Not loving my career choice today

I am a new grad and have been working on a VERY busy neuro med-surg unit for 2 months. Every day when I leave work I feel like I did a horrible job, today was the first day that I actually cried after work though. Every day I feel like I wish I could quit and wonder if I made the right career choice (this is a 2nd career for me). I had 5 weeks of orientation where my preceptor helped me very little. I still don't know how to communicate to doctor's - which sounds kind of stupid but I NEVER know the answers to their questions. At the start of my shift I make a list of what needs done, potassium riders, orthostatic VS, neuro checks, etc... but the unit is so busy that it is usually the end of the shift before I remember the list of "must do's" I made at the start of the shift that never got looked at again. Then there's the charting - which I don't even get a chance to start until after I've given report to the next shift. I feel like I put my license in jeopardy every day I go to work. It seems like I still ask stupid questions all the time. Some of the nurses look at me like "are you kidding, you really have to ask someone about that" which makes me feel especially inept. I really don't feel qualified at all to take care of most of the patients on the floor.

I don't know if I am a 'normal' new grad or if I really am on a floor that is too challenging for me. I have put out apps for a new job like crazy but have not even gotten an offer for an interview. So I am stuck until something new comes along.

Do any of the more experienced nurses have any suggestions that might make me feel better. I don't think med-surg is for me. I know everyone says to start on med-surg and get a good background before moving on but I truly dislike going to work where I'm at now. I know you've all heard the same thing from numerous new grads and maybe I should 'stick it out' but I think a slower pace would be more beneficial to my learning how to be a RN.

I was considering hospice, rehab or the mental hospital - to take care of pts, not for me to become a pt there :chuckle Although that may be a possibility too!

[student200977]

I know exactly how you feel. You should read some of my posts. I feel like I want to quit everyday, but then I think, I cant, for a few reasons...1) I'm not a quitter (this is the first time in my life I have acatually considered it though), 2) I'm under a contract, 3) I need the experience if I want to do anything else, 4) I need the money, 5) and the most obvious, I'm blessed to have gotten this job in today's economy. Being a new grad sucks...I know the hospital is not for me. I went into this field to help people, not run around like some crazy person filled with a whole shift of tasks. Its definitely rough out there, but I try to listen to everyone who tells me that it will get easier with time.

[Imafloat, BSN, RN]

First of all, I want to tell you I am sorry that you are feeling this way. I am offering a few practical solutions, and I don't want you to think I am being critical.

Five weeks isn't a very long orientation. It sounds like they pushed you out on your own really quick.

Maybe you need a better way to keep your list, since the list you make at the beginning of your shift isn't working for you. How many patients are in your assignment.

How do you go about your day. Sometimes you just have to tell someone else to hold on a minute and finish what you are doing so that you don't have to come back.

Do you all use SBAR when communicating with docs?

[willcare4u]

I am thankful to have a job I just wish I liked it more. I did go and talk to someone in the education department at the hospital and she gave me a couple of suggestions: 1) use the SBAR sheets to get report on, that way you have all the info handy when you need to call a doc quickly 2) since we have computers in all the pts rooms I should try to do my charting on each as I give them their morning meds (I feel this will put me waaaay behind, but I'll give it a try) 3) this was my favorite, things will get better with time :)

I realize that I am not alone in my misery of being a new grad, it just really sucks when you feel completely incompetent.

[willcare4u]

WeeBabyRN

I take care of 6 patients. I've been doing some reading here and have come to realize that my orientation was not very long. But, it is all they give and I am one of the fortunate few in my class that was able to get a job as a new grad so I am trying to not complain too much. I am off the next couple of days and I am going to try and figure out how I can organize and prioritize my days better.

This is my usual day:

- Get report

- Look at pt labs

- Write down what times each pt needs meds given

- Give all pts am meds

From here I lose control and end up behind the entire rest of the shift. Like I posted in my reply to Student 200977 I am going to try and chart on each pt while I give them their am meds and see if that makes any difference in my day. I sure hope so.

[PAERRN20]

Don't work med surg but a suggestion from a new grad that is a year and a half out. Try to get everything done on one patient before moving to the next. Give meds, check VS, check IV site/fluids, reposition, take care of any STAT or critical needs and then move on. Everything else can wait. You don't need to fluff the pillow, get fresh ice water, etc. None of that will harm the patient. As a new grad I was so caught up on the little stuff. Then I realized I need to assess, medicate, and chart. Sure I would like to spend all day with the patients talking to them and making them comfortable but charting is a fact of the job. I need to protect that license and I have to make a living somehow so I do what absolutely needs to be done first and then take care of the minor stuff later.

[willcare4u]

Thanks PAERRN20 from what I've learned today from various sources is that I do spend too much time on the 'little stuff'. I do stop to get the water, blanket, towel, etc. It just seems to be part of my nature but I am going to have to concentrate on the needs of the pt. My next shift I am going to do things differently and see how that changes my day.

[considerthelilies]

Nursing is nothing but a whole lotta TRIAGE. You have received some good advice here. I would suggest you do some study/practice in triage and prioritization.

[Up2nogood RN, RN]

We have computers in every patient room too and what has helped me the most is to chart my assessment first thing. Pull them up on the computer at the bedside and just get it done, it really only takes a few minutes and you don't have to second guess things at the end of the shift. The only things I have left to chart are care plans (ugh) and progress notes. I don't take a lot of notes since we do bedside report and I'd forget to look at them anyhow. Oh and when I call a doc I pull up the pt on the computer so I can find the answers fairly quickly. Good luck it does get easier and it just takes some time to find what works best for you.

[Ayvah, RN]

Here's what works out perfectly for me, to help me to remember my "to-do" list. If there is something that needs to be done at a certain time, such as drawing labs, MRI or neuro checks, or if a doc wants to be called at 3 or whatever, I take all of that and add it to my medication times. For example, on the bottom of my patient's facesheet, I'd write my med timelines, i.e.

7-8-9-12-15-17

Then I'd add in my neuro checks, phone call, MRI with reminder to take off tele, and lab.

7-8-8(n)-9-10(MRI, tele off)-12-12(n)-15-15(doc)-16(n)-17-18(lab)

I leave some space so that if another thing popped up during the day I could add it in. When I get done with that time's thing to do, I'd X if off. If I can not do it for whatever reason, like the patient is in surgery, I wouldn't X it off until I could see it as officially done.

If there was something special that needed to be done before I left, or random things that are of extremely low priority, I'd write it at the end, like

7-8-8(n)-9-10(MRI, tele off)-12-12(n)-15-15(doc)-16(n)-17-18(lab) - 19(special/list)

I have got to say, that since I started doing this, I haven't missed a single time-sensitive task yet. I always glance at my pt's timelines before moving onto new things so it is a constant reminder to keep me on track. I really suggest you try this if you are already relying on the medication timeline as it has been a tremendous help to me.

I'm the type of person that can't sit down and chart when I feel like there's something else that needs to be done soon - with so many interruptions in the day, it just fits me better to have the charting be near the bottom of my list. If I chart throughout the day I waste more time because I constantly check to see if I remembered to chart something or not. Instead I have my blank sheet of paper to write notes, and my facesheets. On my facesheets, I write if there is anything out of the ordinary on my assessment (as I'll need to remember it anyway for report). I'll put down the tele box number, the amount of O2, that they are a L BKA, that they have a glass eye. Our computer charting assessment area is cumbersome and takes a good amount of clicks to do. But to each his own, however, as there are a lot of people who swear by charting as you go. But this is what works for me, as if something comes up mid day, I want the time and space to be able to feel like I can get it taken care of, not thinking about the zosyn I could have hung an hour ago while I was charting that is now overdue, or that I still need to check potentially stat orders and talk to the tech. However, I always chart my meds as I'm in the room as this serves as another check for me for accuracy so I feel it is of high importance. I also get real time data this way so I know exactly when the IV bag will run out and will need replacing, or when the next pain med is available.

So, here's what I do. Report/labs, get vitals from techs and give them report, give meds along with doing assessment, check & take off orders and let techs know what is going on, and take care of inevitable morning issues like bad IVs, calls to the doc, and discharging an antsy patient. Do lunch insulins/meds, make sure my patients are comfortable, then take lunch myself if I'm able to around 1:30. Then I glance at my timelines to see if anything is coming due, make sure my patients are comfortable, and then can concentrate on charting without a million interruptions. I can at times get a good chunk of my charting done here before I have an admit, and then the it gets busy again with more meds and things to do. Charting is one of my strong points as I'm very fast on the computer and thorough. I don't feel like I miss much on charting because the important stuff I wrote down on my facesheet which I reference as I write the assessment.

I have another paper for miscellaneous notes. On the right hand side is my area for doctor calls. Here's what I do

1 - Something is wrong with the patient (i.e. meds need clarifying, pt not breathing well, blood pressure too high, family upset and is demanding things, lab is wacky)

2 - I make sure I have a current set of vital signs and that I've assessed the patient (listened to lungs, gotten more detail about their chest pain, etc). I see if I can do anything to help first, such as recheck the bp manually (has saved me many a phone call), or make sure that a foley isn't kinked if a patient's urinary output is low, and look at the appearance of the urine in the bag.

3 - I assess the importance of the problem. Is it something that needs to be addressed asap? (severe chest pain) Is it something that should be addressed but can wait a few hours? (patient forgot that they take flonase at home and wants to have it today, but is feeling fine and is nonchalant about it)

4 - I write down the important information in my doctor area on my sheet of paper. I try to put myself in the doc's shoes and ask myself what the doc would want to know. Do not call the doc until you have sat for a minute and organized your thoughts of what you will say, and your supporting evidence. It will really help. For example, if I am calling about a low blood sugar, I should have the last couple blood sugars readily available so that the doc can see trends and then be better able to decide on med changes. If my patient is sounding coarse I can let the doc know the O2 sat, the liters of oxygen, and the results of the last chest xray and when that was done. I can let them know that he has already had a breathing treatment, and recommend lasix. I write down things so I don't forget when the doc calls me while I'm focused on something else while in another patient's room. I write down the time I called the doc and what patient it was about so when they call I can get right into it, and I can see when another page is warranted, and, so I can chart it. I put one line through it when I'm done so that it can still be read, and I'm sure to include all the doc calls when I sit down to do my charting.

Hope this helps somewhat, 6 weeks isn't very long and its a steep learning curve. Things do get better in the sense that you will know the answer to a lot of your questions in the future instead of needing to take the time to think about it and find someone to ask, such as where to go on the computer to order a new IV pump. Are any of these questions something you can research at home, like 'what is this med for'? However, the work load will always remain high (because when it isn't, they send people home). Some of the stress will ease, such as the stress that comes from "I'm going to do my 4th IV!", but honestly a lot will remain because it is inherent in working with acutely sick people. The question is, once that ancillary stress eases, will the pros outweigh the cons? It is hard to say but if nothing else, you are not alone. So many have echoed your thoughts. Please continue to ask questions rather than potentially do something that will inadvertently hurt a patient. Please also utilize your charge nurse for help. They are life savers. Best of luck to you.

[trulynurseatheart]

WeeBabyRN

This is my usual day:

- Get report

- Look at pt labs

- Write down what times each pt needs meds given

- Give all pts am meds

From here I lose control and end up behind the entire rest of the shift. .

WOW Sounds just like me!! Though, now that I am 3 years in, Im improving.

[starletRN]

Here's what works out perfectly for me, to help me to remember my "to-do" list. If there is something that needs to be done at a certain time, such as drawing labs, MRI or neuro checks, or if a doc wants to be called at 3 or whatever, I take all of that and add it to my medication times. For example, on the bottom of my patient's facesheet, I'd write my med timelines, i.e.

7-8-9-12-15-17

Then I'd add in my neuro checks, phone call, MRI with reminder to take off tele, and lab.

7-8-8(n)-9-10(MRI, tele off)-12-12(n)-15-15(doc)-16(n)-17-18(lab)

I leave some space so that if another thing popped up during the day I could add it in. When I get done with that time's thing to do, I'd X if off. If I can not do it for whatever reason, like the patient is in surgery, I wouldn't X it off until I could see it as officially done.

If there was something special that needed to be done before I left, or random things that are of extremely low priority, I'd write it at the end, like

7-8-8(n)-9-10(MRI, tele off)-12-12(n)-15-15(doc)-16(n)-17-18(lab) - 19(special/list)

I have got to say, that since I started doing this, I haven't missed a single time-sensitive task yet. I always glance at my pt's timelines before moving onto new things so it is a constant reminder to keep me on track. I really suggest you try this if you are already relying on the medication timeline as it has been a tremendous help to me.

I've done something similar. We have binders with our MARs in them. I put a sticky note on the front of it since I'm carrying it around all day and and write in the med times for each patient and tasks I need to get done that day. It works out really well for me. They're pretty large sticky notes with lines like notebook paper, so I have plenty of space to write.

I'm the type of person that can't sit down and chart when I feel like there's something else that needs to be done soon - with so many interruptions in the day, it just fits me better to have the charting be near the bottom of my list. If I chart throughout the day I waste more time because I constantly check to see if I remembered to chart something or not.

This is me to a fault. If I chart as I go, I'm going to get behind on meds and other things my patients need. Charting is not tops on my priority list. Like another poster said in this thread, it's about priorities. I would rather wait until the end of my shift to chart and know my patients are safe than do it as I go and miss something important. I will try to make a brief note on my Kardex copy of anything that occured during the day or any abnormal finding. Then I'll chart it later on the flowsheet when I have more time.

Hope this helps somewhat, 6 weeks isn't very long and its a steep learning curve. Things do get better in the sense that you will know the answer to a lot of your questions in the future instead of needing to take the time to think about it and find someone to ask, such as where to go on the computer to order a new IV pump. Are any of these questions something you can research at home, like 'what is this med for'? However, the work load will always remain high (because when it isn't, they send people home). Some of the stress will ease, such as the stress that comes from "I'm going to do my 4th IV!", but honestly a lot will remain because it is inherent in working with acutely sick people. The question is, once that ancillary stress eases, will the pros outweigh the cons? It is hard to say but if nothing else, you are not alone. So many have echoed your thoughts. Please continue to ask questions rather than potentially do something that will inadvertently hurt a patient. Please also utilize your charge nurse for help. They are life savers. Best of luck to you.

ICAM I've been off orientation for 4 months and I feel better the more experience I get. But I still get stressed and most of that stress is due to the workload. Even the experienced nurses talk about how overwhelmed they are. A good charge nurse is worth her weight in gold and I have gone to mine numerous times. She has been very patient with me. Even when I know I'm asking her a question that I've all ready asked her a week before and forgotten the answer to.

At least now I go home most of the time not worrying about work. Getting sleep before my shift? That's another thread entirely. LOL