New Nurse Struggling and Stressed

[moomin, LPN]

I am 7 days into my orientation at a nursing home and I am already questioning if this field was the right choice I made. School doesn't compare to the real thing and they don't prepare you for what is to come. I am really stressed about being on my own. I have only 4 more days left of orientation and I am really struggling to finish med passes on time, I am always way late finishing them. I am struggling to remember how to efficiently work the computer system and all the paper work and how to correctly do the charting and etc. I honestly didn't think it would be this hard and overwhelming. The other nurses seem to have it down great and they seem unfazed by the heavy work load. I stand out like a sore thumb and feel like the weakest link. The amount of residents given per nurse is unsafe. I am constantly rushing and that's still not enough, even though I am going as fast as I can. I really don't know what to do at this point. It's not like I can just switch careers after all the time and money put into school. I hate not being able to have enough time to really pay attention to the residents, if I take more than 30 sec or a minute to talk to them it would set me way back. I didn't think it would be like this. I can't see myself being worked this hard for the rest of my life and feeling like my license is at risk. I am already being told I am too slow and need to catch on quicker and I've already been lectured twice from the supervisor. The workload is unrealistic. I don't know if there are better options out there for a LVN to work or if most of the places are going to be this crazy and stressful, or if I should already go in a different direction.

[LovingPeds, MSN, APRN, NP]

Every nurse who graduates goes through these feelings to varying degrees. You are not alone in that and it's a very normal reaction to the transition from student to independent nurse. It takes most nurses about a year or two to begin to feel like they have "gotten it" and are doing "okay" or even well with what they do when they first start out.

I always advise students who are starting out to try to find an employer that will invest in a good orientation and who will provide them with a mentor or someone experienced to go to if they need help. If your employer is putting a lot of pressure on you as a new graduate seven days into your orientation - including the supervisor talking to you, then take this as a sign of the type of environment you're in. Every health care facility has a culture to it. You will find some that are high stress and others that are laid back while both may be delivering the same quality of care.

Long term care nurses do have a high number of patients. Part of what you will have to learn is prioritization and delegation which will come with experience. Getting faster with med-passes will also come. The most important thing is to do it correctly - not necessarily as quickly as you can.

Before starting on another career, have a conversation with your employer. If you feel that they are not giving you the time or resources you need as a new graduate nurse, then look into other employers. If you choose to do that, then be sure to ask about orientation when you go for an interview. Interviews also give you a chance to interview your employer. It's about finding the best fit for both.

I hope that things improve for you.

[Nurse SMS, MSN, RN]

Deep breath.

You ARE the weakest link right now. It's humbling. It's also NORMAL. Don't expect more than that. It feels icky, especially if you were a stellar student. Accept that you are the weakest link. You won't stay that way!

Watch and ask questions of the other nurses on how they are managing their time. Time management and difficulty with delegation plagues pretty much all new grads. You will need to see how the others are making it work and mirror them. In time, you will come up with your own system. You will need to practice getting in and out of those rooms quickly, learn the different personalities so you know who takes forever to take their pills and little tricks to help speed them along. You are going to run behind for a while. Your employer knows this. Keep working at it. Notice what is slowing you down. Is it time-in-motion stuff, like opening blister packs? Are you getting stuck in a room with a resident that wants to chat? Are you unsure of the drugs you are handing out and having to take time to look things up? Once you identify what is slowing you down, you can work on it.

Hang in there. It will be much better by the end of the Summer and even better by this time next year.

[TriciaJ, RN]

Being a new grad is a two-headed dragon. The first part is just being a new grad and still having a very steep learning curve ahead of you. And just when you've graduated and thought the worst was over.

The second head is that some LTC facilities really are ****holes, but it is hard to tell if that is the case when you're dealing with new grad problems.

The staff might look unfazed because there is a system and they've figured it out, or there may be a whole lot of corner-cutting going on. Which I don't recommend.

If you're still on orientation, you have a preceptor, right? Please ask your preceptor to show you the "system". How does he/she complete all the work and get off on time? Another good thing to find out: how long has everyone worked there? If several people have worked there for years, then there is a system and you will figure it out. If you can't find too many who've been there much more than a year, or there seem to be a lot of agency staff, then you've landed in an unsustainable pit. The good news: not all LTC places are like that.

Try to figure out how much is you being new, how much is them being a pit. That will take a bit of time. Meanwhile, put one foot in front of the other and learn all you can. Eventually this job will be doable, or you'll be in a much better frame when you start the next one. Hang in there.

[moomin, LPN]

Thank you for all the advice. I ended up leaving the position because I was thrown out onto the floor alone before my orientation was even finished. They did not even give me a heads up and not only that, they put me on the hardest station. Even the seasoned nurses there say it is the hardest station to be on. During my short training I was thrown around to different stations so I was not even comfortable or very familiar with the residents I ended up with. My supervisors didn't seem like they really cared all that much, they were too rushed and preoccupied with other things. I couldn't even find the DON to tell her how I was even feeling. I only lasted 2 days by myself and on both days I was faced with handling difficult situations I was not even trained in. When I would try to find help from another nurse they were too busy to show me what to do. When I would finally get some sort of help, it was always rushed and not clearly explained. I worked 10 hours yesterday with only one 30 min. break and I was still behind and didn't finish everything. Last night was my last straw. I have not felt so mentally unstable and drained due to a job. I do not want to lose my license because of poor training. I also don't want to unintentionally harm a resident because I am so stressed and poorly trained. It felt like a disaster waiting to happen. I just hope this isn't a common way of training nurses. I hope I can find a place with a small amount of beds or maybe even do home care. Wherever I end up I really hope it is better and provides me with good training. I hope my next job provides new nurses with inservices and brushing up on skills because this job sure didn't . I will try no to let this really bad experience as my first LVN job paint the picture of how it will be.

[TriciaJ, RN]

This place sounds like a facility where I did some agency work. I lasted 5 shifts (and I was a very seasoned nurse) before I burned rubber out of there.

I picked up shifts in other places that were MUCH better. So there are good places out there. Facilities with religious affiliations are usually better bets. Good luck!

[ComeTogether, LPN]

You can explain a late administration, you can't explain a med error. The nurses who have it down have been doing it day after day - you will get there.

Go slow, take your time. Don't allow interruptions during your med pass. Prioritize your patients when you get more familiar, some will do better with med after breakfast, some before etc.

The only way to get comfortable is to keep going, just be safe and ask questions. Don't chat with the patients too much during your med pass but go back to them afterwards. Any medications you aren't familiar with look up after work. (obviously you will need to know the type of med and what its for in order to administer, but if you look it up later you'll find out more information and things will start clicking)

You'll find tricks and tips from various nurses, some will work for you and some won't. Take what you like and leave the rest.

Don't focus on your speed - that is how errors occur. Just start as early as you can and keep going until you are done.

[Katie82, RN]

All your coworkers who seem to have it all together were all at one time experiencing just what you are now. LTC is notoriously understaffed and overtasked. I would urge you to consider going for an RN degree, not because it will make you a better nurse, but because it will give you more opportunity. I hated bedside nursing, but my husband was in the Air Force during that period, and bedside was the easiest way to "start over" every 3 years. As soon as he retired and we had a permanent address, I left the hospital. Never looked back, never regretted. You need to have a long-term plan for doing the same.