new nurse waiting for that aha! moment!

nursemike, ASN, RN · Jan 2, 2008

It sounds like everything you have been hearing is true: it does take a while, you are doing great, you do need to pick up the pace, etc. If you're experience is like mine, and pretty much everyone else I know, what you are doing now, transitioning to a working nurse, is one of the hardest things you'll ever do. Messages will be mixed, and so will your performance. What in the world have you gotten yourself into?

It does get better. Most likely, your skills and organization will improve, and in the not too distant future--months from now--things that once threw you into chaos will become part of your routine. Or you'll fail miserably and at least you won't have to do this anymore.

But you did make it through nursing school, so you'll probably make it through this, too.

As for critical thinking, you're already doing it. Neither you nor I are saying Q2H turns aren't important, but if they end up being Q3 so another patient can get meds on time or some other more urgent care, that's prioritizing. Sometimes experience teaches us which corners can be cut--although, I don't think good nurses cut them without a good reason. As your pace improves, you'll have more time to get things done. On the other hand, I often feel I'm busting my tail to get things done that a couple of years ago I didn't even know I had to do. You'll pretty much always have to look at what needs done, now, and what can slide for a bit.

Like anyone else, I don't much care for being criticized, but during my first year, I reached the point where I almost appreciated getting chewed out. "You're doing great." is always nice to hear, but it isn't very instructive. Sometimes hearing where you screwed up is more instructive. But, don't worry, that will come... The big thing, I think, is that the ability to self-evaluate is one of the hardest, but most necessary things a new nurse can develop. The expectations of your peers and supervisors are important, but kinda variable. Some will be too easy on you, and others will likely be too hard. You have to be able to figure out for yourself where you need to improve, and while it's important to be able to react positively to criticism, you also need to be able to not take it too much to heart. If you can look at yourself as objectively as possible, that's your litmus test. But it isn't easy.

Ruby Vee, BSN · Jan 2, 2008

hi all, new nurse here with literally a few shifts on my own. what i feel is very frustrating is that i have no idea how i am doing? i have gotten a few 'great job tonight' from my charge rn's when i feel like i have barely kept afloat. i feel like the expectations for new nurses are so vague; mixed messages are abound! 'you're not going to know everything' and 'it takes time' to 'you need to pick up the pace' etc. i work on a telemetry floor and it is overwhelming. how can you tell if you are doing a decent job as a newbie nurse? this may seem odd, but literally i feel i have no litmus test. i am not a youngn' and this isn't my first 'real job' yet i feel like i am learning to walk and talk all over again. i keep hearing it takes a while for the 'critical thinking' part to come, and i suppose this coincides more so with experience, however how do you practice as safely as you can if you are just task oriented in order to just learn the routine?? right now i am operating at abc's is my pt. breathing? alert to whatever their baseline is? the nervousness is overwhelming and nauseating. i worry about not performing every two hour turning and positioning when i have a boat load of meds to pass, hang and check throughout the night including bp med drips, heparin drips, etc. i know this may sound nuts, to worry about a q2 t/p when vs take precedence but how can it all be done? ancillary staff isn't always around, and i work nights so sometimes its a ghost town. i also worry about writing notes. any other newbies out there have the same worries? did i say enough? too much?? i look at some other notes but the notes are just as varied. 'write what happened' is easier said than done. sorry for the ramble. any advice is much appreciated.

what's a "q2 t/p?"

you're not going to know everything in your lifetime! and it does take a while to get accustomed to the job. what your charge nurses are probably seeing and reacting to is the sight of you trying valiently to get it all done, and to prioritize appropriately and to figure things out as you go. so many new nurses treat it all as a checklist to rush through; prioritization and critical thinking take a back seat. your charge nurses are probably thrilled to see you making a real effort.

the fact is, you're going to be overwhelmed at times, and if you don't doubt yourself sometimes it's proof that you don't care. even sometimes when you've been on the job for 30 years or so, you worry about writing your notes. did i include every bit of pertinent information, and did i sufficiently tone down my commentary on the inappropriateness of the patient's behavior? did his heart rate slow before i suctioned him or while i was suctioning him and why the hell didn't i look at that monitor a minute sooner?

i'm not a newbie -- far from it! but i still remember the night i sneaked up the back stairs and into my patient's room (after change of shift, and after i'd driven home and shucked my polyester dress and white hose) to make sure i'd calculated that heparin drip correctly and hadn't harmed my patient! and even now i get the occaisional 2 am flash of "did i tell the night shift that the new levophed drip is double concentration? hopefully they'll notice before they hang it, but did i tell them?

sounds like you're doing just fine. at least, no worse than i did and probably better!

surfer betty crocker · Jan 5, 2008

thank you both very much for the feedback. i never realized how difficult 'self evaluation' would be in the world of med-surg nursing as a new nurse. i have been told to 'give myself some slack' but i feel that if i do that i may forget things! i hope it gets easier and people tell me it will. or like one poster said, i screw up and don't have to do this anymore. :specs: