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?
No we never use the same lines for different meds. We can use the same line for the same med, for three days, and put a sticker on the line to make sure that the line is not out of date.
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! :)
I have not read through all the responses, but in my (purely anecdotal) observations, I am increasingly seeing new grads hitting the floors prepared for 1990's nursing, not 2015. The pace back in the 90's was brutal enough, but it is more so now and for different reasons. We have much more "background noise"...from computerized charting (which is cool in many regards, but also adds in a whole 'nuther level of distraction), to the Press Ganey circus, to rapid admits and discharges, to Ascom phones strapped to your hip.
These added work-flow distractions deter from the new grad's learning process necessary to mastering basic skills and developing that "eye."
Quite frankly, I don't like what I am seeing in new grads (those with less than one to two years of experience on the floor).
To the OP, you seem conscientious, intelligent, well-spoken, and rational. Good luck.
First of all, CALM down and take a deep breath. You can do it, I promise. At one time, I felt this way as well. I was slower than everyone and felt completely lost. Everyone makes mistakes though and I guarantee you have learned from them because you gave me an elaborate read. :)
Just keep the mindset that you can do it and you will!
If it makes you feel any better, last week I glanced at my IV bags, and 2 hours after hanging noticed that about 40 ml of Zosyn hadn't infused. I'm still not sure how it happened because I remember entering the correct VTBI when programming the piggyback... but anyway, nearly half the med ended up being late (it was reconstituted in a 100 ml NS bag, I think total volume was 120 ml per the pharmacy label.)
That was seriously, seriously unprofessional of that charge nurse to shellac you in front of the pt like that. And I am willing to bet my home that she has made med errors herself.
I'll tell you what I put on my brain sheet for meds. I write the due times in red (along with my other tasks--everything I need to do is in red). Listing the individual meds would take precious time that we don't have. But then after administering my meds, I re-check the MAR--are there any remaining meds that haven't been given? Every once in a while, even though in my mind I've done my thorough first check when pulling the meds, I'll look at the MAR when finished and notice, "oops, there's a dose of something that I missed." It takes mere seconds to do that final MAR-check, but it saves you from missing doses until hours later.
Time management comes with practice, and yes meds can be time-sensitive. But I am of the opinion that it is far better to be a little late with meds than to make a catastrophic med error because you rushed.
No we never use the same lines for different meds. We can use the same line for the same med, for three days, and put a sticker on the line to make sure that the line is not out of date.
Ok good. I thought that's what you were saying you did lol. I had to re read your post a couple times. Don't mind me, I'm slow.
What we have at work is a spreadsheet to print out with columns for the pt. name, code status, primary reason for admission and history (ex. HTN) transfer status (ex. assist x1) and a column for additional comments like if they are on ABT, TPN, dialysis, recent change in status...
The night shift updates the excel spreadsheet every night. It's great. The off going nurse prints it out for the oncoming nurse. It tends to be about 3 pages. I use those different colored rectangle sticky notes and flag very important things like wounds, g-tubes, trachs, jp drain, foley or anything that I know I'd forget to do (I have a bad memory.) I use a multi colored pen with certain colors for specific things when receiving report. Like red if it's an accucheck pt. I use blue for writing down their last prn pain med so I know with a quick glance when that pt can get their next pain med.
I am so sorry that you have had that experience with your coworkers. Not okay!
I am am almost in tears reading your post because I remember how similarly I felt as a new nurse (and again now, two years in, with a transition into a specialty area). It is overwhelming.
You are learning how to be a nurse, all about conditions/meds/cares, and trying desperately to get it all right all the time. And you are juggling expectations of the other nurses that you function like an experienced nurse though you aren't an experienced nurse. And, you are trying to form lasting relationships in the midst of all of this.
It is challenging to go from feeling competent to feeling very not competent! You WILL get there.
Let things roll off your shoulder when you can. Soon, you won't be the newest (but you will still make mistakes). I promise, it will get better!
That's a really good idea about color coding - a friend of mine had a pen that she used in nursing school, that could change colors with just a flick (instead of having to change pens) and I think I'm going to invest in a few of those.
That's a really good idea about color coding - a friend of mine had a pen that she used in nursing school, that could change colors with just a flick (instead of having to change pens) and I think I'm going to invest in a few of those.
It works so well for me! One pen, multiple colors. Even my sticky note flags are color coded. Yellow for if I'm in the middle of patient care and a CNA says, "pt. x wants a pain pill." I tend to forget after I finish what I'm doing at the moment, so I flag that patients name on my spreadsheet. Then when I start to go on to the next thing I had planned, I see it flagged yellow and remember so and so wants a pain pill.
I also use my phone as an alarm. If I'm very busy, for people who have any IV med due *especially ABTs* I flag it pink with the time due written on the sticky note, and set my phone to alarm 10 minutes before IV med is due. This has saved me
I know it sounds like a lot and that it could actually slow you down, but for me it works. The only things that take too much of my time are patients trying to keep me in the room, (I've received a LOT of great advice on that one the last few days on here) family members calling, and trying to find supplies. We have enough supplies, just being new, I don't know where everything is. So I'm going to make a point to spend time time in the med and supply room just learning where everything is.
SilverSister
7 Posts
No we never use the same lines for different meds. We can use the same line for the same med, for three days, and put a sticker on the line to make sure that the line is not out of date.