New Grad RN freaking out

[THG]

Hi guys. So happy I found this website, reading all of the other discussions has really helped me in the last 3 weeks. I have worked around 6 shifts so far and SO overwhelmed. I worked as a PCA for just 9 months (I was in an ABSN program and didn't do it first semester) and feel like my clinicals were just absolute fluff. My preceptors are absolutely lovely, but gosh I feel bad slowing them down with all my questions. My manager and preceptors say "I am right on track" and can tell "I will be great", however, they're Vermont people and just quite nice. I think they can tell how anxious I am and are just saying those things, so I don't always believe their compliments. My floor is an oncology/med surge floor and I feel like I have sooo much to learn--I know that's normal, but gosh I did not know what I signed up for. I have no desire to quit, I just feel so inadequate and like I am never going to be ready to be off orientation. To explain more, I am 6 shifts in and forgot to waste my 1st syringe in a lab draw, I am still confused on setting the IV pump rate&volume when you have back to back abx, and the UFH of a heparin drip went completely over my head--my preceptor didn't really try to explain it to me because she said it may be too much, but that just kinda made me feel like she thinks I'm weak or something. 

I've had a few days off and been reflecting on what I think is going wrong. I am starting to realize I may be trying to understand the "why" too much. For example, I'm stressed that I don't really understand preload/afterload and what affects them (do any RNs fully get that..? I never did in school). I Googled it and it says systolic blood pressure affects afterload and I'm like ?how. Likewise, I started freaking out randomly that I totally forgot the renin-angiotensin-aldosterone system (RAAS), and how it regulates blood pressure and fluid balance. To be honest, my accelerated program briefly mentioned that once but I never had the time to fully get it. I have 0 desire to ever go ICU (kudos to you baddies though), so do you think I'm just being oddly anxious and overthinking how much I need to know? I am trying to just get down IV insertions, setting IV pumps, safe med passes, time management, prioritization, and other basic skills and realizing I may have to know the "why" of so many things just put me over the edge. Do you RNs know all that stuff? Sorry if I am being a total freak right now, I feel like my head has been exploding ever since I started this job and am so scared of losing my license...and flipping harming someone!

[heron, ASN, RN]

STOP!

Breathe.

You're getting out over your skis by obsessing about what you haven't had a chance to learn yet.  You have a choice about that. You seem to have a good sense of where your priorities should be: basic skills, medication safety, time management, etc. Continue to solidify them as you go on to pick up new ones. Learn to accept that you're a beginner. Stop flogging yourself for not being an expert yet.

I started my career 50 years ago at the old Boston City Hospital (adult medicine). While there, I took a class at Lemuel Shattuck Hospital in JP on rehab nursing. One take-away was that it's a waste of time to obsess over what you can't do. To help someone reach their best possible level of function, you have to concentrate on what they can do and build from there. It works for new grads jumping into the deep end of acute care, too. My favorite prayer ... Lady, I'll do the work in front of me, the rest is up to You.

Investigate techniques for managing anxiety in the moment. There's lots of info out there. You will get anxious - you have a choice about how you react to it, so don't let it push you around. Then you can better recognize when you're in over your head and ask for help.

[THG]

thank you for the kind reassurance, I love that prayer too ❤️

[The.RN.Nerd]

I just got my RN here in socal and im also anxious and worried about starting as a new grad RN.  I am trying to get into a new grad program for this reason but even then, I know there is just so much to learn on any floor/unit.  I say take a deep breathe and don't try to know the why for everything just focus on the main parts of the most important safe things for now and then build on that when you get better! I think you are trying to be perfect already when you barley started.  This job takes years and years to get good. This is something you must accept.  I also have to understand this.  I wish you well and I wish I can just get into a new grad program over here. 

[Hannahbanana, BSN, MSN]

First of all: As a volunteer for our state board of nursing I learned early on that if you aren't diverting drugs, coming to work drunk or high, stealing patient belongings, exceeding your scope of practice (you can read it online at your state board's website), falsifying documentation or your credentials, or engaging in prostitution or other felonious behavior, the state board is not the least bit interested in taking your license away. There now, feeling better already? 
Your managers and preceptors are telling you the truth. They aren't telling you you're too stupid, they're telling you they're not going to force the fire hose to your lips when gentler rehydration is appropriate. Try to remember that every single one of them has been exactly where you are — new, scared, thinking you have to be an expert RIGHT NOW or all hell's demons will be on your butt— and they know how to manage it. First year of practice is full of experiences you never saw in school. That's OK. 
I have told this story here before; you can probably search it. Here it is again, though. 
I had been working in this world-class ICU for awhile and still scared every day. One day I was sitting in the break room with Sarah, a longterm ICU nurse who was always calm, a real expert, respected by all, could take any patient they threw at us. I screwed up my courage and asked her, "When do you stop being afraid?” Her answer has stayed with me over the many decades since. She smiled and said, "Every day when I come in for report I feel a little jolt of nerves. I think that the day I don't feel like that is the day I have to quit.” 
Physiologically speaking, fear pushes your adrenals to kick out adrenaline. This dilates your eyes, so your visual field is sharper and expanded. It causes your liver to boot out a bunch of sugars to give your brain extra fuel for thinking, perceiving, and your muscles for fight/flight choices. These are beyond your control but they are to your advantage. Go with that. 
In your career you will have a lot of opportunities to reassure a fearful patient that what's happening is perfectly normal and expected. Now you can give yourself that same grace. Have a great life! Welcome to our profession. 

[Patricia Ordnung]

The thing about nursing school is that you don't learn how to be a nurse, but you learn what it takes to BECOME a nurse, if that makes sense.  You become a nurse by paying attention, learning and repeating skills again and again, and giving it 100%.  You are doing all of these things!  All of us old timers were once where you are right now! 

[KAREN CREWE]

Hi there,

I think you are having a normal reaction to realizing that soon you will be looking after patients technically " on your own"

But as a new grad, starting a new job, there will be support.

To start with, try to separate the 2 different learning concerns.

The immediate job orientation involves learning how pumps work, prioritizing patient care, knowing the medications and their basic actions with the reasons for administering them, and understanding how to "see" your patients and what they need.

The complexities of all the diagnostics, A+P finer details, trying to remember the " stuff" you learned in school, won't all be sitting in your brain ready to go. You will need to go and look things up again to remind yourself, and there will be areas that feel more familiar to remember than others.

I have now reached 40 years in nursing. I still look up info all the time. I look up meds I don't give all the time to check what they're for, or look through the pt notes to see what the diagnosis for treatment is. I still have to check in with colleagues on calculations/settings.

Any high-risk med is a 2 RN check anyway.

No one expects you to know everything. And believe me, they will let you know if you are not keeping up.

Also, write things down. If you need to remember how to program something, or there is an order to do something, or someone has a good way they approach a task, jot it down in a notebook, so you can refer to it.

Give yourself a break. Take on important learning matters one at a time, and you will one day realize " OK, this was a good day"

Good luck