Off orientation, feeling lost

[tired_panda]

There are a lot of other posts like this, and though I know that there are so many other new nurses feeling just as lost as me, I feel so alone. I finished my 7 weeks of orientation on a cardiac floor and after my first week on my own, I feel pretty low. On orientation, I felt so much more confident, but now that I am on my own, I feel like I need validation for every decision I make. When I was on orientation, all the nurses told me to never be afraid to ask questions and to ask others for help. But now, I find myself asking the silliest questions just because I am so anxious about everything. All the nurses that told me questions were okay now give me these looks that imply I should know better, that I should feel more prepared and more comfortable with everything than I am doing. I've cried on my drive home every day I have been on my own, and whenever I am not at work, I am thinking of the things I should have done better, or worrying about whether or not I missed something important or made a mistake. I was feeling so safe and so comfortable on orientation, but now I'm feeling that I have regressed right back into that terrified, clueless nursing student I was so many years ago!

Last night, my patient's heart rate and heart rhythm was all over the place with crazy random pauses and bizarre shifts in rate--outside of any treatment algorithm I learned in school or ACLS. I was terrified and asked for advice from other nurses (despite their apparent frustration with my questions) and called the doctor. When the doctor didn't get back to me right away, I started to get nervous. One of the other nurses said to me, "Well it's not like her rhythm is critical right now, I don't know why you're so concerned." The trouble is, I don't feel I have the experience to differentiate between what is acceptable and critical.

I just feel like I'm doing terribly and I feel like I should know more than I do. Is this normal, and if so, when will I stop feeling like this?

[rrtdave]

Let me give you my perspective. Being right off of orientation can be frustrating for you and others as well, however they know you can do the job, just need to be motivated with a great attitude and ask for help when needed. It may be a little frustrating finding your place, but it will be well worth it. Always ask, but the main thing is to relax, take a deep breath and believe you can handle any situation that comes up. Being relaxed helps you to do the correct thing. Take your time, you aren't expected to be able to do things us lifers can! You'll be fine and ask questions, that's why we are a team!! You can even ask my brothers and sisters in respiratory care if you need too!! They can be great resources as well. David, MSRT, RRT-NPS

[compassionresearcher]

I'm curious, did the MD ever get back to you and confirm your suspicions that something was amiss? And was this on days or nights? If you are on days ask your manager for help and if you are nights as the house supervisor (follow chain of command).

When I was a new nurse, I was floated to the surgical floor, I had a patient who looked terrible, an infant fresh out of CVICU from major heart surgery. I kept asking the manager and other staff nurses what to do, should I call the attending, etc. This was on night shift so of course I didn't want to get anybody angry at me. Fast forward I called the 1st year resident, 3rd year resident, all of them assured me the child looked appropriate. He coded a half hour after I gave morning report. Thank God he lived, but guess who got blamed for not calling the attending? Even though a manager and 2 doctors assessed the patient. My point is, keep on going higher and follow your instincts.

Patient care is a grave responsibility, and working on a tele unit is very challenging for most people in the beginning. I'm more worried about the people who don't worry.

If the EKG is looking bizarre, you would also want to take into account the patient's clinical picture. Are they showing signs of poor perfusion? Is there a tele tech that you could talk to about the rhythms you're seeing. You mention ACLS, but does your hospital require you to take a basic EKG course? That will help you recognize which strips are scarier and more cause for concern. Finally, does your hospital have a RRT? If so, and the MD is not getting back and nobody is helping you, decide if the clinical picture meets criteria for calling a rapid.

Yes, it's normal to feel like this and it goes away gradually, but it takes a while.

[vgyore]

Good news! Your emotions are normal. You won't feel like this forever. There are few things you can do to take care of yourself through this trying time.

Journal- Writing in a journal will capture the personal growth throughout the next few months. During periods of tremendous challenges, one can miss the small successes that creeps in day by day. Also, we all need a place to vent frustration, sadness and worry. Then close the journal.

Mindsets- Every night before bed write out the vision for your practice. I am smart. I am assertive. I am compassionate. I am a guardian. I'm sure you'll think of your own special vision. Whatever you think about prior to bed sets the tone for the next day. Invest in the good stuff.

Find A Mentor- Search out a nurse you admire. Study the nurse's habits, problem solving skills, and interpersonal skills.

Continue to study- Read up on the things you don't understand. The anxiety will fade then knowledge builds. It's beautiful thing to hunt for the answers. You will never forget the information and the sense of confidence is pretty remarkable.

Hang in there sister!

[tired_panda]

Hello!

I do work nights, so I did end up asking advice from others, but I ended up getting a lot of different answers. The doctor approved of all the interventions I'd done (stopping drip, monitoring patient closely etc.) and told me to keep doing what I was doing. Clinically, my patient looked fine, but I still felt uncomfortable because he was having pretty long pauses. I did take a basic EKG class and I've been studying a lot so I feel more comfortable, and though I lack years of judgment, it didn't look great. We do have a RRT team--didn't end up needing to call anyone, and his heart rate/rhythm ended up stabilizing a bit before shift change.

[tired_panda]

Thank you! I'm glad to know it gets better. I'm working with my clinical educator to get connected with a mentor--just so I feel a little bit better about things!

[barcode120x, RN, NP]

Hey cloud, don't worry, those are just the new grad blues! I was in your shoes just a bit over a year ago. I actually just hit my 1 year mark this past week. It'll ease over time, trust me. I was like you! From when I got off orientation to about 4 months in I had major anxiety. I had a rough time sleeping as I would lay in bed for hours thinking about "what if's." I would wake up in the middle of the night or a nap with tachycardia and my mind racing about some random patient I never had. I would get to work an hour early to try to know everything about my patients. I would stay in the parking lot after work another 30 minutes just to make sure I didn't forget to do anything. Trust me, it eases up. Right around 3-4 months, my anxiety (high heart rate, sweating all the time), significantly decreased. I was getting much more sleep and feeling a lot less stressed. 6 months in, I felt even better. Now that I am a year in, I won't say my anxiety has completely disappeared, but it's at its all time lowest! I used to dread going to work when I first started (contrary to what nursing is all about, right? haha), but now it's basically a routine and a job. I enjoy coming to work especially because I have a great time and management too.

Last but not least, you WILL make mistakes. Everyone does at their new job. Just make sure you make note of it and don't do it again. Learn from it and always make sure what you're doing is keeping your patient safe. Always, ALWAYS ask for help or questions no matter how stupid it is. I would rather be an annoying new grad nurse that asks questions 12 hours straight than be an unsafe nurse that isn't sure if I was doing the right thing or not.

Oh, find coping mechanisms too! Mine were grabbing extra sleep time, working out, and praying :). Good luck!

[alexamasan]

I just had my first night on my own after orientation. I was completely overwhelmed and I feel pretty depressed. I'm happy to hear that this gets better over time, my goal is to evaluate how I did the previous shift and find a different way of doing things to try and make the next shift better.