New Grad Stress

Fiona59 · Jan 1, 2012

I have to ask, how did you manage to finish nursing school without performing your skills on a "real" patient?

Where did you do your final placement? What skills did you perform there?

I don't mean to sound harsh but when you are hired as a new grad, you are expected to be ready to work. Orientation on non-specialty units is geared at learning the unit's routine and paperwork, not a time to consolidate your skills. As a new grad in LTC, I had three day's orientation and was left to sink or swim. The same orientation when I moved to acute care.

Are you a casual on the medicine unit? Because it sounds like they are dumping their trainwrecks on you. If this is the case you need to talk to the staffing office's manager. He/she may be able to arrange orientation shifts for you on a different medicine unit. But you have to be aware that these shifts aren't for you to learn your skills.

Whenever I've had to use a skill that I haven't performed in a long time, I ask another floor nurse if they'd mind coming in with me for support and an extra pair of hands if needed. Usually most people are good about it, but it can't become a regular thing.

Does your unit have a CNE? If so, ask them to stand by while you do your skills.

I honestly feel that your university short changed you if you were never permitted to perform skills on a live patient. It's really not your employers role to have to reteach you.

Ashnurse · Jan 2, 2012

I did my clinical placements on a medicine unit, but the hospital has a policy that students are not allowed to do certain skills (IV insertions and trach care), since you have to be an RN to do them. Besides those skills I have done most skills while in University and am confident in other skills (ie, med administration, dressings, etc). I have asked nurses to come in the room with me for assistance, but I defiantly do not want to keep doing this. I understand that it is not there job to be teaching me and I do not expect that from them either.

Now that I am working at this hospital I am finding it difficult to do this skills that I was not allowed to practice as a student without a proper orientation to them and I feel unsafe. I have already talked to my manager about this, but did not get much of a response or help. Since, I am on a casual contract my manager says I will not get a longer orientation that full time staff get. I will look into talking to the nurse educator for help. I was also thinking about talking to my manager to see if I can work night shifts only on medicine as it is less chaotic, which may allow me to take my time and become more familiar.

Fiona59 · Jan 2, 2012

Which province are you working in? Trach care was considered a basic skill when I was a PN student. IV insertion usually isn't done, BUT when hired we are buddied up with the CNE to get the required three supervised starts to be OK'd to start on the floor.

Get a hold of your CNE. Night shifts usually are not less chaotic. Staff ratios go down. Instead of 3-4 patients on a surgical unit on days, night nurses are required to take 6-9 patients (usually without an NA).

chubby40 · Jan 2, 2012

Hi Everyone. I graduated from my BSN in May and I just started working on a medicine unit and a long term care unit. Most of my shifts are on the LTC unit and I really enjoy it. I find it challenging, since I am a new grad, but I am able to get through the day and learn something new everyday.
My shifts on the medicine unit are a different story. The unit is very busy and there are so many skills to be performed everyday. Most of these skills I have never done on a real patient before and I am having extreme anxiety everytime I think about having to go there to work. The staff are not very helpful. The other day they assigned me four cardiac clients with telemetry/chest pain/IV meds, etc and a post-op client with a trach. When the nurses gave me my assignment they started to laugh and said "good luck".
I was so upset after this shift I called and cancelled my next shift. I do not know what to do? I want to be there for all the learning opportunities, but at the same time I feel so unsafe practicing there. I have brought up the issue to my manager, but was refused more orientation at this time. I just feel so lost. It took me a long time to find a job and I don't want to quit, since I love the LTC unit I am working on. I just feel so lost on what to do about the medicine unit and practicing there. When I am on my days off all I can do is think about work. I am constantly looking up information or practicing dosage calculations, so I don't have to ask for help from an unfriendly co-worker. I have never felt so alone at a job and the worst thing is this is a job that I need some guidance at.
Sorry if I sound annoying. I just don;t know where to turn to for help. If anyone has some advice I would really appreciate it.

You're not annoying, you are going through what a lot of us go through fresh out of nursing school. I am sure if you made it out of nursing school you have heard the term "nurses eat their young" It's sad to say that we complain about the doctor's but in fact we are our worst enemy because we are not very supportive of each other.

In terms of your nursing skills i can totally relate because not every skills you get to perform during nursing school, even if you do perform every skills you do not do it enough to be comfortable, this is what on the job training is about this is when we go from novice to expert, even when you become a season nurse you will find this as you change specialty or relocate and therefore, force to change job. I have been an RN for about 9 years and what help me when i started was the fact that i had excellent clinical teacher's, i was also a Lab Tech, Medical Secretary and nurses aide, which help me a lot with the medical terminologies, moving and positioning and diagnostic testing, even than it was still a challenge.

My suggestion to you is that if you like General Medicine look for another General Medicine Job at another hospital, you don't want to be somewhere where you don't have the support as a new grad, beside in nursing just like anything else in life you of to find your niche. Furthermore, it seems like you're stress this can cloud your judgement and affect your ability to practice safely.

Keep searching not all of us eat our young, somewhere out there in this profession of ours you will find the support you need that will bring you from a novice to an expert.

Fiona59 · Jan 2, 2012

Chubby, where do you work?

Canada is different from the US. New grads rarely get prolonged orientation periods because they are usually hired by the facilities that hosted them as students. Only specialty services such as the OR, Dialysis, ICUs offer prolonged orientations and those slots are often taken by experienced floor nurses.

Floats/Casuals are usually only given five shifts on a unit. Three weeks is unheard of in my hospital. We dont have unsafe nurses or unsafe units. We just have to deal with the cards we are handed and battle on.

Ashnurse · Jan 3, 2012

Thanks for all your replies. Thank you Chubby for being understanding and giving me some encouragement. I know there are a lot of great experienced nurses out there and I'm hoping to work with some soon, so I can learn from them. I have decided to start applying to some specialty units at my hospital (peds & psych) that are going to be hiring in the next month or so. In the mean time I will just stick it out and do my best. Medicine was never my favourite area, but I thought it would be the best area to start for practice and learning time management. For the most part I feel confident in basic nursing skills, but I am nervous about working in an area that did not let me practice certain skills as a student and then expect me not to have a proper orientation to them. I will miss working on the LTC area of this unit if I do get a new job in the next few months, but I really want to work in supportive environment.

I think that the medicine unit is just so busy at times and nurses who work they do not have the time to help new nurses. I understand that and I am not blaming any of the nurses I work with. I know they are busy and I do not want to be extra stress for them. I have talked to a few nurses on the peds floor where I am going to be interviewing and they have a more comprehensive orientation for new nurses to their unit and the unit is smaller, so they find they are able to work together more as a team and help each other out. I will keep my fingers crossed and hope I get one of the positions they are looking to fill.

Dela RN · Jan 3, 2012

What you are feeling right now is completely understandable. I graduated about a year ago and let me tell you, that first year of nursing is super hard...(As if it wasn't hard already?) There's a lot of research about transition shock and new grads. You can search some articles about it and the name Judy Boychuk Duchscher. You can also go to her website, Nursing the Future. BASICALLY you're going through transition and her research shows that a lot of new grads struggle with transitioning from a student nurse to a professional nurse. I remember one time, when I was struggling with my nursing job and I started seriously considering quitting nursing and beginning a new career so I picked up my Nursing the Future book for guidance and in the chapter about being 3-6months pst grad, it stated something a long the lines of you will consider quitting nursing. After that I laughed and just continued chugging along.

By the one year mark, I felt okay at my job... Obviously not super confident because there is always a lot to learn but competent enough not to stress about going to work every day. There was a time too after I had first graduated where I would feel anxious before work and after work. I would stress out about work even on my days off too. To help with my anxiety, I did a lot of self-learning. I continued to read up on my patient's conditions and skills that I might have to perform. It's not that I didn't know them but it was more so a way of calming down my anxiety. Everyone likes some bit of control and this was my way of gaining some.

If it makes you feel any better, I didn't do trach care as a student either. I wasn't allowed as a student. I saw people do it and my educator taught us during orientation but obviously, there's more anxiety when you have to do it on a real live patient instead of a doll. The first time I did it, I asked a fellow nurse to come in with me. Lucky for me I work on a great unit where they understand that new grads need extra support. You're not just new to the unit, you're new to nursing! I also went a year and a half into my nursing career before ever starting an IV. (I work in pediatrics with a lot of chubby babies where even experienced nurses sometimes had difficulties starting IVs).

In regards to your patient assignment. Could you talk to your charge nurse about this especially if it keeps on happening that you're getting all the "hard" patients. Just makes you wonder if someone is being malicious or if that's just the acuity of your unit and there's nothing you can do about it. I know that on my unit, they try to give new grads or new hires easier/less acute patients.

I know how you feel about asking questions... I think for the little things that you kinda know but want to make sure, try to find out the answer on your own before asking. Anything else try to find someone who likes to teach! Most importantly do you have someone you can vent and debrief with? Could you find a mentor on the unit?

It's really too bad some experience nurses aren't receptive to teaching. They say from competent nurses rather than expert nurses make the best teachers. I think it's because they know what they're doing yet they still remember what it's like to be new at everything! So sorry about my ranting, keep on chugging away. Take advantage of learning opportunities and getting more skills.

akcutie238 · Jan 3, 2012

i would like to add my 2 cents on the situation. I am also a new nurse and just got off orientation a few weeks ago. I would like to say for one, if you are working prn or very part time on this unit, this makes it ten times harder!! i did that as a PCA and would always forget things because you dont do them nearly as often and cant really get them down as well because you dont work as much. i have also done what you are doing and tried to juggle different jobs. I think this also adds to the hardness of being a new grad. I would say if the hospital is really where you want to be, try finding ONE FULL TIME job and get a really good orientation and ask lots of questions. being a new grad is hard enough to learn everything, let alone only being there once or twice a week and trying to retain everything. It definitly takes getting used to a routine to be sucessful. Also, many new grads feel this way and if you cant get help from your coworkers in helping you perform new skills then i would definitly look into another hospital or unit. i think being new is very hard but also have really great coworkers to help me out if i need it. maybe suggest that you can come in and shaddow a couple of more shifts without pay?? this will at least make you appear that you really want to learn this stuff and they wont have to worry about it costing them extra money. Good luck in whatever you choose to do and stick with it! Dont worry about everyone saying that you should allready know these skills, bc i have learned from experience that the real learning begins once your on the job. anyone wil tell you that!!

i would like to add one more thing. you say during your days off you are stressing and looking up skills/diagnosis's. I actually took the advice of the education person for orientation and that was to not do this. he said let your days off be your days off. the reason he said this was because one of the other new grads stated to him that she was doing this and he encouraged her not to spend hours doing this. I actually took his advice and only looked up breif stuff to get my assessments down well. at this point, the other new grad ended up quiting and im still there. im glad i took his advice so my head wasnt spinning constantly!

ButtonNose · Jan 4, 2012

I understand where you are coming from when you say you are overwhelmed and are feeling unsupported as a new grad. I graduated early this year and have started working at a hospital through the Health Force Ontario new nursing grad guarantee. This is considered an 'orientation period' which is about 3 months of guaranteed full time work in an Ontario hospital for new nursing grads. During this time I work with a preceptor and together we support each other and learn from each other.

I have been on 2 units so far and can honestly say that it's your co-workers who make or break your new grad experience. Some nurses are so into their own ways they 'eat their young', sit back and laugh at us to see if we can handle the new work. Other nurses are more patient and are willing and eager to help us when they can. I would try to switch units at this point because it seems like the medicine unit it too heavy for you right now and the nurses too unwilling to help a new grad in transition.

In school you're right, as a student we really get much hands-on experience in terms of IV insertions, trach care, and more invasive procedures... these are things we learn on the job as an RN. I'm really sorry that you don't have enough support to guide you during your career as a new RN (in the unit and on the forum...) hopefully you can find a new unit and helpful coworkers in the future. Good luck!

newnursejoan · Jan 9, 2012

I totally agree with you that the nurses on the floor can make you or break you. I have been on several units, where there is some kind of lateral aggression between older nurses and younger ones, specifically new graduates. Its the strangest thing I've ever seen, and quite common in my experience. I think you need to find a unit that is staffed with a good team. Older nurses forget what it is to be a new graduate and sometimes just need to lighten up.