New nurse coming off orientation and feeling like I can’t do it

[Wanderlust22]

My first day off orientation was terrible, and I think I’ve made a mistake in choosing my career. I need to vent so this might be long.

I’m a brand new nurse starting on an ICU floor. I’m part of a new program at my hospital designed to support new nurses with additional education and career development opportunities (like a residency, but more). Part of this program includes a full 20 week orientation, and two weeks with a “buddy”, meaning you’re on your own but paired with another nurse to periodically check on you. I’ve known I was going to start my buddy weeks this week for my entire orientation, but last week one of my preceptors told my manager that he didn’t believe I was ready to be on my own. My other preceptor and clin spec disagreed, so I went on buddy week and had my first day.

Despite my primary preceptor’s confidence that I could be alone, my other preceptor’s doubts really shook my confidence. I was super nervous starting the day, and I was so frazzled in the morning that I forgot to scan out my morning meds!! Never have I ever forgotten to scan my meds, and I can’t believe I was so irresponsible. The rest of the day was okay, but I consistently had issues with transport, dialysis and coordinating care between my patients and their diagnostic tests. I sounded like an idiot during morning rounds, suggesting my patient wasn’t appropriate for PT because she was intubated despite the fact that she was awake and following commands. My buddy nurse basically cut me off and was like “yes, she’ll need PT at some point”. Then, at the end of the shift, sh*t hit the proverbial fan and I did what I’m most ashamed of: I snapped at a patient.

It was towards the end of the day, and I was trying to chart before 6 pm meds were due. Suddenly, patient A’s BP dropped. I knew it was a fake BP, as the patient was awake and could answer questions (it was reading EXTREMELY low, like MAPs in the 40s). I know this patient is extremely labile with her BP, but I couldn’t get a good cuff pressure and I started her on her levophed. I called the docs in and they attempted to get an A Line, unsuccessfully. All the while, I’m attempting to tritrate levo, give a fluid bolus, get an A line set up, and find a decent cuff pressure. By the time Patient A was finally settled, I was late on all of my meds, and patient B needed to get back into bed, have labs drawn (the docs threw in an order for a CBC at 6:22, like WHY) and be straight cath’d. And of course, transport finally arrives to take Patient B to CT, and gave me a hard time for not being ready. AND my charge saw me in Patient A’s room titrating levo, and made a comment about me “ignoring contact precautions” and “not having all of my tubing labeled” even though I was so overwhelmed I had honestly forgotten. As I’m running around trying to collect everything and get Patient B settled, the patient complains that he had been waiting to get back into bed for half an hour and wanted a swab for his mouth. And i snapped at him. I angrily said “i’m sorry, i was very busy and that is not my number 1 priority right now. You need to wait”. It doesn’t sound bad written out, but I said it with anger. Nurses are supposed to be kind and caring, and I snapped at a very sick person for absolutely no reason.

I needed a lot of help from my buddy during that time, despite the fact that my buddy had an even tougher assignment and was handling it with ease. I felt like if i had organized my time better I wouldn’t have been so behind when things got bad, and I shouldn’t have depended on my buddy so much for an “easy” assignment. Of course, during this time, my preceptor who doubted me came to see “how i was doing” and saw how frazzled I was, further confirming to him that I wasn’t ready to be off of orientation.

All day I’ve been thinking about what I did wrong, and wondering if I had done the proper documentation for my titrations. I feel like I chose the wrong path and that I’m too stupid and incompetent to be on my own. I feel like I stuck a foot in my mouth at every possible opportunity, not to mention my room was super messy when night shift finally came. I feel like I needed too much help, and that I shouldn’t be off orientation yet because i clearly cannot handle when a patient deteriorates—AND IM IN THE ICU! Any advice would be helpful during this time, how do i stop feeling like such a failure?

[Wuzzie]

13 minutes ago, Wanderlust22 said:

Any advice would be helpful during this time, how do i stop feeling like such a failure?

You feel like every. single. one of us did when we came off orientation and you know what... we all made it in some form or fashion. I have complete confidence that you will too. Also, stop comparing yourself to an experienced nurse. You aren't one and you aren't expected to perform like one.

[NICU Guy, BSN, RN]

^^^THIS^^^

It is similar to the time when you were learning to drive a car. You were very nervous and scared when you got your license and was all alone. Now you are far less nervous to drive. Same thing with nursing, as time goes on, you will become more confident and find ways to be more organized. You also need to be able to ask for help when you are drowning. Every nurse has been in your position as a new nurse and should recognize that you will be struggling and need help more frequently. It takes 12-18 months to feel competent in your job.

[MountaineerFan57, BSN]

Don’t feel bad about your buddy helping you. In the ICU, there will be times you need help, no matter how long you’ve been a nurse.
also, I think anyone would have ended up frazzled/behind with all that happening at the end of shift.
I definitely sounded dumb my first few weeks rounding, but after only 1.5 years I now know what to expect and have most of the answers ready for the doc’s questions.
give yourself some time. You can do this!

[nursex23, BSN, RN]

I felt exactly how you described when I first came off of orientation. I thought it was a unique feeling and I could not fathom that every nurse feels like this when they start. But the crazy thing is one day, after a year, I realized I didn't feel like that anymore and I saw other new grads coming in after me feeling the same way that you are feeling and the same way I felt. I also noticed many nurses gave me a hard time about small details when I was new and they eventually let up on me and started doing that to newer people. Whether it's because of the whole "nurses eat their young" idea or just that they're trying to help bring your attention to these details that you're overlooking. With experience and time, others around you will see your unlabeled tubing and trust that you are going to label it before you leave and I would honestly just throw a gown on before going in.

I can almost promise you that after a year or two you will be almost like your buddy - helping out other newer nurses with easier assignments. You will get the hang of it and get faster at doing the "tasks." From what it sounds like though, you had a lot going on at once and prioritized correctly. The next time you have a day like this, you will just move through everything quicker and it will all come together.

As far as your other patient *shrug* He will be fine. I once had a coworker's patient request to leave AMA when it took "20 minutes" for someone to put him on the bedpan. It was 10 minutes tops. My coworker said "OK" went straight to the filing cabinet, pulled out the form, called the supervisor and went into his room to let him know the process of leaving AMA. He ended up not going because he just wanted to whine but my point is, you will eventually realize when their complaints are valid and when they need a small reality check. While I get your reaction and I know you're only human, I would have apologized (we're in a service based profession so we're always apologizing for things out of our control) and informed him that there is another patient who is doing really bad. Almost every time, they say it's ok because it hits them that they're in a hospital and people could actually be dying. However, I've seen other nurses react as you did and you're not totally wrong - he has to wait.

I remember when I first started and I got a call from the lab that my patient's hemoglobin was like 5 and I had to do a transfusion and I panicked and was frantic and blood transfusions were the scariest thing. A few weeks ago I had 2 in one shift and was like meh. You will eventually get that way with time. In about a year you'll be dealing with a low BP like meh. I know it feels like a nurse, even a new one, should be confident and know it all but that's just not the reality of it.

Give yourself time and you will eventually become a great nurse. ?

[1vocation]

After working for 1.5 years as a nurse, I am planning an exit career - invest in vacation business. Workplace violence (physical and verbal), from patients and from backstabbing female RN snakes. I'll let them sting each other, not me. Nursing? NOT worth it.

[Brit917, RN]

So how do you feel now? You almost have a year under your belt.