New Grad RN Med-Surg: Is this right for me?

JKL33 · Dec 3, 2019

7 hours ago, nursejo said:
I am now four weeks into my 8 week orientation on a Med-Surg floor. The day before an upcoming shift, I have anxiety attacks throughout the day. I isolate myself, watching the clock and counting down the hours that I have to clock in for work the next day. I get nothing done, I’m paralyzed by my anxiety, and it’s starting to affect my health. My blood pressure shot up to the high 130’s SBP, I’m starting to have rapid weight gain from poor coping strategies, and my overall demeanor and appearance is reflective of the cognitive dissonance that’s happening in my mind.

Speak to your PCP about this. It might be a mistake to associate your anxiety strictly with this job; this may be more of an exacerbation of chronic anxiety, uncertainty, indecisiveness, etc.

It seems like people should seek to mitigate what they can (optimize underlying issues) before trying to make important life decisions and before deciding that one is this or that. Meaning, it might be best to optimize any physical or mental health concerns before deciding what you are or aren't cut out for over the long haul. If you don't, you may decide that you aren't cut out for med-surg and subsequently that you aren't cut out for the next 5 things you try either (or that they aren't right for some reason). Don't make the mistake of blaming your discomfort on t, then u, then v, then w, x, y and z. Address the heart of the matter and then see where things stand.

Plus you don't need to suffer this way.

7 hours ago, nursejo said:
I have a work flow sheet that maps the hours during my shift as a checklist, a brain for each patient, and an amazing preceptor who is firm, organized, and the kind of nurse that I want to be one day. I have a workflow schedule to keep me on track for the day. I’m never short of resources (access to people, policies, etc.).

These are all very good things that aren't as easy to come by as one might think. Especially the level-headed preceptor and the resources.

7 hours ago, nursejo said:
I feel like I’m too slow for this unit. I’m always playing catch up with my charting, I feel like I don’t even really know my patients because I’m so limited in time and attention due being such a task-oriented unit.

What you can't see is that many new grads feel this very way. And many people in new situations do too, even if somewhat experienced. Nurses' time is severely limited in almost all acute care bedside positions, and some other areas as well; LTC is notorious for lack of time and resources.

8 hours ago, nursejo said:
I’m terrified of hurting someone, I’m terrified of jeopardizing my license, and I’m terrified of disappointing myself, my preceptor, my educator, and my director.

So you have the makings necessary for becoming an excellent nurse, if you can harness your conscientious nature for productive use. ?

8 hours ago, nursejo said:
I’m just so full of doubt and guilt. The anxiety is wearing me out. I don’t know if this is where I’m supposed to be. I don’t want anyone to get hurt because of my incompetence.

A little doubt is normal. Almost any guilt, is not. You haven't described one thing worth feeling guilty about. Acute care nurses are not in control of the situation that leaves us with less time with patients than we would like; that is almost solely the result of the actions, decisions and motivations of others. You don't have enough perspective/experience to see that there isn't a single thing in nursing/patient care that should make you personally feel guilty right now. The question is, can you get to a place where you are doing your best, learning, helping people, and not trying to take responsibility for things out of your control.

8 hours ago, nursejo said:
In all honestly, I want to serve marginalized communities...families with limited resources, to educate, to screen, to prevent disease and illness, to do health fairs, to study diseases and how to mitigate/treat, to develop policies, to give medical aid to people who are limited in access and courage to seek medical aid.

It's possible that your best bet is to get some solid m/s experience to lay the foundation for a position out in the community where you will be independently assessing needs and recommending plans for how to meet them...without a ton of others' expertise and resources immediately at hand.

Unless you have been notified through meetings, concerned conversations, improvement plans, etc., that you need to step it up, then you are doing fine with your orientation. [I realize you don't feel fine, I'm not trying to say that]. Maybe it would help you to take 5-10 minutes to low-key let your preceptor know the basics of how you are feeling and ask whether you are pretty much on target. I suspect you will get some reassurance. Your brain chemistry may not allow you to feel reassured, and that is why I recommend meeting with your PCP ASAP.

This doesn't sound like it's bound for failure to me, but you must take some positive steps in your own best interest, for your own long-term well-being.

???

Nurse BB, BSN · Dec 29, 2019

Hi there @nursejo,

I'm going to tell you what I tell the new graduate I'm currently precepting: BREATHE. Pause for a moment. Let's just focus for a moment on the fact that you are SO brave to step onto a Med-Surg floor to gain experience that you'd like to have under your belt later on!

Let's think about this: You're four weeks in. Count how many shifts that is. 12-15? This is your first time working in Med-Surg in your career? It sounds to me that you're in the toughest part: the beginning.

As adults, I think we sometimes forget how difficult and uncomfortable learning something new is! We do it NON-STOP as children. We learn how to walk, how to talk, how to jump, how to ride bikes, how to share and play with others, how to read and write, etc. The list goes on. By now, as adults, we have our fair share of knowledge under our belts and hopefully we're functioning on the daily without that steep learning curve. But now, you're taking on Med-Surg nursing. That is SO vast. You're thrusting yourself full force into a very steep learning curve that occurs in a very fast, sometimes chaotic environment! You have your new coworkers whose faces you're trying to put names to, you're trying to identify who your resources are, you're learning everybody's unique personalities that you're working alongside, you're trying to locate where supplies are kept, you're developing a med-surg work flow for the first time, being faced with challenges and obstacles (such as all the patients requiring help at once, encountering diseases or conditions you're unfamiliar with, practicing skill sets you haven't touched since nursing school), the list goes on. Your brain's wheels are turning FAST, you're working overtime mentally to keep track of all these little nuggets of knowledge and attempting to connect them all together so that you can work with ease. Nothing right now probably feels easy, and that's okay. It likely won't for some time. My best advice for that is to be patient, continue to learn each and every shift, and allow time and practice to connect all those data points together. That is learning. It's making neural connections - and building those is WORK.

So don't panic when you feel like it's not natural yet. It's because it's probably not. But if you quit now, you'll never get to cherish the feeling when one day, you make it through a shift and realize you didn't panic when four patients needed something from you at once while your phone was ringing and you were a little behind in your charting. You'll miss out on being able to appreciate the journey you've walked and the growth you've accomplished. You're at the beginning of the story right now, so allow it to play out. Keep doing your best in the meantime!

You also talked about the racing mind. Calming that is a skill that is learned with conscious practice. It's not there right now and that's ok, but be reassured that it CAN be there. When I first was hired on a cardiac telemetry floor, my palms were sweating, my eyes were filling with tears, and my heart was thudding in my chest. It was sheer panic that took over during my first crisis where a patient was struggling. One of my coworkers saw the panic and said to me, "Breathe. One thing at a time. That's all you can do." She was right. The way you get through a nursing shift on a med-surg floor with lots of demands is one thing at a time. Empty your bladder. Drink a sip of water. Then take inventory of what needs to be done, and start. As you go, check it off. More things will get added to your list - that is normal. That's ok. Just continue to work and check things off. Eventually the hours of the shift come to an end and somebody else takes over where you leave off. It's a 24 hour business. Tortoise and the hare (just don't be a complete tortoise LOL. Move at a fast but steady pace haha). Regarding that speed - that will come with time and practice too. Nothing is fast in the beginning. I sent my students and new grads off to find a blanket and they come back 5-10 minutes later. That's how lots of folks begin. It won't always be this way.

So let's talk about before your shift - Kind of like how we know it's a good idea for healthy sleep hygiene to have a bedtime routine, use trial and error and find out what is a great pre-work routine for you. I work 8 hour shifts, so mine might look very different from yours. But I do things I love before work: I walk, I run, I have coffee with a family member or friend, I clean the house, I go to a piano lesson - but then, 1.5 hours before I need to leave for work, I begin my routine. I shower. I pick out my scrubs. I get myself dressed and looking shift-ready. I pack my lunch. I fill my water bottle. I pet my cat and dog and kiss my husband goodbye. I listen to something that lifts my spirits and sip on a cup of Chai as I drive. I tell myself that whatever happens this day is meant to happen. I tell myself that it will all somehow work itself out. As I ride the elevator to my floor, I tell myself to be brave, I slap on my smile, and walk out with confidence. Sometimes, I pray. But no matter what, before that 1.5 hour routine begins, I leave work at work. I am just me that morning. I don't sit around and allow myself to worry and stress about what's going to happen that day because it robs me of the joy I have elsewhere in my life. Harness those thoughts and control them, then get into the zone as you begin your routine. You've got this!

You also mentioned your fears - you're terrified of x y and z. I'm going to encourage you to do a drill I had a nurse coach once do with me after an incident at work that caused me to have many of the fears you named. On a piece of paper, answer each of these: What will actually happen if I lose my license? What will actually happen if I let down my preceptor? What will happen if I disappoint myself? What will actually happen if I bring harm to a patient? For me, my worst fear was losing my license. The drill caused me to write down and name all the possible outcomes of that - the guilt, the job loss, the identity loss - but ultimately, the nurse coach pointed out to me: "You lived life before you were a nurse, before you had a license. You could live life again without it. You'd face each crisis at it came, deal with it, and then life would go on. That's the reality. Losing your license is terrible and I hope it never happens. But face that fear on paper and realize that you're capable of handling that fear if it were to be realized. Don't let fear paralyze you." She was right. I stopped letting those fears dictate me at work or before my shifts. I told myself I would do everything in my power to be safe: I set my bed alarms, double checked my orders, carefully gave my meds, and stopped fearing the what-ifs. Deal with those fears if they are ever realized. In the meantime, let them go. They are not happening right now in this moment. They can't hurt you. If they were to happen, you're capable of facing them. Again, You've got this!

You mentioned that your strength may lie in another field. That could be true. Maybe you'd make a stronger dialysis nurse or home health nurse or hospice nurse. Maybe you'd make a better school nurse or nursing school instructor. Maybe maybe maybe. But you're four weeks in! How do you know you won't be a great med-surg nurse? Give it time! Allow yourself to develop expertise in this area. You're only in the beginning now, so keep that perspective. You're reminding me of when I began the martial arts. I saw this AMAZING kickboxer perform her black belt test. In classes, when I learned the combos she did in her test and performed them with less than a quarter of the finesse that she did despite giving 100% effort, I began feeling discouraged. There's only so much that spirit and enthusiasm and hard work can give you at the beginning. The rest is literally practice and time under exposure and that can't be rushed. Now, ten years later, I have people who say "I want to be like her," and feel down when they can't do it like I do it. But what they don't see is the four nights per week of training I've done for the last decade, just like back then, when I wanted to be just like that girl I saw in her test, I didn't see the countless years that she had trained with all her focus and all her might. You've got your white belt in med-surg right now. Keep showing up to your shifts. Keep practicing. Keep sticking with it. Then decide if you're cut out for this or not. It's too early to tell right now! Put a pause on looking for other jobs, that's my encouragement. Give this one a run for its money before you jump ship. If one day, you after really giving this one a concerted effort, you wake up and realize this just isn't lighting you up the way serving marginalized communities does, then maybe it isn't right for you. OR maybe you can do both. Once you're trained and on your own, you'll see the movement within your organization. Maybe a new schedule will open up with less hours. You can free up some time to pursue another time of nursing that lights you up. You can be gaining experience in Med-surg which was one of your desires, and fulfilling a passion in another area. Or maybe you'll find out that one day, med-surg will light you up. Again, it's really tough to make that call right now - you're in the most stressful part of your career- learning all the pieces in the beginning. That's the tough stuff. Be patient as you go through it, and get comfortable with being uncomfortable. Don't let it cause you to panic or deteriorate. That's a somewhat normal feeling in my experience whenever we're outside our comfort zone and trying something new. Be friends with that feeling.

At the end of your shifts, don't go home defeated. That's easy to say, I know. But at the end of your shift, instead of focusing on what frustrates you, on what you didn't do right or fast enough, or who you let down, focus on what you learned. Focus on ideas to try on the next shift - tell yourself, "My med passes were all a little late today. Maybe tomorrow I could try checking the blood sugars a half hour earlier and see if that helps those med passes go quicker." Rather than putting yourself down for those meds being late, observe it, troubleshoot it. Becoming defeated by it doesn't serve you. Focus on thoughts that serve you. Let these thoughts happen on your drive home, however long or short that is. When you get out of your car, leave work there. Just leave it. I know again, that's easier said than done. But bringing it home with you, dwelling on any defeats or stressors, that's going to steal away from the parts of your life you need to enjoy and love, whether its your recovery time between shifts, your time with your family or pets, or your time doing a hobby or watching your favorite shows. Don't spoil those good things by thoughts that bring you stress or worry. Harness those thoughts and leave them be. The day is done, what's done is done, tomorrow's shift is a new one, and you can try again.

Keep in mind that when our brains are tired and exhausted, it's easier to fall into defeat. At the end of your day when your mind is racing 100 miles per hour on that steep learning curve, with all the demands placed on you that the shifts bring, you're going to be more prone to sadness or despair. Tell yourself when those feelings come to take care of yourself and get some sleep. If it still feels just as crappy in the morning, then address it. In my experience, the majority of the time, I wake up feeling like my worries and stress or sadness from the previous night have fizzled away.

My last plug is going to be for a podcaster I found who I love love love. I listen to her podcasts on walks, while shopping or cleaning, or in my car on my way to work. Check out Abby Sanchez's Thriving Nurse Podcast or on her website. You won't regret it. Good luck on your nursing journey and welcome to the Med-Surg ranks!

BoldNurse · Jan 2, 2020

The good news is you're totally normal. As a new nurse and in a new job, feeling totally incompetent and overwhelmed is EXACTLY how you should be feeling! It will get better with time, but for now, just get comfortable with being UNCOMFORTABLE. Sounds weird, but I promise you, that is the way to continue to grow and challenge yourself. There's a podcast I recommend called Thriving Nurse that talks all about this. I think you'd really enjoy the episode called New Nurse Thought Traps. Hope it helps and best of luck!