I know this has probably been a topic on here before but I wanted to write out my feelings in hope someone could give me some advice.
I recently graduated in May and currently working on a Med/Surg Ortho unit. When I graduated, I was so ready to be the best compassionate nurse I could be. But now that I have been doing this for some months now, I feel overwhelmed and have constant anxiety. I find myself not being able to do the things I used to love to do, I can't fall asleep at night and if I wake up at 3 A.M. and I work the next morning, I toss and turn until my alarm clock goes off. I have an upset stomach, diarrhea, headaches etc. I leave work and I constantly think about something that I could have done better or missed. On my days off, I count the hours down until I have to go to work again.
For my job training, I learned about Ortho patients and surgeries but I was hired for the new unit which has been deemed anything but Ortho. It is more like whatever they can find to fill the unit: chest pain, sepsis, elevated lactic acid, small bowel obstructions, altered mental status---All things that I was not trained on. I am lucky if I get one Ortho patient a month and when I do, I feel like I forgot everything I was trained on.
We are constantly short with no HUCs/CNAs and having to TPC our patients but receive nasty emails from our manager when the unit is messy or when HUC duties aren't done etc.
I have had numerous conversations with doctors who make you feel like the smallest stupidest person alive and deal with intimidating experienced RN's who question you about stuff you didn't have time to look into or tell you that you did wrong but I won't dive into that.
I don't really know what answers I am seeking by posting this, but I just know that they didn't teach you how to deal with anxiety, doctors, mangers and the constant stress that is nursing. Any advice? I feel like I am ready to quit or look for a job in a clinic but I want to gain the knowledge that comes from working in the hospital.
I agree with the previous comments about confronting the rudeness, but it sounds like the OP may also be a little overwhelmed with the nursing too. If that's the case, I just want to tell the OP that just because you are struggling with your first job, it doesn't mean you're going to keep struggling! While many of my classmates were sharing positive feelings about their first jobs, I *struggled* but it got better!
I have a couple months experience on a poorly staffed med-surg unit as well as orthopedic experience on a well-staff, quality unit. When I went to leave the poorly staffed unit, the manager told me that I was quite possibly jumping out of the frying pan and into the fire with going to an orthopedic unit. In many ways, she was right.
I worked on an orthopedic unit for (almost) the first 20 months that I was a nurse (minus the couple of months on the first , poorly staffed unit). I found orthopedics to be a tough unit (compared to when I was pulled to other med-surg units and compared to moving to a progressive care unit after 18 months). I worked nights (which are much easier than days IMO). My assignment was typically 5 patients, occasionally 6, rarely 4 -- and most of them actually were hip/knee/spine post-op patients or ortho-trauma pre-op patients. Our unit was so well-staffed that we often had an RN or NA pulled to other less well-staff units.
I tell you all of this because even on a unit that sounds like a dream compared to what the OP describes, I still found the first 6-12 months to be very difficult. At 6 months, there was a slight improvement, but I still felt so stressed for most of my shift that it was not unusual for me to have a spell of frustrated tears in private nearly every shift. (I was so embarrassed by these private cries, but was thankful that my patients still frequently commented on my cheer & energy, regardless of the hour, so I guess I didn't let them affect my ability to provide quality care.) I talked with my manager about my disappointment in my performance (I was often having to stay late to finish charting due to prioritizing patient care, and I couldn't figure out how other people had so much free time each shift.) My manager didn't have tons of suggestions for improving efficiency. She just told me that she felt I was on track and to give it 6 more months.
At 12 months, there was another improvement in my efficiency and ability to cope (fewer tears in private too), even though I didn't feel that I had done anything significant to cause an improvement. My coworkers assured me that I would probably see improvements again at 18 and 24 months, so I just tried to keep the faith.
I felt my former manager was right about "jumping into the fire" because, in my experience, ortho patients were so time consuming. Even with adequate nurse aid staffing, the RNs are needed to help with mobility more often than any other unit I've worked on. Almost everyone is a fall risk and needs helping getting up to the BSC or BR and often need help to even swing their legs over to the edge of the bed much less to get to a standing position. Just about every patient is getting some sort of pain medication q4h PRN (and needs it that often) and it's not unusual for them to need even more frequent meds for breakthrough pain for the first 24-48 hours. Every time I got pulled to another unit, I was shocked by how much easier my night was when at least a couple patients were up ad lib and most of the others were standy-by assist due to fall risk rather than needing all the extra time to actually help them get out of bed. And not having multiple meds to give almost EVERY hour of the night? It seemed to make my charting go so much faster.
At 18 months, I moved to a progressive care unit where I typically have 4 patients, and occasionally 3 or 5. The initial transition was stressful too as I lost some efficiency with a completely different patient population (and with having to train on days when there is so much more going on with discharges, admissions, and having to accompany cardiac patients to tests), but once I went to nights I could tell it was going to be a better fit for me. Having an average of just one patient fewer made a huge difference. I had more time for the details. I'm still way too slow for days, but now even when I start a shift and can tell I'm going to need to run in 6 different directions at once, I don't get nearly as stressed. I can feel the stress starting to choke me, but it rarely turns to tears and I'm usually able to just get it done. I almost never have to stay late for charting.
It's hard to tell without knowing more from the OP, but it's possible that the problem isn't you, but the unit (or facility) you are currently in. Chronic under-staffing of nurses or nurse aids can be a HUGE stressor. No matter how organized and efficient I am, I don't feel that I can give quality, compassionate care to 8 patients. It's one of the reasons I ended up leaving my first job after such a short amount of time. But many other stressors have things that you can do to help yourself. If you think you have some efficiency problems contributing to your stress, I thought Nurse Eye Roll (Kati Kleber) had some great suggestions when I first started. If certain skills are stressing you out (like trachs, NG/PEG tubes, tube feeds, chest tubes), I found that just admitting to my charge nurse that I hadn't had a patient with XYZ and hadn't used that skill since skill lab helped. (I hope your charge nurses are supportive like mine were.) Depending on the skill, we would quickly review and then I would do it with them in the room (ready to step in to help out if needed) or they would do it the first time and would watch me do it the next time. Keeping a binder in my locker with some cheat/reminder sheets for certain treatments (and the care/charting required) helps me remember (and decreases stress) when I haven't had a certain type of patient in a while.
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
Also, once you get more experience, you may consider working for a nursing agency. I do this on the side. The nice thing about it is that you move around. You go to several different hospitals. You do not work for them so you are not involved in all of the corporate BS and backstabbing. You do your shift, and you may not see the same staff for months.
YES> another nice thing about working agency is that you can plan your life, because you decide when, where and for whom you will do your assignment. You also don't get stuck with the same old stuff and get out of the grind.
But none of this is a replacement for taking care of yourself. Get to the doctor, then make plans to get the hell out of dodge.
I completely agree with your post, OP. I am a new ER nurse just getting off orientation and my anxiety is SKY high. My unit is short staffed and some nurses have such attitudes that I feel uncomfortable asking for their help. I am actually applying to graduate schools in the fall just because I am seeing I can't do bedside forever. Definitely see your doctor about medication. Take it day by day & know that you are slowly getting closer to the 1 year mark where you won't be the new grad anymore. Then you can apply to another unit that interests you.
Please, Please always ask for help if you need it. Better for safe patient care. Nurses with attitude is not a personal reflection. You don't need to bring these peeps home with you.
There is a difference between confrontational and direct. Just be direct and to the point.
Please, Please always ask for help if you need it. Better for safe patient care. Nurses with attitude is not a personal reflection. You don't need to bring these peeps home with you.
There is a difference between confrontational and direct. Just be direct and to the point.
I do ask for help. I meant I have my go to experienced nurses that I seek out for advice and help, there's always at least 1 or 2 per shift I feel comfortable asking. I should have expanded on that.
First of all, it feels GREAT to be finally posting in here.
To get back to the original post -
Hang in there, you are learning many things that you would otherwise have to pay a lot of money to learn or may never get the chance to in another place. This is actually making you a better nurse and could potentially make your future better for you. Things you are learning right now on your 1st gig in nursing straight out of school:
1 - To be able to handle a variety of different medical issues all at once
2 - Develop thick skin
3 - How to deal with an cr@P manager (you need to keep as much communication with your manager in writing as possible)
4 - How to deal with bad docs (you need to break out of that shell and start to check these guys as well, ESTABLISH BOUNDARIES)
These are very important things to have down not just for nursing but also for life.
Ways you can cope:
1 - Come here and vent
2 - Start planning major fun activities on your off days
3 - Eat good nutritious healthy foods, get in the gym, start yoga
Thats just my 2 cents. Not all of nursing is like this, but this is a great experience for you for your next move and hopefully will be great for your future in nursing.
Specializes in clinic, ortho/neuro, trauma, college.
Oh OP, I feel you. I was at a hospital for 18 months, my first hospital job, and believe me, it took everything in my power to eek out those 18 months. Nursing school is NOTHING like floor nursing, and I wish BSN programs could figure out a better way of preparing students for the reality of nursing. That being said, nursing is HARD, and a good nurse manager and great co-workers are required. Ortho is tough for exactly the reasons you mentioned, and as awful and annoying as those unfamiliar diagnoses are, they are setting you up for valuable experience that you can take elsewhere when the time is right.
My advice is the same as others'. Take care of yourself, and set your sights further down the road. If you need something to help you sleep, talk to your doctor. It's not fair to wake early and ruminate about the coming shift! Keep us posted. You won't be there, or in that new nurse position, forever!
First, congrats on landing a nursing job! Second, I feel like I wrote this myself. I also graduated in May and started work on a trauma floor with ortho at a level 1 trauma center. I also woke up during the night with anxiety and was constantly worried about things I forgot to do or could have done wrong. It got to the point where my hair started falling out and still is. I decided to quit after 2 months because I could not handle it, especially being my first RN job. I started a job in psych this week on a women's unit and like the pace a lot more. The staff is supportive and helpful and want everyone to succeed. My advice would be to try to work out some problems with management and the way you are treated. Just know that you are not alone in feeling this way. Sometimes the stress and anxiety get so hard to deal with that the job just isn't worth it. I hope this helps and good luck to you! :)
OP, I'm an older RN and have precepted a lot of new nurses.
On my unit we try to dispel the idea that "Nurses eat their young." Even so, I routinely tell new nurses that they can expect to be on our unit for at least a year before they feel comfortable. That's normal.
Your unit sounds like a pressure cooker. That said, you are learning a lot! My unit is supposed to be cardiac centered but pts have many comorbidities and we must learn to deal with all the different physiological systems.
I too started my career on an ortho m/s unit. I hated every minute of it. Not one day did I walk in feeling good. I did that for about 2.5 years b/c you hear the same bs "give it a year". Well I did and then some, and my anxiety got out of control that has now turned into depression that I now am on medication for. A job shouldn't make you feel so horrible mentally you need medication (in my opinion). I then moved to the er thinking maybe I need to build my confidence and experience up and then I will feel better about how I'm doing. I couldn't last 6 months there lol. And I just don't have the personality to work in an atmosphere like that. I finally built up courage to leave the hospital for good, such a hard decision but my health was being affected and I knew it was time to leave. I now work in an outpatient center and LOVE it. Don't get me wrong, the hospital experience helps tremendously, but it is NOT for everyone. And don't feel bad if its not. Unfortunately, you will at least want that year of hospital experience to market yourself for a position elsewhere. But don't settle for something that you are so miserable in! life is too short!!
Seems to me like u work in a toxic work environment. Nothing worse than walking on eggshells all day at work. Get your experience while youre there...and CONSTANTLY look for other job opportunities. Not all work environments are alike...ive been in really great team oriented places and also the type of place u describe.
You will never make it out of there unless u try...which equals to u applying and networking for better jobs. Many people just get comfortable and stagnant at their job. You will lose out on many opportunities like that. Keep pushing through...you will be fine. Many nurses like to flex their seniority on new grads, but eventually ease off.
SarahRN2013
32 Posts
I agree with the previous comments about confronting the rudeness, but it sounds like the OP may also be a little overwhelmed with the nursing too. If that's the case, I just want to tell the OP that just because you are struggling with your first job, it doesn't mean you're going to keep struggling! While many of my classmates were sharing positive feelings about their first jobs, I *struggled* but it got better!
I have a couple months experience on a poorly staffed med-surg unit as well as orthopedic experience on a well-staff, quality unit. When I went to leave the poorly staffed unit, the manager told me that I was quite possibly jumping out of the frying pan and into the fire with going to an orthopedic unit. In many ways, she was right.
I worked on an orthopedic unit for (almost) the first 20 months that I was a nurse (minus the couple of months on the first , poorly staffed unit). I found orthopedics to be a tough unit (compared to when I was pulled to other med-surg units and compared to moving to a progressive care unit after 18 months). I worked nights (which are much easier than days IMO). My assignment was typically 5 patients, occasionally 6, rarely 4 -- and most of them actually were hip/knee/spine post-op patients or ortho-trauma pre-op patients. Our unit was so well-staffed that we often had an RN or NA pulled to other less well-staff units.
I tell you all of this because even on a unit that sounds like a dream compared to what the OP describes, I still found the first 6-12 months to be very difficult. At 6 months, there was a slight improvement, but I still felt so stressed for most of my shift that it was not unusual for me to have a spell of frustrated tears in private nearly every shift. (I was so embarrassed by these private cries, but was thankful that my patients still frequently commented on my cheer & energy, regardless of the hour, so I guess I didn't let them affect my ability to provide quality care.) I talked with my manager about my disappointment in my performance (I was often having to stay late to finish charting due to prioritizing patient care, and I couldn't figure out how other people had so much free time each shift.) My manager didn't have tons of suggestions for improving efficiency. She just told me that she felt I was on track and to give it 6 more months.
At 12 months, there was another improvement in my efficiency and ability to cope (fewer tears in private too), even though I didn't feel that I had done anything significant to cause an improvement. My coworkers assured me that I would probably see improvements again at 18 and 24 months, so I just tried to keep the faith.
I felt my former manager was right about "jumping into the fire" because, in my experience, ortho patients were so time consuming. Even with adequate nurse aid staffing, the RNs are needed to help with mobility more often than any other unit I've worked on. Almost everyone is a fall risk and needs helping getting up to the BSC or BR and often need help to even swing their legs over to the edge of the bed much less to get to a standing position. Just about every patient is getting some sort of pain medication q4h PRN (and needs it that often) and it's not unusual for them to need even more frequent meds for breakthrough pain for the first 24-48 hours. Every time I got pulled to another unit, I was shocked by how much easier my night was when at least a couple patients were up ad lib and most of the others were standy-by assist due to fall risk rather than needing all the extra time to actually help them get out of bed. And not having multiple meds to give almost EVERY hour of the night? It seemed to make my charting go so much faster.
At 18 months, I moved to a progressive care unit where I typically have 4 patients, and occasionally 3 or 5. The initial transition was stressful too as I lost some efficiency with a completely different patient population (and with having to train on days when there is so much more going on with discharges, admissions, and having to accompany cardiac patients to tests), but once I went to nights I could tell it was going to be a better fit for me. Having an average of just one patient fewer made a huge difference. I had more time for the details. I'm still way too slow for days, but now even when I start a shift and can tell I'm going to need to run in 6 different directions at once, I don't get nearly as stressed. I can feel the stress starting to choke me, but it rarely turns to tears and I'm usually able to just get it done. I almost never have to stay late for charting.
It's hard to tell without knowing more from the OP, but it's possible that the problem isn't you, but the unit (or facility) you are currently in. Chronic under-staffing of nurses or nurse aids can be a HUGE stressor. No matter how organized and efficient I am, I don't feel that I can give quality, compassionate care to 8 patients. It's one of the reasons I ended up leaving my first job after such a short amount of time. But many other stressors have things that you can do to help yourself. If you think you have some efficiency problems contributing to your stress, I thought Nurse Eye Roll (Kati Kleber) had some great suggestions when I first started. If certain skills are stressing you out (like trachs, NG/PEG tubes, tube feeds, chest tubes), I found that just admitting to my charge nurse that I hadn't had a patient with XYZ and hadn't used that skill since skill lab helped. (I hope your charge nurses are supportive like mine were.) Depending on the skill, we would quickly review and then I would do it with them in the room (ready to step in to help out if needed) or they would do it the first time and would watch me do it the next time. Keeping a binder in my locker with some cheat/reminder sheets for certain treatments (and the care/charting required) helps me remember (and decreases stress) when I haven't had a certain type of patient in a while.
Best of luck finding your happy place in nursing!