New Med Surg RN...feeling slow and low

ShayRN0217 · Mar 19, 2017

I found this encouraging post from some years ago, but wanted to post something more recent:

My experience:
I was thrilled to start working as an RN & initially loved my job, though I felt overwhelmed. Then I recognized all the communication problems within a hospital & started to feel a little depressed. Next I hated my job with a passion, and longed to leave nursing & do something else. By the 6 month mark I started feeling more relaxed & competent, and I began to enjoy it again. Now I'm at the year mark, feel MUCH more competent/capable as an RN, and am ready to move on to another area of nursing (such as ICU or research).
My advice would be to STICK WITH IT for at LEAST a year. You will feel overwhelmed, bored & frustrated at various points, but the amount of learning you do in your first year is tremendous. I'm convinced that at least a year of med-surg is invaluable experience for any nurse, no matter what area you eventually decided to go into. You will not know if you like med-surg, or even nursing, until a year has passed.
I agree with everything the previous poster already said. Very well-spoken. I'd agree that you should do all the blood draws & IV sticks you possibly can, ask questions if you don't understand something, write down anything new learned (so that you don't repeatedly ask the same questions over and over), keep a list of important phone numbers/lab values/facts that you will need to know (ie. stay organized), and offer to help out your co-workers whenever you have a free moment (be helpful and flexible). And above all, maintain your sense of humor! A good laugh will get you through some really tough moments...
Oh -- would especially emphasize: 1) to stay calm/collected no matter what happens. You can't think rationally if you're in a panic, and the patients/families & your co-workers rely on you for your strength. Pretend to be confident when you're doing your first blood draws, IVs and catheters, too. 2) set limits with demanding patients. You have to prioritize every moment. If you can't adjust the bedding or get jello for a pt at that moment, it's OK to say "I have several patients and need to prioritize my work right now. I have an urgent matter down the hall. Once I'm through with that however, I'll come back & do X". Also, if a patient is particularly needy, emphasize that part of their recovery is to be able to do things for themselves. Tell them you would like to help them in becoming more independent. Finally, if someone is on their call-bell constantly, contract with them -- go through the priority speech again, but agree to return to their room in an hour (& then be there @ the time you set). You are not a slave or a waitress. Remember that!

m4howie, ADN, BSN · Mar 26, 2017

I have been a nurse for 6 years and I still get out late from time to time. Most of the time if I look back at my shift I can see where I "lost time". I work night shift and I'm a med/surg/stepdown float nurse. In general there are 3 main reasons why I get out late. 1) Poor planning or I'll do it later thinking. Ex. Pt got up twice in an hour at 2 am to pee. I thought, "Hmm I should bladder scan him. Nah I'll do it later if he goes pee again." I did scan him after the 4th trip to the toilet at 6:30am. My shift is from 11:30pm to 8am. I screwed my self. Page doc, they call back, wait to see what order is put in etc. 2) Lots of social time. If I am working with certain nurses I can be very chatty. I loose a precious hour or two by the end of the tour from just chatting. 3) Focusing to much on Pt "feelings" and not on good nursing judgment. Sometimes I decide to let a pt sleep longer instead of getting vital signs or a weight, or labs. Or maybe wait to do a dressing change because family is there. But then I will get a critical lab at the end of my shift when I have less time to hang and IV.

The nurses that I see get out on time do a lot of the same things. 1) They have a do it now or do it early philosophy. If IV abx need to hung at 5am they will hang it at 4:01. If pt has a dressing change q-shift it is done in the first 1/2 of their shift. 2) These people are constantly moving. They are friendly but you won't see them constantly checking their phone, on the internet, or excessively chatting with coworkers and patients. 3) They have mastered the balance of being respectful of pt rights and following orders. I hate waking people up in general so if I have to do vitals on someone who is sleeping it could take me 5 minutes. I watched an aide do the vitals on 3 sleeping people in the time it to me to do one. I feel like I am promoting sleep when I wait to do things. It is better to just do it and get it out of the way.

To go back to the beginning. I would look at your day and see where you are loosing. These are areas where I loose time. My background in work is all customer service. On one hand it makes me a well liked nurse by my coworkers and my patients. However, my customer services ways can affect my productivity. Nothing will pull my from a task at hand faster then someone asking for a glass of water.

BSNbeauty, BSN, RN · Mar 26, 2017

Make sure you are clustering your care. I always have a do it now or early philosophy too. But be gentle on yourself . you will get it with time.

pmabraham, BSN, RN · Mar 26, 2017

You are not alone. I started 2/6 of this year. I just posted on my FB page that my nurse educator monitored me for the 1st half of the day this past week (Wednesday); while I got positive criticism in terms of providing safe and meticulous care, I was told I had to be "faster, faster, faster." Like you, I've created my own brain sheet (there's no standard on our unit), and continue to revise it as applicable.

My advice is based on what I've been hearing from seasoned nurses where I work: 1) Be patient with yourself, everyone goes through learning proper time management, 2) It takes 1 to 2 years before being comfortable. 3) Even after that, you can have days where you are running behind.

Find a system that works for you that can be adapted when circumstances change. Review what's required of you to be done when within your shift. I.e. our floor requires once a shift IV flushes (if not already infusing); that doesn't have to be done as part of the first assessment if you are pushed for time on the 8 AM med pass. Dressing changes can typically be done after the noon med pass, etc. Chart in the patient room when able; before leaving the room, check for new orders on all your patients, your next patient, etc. Cluster what you can cluster, but don't get tied to clustering (i.e. if a patient's med should be at a very specific time, don't try to "cluster" it early or just because you have two patients in the same room, doesn't mean you have to cluster care for both patients in the same room if one patient in the room has a priority 1, the roommate has a priority 5, and the patient down the hall has a priority 2 -- in that case, take care of the priority 1, then 2 and come back to the 5 -- my opinion).

ShayRN0217 · Mar 27, 2017

Thank you so much for all of your replies. I too have a customer service background and am learning how to politely "cut the conversations short" so that I can focus on caring. I am learning from the seasoned nurses how to give quality care even when we don't have the quantity of time available. It is refreshing to hear from both experienced and new nurses. Thank you all again