New Nurse ... not distinguishing myself as brilliant

AspiringNurseMW · Aug 1, 2015

Your coworkers sound like dicks.

I was thinking this while reading your post. I'm 28, starting nursing school in the fall, but from my years experience stalking AN (LOL) you don't sound like you are in a good environment for ANY new nurse. Not supportive at all.

But your feelings also sound VERY similar to a lot of posts by other new grads, you are not alone, and it will get better.

At least you are aware of and admit your mistakes and own then. I would as for specific feedback, and perhaps keep a little Notebook to keep track of certain things so you don't find yourself asking the same questions? Again not a nurse, but things I've heard here on AN.

Exhaustipated, ADN, BSN · Aug 1, 2015

SilverSister -- I have no words of encouragement coming from experience because, like you, I'm a second-career new grad. Late 40's, graduated in May, passed NCLEX in June, and starting my residency next week. I just wanted to step in and CONGRATULATE you for your achievements and say THANK YOU for sharing your experience. It couldn't have been easy, but it will be helpful for me and others like us to see and refer back to. When I have those same doubts (and it's my understanding I will) it'll be nice to know I'm not the only one.

Many others here have given you great advice, and I know you'll take from it what you need and move on to excel. Good luck!

Susie2310 · Aug 1, 2015

Hello,
Apparantly I'm a rock star when it comes to charting, and apparantly this is an unusual skill for a new nurse. Not exactly going to help anyone get better though, being good at charting, which carries no stress because no one ever got hurt or sick from a nurse forgetting to chart gastrointestinal sounds, have they?
I am frightened.

Don't underestimate the importance of good charting. Your charting paints a picture of the patient's condition and the care you gave the patient. Remember, "not charted, not done." Failure to chart pertinent assessments, such as absence of bowel sounds, and to take appropriate action, and to chart those actions and patient responses, can indeed have very serious ramifications for the patient (and for the nurse/facility). Your charting makes it possible for you, nurses following you, and other team members, to determine if the patient is experiencing a change in condition, is improving, staying the same, or worsening.

Mavrick, BSN, RN · Aug 1, 2015

Well, you are making beginner's mistakes. We all did at first and for those of us that stuck with it, now have a wealth of experiences that formulated our good habits and remind us to double check the tricky things.

Learn your resources. You can't depend on just one person. You will soon recognize the go-to nurses in your area and how to make a quick call to Pharmacy to clarify drug stuff. Your unit's policy and procedure manual (whether in book form or on-line) can be very helpful. Get to know how it's organized so you can quickly access what you need.

Repetition leads to mastery. There was a time when driving a car took all the mental concentration I had to keep moving forward in the direction I wanted to go. Now you don't want to know how much other stuff is on my mind as I hurl my 3,000 lb vehicle down the road a mere 4 inches away from the other guy hurling his vehicle at me.

Let it go. You did the best you could with what you knew at the time. Try not to keep replaying the mistake, spend your mental energy remembering the solution. I even talk (quietly) to myself. "Hooked up, plugged in, turned on" and that's just for SCDs. "Mix diluent, hook up, turn on" for antibiotics. Doing the right thing becomes the habit you almost forget about. (Remember learning to back up? Brake on, check mirror, put in Reverse, let off brake.)

Your little charge nurse is on a learning curve too. Do not chastise, belittle or humiliate your fellow worker in public. You can mention this to her yourself or to her supervisor just as you would with any co-worker making a mistake.

Go get 'em, Tiger.

doodlebuttRN · Aug 1, 2015

SilverSister,

Reading your post brought me right back to my first year after licensure...it can be extremely intense, and emotionally texting, and I remember wondering as a new grad, what ever possessed me to think I could do this... But please hear this: no nurse ever entered this profession knowing everything. All of us, including those on your unit who are less than supportive of you as a new nurse, were once in your shoes. If you can take any comfort from that, please do. From your post, it really sounds like you are doing your best, and YOU WiLL learn, and gain confidence. I remember the first time I dealt with a truly emergent situation as a nurse without panicking. Once it was over, I realized... Hey, I didn't panic at all! I did what needed to be done, step you step, without my heart racing or second guessing myself. And that was in my sixth year as an RN. We all have things to learn and areas of our nursing practice to focus on developing and improving.

I am really impressed with your self assessment and recognition of your weaknesses, but don't forget your strengths! Keep yourself positive' and as a previous poster mentioned, it really does help to 'fake it till you make it' in many situations. Of course, don't hesitate to ask if you don't know; but that confidence will help you and your patients.

Many, many hugs and much encouragement!!

emmylue

slauren · Aug 1, 2015

I think most new nurses go through this feeling. When you get overwhelmed and anxious, just take a deep breath! Don't rush yourself. It's not fair to you if you compare yourself to nurses that have been doing this for many years. When you rush yourself, the patients can tell and see how unconfident you are. When you get report and the previous nurse gives you report, just think in your head what you will need to do for this patient. Patient diabetic? Check MAR for accuchecks and insulin times. Patient has wounds? Check what dressings you may need to do. Patient has IV medications? Check times/types for each med and what they are for. Maybe after you do rounds and meet your patients, go through your tasks for the shift and try to plan your shift if you have too. In nursing, not everything can be done perfectly on time. I've learned it's better to spend 10 minutes plan my tasks and know everything going on with my patients then get the job done.

Best of luck! Give yourself time but don't forget to just breathe and don't rush yourself.

Also, with the nurse preceptor avaliable, maybe ask him/her for any time management tips or suggestions. If you're willing to learn most people won't mind giving you a hand up.

imintrouble, BSN, RN · Aug 1, 2015

I still get frightened.

They've hired a new grad and expect a seasoned nurse. Their bad, not yours.

Everything you describe is a new employee learning curve.

The one piece of advice I'd give is to toughen up. You can't let yourself be treated second rate, because you're not. Do not accept disrespect. You can be reprimanded for making mistakes, but not for asking questions.

What do you have to lose? If they're going to let you go, and that's what's got you walking on eggshells, then how much worse can it be if you just stand up for yourself?

Your post makes me remember the way I felt all those years ago. I hated it.

I'm rooting for you, and hope you'll give us updates on your progress.

BrandonLPN, LPN · Aug 1, 2015

What alarmed me most in the OP was that your charge nurse dragged you into the patient's room to point out an error *in front of the patient*. Apart from how unfair that was to you, imagine how upsetting that was for the patient!

TriciaJ, RN · Aug 1, 2015

It certainly seems as though your workplace could be more supportive. A preceptor you can never find? What's the point of having a preceptor or being on orientation? As for all the "friendly" reminders about your license being on the line: if your BON publishes the disciplinary actions, you will see no one got drummed out for typical new grad errors while on orientation with an absent preceptor. So put license worries out of your head. They're not helpful.

Here's where young, new nurses have an advantage: they often don't grasp the scope of the harm they can do. You have been around long enough to know about bad things that can happen; makes being a new nurse so much more nerve-wracking. You do sound very conscientious and I'm sure your manager recognizes that.

See if you can find yourself a mentor in your workplace. Someone who can show you the ropes and ease your concerns and not need to puff herself up at your expense. If possible, is there anyone with whom you can debrief when you get off duty? That might help you get some things off your mind and shift some mental gears so you're not rehashing and second-guessing yourself at home.

The new grad hump is a tough one to get over. If we could all do it, so can you. Hang in there. :up:

BuckyBadgerRN, ASN, RN · Aug 1, 2015

Alright, I'm probably going to get ripped for this, but this is what I'm picking up from reading your posts, mostly related to your shift change problems:

Seriously, you are too "darn" wordy!! If you give report like you make posts here, and EXPECT report like you make posts here, I can totally see that there are problems. Your co-workers are right, you need to learn to condense, and be far more concise!! It WILL be up to you to find out some details about your patients on your own, you cannot expect the off-going nurse to relate every single detail to you while you write it down.

I don't know if you're doing a group-type shift change or a one on one report, but take note of how others are organizing their shift. I know they aren't writing volumes about their patients. Recognize someone who's style you like and ask him/her for a few tips on how they manage their "cheat sheets". It's OK to use your own format, but MAKE it work for you.

As far as the errors you've made, learn from them and don't do it again, that's all anyone can ask of you. Like others have said, every RN on your floor have made errors of their own, don't let them tell you any different!

Embrace your extra week of orientation and be the biggest sponge you can be. Show them you're serious and WANT and DESERVE this position, knowing that they will not extend orientation indefinitely until everything clicks for you.

I won't beat a dead horse about some of the professionalism you've been shown by coworkers, others have covered that.

Wishing you the best of luck

sjalv · Aug 2, 2015

I have read time and time again that the orientation you receive as a new grad can make or break you in this field. I myself am a new grad, having only been a nurse for about two months. Let me tell you: my coworkers are nothing like yours. Those condescending remarks are not okay in any situation, especially not when a new grad has shaky confidence. I can always find my preceptor within minutes.. are your patient assignments not being made so that y'all are in rooms next to each other / at the same nurse's station? If their behavior continues, I would seriously reconsider letting this job be the one that starts your career. A supportive unit is crucial.

jena5111, ASN, RN · Aug 2, 2015

Hello,
I am a new nurse. Just passed the NCLEX July 16 after graduating in May and acquiring a job which started June 8. I graduated top of my class. Not because I am all that smart but because I work very very hard. It's not helping me in the new job ... a busy 38-bed oncology med-surge unit at a local hospital. I had to get an actual nursing job to discover how imbecilic I can really be. My hope had been that if I just tried really really hard and worked really really hard, I'd do well. Not happening. I'm a nervous wreck. About 100 times every day I wonder if I should see a doctor, myself, and get a prescription for a beta blocker, because when I lay down at night I go over everything that happened during the shift, and my heart feels as if it will beat out of my chest and fly around the room. I'm 50 years old and should be way too mature to be having these emotional ... reactions.
Here is a list of my so-far mess ups (after only 7 weeks!!!)
1) I hung meropenem and there was still about 50 mLs of vanc left to infuse. What was I thinking? I don't know. Nothing. It was time to hang the meropenem and the pump had stopped on everything else so I just hung it. For this the charge nurse stomped down the hall, hauled me into the patient's room, and dressed me down in front of the patient. I was surprised the patient even let me into her room after that. I can only say that the patient actually liked me, after complaining bitterly of day shift's neglect. I checked on her often ... I have people skills. Too bad I didn't THINK and check the vanc before I hung the meropenem. Stupid.
2) (and very serious) I was late administering Reg Insulin. Really late. As in, about 2 hours late. I gave the Lantus but not the Reg insulin, and discovered it in a run-through of the MAR 2 hours later. Had to call the doctor and then WAIT on his call back, after checking the insulin level (which had risen), and reporting to him the value. Then I could administer the late dose.
3) Didn't know how to interpret under the "orders" tab and so didn't put telemetry on a patient who had come in for DKA. On shift change the nurse I was reporting off to asked me about it and I was like ... "duh ... what?" and had to put on the telemetry before going home.
This is not to mention that I am slow at EVERYTHING. And it makes it even slower because I can never find my preceptor to ask things. Protonix? It comes in a powder. Great. I didn't know what to reconstitute with and couldn't find it on the little vial. Had to find someone to show me how to do it. So another nurse notices how long it took me to administer this because it takes long to find someone, gather the necessary materials from the overwhelming supplies room (where nothing seems to be in logical order) and administer, and tells me she's glad she's not my patient. Not to mention it was only LUCK that I looked it up in the computer and discovered it needed to be administered over 2-5 minutes, or I would have pushed it at lightening speed and maybe done some damage.
I swear, too, that if I had a nickel for every time someone has said to me or asked me "didn't I tell you this before?" or "your license is at stake!" or "you must go faster!" etc., I wouldn't owe anything for my school loan. It'd be paid. My list of fantasy comebacks is growing ...
The other night I tried to administer a PRN percocet (PO) to a patient, and the minute the pill touched the back of this poor lady's throat, she spit it out and began to cough. Hard. Then gasp. Drool coming from her mouth. I had no idea what to do besides raising the bed and patting her back ... and I called for help. Immediately 4 nurses and 2 young doctors in the room. And we all stood there and watched her get over it gradually. I was told I over reacted and that my problem (among many) was that I was always looking for zebras and there are only horses. I need to get out of the HURST mindset where every symptom is one where the patient is potentially dying (and if I don't recognize it I am a scary nurse ... which of course I already AM a scarey nurse) and recognize the horses, so to speak.
I made up a new sheet for myself - since the hand-off sheet is confusing to me and doesn't help with med administration. It DOES help me, but I've been told numerous times that it's no good ... I shouldn't be using all that paper I should just be writing down times of administration, not meds, or should be remembering things, or writing down the first letter of every med, and then not taking the WOW into the pixus room. And I definitely shouldn't be standing there with my sheet asking the handoff nurse questions and writing down her answers to fill in my sheet ... it's insulting to the handoff nurse. And I should not trust anything the handoff nurse says ... I should check the WOW myself, because she could be mistaken and my license is at stake. So what good is a handoff? Apparently just to report what the patient did on the last shift. Everything else should be gotten from the machine. Only there is little time to gather the information from the machine. It does no good to come in early because they don't make patient assignments until 5 minutes before shift change. I could REALLY use them doing it before that, and would get my "stuff" together off the time clock, so that I'd have more of an idea of what was going on, before shift change. 15 minutes after report people are asking me if I've made rounds on my patients (I'm supposed to have done a head to toe on 6 patients in that time period, like everyone else does).
Anyway ... I'm not doing well. I'm seriously not doing well. They've put me on an extra week of orientation. I feel like I could use another 4 weeks of it. They said they're taking it week by week and tried to be very reassuring that so many new nurses have been through this. And I've been switched to day shift for a week, so that I can precept with this other gal, who the Nurse Manager says is more like me and "quiet" ... which, I'm not all that quiet, but seem so when I go to work. Sitting there in the Nurse Manager's office, I was trying to be very calm and professional, but was preoccupied by my uncontrollable mouth, which wanted to quiver. Geez. I wasn't about to cry but my mouth disagreed. I have not told anyone except my best friend about this. Too humiliating. Will I be a bad nurse? Is this a bad omen? Am I only fit to sit by someone's side and pat their hand? Heck it's my only skill. Oh except for charting. Apparantly I'm a rock star when it comes to charting, and apparantly this is an unusual skill for a new nurse. Not exactly going to help anyone get better though, being good at charting, which carries no stress because no one ever got hurt or sick from a nurse forgetting to chart gastrointestinal sounds, have they?
I am frightened.

Maybe Protonix isn't a high-risk med but...it shouldn't be "luck" that a nurse checks a hospital-approved drug reference before ANY medication administration. Especially if you're unfamiliar with the med in question.

When I've given Protonix IVP, I've removed the vial from a box which contains a leaflet with reconstitution/rate of administration instructions.

And--I've learned that taking report is one thing, but verifying what you learn there is another. You can't take everything said by the off-going nurse as gospel. You verify it by your head-to-toe assessment and what you read in the chart (and what the patient tells you). Nurses accidentally omit info and make mistakes during report. You can't take everything you hear there at face value.

That being said, of course you'll have struggles and challenges as a new grad. I know I will! It sounds like you're working at a place that isn't too open to questions (or maybe you're not asking enough?). Charting know-how is good--I've also been praised for this in my clinical rotations. But hang in there with the speed, pacing, and brain-sheets. It sounds like you just need a some more practice at the RN role, and you'll be fine.