Not really "feeling it"

Specialties Cardiac

Published

Hi all-

I am a relatively new RN- graduated in Dec 08, just passed my 6 months on the floor. I work a cardiac step-down, with telemetry. I used to get 4 pts, but now regularly get 5 - including active CP & post-cath. On our floor, RNs have to take our own vitals Q4, in addition to all our other duties.

My preceptors and my managers have said I'm doing well, but I feel like I'm just not putting everything together. I feel like a fraud when I'm doing my assessment, passing meds, giving report... I have the degree and the title, but most of the time I still feel like I don't know what's going on. I know that critical thinking takes a while to develop, but I thought by 6 months I'd feel a bit more confident. I think I'm still too task-focused instead of seeing the whole picture. I know I need more work on meds (knowing effects off the top of my head, and what/when to hold or give). I'm not shy about asking questions or advice from other RNs, and I don't mind working hard.

I don't know if I'm looking for advice, or commisseration, or what- I haven't told anyone about feeling like this, so it feels good to just admit it. Maybe you can tell me about *your* first year. How long did it take before you felt like you had it all together??

Thanks!

S

Spatialized

1 Article; 301 Posts

Specializes in Cardiac Telemetry/PCU, SNF.

There are days I still don't feel like I have it together and December will be 3 years for me. If you really think about it, 6 months is not that long at all on an active cardiac floor. There's a very wide scope of information that you have to understand and figure out how it all weaves together which takes time. Instead of thinking how little you know, try to think about how much you have learned.

I can remember when I was a newly minted RN on my floor and the very thought of having someone in active chest pain scared the dickens out of me. Sure, I knew what to do, but I hadn't done it. Then late one night I had a patient decide to clot off the the 5th out of his 5 grafts. 10/10 crushing chest pain, he's freaking out, his wife is freaking out, I'm freaking out. I'm giving nitro, morphine, starting a nitro drip, more morphine, beta-blockers, the works and finally as the sun was coming up transferring him to the ICU. But I learned a lot that night. Now, when someone has chest pain, it all becomes near-automatic. I know what I'm doing - but importantly, I know why I'm doing it. That first night I'm going, "Beta-blockers? Why?...OK if you say so." Now I can ask the doc if they want it in an evolving case. You learn as you go.

Last summer we hired a big bunch of new nurses and I watched as they struggled through and between 6-8 months in they started to "get it" some faster than others, but nonetheless, still they were getting it. And those that felt the exact same way you do all asked the same thing as you. And I counter with the same thing: look at what you HAVE learned and achieved, then start looking at where you feel you're weak. Some positivity can go a long way y'know?

And for awhile, nursing will be task-oriented for new nurses, that's a given. Until you can get the tasks under near-robotic control, having the time to think about the bigger picture is rough. Be patient, it will come, just give it some time.

Good Luck,

Tom

maddie45

10 Posts

I've been an RN for 1.5 years on a Tele floor where we have 4-5 patients. We chart vitals/I's&O's and frequently have to do our own accuchecks, baths, meal trays, etc...

It sounds cliche but after about a year you start to get the hang of it... still have many days where you don't "feel it." Just do your best and give 100%.

My advice (from personal experience) take advantage of classes your hospital offers. Talk to your clinical educator! Banner health in AZ offers soooo many classes! I hope other places do the same.

If they don't have these opportunities then take advantage of local conferences/seminars on cardiac topics. :redbeathe

ShyViolet

21 Posts

Specializes in ICU, cardiac, CV, GI, transplan.

When I was 6 months in and feeling like I wasn't good enough yet, one of my preceptors gave me this breakdown:

1st year: Task oriented. You are all too aware of the clock ticking and you know that you have to assess your patient, do vitals on schedule and get meds passed on time. Your main question is "What do I need to do to get through my shift?"

2nd year: Numbers oriented. You're starting to understand your assessments a little better, starting to put the numbers together and understand what it all means. Your main question is "What do I need to do to fix these numbers?"

3rd year: You're finally a holistic nurse. You know the numbers, you know the norms, you know what to do in a lot of situations. Now your main question becomes "What does this person need me to do for them?"

Kittyfeet

81 Posts

Specializes in Med/Surg, Tele, Critical Care.

I feel the same way... I'm a new grad, about to be off orientation after 10 weeks. I'm working on a Medical/Tele unit. I'm getting a lot of praise from my preceptors and manager, and I think that they really do think I will be fine but I also know they are short staffed and need another person. Luckily there are several nurses willing to help me and most of the time I feel very comfortable that if I need someone to go in the room with me and help me do something that I can get it. I have even had nurses who were not my preceptor volunteer to show me how to do something just because they had a free moment and wanted to teach. If only everyone had that attitude!

But I totally feel the same way about being task oriented... we learned all this great critical thinking in school but right now I just want to figure out a way to get meds passed to 6 patients on time and to somehow not freak out about things like blood and heparin drips. I just feel like a robot and not at all like an RN trying to get all my documentation in and just cover all the bases. I want to be a good nurse, but right now I just feel like I'm trying to stay above the water.

I hope that the big picture starts to become more clear after about a year! It's something to look forward too. At least I'm almost 1/4 the way there. I already feel better than I did the first day. Good luck!

suanna

1,549 Posts

Specializes in Post Anesthesia.

I felt the same way. Strangely enough one of my first jobs was tele/post-pre cath unit. What made the biggest difference for me is everyone else quit!. I went from being the new nurse to being the most experienced staff member on the shift. It's amazing how my confidence grew when I was the one with the answers instead of the questions. My advise- try trusting yourself more. If you lean on your peers all the time you will never feel strong enough to stand on your own. I bet you know a lot more than you are giving yourself credit for.

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

I definitely didn't have it all figured out by six months in! But by two years, I was an up and coming rock star! That's why it's so discouraging to be at square one in a new unit, as if I am a new nurse all over again! It takes time, and six months is not enough to be totally together....you will get there. You just have to keep putting your scrubs on one leg at a time and showing up for work. You'll get there.

jjjoy, LPN

2,801 Posts

And for awhile, nursing will be task-oriented for new nurses, that's a given. Until you can get the tasks under near-robotic control, having the time to think about the bigger picture is rough. Be patient, it will come, just give it some time.

I agree. However, it can seem contradictory to advise that "it will come" and "just give it some time", when one's patients' needs for a safe, competent, efficient nurse is NOW. How does one live with oneself during the time that it feels like the care they are providing isn't as safe or as competent or as efficient as it should be? The standards (such as 'don't be task-oriented' and 'never trust another nurse's judgement over your own') that were taught in nursing school CANNOT be fully met on all levels by most newbie nurses. If a newbie chooses to go into a work another day, knowing that they have these deficiences are they compromising patients safety in the pursuit of their own personal benefit (gaining experience)? Do they deserve to work as a licensed nurse when they clearly aren't up to par and are regularly unable to meet all of their job requirements? Especially if colleagues are also so busy and overwhelmed themselves that helping the newbie means risking not meeting their own responsibilities.

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.
I agree. However, it can seem contradictory to advise that "it will come" and "just give it some time", when one's patients' needs for a safe, competent, efficient nurse is NOW. How does one live with oneself during the time that it feels like the care they are providing isn't as safe or as competent or as efficient as it should be?

One does the best they are able, learns to delegate and prioritize, and always remembers the ABCs. One remembers that safety comes first, and the rest, like efficiency, come with time and practice. So long as those patients were pink, warm, and dry when you left, all the other "deficiencies" will iron out in time.

The standards (such as 'don't be task-oriented' and 'never trust another nurse's judgement over your own') that were taught in nursing school CANNOT be fully met on all levels by most newbie nurses. If a newbie chooses to go into a work another day, knowing that they have these deficiences are they compromising patients safety in the pursuit of their own personal benefit (gaining experience)?
We are all task oriented at times. Even seasoned nurses. While it is discouraged in favor of a more holistic view and learning to see the "big picture", being task oriented is a necessity at times, and it isn't the end of the world. If a nurse is never able to grow beyond being task oriented given enough time and experience, then yes, I could see it as being a "deficiency". But for a new nurse, I would expect it for a certain amount of time. The same goes for developing nursing judgment. Where the new nurse (or any nurse) has a responsibility is in whether or not they accept assignments that are beyond their level of education and experience, and whether they speak up when they have questions or are unsure about something.

Do they deserve to work as a licensed nurse when they clearly aren't up to par and are regularly unable to meet all of their job requirements? Especially if colleagues are also so busy and overwhelmed themselves that helping the newbie means risking not meeting their own responsibilities.
If they are able to keep their patients safe and respond accordingly to changes in patient condition, then yes. If the job requirements you speak of are med recs, charting, admission paperwork, etc., then yes. If the new nurse notices when the patient is requiring more and more O2 to maintain a sat and calls the doctor to inform them of this change in patient condition, or the new nurse notices that the patient has had a change in LOC and makes the call to the doc, or notices the patient is not breathing and calls a code, then who cares if they have to stay late to finish charting, or if they can't help pass meal trays, or if their med pass is a little bit late? Those things will come with time. It is the basic ability to notice changes in patient condition and respond promptly that is the primary job requirement, and the most important thing I would expect from any nurse, let alone a new grad.

This is the reality of nursing. We come out of nursing school prepared to function at a basic level. We are not expected to be seasoned nurses right out of the gates. Only on the job experience can make a seasoned nurse. It is a heavy responsibility we carry on our shoulders. Your questions are all very reasonable questions to ask, and I think most of us have asked ourselves these questions at one time or another.

Ruby Vee, BSN

17 Articles; 14,027 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
hi all-

i am a relatively new rn- graduated in dec 08, just passed my 6 months on the floor. i work a cardiac step-down, with telemetry. i used to get 4 pts, but now regularly get 5 - including active cp & post-cath. on our floor, rns have to take our own vitals q4, in addition to all our other duties.

my preceptors and my managers have said i'm doing well, but i feel like i'm just not putting everything together. i feel like a fraud when i'm doing my assessment, passing meds, giving report... i have the degree and the title, but most of the time i still feel like i don't know what's going on. i know that critical thinking takes a while to develop, but i thought by 6 months i'd feel a bit more confident. i think i'm still too task-focused instead of seeing the whole picture. i know i need more work on meds (knowing effects off the top of my head, and what/when to hold or give). i'm not shy about asking questions or advice from other rns, and i don't mind working hard.

i don't know if i'm looking for advice, or commisseration, or what- i haven't told anyone about feeling like this, so it feels good to just admit it. maybe you can tell me about *your* first year. how long did it take before you felt like you had it all together??

thanks!

s

most people seem to start feeling as if they've got it all together at about the two year mark. they seem to actually have it together at about five years. you've got time yet!

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