new grad struggles

[nursing6207]

I graduated in May and started my job in June after passing boards. The hospital I work at orients you to different units and then you are placed on a floor of your choice. I have accepted a position on a medical/surgical floor working night shifts. I am struggling tremendously. The whole night I have a huge battle with time. Every time I turn around hours have gone by and feel like I am fighting to keep up. I struggle with delegating bc I am scared the job won't get done. I fear NA's not reporting critical information and me not looking up the vitals or whatever it may be until later and seeing the information. I am having a hard time incorporating what I have learned in nursing school and applying it to the real world. I am constantly analyzing my charting for fear that it may not make since in court. And I haven't found a good way to keep my self organized throughout the shift. I thought I would be okay working nights but I have realized that half way through the shift my brain shuts off and I don't know if I am coming or going anymore. Any advice would be great. I am starting to question ever choosing this major. I come home everyday anxious, can't relax, emotional, and scared that I won't make it in nursing. Thanks!

[litlamp]

I completely understand and I am a new nurse myself.

Working on time management, as I have found out personally can have a huge effect on how your shift may go. For instance, when you receive your assignments and report, look at your patients and their diagnosis and current condition, which patients need to be seen first, set a priority list and try to go by it. Take a few minutes after report to set a list in order.

Although we use electronic charting and flow sheets I always carry a notebook with me along with my patient list and a copy of their paper kardex. I use a multi colored pen and for instance use red to make notations to check blood pressure if I received in report that they were running low, or for accuchecks if they are q2 .... whatever the case may be.

Granted, I'm still working out my own way but thats what it takes, trying different ways in order to find out what works for you and your patients.

I don't know your patient load but for vitals I get my vitals first thing at the beginning of the shift when making my initial assessment that way I know myself what they are. If your NA get the vitals maybe try talking to them? Give them the heads up based on what you receive in report.. ex.) "Sally, room __ or Mr. ___ has had a high blood pressure, could you let me know what his next blood pressure is?" or "Sally, could you please let me know when you get vitals on ____ or if it's at this range ______? I'd really appreciate it, Thank you". Or, when in doubt, get them yourself when doing your rounds, it may add a few minutes but it would save you the anxiety and you would have your patients information for yourself.

Keep in mind, and remind yourself often that there is a learning curve. It takes time, allow yourself that. Always ask questions. Do you have a preceptor or someone you could ask at work? Look at how your senior nurses prioritize and take a que from someone you admire as a nurse.

As to charting, chart what you see, be accurate, detailed, and confident. Be aware that it is a legal document but don't let that overwhelm or paralyze you. If you do a complete assessment, you have all the information needed to chart accurately. If in doubt, find that 'mentor' and have them read over a few entries to get feedback.

It takes time, let yourself breathe, hold your chin up. You never stop learning, and thats a good thing!! You can do it.

[ifyouwereme]

My heart goes out to you, sister. I am sure everything will be okay, but it is nice to read a post about something other than salary and other complaints. I would be glad to have you as my nurse because you really seem to care. Be good to yourself.

[Ilithya]

My question is have the CNAs given you any reason to think that they wouldn't know when to report a vital? I don't know about your facility but at mine the CNAs are great. If your not sure than talk to them about parameters to report to you. You can't do everything yourself.

[nursealanarae]

I hear ya! I am in constant fear of what I am doing. I am always rushing around trying to get things done, and then realizing the things I could have done or should have done when I get home. Sometimes it's good to just take a second to sit down and collect your thoughts. Make a plan of action for each patient and set goals for your shift. I suggest looking at your vitals first thing and when you give report to your CNA, tell him/her what you want a heads up on. You have to think that they are licensed as well and that you cannot tackle everything by yourself. You are all working as a team and they are there to help you and the patient. Also, what I have been doing is waiting to right my notes after I give report at the end of my shift. You are able to calm down and think straight because your shift is over and you can reflect on what has happened throughout the night. Best of luck! Don't worry, it gets better :)

[DMae]

I know the first year is supposed to be the roughest, but it's physically taking its toll. I have a couple weeks left of my ICU orientation and I'm freaking out. Granted, this week was the most stressful. Last night though, I had to go home because my anxiety was freaking debilitating. I ended up throwing up, getting cold sweats. I was shaking. I don't know what to do with myself.

[mama_d, BSN, RN]

Take deep breaths.

You will learn in time which techs you can trust and which ones you have to check up on. Unfortunately, there is no easy way to figure this out, so it does take some time.

Pick the brains of the nurses you work with as far as organizing your information. It may take quite some time before you come up with the way that works best for you. My floor has report sheets you can print off of the computer with information on about the top third and lines to fill in for a review of systems. I then draw a line about a third of the way from the right side, and divide this section up into four smaller sections (basically, one column wide by four rows long). The first box gets notes as far as what needs to be clarified for paperwork issues: code status, flu/pneumovax status, height, weight, and if any consents need to be obtained. The second box is for labs I'm responsible for in my shift. The third box is for med times, with a star next to the time if I need to check vitals before giving. The fourth box is for my assessment. In the remaining undivided space is where report goes, along with anything I need to follow up on jotted down in red. If there is anything I need to chart on beyond assessment as the shift goes by, it gets written at the bottom of the sheet (like refused meds, MD calls, etc).

As far as my time management goes, in a previous post I listed how I have my typical shift organized here:

https://allnurses.com/forums/f8/new-nurses-considering-quiting-332429-3.html

Good luck, hang in there, it takes most people at least a year before they feel comfortable working as a nurse. It's a huge adjustment to make to be on your own, and nursing schools are not well known for teaching time management and organizational skills that are beneficial in the "real world".

[joseash]

Time management is a learned skill. You will get the hang of it in due time. You just need to figure out your own organizational system. I have my whole own system of notes and organizing myself on the patient worklist. The bottom of the page is for pertinent info from report in blue ink. I use red ink to underline or box in allergies and isolation info. Across the top but below the printed pt info is where I write in VS in green. Our techs start doing vitals at the beginning of shift so by the time I listen to report and go make my initial rounds, the VS are usually in the computer and so I can write down the latest and greatest.

Next, going down in a column on the far right side of the paper is where I write my to do list like Accucheck HS with a long obvious line beside it so I can write it in or check it off when it's done. This cues me to remember to look it up when doing my other 10pm meds. Other to do items go in this column like urine specimen, replace IV tubing, blanket, pain med 2330 (or whatever time they are next due and I know they want it), etc. Whatever they might've asked for or that I know I need to do for them goes in that column as a checklist so I don't forget it.

I write times for meds due in blue ink at the very top of the paper. If I know they will run out of IVF at xx time that I include that up top with med times and just note "LVP up" so I remember to take that in with me and save a trip.

At the top left corner, I have a master checklist system-A for Assessment (not just doing it but also recording it in the computer), C for the 24 hr Chart Check, N for writing my progress note in the chart, M for giving and documenting all meds, and R for recording report. I acquired this checklist business from my preceptor, a wonderful and highly organized nurse, and I still use it to this day so I don't forget to do anything and can feel like I'm making progress when I get to check something off. :nuke:

Things will start coming together for you and you will be a pro at wisely managing time before you know it. That said, we all have those crazy days now and again where we can't seem to manage anything!