Not making the grade at my new job...

Trauma Columnist · Sep 22, 2004

Please just take a deep breath first. Okay, decide on a course of action - do you want to stay? If you do, decide on a course of action. Sometimes staying with a poor situation is better for your growth in the long term. However, I agree that it may be painful right now. If you think there is no way, no how that you can continue in this unit, then you need to visit the job board and talk to the nurse recruiter. If you take this route, make sure you talk to nurses on your new unit who have similar experience/education and see if you can shadow him/her for a shift. Good luck...sometimes what we view as a bad situation, can turn out to the best thing. Good luck!

llg, PhD, RN · Sep 22, 2004

I've been on the opposite side of the situation -- being the unit educator who had to meet with the struggling new employee to make a plan. Listen to what they have to say and see if their ideas for a plan sounds reasonable to you. If they seem reasonable and you really like working with this particular patient population, there is no reason not to stay and try to make the situation work for you. A lot of people need a little extra time and help to adjust -- and then go on to become great nurses.

If, however, you assess your own skills and your feelings about working on this unit and decide that maybe this particular unit is not a good fit for you ... there is nothing wrong with exploring the option of a transfer to another unit. When you talk with other units, be honest but positive about why you are transfering and someone should be willing to give you a "second chance" on another unit. Simply say that it was not a good fit and as a new grad, you need a unit that offers more .... whatever it is you need more of ... or less of.

I would also not hesitate to ask your manager/educator if they think you will be able to turn this situation around. If they express confidence that you can, then take that to heart. If they seem doubtful, then you need to start looking for another placement. It's always easier to get a job while you still have one. Don't wait to actually lose your current job before you start looking. Your current manager/educator might be able to help you find a better fit within the same hospital and you should take advantage of that opportunity. That's what my hospital does when a new grad is struggling: we try to find them a better fit so that we don't lose them to the hospital.

Please let us know how the meeting goes. Good luck,

llg

jad2 · Sep 22, 2004

I am a new grad RN/BSN and I took a job in the stem cell transplant unit at a university hospital. It's extremely intense and the patients are very complex. I have felt over my head since Day 1, but thought that was normal. I got called in by my manager yesterday and she said she was concerned because I'd been making mistakes. One was just unexcusable- hung the right medication but for the wrong patient. No bad outcomes, but it could have been bad. The others were mixing up a label on a tube of blood, and sending a patient down to the OR in his own clothes instead of stripped down- not exactly excusable but less huge in my mind. I've just been so overwhelmed, and it seems like if only I could get through the day without my patients spiking fevers/ having blood transfusion reactions/ starting to have sudden and intractable pain I could organize everything, but that never happens.
I'm supposed to meet with her tomorrow to make up a plan, but honestly I'm terrified. I did so well in school and now I'm just slipping. I don't know what happens to me if I can't make the grade. What unit would want me after I've proved myself incompetent on this one? I feel like I'm getting to the point where I can never be a nurse again, never get a job again, and I've only been out of school for four months. I'm terrified- I'm in a lot of debt that I'm trying to pay off, and what's more I feel like I put all this time and money and passion into a career that I really want but I can't do.
Please help. Has anyone else run into this? Does anyone else know how I could ever get another job if I fail at this one? It's my day off and I just can't stop crying...

First of all, I wish I could give you a BIG HUG. You know what? consider yourself "cyberspace hugged" :)

What you have described has happened to everyone in this community. Do a search, and you will find people who have been or are in your shoes.

Are you off orientation?. How good was your orientation? Did they "throw you to the wolves". Did you have a preceptor?

Take a deep breath. You will and can survive. Forgive yourself.

Yes, you can get another job, or switch to another unit within the hospital or leave em' altogether.

Try your best to do something positive for yourself tonight. Take a warm bath and yes, cry if you want to. There is nothing wrong with having a good cry.

You sound like a smart, caring person. We are proud that you have worked so hard and care for your patients.

Don't let anyone make you think otherwise.

Take care and please let us know how you are doing.

sandollargal · Sep 23, 2004

[ concerned because I'd been making mistakes. One was just unexcusable- hung the right medication but for the wrong patient. No bad outcomes, but it could have been bad. The others were mixing up a label on a tube of blood, and sending a patient down to the OR in his own clothes instead of stripped down- not exactly excusable but less huge in my mind. I've just been so overwhelmed, and it seems like if only I could get through the day without my patients spiking fevers/ having blood transfusion reactions/ starting to have sudden and intractable pain I could organize everything, but that never happens.

Hi Jen

I am a new LPN, I started on Cardiac Unit the beginning of this month. I have made a few mistakes...while I am in orientation, my charge nurse is "assisting" with my patients...well I thought I was doing GREAT!! I had 4 patients, one who seemed to get lots of meds every other hour- I was on top of it when at about 3 am my cn and I were in his room and she started the pump and checked to see that my piggyback was running correctly...everything was great , I gave report went home and remembered I didn't finish the written assessment for a nother patient, so when I called the new charge she was furious- apparently my patient was in fluid volume overload and she wanted to know why i had hung the Ns in there...I told her I didn't and that it was there when I came on at 7p...when I had done previous piggy back I didn't run it thru the NS...but when cn was there she did and the fluid was apparently dripping from about 3 till 7...So that was my big screw up and I hope I do not get into any trouble with it. By the way, my copder was fine the next day- but I have been going to iv therapy classes and had to redo my first aid today..it expired!

I come in and assess my patients, check their mars, usually I try to list my procedures and meds I need to give and when...but like you said something always happens...I can't imagine having 6 or 8 patients, can you???

I wanted to write in to let you know we all really do go thru this but for you senior nurses- how can we improve??? And what did you think of my situation??

Take care and be well

Sandy

JacelRN, BSN, RN · Sep 23, 2004

Hi Jen,

I can feel what you're going through is terrible for you. I cannot relate in my own experiences as a new nurse but I do have a close friend who's story sounds a lot like yours. I think the previous posters have given you great advice. I would also suggest to see how the meeting goes and just be honest with your manager. If she's a good manager, she'll listen to you and help you decide the best route for your career.

As for another side of the coin, my friend started in a really intense unit and found herself overwhelmed. She couldn't think straight and she became really unhappy there. She decided she had bitten off more than she could chew. So she left the unit and went to another unit where she is much happier and feels like she makes a difference in her patients' care.

Either way you chose it, make the decision for what you feel is best. You are a good nurse, keep reminding yourself that. If you weren't a good nurse, you wouldn't care enough to cry. :crying2:

Praying for you,

JacelRN

angel337, MSN, RN · Sep 23, 2004

jen, first thing you need to do is forgive yourself. nursing is a hard job, especially in the beginning. there are nurses with years of experience that still get overwhelmed, so don't be so hard on yourself. also, you must remember that you worked very hard for your license. keep that in mind every time you take care of a patient. double, triple, quadruple check EVERYTHING. you may take a little longer than some of the other nurses, but in the end its worth it, because you will know you did things efficiently and correctly. i think most new grads are trying to please so many people (management, coworkers) that it is easy to forget who really matters, which of course is the patient. if you feel rushed to complete an assignment/task, tell your charge nurse and let him/her know that you need help and that you feel overwhelmed. seeking help will decrease errors and will also make you feel more competent and your coworkers will also know that they can count on you to be responsible for your own actions. you also may want to consider working on a floor with a lower acuity, so you can focus more on the why and how of patient treatment, instead of doing a bunch of things at once on people that are severly ill. again, don't be so hard on yourself, and look at this as a very valuable learning experience. good luck and let us know how you are doing. :)

jemb · Sep 23, 2004

Jen, I'm sorry that you are having such a rough time. Please let us know how the meeting with your manager went.

Although any busy floor has its share of interruptions and disorganizaion, some units are more so than others. The nature of the patient population on a stem cell transplant floor is that they will continuously need transfusions, spike temps, etc. Most of them are in such fragile states that they need constant reassessment and supportive measures. I think even with an excellent orientation period, that sort of unit is not a good location for a new grad, generally speaking. (I'm sure there are a few exceptions somewhere.) The environment is too intense and the patients are too fragile for someone who is still learning to assess and prioritize. And you definitely have too many patients to keep up with all of their potential moment by moment changes.

Jen, this post is not meant to be any criticism of you! I commend you highly for wanting to tackle the position. But I strongly believe that the facility is doing the patients an injustice by hiring an inexperienced (i.e. less expensive) nurse for that floor. There is no way that someone without prior nursing experience could be expected to know everything you need to know and keep up with it all on that floor after only an orientation period.

While the mistakes you made might have been made on any floor or in any unit you hired into, the stress of your constantly being overwhelmed there most likely contributed to them.

My suggestion would be that you transfer to an oncology or medical unit if possible. You will be dealing with many of the same problems and illnesses, but while the patients are in a less fragile state. That would give you a better chance to hone your organizational skills and increase your nursing knowledge in a less critical environment.

You sound like you are a wonderful nurse in the making. You just need to find a place to 'let you bloom'!

Tweety, BSN, RN · Sep 23, 2004

Good luck. If you were not a good nurse they wouldn't take the time to develop a plan. Be very honest during this plan with your educator and manager. Try to consider it a learning experience and not a punishment.

It is so easy when you're new to loose your focus and make mistakes. When I was a new grad I sent someone to surgery with tube feeding running.

Be confident, put yesterday's mistakes behind you as you learn from them. The very best nurses struggle at the beginning. The very best educators and managers acknowledge this a work with you on it.

Hang in there and best of luck to you. :)

jen42 · Sep 26, 2004

Thanks guys... I went to talk to my manager, and it was a pretty good meeting. She said my care was "detached" and "vague", both of which I couldn't even decipher, but we decided that a main problem was organization and how I structure my day... We made up new sheets for me to carry with myself, and I now have a resource person during shifts to help me along. Things have been going much better over the past few days as far as care goes... we decided if it turns out it's not a good fit, I'll go to a general oncology unit, which is hardly a bad fate... so I just have to see. Thanks for all your support, everyone- I'll see how it goes.

We just hired a bunch of new grads, as well as more experienced folks. I can see how this is a very hard place for a new grad to start. I'm still intimidated, even though things are better! I wasn't prepared for how hard it would be... The nurse population here is mostly highly experienced nurses, though, with ICU experience, since there are 8 ICU beds on the floor. It helps, they're all very willing to help me out when I need it.

Anyway... I will keep you posted!

Jen

Trauma Columnist · Sep 26, 2004

Glad things are going much smoother for you! Take care.

llg, PhD, RN · Sep 27, 2004

Jen: I am certainly happy to hear that the situation seems to be moving in a positive direction. It sounds as if your manager really wants to help you either become more comfortable on that floor or find a fit that is right for you -- and that she is not just "out to get you" or "throw you out into the street" or anything like that. Give the plan a little time to work ... and let us all know how you are doing from time to time.

Good luck,

llg