can not function without this form.

08-05-17_NurseAssess_Individual.doc

jjjoy, LPN · Jun 13, 2008

While a new nurse who is slow and doesn't have honed assessment and prioritization skills may be "right where they should be" and that speed and other skills will "come with time and experience", what advice do you give them to cope meanwhile? That is, how are they to be okay with the reality that for the next several months they often won't finish all their tasks in a timely manner? That "prioritization" not only means what they will do first, but it also means that they might not ever get to some items on the list (and likely be scowled at and/or reprimanded by the next shift for not getting to it)?

How do they deal with the fact that they may miss certain symptoms or misprioritize patient needs because it's all new to them? Sure, next time, they'll do better, but how is it okay that they didn't get it THIS time? Having had it drilled into their heads for some time they should *never* compromise patient care, how are they to accept that it's alright for them to go into work each day knowing that they'll be fumbling along, technically with full RN responsibilities for a full patient load, for several months until it finally "starts to come together"?

Yes, ideally they can look to their colleagues for support and aren't really 'alone', but when you're that new, you often don't know what you don't know, yet after just a few months, the newbie has complete responsibility to recognize their limits, yet also push their comfort level in the midst of learning to juggle competing demands and ask for help from colleagues often barely managing their own workload.

Yes, eventually, it will "start to come together"... but how to get by til then without feeling like a potential danger to patients and an unwanted burden to colleagues?

MMARN, BSN, RN · Jun 14, 2008

While a new nurse who is slow and doesn't have honed assessment and prioritization skills may be "right where they should be" and that speed and other skills will "come with time and experience", what advice do you give them to cope meanwhile? That is, how are they to be okay with the reality that for the next several months they often won't finish all their tasks in a timely manner? That "prioritization" not only means what they will do first, but it also means that they might not ever get to some items on the list (and likely be scowled at and/or reprimanded by the next shift for not getting to it)?
How do they deal with the fact that they may miss certain symptoms or misprioritize patient needs because it's all new to them? Sure, next time, they'll do better, but how is it okay that they didn't get it THIS time? Having had it drilled into their heads for some time they should *never* compromise patient care, how are they to accept that it's alright for them to go into work each day knowing that they'll be fumbling along, technically with full RN responsibilities for a full patient load, for several months until it finally "starts to come together"?
Yes, ideally they can look to their colleagues for support and aren't really 'alone', but when you're that new, you often don't know what you don't know, yet after just a few months, the newbie has complete responsibility to recognize their limits, yet also push their comfort level in the midst of learning to juggle competing demands and ask for help from colleagues often barely managing their own workload.
Yes, eventually, it will "start to come together"... but how to get by til then without feeling like a potential danger to patients and an unwanted burden to colleagues?

That, my friend, is the number one question I ask myself all the time.

Chloe'sinNYNow · Jun 14, 2008

JJJ, this is exactly what cost me my most recent hospital job in a placement I really wanted.

Yes, eventually, it will "start to come together"... but how to get by til then without feeling like a potential danger to patients and an unwanted burden to colleagues?

My orientation sucked and instead of helping by showing, the facility kept throwing more pts at me and more responsibility and by telling me that I only had "x days left until I was off orientation". That did nothing to boost this ole gal's self-confidence. I was already scared. So on the first night off orientation when they gave me the ultimatum, they also told me I"m a "danger to my pts" if I'm unsure of myself. WHA?!?!?!?!!??!?

Well I decided a day later, with difficulty, that this new grad needed (and deserved) a better orientation and a more supportive environment.

I chose this hospital for its reputation, but I should have looked closer. Unhappy, grumpy, overstressed overworked employees, old outdated equipment (that's never avail when you need it, nor cleaned appropriately between pts!) and so much more.

P.S. to the O.P. I was told that 3 mos orientation is also much longer than anyone should need.

So glad I'm out of there. I'm seriously looking at taking my limited skills to a nursing home and digging in there.

Good luck to you newbies! I'm right there with you after almost a year out!

Chloe

SoundofMusic · Jun 14, 2008

Good for you, Chloe -- I'm glad your'e taking it elsewhere. I don't think 3 months is anywhere near long enough for an orientation -- my God.

I think back to the job I left first, and I realize I probably could have given it more time, but now I'm know I'm in a better place. I was given the right kind of orientation and am with a pretty supportive group now that I'm off orientation, hey, I'm doing relatively well. It's still hard and it's sitll hell, but I'm making it OK.

So, that was the total LOSS of that first unit who could not find it in themselves to precept me properly. Or, perhaps they just needed someone who was unthinking and uncaring and who could cope with their lack of precepting skills. Whatever the case, it was the wrong fit and that's what happens sometimes. it's not YOU, -- it's just a wrong match of personality type or whatever. It's not because we're stupid -- but I do feel it's because THEY are too stupid to know how to train people in many of these places.

I personally think that to survive in many of these units, you need to be able NOT to care about anything. If you're caring and conscientous -- it's awful.

Now I do have a very anal retentive master preceptor -- she is good almost to a fault and is very persnickity about things -- but she's darn good and has been able to encourage me to stay and stick it out. She listened to me, laughed with me, cried with me, etc -- some days she still drives me nuts, but I found that right place. I wont' stay forever, but it's good enough for the next 18 months or so and I'm finally learning and growing ok at the pace right for me. That's what you want to find.