New Nurse ... not distinguishing myself as brilliant

[SilverSister]

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. Apparently I'm a rock star when it comes to charting, and apparently 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.

[ixchel]

OP, breathe. Repeat when necessary. :)

My orientation was okay at best. My first half I spent in classrooms or desperately trying my best to not fall apart with terribly inappropriate patient assignments. My second half I spent with a nasty person who does little more than gossip about others and undermine all ability for anyone she's precepting to develop an ounce of confidence... the kind of person who always has to find a way for you to be wrong, even when you're not. It took awhile to figure out that's what she was doing, and thank god I did because I never would have gotten out of orientation under her wing.

I made a post shortly after starting my first job totally pouring my heart out because I went from on top of the world to devastated. I left that place every day a failure. (Well, I thought so anyway.) The responses I received made me realize I was completely normal.

We all go through this. Part of it is just growing pains. Most of it is a failure of our nursing programs to give us this dose of reality before we get blasted with it on the job. I felt quite a bit of anger after thinking that over for a bit. They certainly pretended they were giving us all we needed. It almost felt like reality was this secret they all were sworn to keep from us as part of their faculty contracts or something.

But really, it is, unfortunately, what it is. There really is no way to turn back time and pick up the pieces that they left out. It's time to pick those up now. Even when you finish orientation, you'll feel like a hot mess. I'm so sorry to say that, because with all of my heart, I wish it weren't true.

So right now, your learning process and competence are your responsibility. You have preceptors to help you with that. It sounds like yours could do a better job, but you have what you have. Take what you can, and leave behind that which is not helpful.

Some advice -

1. Use the report sheet that makes you feel comfortable. I used one page long report sheets for each patient's until I got better at remembering things (p.s. You will get better at remembering things - I PROMISE)

2. You are going to suck at report. Practice. I'm not kidding. But more than that - you've made your own report sheet. Is it organized in the way you give and receive report? If not, use SBAR format. Situation (patient name, age, reason for admission), background (history, MD, allergies, code status, family or other psychosocial issues - relevant ones only!), assessment (specifically list these spaces - neuro, cardio, respiratory, GI, GU, integumentary, lines/tubes/devices, labs, radiology), recommendations/plan of care (future testing, procedures, disposition). This is how your report should be organized, and ONLY share that which is relevant. If you are interested, PM me your email address and I'll send you the condensed sheet I now use.

3. Meds - I write them all down at the start of my shift and I plan my day around them. This list is actually on the back of my report sheet.You won't need your WOW in the med room if you do this. BUT I STRONGLY CAUTION YOU - check for new orders all day long. Refresh often!

4. The more patients you take care of, the easier it will be to know what is important to remember.

This is the MOST important thing I want you to remember:

YOU HAVE TO GO THROUGH THIS TO GET THROUGH THIS. If you are at a breaking point in your mental health at any point, please seek help. I turned to antidepressants and regret nothing.

You can and will get through this!room. Ghg

[ixchel]

Grrrr my message cut off at the end. Ignore those random letters at the end.

[canigraduate]

Paragraphs are your friend.

Slow down your thoughts, not your actions. It sounds like you've worked yourself into a frenzy.

Stop letting your coworkers treat you like dirt. It takes two to be a doormat - one to do the walking, one to lie down and take it.

You will be OK. I would haul that charge nurse in to the unit manager's office and proceed to ream her. That was completely unprofessional and just plain bad people skills.

Start looking for a new unit. Once you can transfer, get out of there. It sounds like they've decided that they don't like you, for whatever reason, and that's really hard to come back from. Unless they start respecting you once you've started standing up for yourself. Stop with the negative self-talk, too. You believe what you tell yourself, and so do others.

Good luck.

[icuRNmaggie, BSN, RN]

That so called vanco error is nonsense. 250 IVF bags have 25 ml overfill 500 cc bags have 50cc of overfill and liter bags have 100cc of overfill. The diluent used to reconstitute the vanco also adds 10-20cc to the total volume.

IV tubing takes 20cc to prime(read the package) and you will still always have 25-50ml remaining after the infusion is complete for these reasons and you will have to program that extra amount of VTBI for the pt to receive the entire dose.

Check the pharmacy label for the total volume and rate . I assure you that you will always have a volume remaining and that is not an error.

It is due to the variability in the volume of these IVF bags. Also be careful when you backprime to make sure you are not adding a lot of volume to the IVPB bag.

Your charge nurse should know this and she clearly has a lot to learn.

Alabama is known for horrid working conditions. It is not like that everywhere. Many travel nurses come from that region.

[TriciaJ, RN]

OP, breathe. Repeat when necessary. :)

My orientation was okay at best. My first half I spent in classrooms or desperately trying my best to not fall apart with terribly inappropriate patient assignments. My second half I spent with a nasty person who does little more than gossip about others and undermine all ability for anyone she's precepting to develop an ounce of confidence... the kind of person who always has to find a way for you to be wrong, even when you're not. It took awhile to figure out that's what she was doing, and thank god I did because I never would have gotten out of orientation under her wing.

I made a post shortly after starting my first job totally pouring my heart out because I went from on top of the world to devastated. I left that place every day a failure. (Well, I thought so anyway.) The responses I received made me realize I was completely normal.

We all go through this. Part of it is just growing pains. Most of it is a failure of our nursing programs to give us this dose of reality before we get blasted with it on the job. I felt quite a bit of anger after thinking that over for a bit. They certainly pretended they were giving us all we needed. It almost felt like reality was this secret they all were sworn to keep from us as part of their faculty contracts or something.

But really, it is, unfortunately, what it is. There really is no way to turn back time and pick up the pieces that they left out. It's time to pick those up now. Even when you finish orientation, you'll feel like a hot mess. I'm so sorry to say that, because with all of my heart, I wish it weren't true.

So right now, your learning process and competence are your responsibility. You have preceptors to help you with that. It sounds like yours could do a better job, but you have what you have. Take what you can, and leave behind that which is not helpful.

Some advice -

1. Use the report sheet that makes you feel comfortable. I used one page long report sheets for each patient's until I got better at remembering things (p.s. You will get better at remembering things - I PROMISE)

2. You are going to suck at report. Practice. I'm not kidding. But more than that - you've made your own report sheet. Is it organized in the way you give and receive report? If not, use SBAR format. Situation (patient name, age, reason for admission), background (history, MD, allergies, code status, family or other psychosocial issues - relevant ones only!), assessment (specifically list these spaces - neuro, cardio, respiratory, GI, GU, integumentary, lines/tubes/devices, labs, radiology), recommendations/plan of care (future testing, procedures, disposition). This is how your report should be organized, and ONLY share that which is relevant. If you are interested, PM me your email address and I'll send you the condensed sheet I now use.

3. Meds - I write them all down at the start of my shift and I plan my day around them. This list is actually on the back of my report sheet.You won't need your WOW in the med room if you do this. BUT I STRONGLY CAUTION YOU - check for new orders all day long. Refresh often!

4. The more patients you take care of, the easier it will be to know what is important to remember.

This is the MOST important thing I want you to remember:

YOU HAVE TO GO THROUGH THIS TO GET THROUGH THIS. If you are at a breaking point in your mental health at any point, please seek help. I turned to antidepressants and regret nothing.

You can and will get through this!room. Ghg

I can't "like" this enough.

[cupcakeluver]

Hello SilverSister. Lowly student here. I start my 3rd semester of a 4 semester program in two weeks. As graduation looms closer, I've been sneaking over here to the nurses side to gain some further insight into the reality of actually working as a nurse. I'm already seriously freaking out about the learning curve in the first year. At least I know there is one coming. I think some people don't realize it, and so I'm thankful to AN for the heads up.

I don't have any advice to offer. Your post just hit a nerve with me. It sounded like what's inside my head when I start thinking about doing this whole nursing thing on my own. I'm thankful that you shared your experiences. It's helpful to see that people struggle and are eventually successful. I believe you'll be successful as well. Please come back and share when you've made it through the fire. I'll just be jumping in.

It's also super helpful to read all the tips the veteran nurses have. I plan on using them all!

[icuRNmaggie, BSN, RN]

Silver Sister missed an order for telemetry and an order for SSI coverage. I have done both and so have thousands of other nurses. The so called vanco error was a lot of trumped up nonsense. These were not sentinel events or near misses. She reported the error and took appropriate actions. She has a conscience and a soul, she kept her integrity and she is going to surpass her detractor. She probably already has.

[Nurse_emgee]

I am also the same. Learning from your mistakes is what important for as long as you care for the patients, honey!

[adamRn79, BSN, RN]

A year from now you will realize go much you've learned. No shake in asking for a longer orientation. Sounds like you work with some real jerks

[SleeepyRN]

I feel like I could have written much of this post myself. So I'll be reading the answers for advice.

[SleeepyRN]

Question. Did you use the same IV tubing from the Vanco for the Meropenam?

[SilverSister]

Wow. Now that was helpful. I keep tweaking that report sheet of mine so that it is more helpful, but at this point every patient gets one entire sheet, with 1/2 the sheet devoted to writing down the meds/tasks, their route, and any other little note I need there (take BP, etc). Since we already have a report sheet that gets passed from one nurse to another until the patient is discharged (I shred my own at end of shift) I don't have a place for systems (already on the primary report sheet, which I am not supposed to write on - it only has the stuff on it that was given by the ER or whoever, when the patient arrived) but could make a space at the end of the sheet for the critical system effected in that patient. I went through some of those "brain sheets" and my sheet is similar. I'm not sure how to PM on this site will have to look that up. Thanks! :)