new graduates

For me it greatly depends on the week and day. I had a lovely honeymoon period that ended maybe two or three months ago. Had a wonderful preceptor, and all of the new grads came off orientation a week or two ago. We're supposed to have mentors that will not have an assignment and just be helping whatever new grads are working that day but so far it hasn't been happening. Thanks so much for your words of encouragement. They are greatly appreciated.

No mentor. No transition classes. I went in and just jumped in. The orientation was really about how to use the computer system and where to find the charts. I work in LTC so its more about time management than anything.

I am really looking forward to orienting to my hospital job. Hoping it will challenge me more.

I'm almost 4 months in on my own after a 3 month orientation. My stress management is getting better, but it's very far from perfect. I feel like I can handle status declines better. Like a patients blood pressure drops and needs additional lines, a bolus, maybe pressors. Or somebody has increasing respiratory distress and needs more O2, neb tx, suction, chest PT, repositioning, or even BiPAP/ETT interventions. Even a massive bleed (ESLD with ^^^coags) with profound hypotension (60s/40s). Definitely stressful, but I'm at the point where I've seen it a few times before and I can expect more of what to do.

Big problem for me is being assertive with patients who insist on pushing the limits. I work on a monitored unit and "oh I think I'll have a walk around the hospital" or "I need to step outside and have a smoke" are completely unacceptable for us, even for the patients who are improved to the point of being ambulatory. Especially younger patients who have their strength. I state up front that it's not allowed and give them good reason (you need close monitoring, something could change in your condition and you would be helpless) and they keep trying to bargain and refuse. Many seem to just like the attention and keep at it just so you're constantly attending to them. They also tend to be loud and obnoxious and disturb every other patient. It gets extremely frustrating and makes for a physically and exhausting shift, to me. I used to work as a 1:1 and absolutely hated it for this reason. I had no tolerance for these types of patients, and still don't.

Then the younger patients who are there for SA or EtOH withdrawal, 302'd with 1:1 who get up and walk out. There have been 3 people that I know of on my floor (only one was mine) get violent with staff, require security to haul them back to their room to place them in behavioral (4 point) restraints where they thrash around and scream until the psych meds kick in. That's another thing, since the patients we get are pretty sick to begin with, physicians are hesitant to order Haldol and Ativan because of their cardiovascular side effects. Then it's left to us, and all of the other sick patients, to enjoy the aggression.

These situations are what still make me dread going to work. Obviously not every patient is that severe, but the "I now decide I'm going to leave" attitude is pretty common and I still don't have what it takes to handle them. What happens when I'm busy with my other patients and they happen to get out and fall? I long for the ICU where patients are too unwell or sedated and simple UE restraints get the job done, if needed at all. Where you have a lower ratio and that much more time to be attentive to them. Where the only confrontation is with coworkers, where knowledge and reason are applicable strategies. Some day...

TU RN, I feel ya, I would rather have ANY patient than one with AMS who won't stay put.