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New grad sinking fast

First Year   (6,812 Views 48 Comments)
by Sheika34 Sheika34, BSN (Member)

591 Visitors; 17 Posts

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You are reading page 3 of New grad sinking fast. If you want to start from the beginning Go to First Page.

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I'm new myself. The one take away from every interview I had is that there is an orientation and some individuals take longer than others. I'm sure your preceptor has seen nerves before. It's only day 2. It took a lot to get you on board. You've been given a lot of wonderful advice. I thank you for your post because I'm going to be in your shoes in a few weeks and my nerves are getting to me too. You're not alone. I beat myself up too. Breathe... In a few months you'll be looking at this post in a new light. :)

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1 Like; 106 Visitors; 5 Posts

First of all, you are new grad!!! It is expected you have to learn a ton of things. Almost all nurses started like that. Do not panic!!! True is that nursing is getting more and more overwhelming and it must be understandably harder for new people to flow in. Try to create some system in the madness. One thing at the time. I also started as a nightshifter at the similar type of floor. I feel your gasps for air as you sinking. Calm down. Grab a coffee, eat well, sleep well, do not stress, get yourself a uniform with at least 5 pockets on (will explain), so calm down you have a preceptor. Try to learn as much as you can. I am not saying this is best approach but I tell you how I did it, if it works for you great. I came, (like half hour earlier at least) look at assignment (it usually changed anyway as the seniority nurses quarrel about who is going to have easy patients, so be ready to be flexible) and I take large sheet of paper, (here is where the routine part starts to make it a bit easier) patients sticker and log in the pc and look up all info and write on my paper - as I divided patient by patient (horizontally) each had their own column (with status - you do not want to pump chest of the patient who is DNR or call code blue on them), I would write who is the family plus contact (in the night they tend to do the pc maintnance an you wont have an access), where they came from and where they will go back eventually if known, what is there going on now, history, orders, VS (and frequency), I looked up their labs and checked what labs were ordered and noted it (sometimes I had a plastic bag for all supplies for each patient ready, I divided it also by time (vertically) - so I knew that at 2000 I have to make an assessment and address all what is going on with pt now, I knew what meds needs to be given at that time (and I pulled usually the PRN meds too - sleeping pills, pain pills if allowed, quifaneisin etc. as it is time saving - patients tends to ask you for them so then it takes you lot of time to lock everything, go back pull it, go back to patients room...yadayada yada), so when I walked in the room and assess patient I would scan them and pass the meds right away, (check mark, one man down) I would note things as BS checks - what time (midnight) other had it at 0400 or at 0600, restrains, I had noted which patient had folley - so I would do UO at 12:00, 04:00 or hourly if order says, who was intubated and needed oral care, what is their tely status - so you know the step down you need to do every two hours, the tely every four...but you still round in between... So you go by table and address all tasks at the given time, rounding patient one by one. I carried the sheet on me, and noted there everything what was going on with patient what they wanted. Don't be shy to tell your tech, you needed pillow, water, or BS on some patients. Try to call doctors after you assess patients if you need any order so you spare yourself some nasty yelling if you got to call at 0200. At the same time keep and eye on the strips even if you have a tely tech. Now the pockets on the uniform - yes, people laugh at me, but then trust me they learn to appreciate it. So in one pocket you put several flushes (as you come at 2000 or whenever your shift starts and you round on patients - flush IV as you flashing it check also when you need to change it or dressing on piccs, or start new IV if your IV can't be flushed as no one did it for past few days - you know you need new one rather sooner than later there is nothing worse than patient coding with no access...), that means you can have at least one IV starter kit, the needle and J tube on you in another pocket, one pocket for an extra gloves, stickers for tely box (damn those patients love to pull them off), tape, 2x2 and 4x4 sterile gauze, few blood draw ampules (rainbow - each of all colors) and butterfly and other things you learn to be useful and time saving to carry on. So when the surprise arise - you can just act right away, no need to run around looking for the supplies, finding they run out and you need to go to another floor... and other pleasures of nursing. Be nice to yourself and carry the basics on you. Now that was for detangling the jungle of orders. For the PC - just come one day you are off and just practice searching your patients, orders, meds. Soon you will be pro in meds administration - it is just practice, carrying out the orders as folleys, dressings, and this all takes time and through experience you will find out how things works, you will learn on your own how to get this or that or how to page on your own. (EACH time write it down, so you can look it up and don't have to slow down your preceptor). When it comes to meds error - yikes, but it happens to everyone, just concentrate when you do meds and rather recount it twice or take your time, pay attention, you do not want to kill someone, really really pay attention what you passing, why, and how much and what time and if you have the right patient. Everything will work out. And if you are not seeing any progress after few months then you can look for rehab floor or something less overwhelming. Good luck

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1,329 Visitors; 31 Posts

Your first year of work is your last year of school. You will get it-trust me. Ask lots of questions and hang in there!!!

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Ddestiny has 6 years experience as a BSN, RN and works as a ICU RN.

13 Likes; 6,876 Visitors; 248 Posts

It sounds like your biggest problem isn't the skills, or the knowledge base, or the lack of experience.

It's comparing yourself to how you EXPECT you should be doing.

This is your first week at your first nursing job.

Nursing is a field where we learn SO MUCH on the job. You learn a general foundation in nursing school but the bar to pass the NCLEX states you are minimally safe. Everything else you have to learn on the job.

Stop comparing yourself to this ideal you have in your head or your perceived ideas of how your friends/classmates are doing. If they're not freaking out everyday, then maybe they're arrogantly unsafe? Who knows, but don't compare yourself to anyone, nonetheless a story someone is telling you when you're not seeing how they're screwing up along the way, too. It's expected for a new nurse to be anxious, make mistakes and to ask a lot of questions.

Along with gaining this experience, the next best thing you can do for yourself is to learn how to *tolerate discomfort*. The first year of being a nurse is very uncomfortable. Even more so than nursing school, for many. Don't expect it to come easy. Be okay with learning things you didn't know and even being wrong. The learning curve is steep no matter the specialty in which you start.

Stop worrying if the patients can tell if you're new. Let them know that if you don't have an answer to a question then you will find it for them. Let them know you're invested.

Be willing to ask questions. A good unit culture is one where you can continue to always have a resource, either your charge nurse or another experienced nurse on the staff. Find those people while on orientation so you can seek them out later.

Also, stop focusing on the hands-on skills. "I have to be shown how to use the pumps multiple times." "I didn't connect the Yaunker right." These are the easy fixes. If you were my preceptee then I'd show you how I learned to set these up and any little tricks I picked up along the way, but ultimately the focus on these little hands-on skills is not the most important piece of being a nurse. With enough practice you can train a monkey to insert an IV. What you can't teach it is critical thinking and the medical knowledge required in order to actually have critical thinking in a medical setting. You have your foundation in that or else you wouldn't have passed nursing school and the NCLEX. This knowledge is much harder to teach because it requires more than just showing you a skill a couple times, you have to actually put effort into learning it and retaining it over time. The skills and the products will come and then they'll be different every time you change jobs and have to learn a different pump, a different way of finding which doc you have to page, how to find their number, what the facility's policy is for X, yatta yatta....

We all had this same year. Some forget that fact faster than others. Remember how uncomfortable this is so later when you're precepting you can meet these new nurses where they are and be patient with them while they try to connect the dots.

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caffeinatednurse has 3 years experience and works as a Registered Nurse (RN).

3,606 Visitors; 253 Posts

Hand-holding is normal.

Feeling uncomfortable in your new role is normal.

It's too early to know whether or not you're cut out for this. Remember to breathe, try to learn as much as you can, and ignore the gossip. Chances are, you're being way too hard on yourself. The only people you should be concerned about right now are yourself, your preceptor (since they're the one teaching you), and your patients. Try not to worry about what management thinks about you - they know that you're new and that you're adjusting. Those other nurses? They may or may not stick around, and it matters none to you either way.

You've got this. ;)

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cmueller has 1 years experience.

297 Visitors; 6 Posts

You'll get there! It helped me to find a good report sheet to use on my people. I could note med times, key things to remember, and everything I needed to remember to chart about my assessment. Visually reorganizing helped me a ton.

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588 Visitors; 16 Posts

It's normal to not know and to feel incompetent. Trust me we've all been there.

Okay, you didn't perform so well at your clinicals. But you will improve. What you need to do is after each clinical, go over how your day was. What went well and what didn't. How can you make your work flow better and how can you had handled things differently. If you're taking a long time with looking up medications this time, when you go home look up the same medications and try to familiarize yourself with them. Next time, when you are giving out meds you will probably recognize them from before. Also, look up at home what you had questions about of your previous care; ex. nursing interventions for chron's disease. Be proactive in improving your skills.

As a new nurse, it's okay to ask for help. Do not ever push yourself to take on duties that you're unsure of-- ex. putting in a NGT for the first time. You rather that your preceptor hold your hand through this skill than to cause a pneumothorax and cause the pt respiratory failure.

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591 Visitors; 17 Posts

First of all, you are new grad!!! It is expected you have to learn a ton of things. Almost all nurses started like that. Do not panic!!! True is that nursing is getting more and more overwhelming and it must be understandably harder for new people to flow in. Try to create some system in the madness. One thing at the time. I also started as a nightshifter at the similar type of floor. I feel your gasps for air as you sinking. Calm down. Grab a coffee, eat well, sleep well, do not stress, get yourself a uniform with at least 5 pockets on (will explain), so calm down you have a preceptor. Try to learn as much as you can. I am not saying this is best approach but I tell you how I did it, if it works for you great. I came, (like half hour earlier at least) look at assignment (it usually changed anyway as the seniority nurses quarrel about who is going to have easy patients, so be ready to be flexible) and I take large sheet of paper, (here is where the routine part starts to make it a bit easier) patients sticker and log in the pc and look up all info and write on my paper - as I divided patient by patient (horizontally) each had their own column (with status - you do not want to pump chest of the patient who is DNR or call code blue on them), I would write who is the family plus contact (in the night they tend to do the pc maintnance an you wont have an access), where they came from and where they will go back eventually if known, what is there going on now, history, orders, VS (and frequency), I looked up their labs and checked what labs were ordered and noted it (sometimes I had a plastic bag for all supplies for each patient ready, I divided it also by time (vertically) - so I knew that at 2000 I have to make an assessment and address all what is going on with pt now, I knew what meds needs to be given at that time (and I pulled usually the PRN meds too - sleeping pills, pain pills if allowed, quifaneisin etc. as it is time saving - patients tends to ask you for them so then it takes you lot of time to lock everything, go back pull it, go back to patients room...yadayada yada), so when I walked in the room and assess patient I would scan them and pass the meds right away, (check mark, one man down) I would note things as BS checks - what time (midnight) other had it at 0400 or at 0600, restrains, I had noted which patient had folley - so I would do UO at 12:00, 04:00 or hourly if order says, who was intubated and needed oral care, what is their tely status - so you know the step down you need to do every two hours, the tely every four...but you still round in between... So you go by table and address all tasks at the given time, rounding patient one by one. I carried the sheet on me, and noted there everything what was going on with patient what they wanted. Don't be shy to tell your tech, you needed pillow, water, or BS on some patients. Try to call doctors after you assess patients if you need any order so you spare yourself some nasty yelling if you got to call at 0200. At the same time keep and eye on the strips even if you have a tely tech. Now the pockets on the uniform - yes, people laugh at me, but then trust me they learn to appreciate it. So in one pocket you put several flushes (as you come at 2000 or whenever your shift starts and you round on patients - flush IV as you flashing it check also when you need to change it or dressing on piccs, or start new IV if your IV can't be flushed as no one did it for past few days - you know you need new one rather sooner than later there is nothing worse than patient coding with no access...), that means you can have at least one IV starter kit, the needle and J tube on you in another pocket, one pocket for an extra gloves, stickers for tely box (damn those patients love to pull them off), tape, 2x2 and 4x4 sterile gauze, few blood draw ampules (rainbow - each of all colors) and butterfly and other things you learn to be useful and time saving to carry on. So when the surprise arise - you can just act right away, no need to run around looking for the supplies, finding they run out and you need to go to another floor... and other pleasures of nursing. Be nice to yourself and carry the basics on you. Now that was for detangling the jungle of orders. For the PC - just come one day you are off and just practice searching your patients, orders, meds. Soon you will be pro in meds administration - it is just practice, carrying out the orders as folleys, dressings, and this all takes time and through experience you will find out how things works, you will learn on your own how to get this or that or how to page on your own. (EACH time write it down, so you can look it up and don't have to slow down your preceptor). When it comes to meds error - yikes, but it happens to everyone, just concentrate when you do meds and rather recount it twice or take your time, pay attention, you do not want to kill someone, really really pay attention what you passing, why, and how much and what time and if you have the right patient. Everything will work out. And if you are not seeing any progress after few months then you can look for rehab floor or something less overwhelming. Good luck

thank you so much for the advice!! I will definitely practice this! I probably could've gotten over some things but it was the med errors that were the most upsetting. I want to safe for my patients. & I don't won't them to suffer because I'm not able to get their medicines together.

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25 Visitors; 5 Posts

Every nurse was a new grad at one time. When I first started I had a hard time with most of the things you have mentioned. It will get better. It will get better. It will get better. What really helped me was my preceptor and I would talk at the end of our shift about what went well, what needed to be improved, and one subject-i.e. drips or something that came up and I didn't know- that I should go home and study so I will be more prepared next time. Hope this helps!

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591 Visitors; 17 Posts

Thank you everyone for the helpful feedback!! I'm going on tomorrow night with a better attitude & hopefully I can get my self together. Accept some of the humility pie someone mentioned because after some self reflecting that is part of the problem as well. I was jus so distressed because by this hospital standards I am technically behind in handling pts. But I also understand that I gotta go by what I can handle & keep the pts safe as priority. I just want to help ppl & I know there's hardly anything scarier than a nurse coming in & looking like they don't know what they are doing with you or your loved one. Thank you so much everyone for being so open with the advice.

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59 Likes; 3 Followers; 33,535 Visitors; 4,124 Posts

A new grad who hasn't completed orientation in 2 days. I really have heard it all now. Girl, please.

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Have Nurse has 25 years experience and works as a A.D.O.N..

4 Likes; 15 Articles; 7,668 Visitors; 713 Posts

OK, Sweetheart, settle down now. (Grandma here.) You are brand spankin' new to this profession, of course you won't get one patient to yourself just yet, especially on that floor.

It sounds from what minimal information I am reading here, that your anxiety level increases with an unfamiliar charting system, which results in tasks and such being such a struggle.

Many of us started out a bit clumsy when it came to equipment management. But I'll bet that the more you do it, the more proficient you will be. Please be kind to yourself.

This is normal. Perhaps it might be a prudent idea to see if you might get with the Nurse Educator in your facility to see if you could have some 1:1 charting practice on this different system.

As far as your Preceptor goes, if she forgets to do something, that's on her, not you. Part of Precepting is to prepare for those times when things might take a bit longer and plan accordingly.

(Preceptors shouldn't be carrying a full load while they are training others, but that's just my opinion.)

What I use to do was actually play with the equipment (stuff that we could open and not actually use on a patient, just did for "handling" practice.)

Volunteer to help with tasks as long as someone is there to check your work or guide you as you do. Example: Hanging an IV piggyback for instance.

If an IV pump alarms, and it isn't your patient, let that nurse know and ask to observe how she fixes it.

If suction equipment needs to be set up, offer to do under supervision. The more you offer to do, and do it well, the more trust you will gain from your peers.

You are going to be alright. Just jump in and start swimming! (And talk with your Nurse Educator regarding that computer.) Your not "sinking fast." You are just finding your "sea legs!"

"I'm not telling you it's going to be easy. I'm telling you it's going to be worth it." -Art Williams

Edited by Have Nurse
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