New Nurse, terrible shift

[ascty87]

I am a brand new RN, and just worked my 4th shift. It left me feeling overwhelmed and incompetent. I have always been a quieter person, it takes me time to feel comfortable in a new place, and sometimes my "Shyness" can be mistaken for obliviousness. I am 31, so I am older than the new nurses on my unit, but their outgoingness and confidence just makes me want to shrink more. I do really well with patient communication, but skills have always taken me longer (I NEED repetition). Report overwhelms me, because I know what I WANT to say, but I feel so judged, like I must be forgetting something. I guess I just need someone to tell me it's going to get better. Today was also the 1 year anniversary of my Mom's death, so that didn't help my emotional self. I know I know things, and can do this, I just feel so defeated right now. Anyways, I have always enjoyed looking up things on this site, and am happy to finally join as a nurse.

[L-ICURN, BSN, RN]

I found what helped me in the beginning was to write out what I wanted to go over in report. You may not have time to do this, so always have your brain sheet ready. As for repetition for skills, you will get plenty of that. Don't be so hard on yourself. You're new. You will not be new forever.

I believe you've got this and you can do this.

[dennis8, ADN, BSN, CNA, RN]

Sorry for your loss. I feel your pain from losing a father, but it will get better. You will feel better with the flow of time and keeping the good memories of your mother. Nursing is the same, the longer you do it the more you will feel comfortable with it. About handing off report, I use to have a difficult time as well. I use the paper SBAR to guide me. It will also help as time goes along knowing the report style of your coworkers when you hand off the report. Some like a detailed report while others just want to get the most important details because "they are going to look it up anyway." And there are some that no matter how good your report is, they will always find a question that you will not know and it's okay to say "I don't know." I usually keep the old SBAR that the previous shift gave me and have a whiteout pen handy to change things like lab values or obsolete information so I don't waste time making a new one. My flow is usually patient name, age, date admitted, code status, where they came from (home, SNF, direct admit), diagnosis, important medical history (I only say pertinent history such as history of PE, diabetes, cancer, or what pertains to the admission reason etc2. the rest they can read up), oxygen and how many liters if any, diet status and if they take pills okay/feeding tube, IV site and fluids if any, wounds and wound care, voiding status and foleys if any, pertinent labs, pertinent imaging, and most importantly plan of care. I say this is the most important because most things can be looked up or seen but sometimes the doctor rounds and he doesn't put in his note right away, or sometimes a nurse forgets to write what the doctor says on the nursing notes. When I receive report I always ask what the plan of care is if the nurse didn't already say. Sometimes, I get "Oh yeah doctor so and so says he wants to do this procedure tomorrow so please make sure the patient is NPO after midnight." As I said before, the longer you stay in nursing, the easier it will become. Good luck, you got this!

[LibraNurse27, BSN, RN]

First of all I am so sorry for the loss of you mother; being a new nurse is hard enough and I cannot imagine dealing with the difficulty of both of these things at once. The fact that you continued nursing school, graduated and got a job while dealing with the loss of your mother already shows that you are a strong person.

As far as being a new nurse, if you stick with it it WILL get better even though it often feels hopeless at first. I agree more reserved nurses can be great listeners and listening is often what patients need the most. I am not reserved but learning to shut my mouth and open my ears is one of the best nursing skills I have gained! Technical skills improve with practice, so don't be afraid to ask for opportunities to practice. Some nurses love to teach and show off their skills. I can shamelessly say it flatters me when people ask me for help with IV starts and makes me happy to see the confidence they get when they improve. I used to absolutely SUCK at IVs, like not get one on a bodybuilder with huge visible veins! Now I can step in during an emergency and get the hard stick and I am learning the ultrasound.

As for report do the name, age, code status, allergies, diagnosis, pertinent history then go system by system then pertinent lab results, IV sites and fluids, plan of care. You seem very caring and conscientious and I am sure you can do it. I was a total hot mess as a new nurse (21 years old and crazy, lol) and the confidence and professionalism I have gained make me so happy. I wish the same for you. Feel free to PM me any time!