new grad questions - when does it all come together?

[kxvc]

I had a terrible night last night in the ER. Had 2 very, very ill patients who were septic. The ER was so full my other beds had to remain open so I had my septic patients on cardiac drips and all sorts of other goodies and all my other patients too. A total of 4. I know 4 patients is something I should be able to handle, but when you turn over patients so quickly it is a struggle to keep up. I get irritated when patients get upset because I haven't had time to find them a pillow or get them food when they are perfectly stable and the patient next door is swirling the drain. Makes me want to bring them out and show them what all is going on and why I haven't gotten a pillow or a pudding.

Everyone told me I was doing a good job, but I didn't feel like I was. I cried. I cried and my manager saw me even though I was fighting back the tears. They just rolled out. He was so concerned, but I told him I was fine. I sucked it up and kept going.

I am worried because my yearly evaluation is coming up and the last couple of nights I have felt like I am trying to keep afloat with 100lb weights attached to all 4 extremities.

I still love the ER. I have had better nights before, but when will I feel more sure of myself? When will I not freak when I have to give a drip that I have never given before and there is no one around to guide me? When will the hospitalist trust me when I call to inform that the drip is negatively affecting the pt's cardiac rhythm?

I am a new grad, graduated 6 months ago, and started in the ER. How do I know if I am where I need to be knowledge wise? I feel I don't know anything.

[SummerGarden, BSN, MSN, RN]

you feel this way because you do not know anything. relax, everyone starts at this point. there are plenty of nurses who worked er as a new grad and are great nurses today!!! they seem to know their disease processes and course of treatments within the ed and outside the ed like the back of their hands. on the other hand, you need to progress to the point, quickly, where the ed is a place to apply your knowledge and skills rather then a place to haphazardly gain knowledge and skills. in order to do this, you may wish to try studying on your days off and get additional training outside of work. lastly, keep looking forward rather then backwards. one day you can be one of the good ed nurses too. don’t forget that they all started out as clueless new grads once upon a time.

[BellaInBlueScrubsRN]

I graduated dec 08 and work in the ICU. I feel like just now things are really starting to click. It made my night when an older nurse asked me a question about her pt! Sometimes I still feel like I ask A LOT of questions. I have a couple people that I know I can go to though when I have a question or something just doesn't look right. Is there anyone like that that you can turn to?

6 months is still pretty new! I definitely agree with reading up on stuff on your time off. I bought quite a few just because I feel so dumb sometimes! And maybe during your evaluation, don't hesitate about telling your NCM how you feel. Maybe he/she will have some advice.

[HollyHobby]

I started in a very busy ICU with very sick patients as a new grad. (Looking back, I shudder to think that I was allowed to take care of those poor people!) It was about a year before I wasn't afraid to go to work, and another year before I felt like things were really coming together.

I've been at it now for 12 years, and I still have questions and moments where I just don't know what to do. For me, this is what keeps my job interesting. How boring it would be if you never saw anything new or never had to learn anymore.

There is so much to learn. You already know the theory, of course, but as you've seen it's a whole 'nother story to put that theory into practice. No school can prepare you for it. You simply learn by doing, and eventually you will have learned enough where you feel almost comfortable. I say "almost" because a good nurse is never, I think, completely comfortable.

There is always more to learn, better ways of doing things, and better ways of relating with patients. You're already well on your way. Think for a minute how much more you know now than you did six months ago!

Instead of focusing on how much you don't know, remember to take a minute to be proud of what you DO know. All you lack is experience, and every shift you work is packed full of adventures.

Try to think of each new thing like you did back in school. Remember the excitement of getting your first IV? The first time you gave an injection or put in a foley? Just because you're not being "graded" on it doesn't mean you aren't learning valuable skills each day!

Be patient with yourself. You're getting positive feedback, so you are on the right track. It's okay to be scared: who wouldn't be? It sounds to me like you are a fantastic nurse in the making. Please don't even think about giving up. One day in six months or so, you'll be on your way to work and you'll suddenly realize that you're happy about it. And from then on, the satisfaction your job gives you will be worth every moment you've put into it.

Give yourself some positive feedback. Pretend like you're your own clinical instructor. I bet I'd give you an excellent grade if I was your teacher, and you should give yourself the recognition you deserve, too.