New RN having the worst time

Posted
by Nursetaylor3 Nursetaylor3 (New) New

Hey guys,

So I've been at my new job about a month now and I can honestly say I feel like the stupidest person out there. I work in a nursing home giving out meds and doing skin assessments and things like that. Multiple people have been telling me a nursing home is no place for a new RN because you don't learn anything. Which I understand but I thought it would be a good place to get my feet wet. But being here for a month still makes me feel like I know absolutely nothing. Anything that comes up like a patient complaining of difficulty urinating or someone who has a skin tear I feel like I have no idea how to handle it and I go ask the other RN for advice.

I honestly feel like I don't know anything and I'm not confident in making a judgement call on my own. Even about something as small as a skin tear. I feel like I'm a bad nurse and I'm being annoying asking the other nurses advice. Its like everything I learned in school just went out the window and I have no idea what I'm doing.

Anyway I just wanted to be able to vent to someone and hopefully get some advice or feedback..

BSN16

BSN16

Specializes in ICU, trauma. 389 Posts

you have been a nurse for a month of course you don't feel comfortable. I still ask tons of questions to my other nurses on a daily basis. Dont feel bad or guilty about it.

Teresag_CNS

Specializes in ICU, trauma, gerontology, wounds. Has 34 years experience. 3 Articles; 194 Posts

First, those who say a nursing home gives you no experience are flat-out wrong. Your practice is complex, as your dilemmas illustrate. What is the best way to prevent and treat skin tears and UTIs? How is delirium best managed? How to make decisions about end of life? And so on....These are questions that demand expert knowledge of gerontological nursing. My first suggestion is to join the National Gerontological Nurses' Association - Home - the journal is excellent, and you will have a cohort of other nurses skilled in caring for aging adults to back you up. My second suggestion is to read, read, read about gerontological nursing. It is a growing specialty, and those who have these skills will be in HUGE demand in coming years.

We need great gerontological nurses like you. Stick with it! And best of luck.

quazar

quazar

Has 20 years experience. 603 Posts

If you acted like you knew it all right out of the gate, fresh out of school, fresh out of orientation, that's when I'd worry. Asking quesitons is a good thing. It's the only way you'll ever learn. However, do give yourself some grace here, okay? I think part of the reason your brain freezes up is because of lack of confidence and fear (normal). When you feel those negative thoughts coming on, flip it around and ask yourself, what would you tell a friend who was feeling the same way as you? What would you say to a friend who is a new nurse in a new job and is doubting herself? You would probably tell her to give it time and to hang in there, right?

You're still learning, and you will always still be learning (hopefully). There's no shame in that. No one knows everything, and those who claim they do are either dangerous or stupid or both.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience. 67 Articles; 14,008 Posts

First, a month is just a tiny speck of time. Of course you feel as though you don't know anything. You don't know anything! But that will come, with time, experience and numerous questions asked and answered. No one really EXPECTS you to know anything after just a month. Now you begin to learn what it is to be an RN!

Those people who told you that you don't learn anything in a nursing home are wrong and ought to be ashamed of themselves for telling you such a thing! A nursing home nurse has an incredibly difficult and complex job, and one that I don't think I can do -- and am thrilled as all get out that I don't have to! You have to pass medications to thirty patients, getting them to actually TAKE the medications which means learning who won't take a pill unless it's crushed in apple sauce and who has to be flattered about his decades-ago military service before he'll take a pill. When a resident starts screaming and stripping in the middle of the dining room, is that business as usual, or is this a new behavior that could herald a change in medical status? And if it's the latter, WHICH medical status? A new UTI or an exacerbation of the patient's already diagnosed dementia?

You learn to assess skin and what to do about alterations in skin integrity. Assess mental status and calm the resident, assess and document decline in physical or mental condition and numerous other assessments -- too many for me to type right now. You learn when to call a physician, how to relay the information, and what to do about orders. You learn how to talk to patients and their families, how to deal with an out of control or out of bounds visitor, how to read a medical history and what to look for in a chart. Don't let anyone tell you that you "lose your skills" because while you may get rusty on skills you don't use, you will develop so many more skills that you didn't know you needed but that will serve you well for the rest of your career. Should you ever change jobs or specialties, those "skills you lost" will come back very quickly and even better, you'll have the calming the patient and explaining to the family skills down pat BEFORE you start dropping an NG or placing an IV.

Any new grad who doesn't ask questions (lots of them) scares us crusty old bats. It's the new grad who doesn't ask who does something stupid that hurts someone. You'll be asking questions for the rest of your career -- nobody knows everything, after all. Might as well get used to it now. After forty years, I still learn something new every day.

CalArmy

CalArmy

95 Posts

Take a breath and know that seasoned nurses expect you to ask questions. You will still be asking questions after one year. I am sure you are doing fine and just going thru the normal novice nurse period. Have confidence I. Yourself and know that thousands of nurses before you have had the same concerns so you are not alone.

DTWriter

DTWriter

322 Posts

As a fellow new nurse, here is my two cents.

Ask questions - but be smart with whom, where, and when you ask questions.

Sad but true - There are older nurses out there who would encourage new nurses to ask questions...yet, some of these same nurses would use those questions asked in confidant to complain about the new nurses to the manager. And then, these same nurses would wonder why the new nurses, let alone anyone else, do not ask them questions anymore. :sarcastic:

DeeAngel

DeeAngel

826 Posts

IMHO you need hospital experience before ever working a nursing home. Nursing homes expect you to know your stuff and hit the ground running, no new grad is capable of doing that. Find a job where you will actually learn skills, and a nursing home is not that place.

Libby1987

Libby1987

3,726 Posts

Speaking just to the general knowledge that you need to care your patients, there is a plethora of educational resources out there. In 15 minutes you can probably read everything you need to know to assess and treat skin tears.

Give yourself a prioritized list of conditions and treatments that you need to familiarize yourself with on your time off. Your employer will never be able to provide all of the education that you need, the reimbursement in SNF just isn't there, but I'd hope they would help you devise that list and support you in your learning.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience. 67 Articles; 14,008 Posts

As a fellow new nurse, here is my two cents.

Ask questions - but be smart with whom, where, and when you ask questions.

Sad but true - There are older nurses out there who would encourage new nurses to ask questions...yet, some of these same nurses would use those questions asked in confidant to complain about the new nurses to the manager. And then, these same nurses would wonder why the new nurses, let alone anyone else, do not ask them questions anymore. :sarcastic:

Be smart with HOW you ask the questions. Those older nurses out there don't appreciate questions like "What's the phone number for the Blood Bank?" While they're elbow deep in someone's butt decub or river of poop. They don't appreciate questions like "What's that yellow thing coming out of his neck again?" When you work in CTICU and every patient comes back from surgery with a PA catheter or when the patient is crashing, they're frantically trying to save him and you're standing in the doorway spectating.

Ask smart questions and ask them the right way. "Mr. Pee needs a Foley. What do I do?" Is not a smart question. Better would be "I have an order for a Foley for Mr. Pee. I've read through the procedure and I think I have everything I need, but I've never done this before, so could you talk through this with me before I go in to see the patient?" Rather than asking "What's the policy on XXXX?" You could ask where to find the policies.

Yes, you should ask questions. And you should be careful who you ask -- make sure you ask the experienced nurse who might know answers rather than another newbie who might steer you wrong. Make sure you ask smart questions because if you have a reputation for asking dumb questions (what's the number for blood bank? Rather than "where could I find a list of the numbers for other departments?") or for not even trying to figure things out for yourself others WILL tell the nurse manager that you seem to be struggling. It would be negligent on the part of the experienced nurses who watch you spinning your wheels without gaining traction NOT to talk to the nurse manager about getting you some help.

nynursey_

nynursey_

Specializes in Med/Surg/ICU/Stepdown. Has 3 years experience. 642 Posts

Like the others' have said ... it's been a month.

I was never an RN in a NH, but let me tell you ... I am/have been a MedSurg RN, and > 80% of those patients are often NH patients in acute exacerbations of their illnesses. Should you ever choose to go into the hospital setting (and that's not to say you should--it's more of an IF you CHOOSE to), the skills you've gained working in that NH are going to be INVALUABLE and you are going to see your co-workers asking YOU for help.

Keep on truckin', dear. A month is just a blip on the radar. Give it a year. Remember Patricia Brenner!