Off orientation and sometimes asking myself, "Am I cut out for this?"

[newSN]

I've been off orientation a couple of weeks now and, at the end of most shifts, I feel like I've been hit by a freight train. I'm forever trying to get "caught up", I'm always behind on charting, and I find myself staying SO late sometimes just to get some charting in on my patients. My charting throughout the day is often hurried, so I worry that it's insufficient. I feel uncomfortable on my own in the trauma bays (I always had my preceptor there to back me up). There's almost nothing I DON'T have questions about. It's such a busy ER so I always feel guilty that I'm making my team's life harder when they have to do so much to help me throughout the shift, and I bug them so often for assistance and answers to questions. Also, and probably most importantly to me, I feel like I'm not able to provide the best care for ANY of my patients because I'm usually scrambling to keep up. When I was on orientation, I got great feedback. Preceptors and management felt really confident that I was ready to come off and, most days, I did too. For the last month or so on orientation I had the entire patient load and only used my preceptors for assistance (delegated to them only things that I would delegate to our ER techs). It was only in the trauma bay and with critical or complicated patients that I relied more on them. Now that I'm off, my head is spinning most shifts and I'm starting to ask myself if I'm ready. I've always had such a positive attitude there, and never felt like I couldn't do this. Now that I'm off, I can feel myself becoming more negative and questioning my competence. I'm not sure if I'm venting or if I need advice, but thank you so much in advance for reading and responding.

[decembergrad2011, BSN, RN]

*hug*

I hope you feel better after getting it out. How long was your orientation? Do you feel that this is a problem that more time on orientation would have solved, or do you think it's the growing pains of becoming an independent nurse? If you got great feedback, were taking care of your entire patient load, and everyone felt confident you would succeed on your own, I think this may be an issue of your own self-confidence.

I've just become an RN myself, so I do not have any good advice to give regarding practice changes. But I do know that there is something to be said for your own confidence in yourself. If you feel that you have many questions during your shift, would it be possible to keep a voice recorder or a small notepad on your and record or jot them down when they come to you? Then you could do a little research on your days off.

I definitely think that you should continue to ask questions and rely on your co-workers, though. You are a licensed nurse who is helping take care of the patients in the ER. You are not a burden to them and those who are good mentors will be pleased to have been sought out and will love to give advice.

Keep your head up and remember that people believed in your abilities for a reason. Good luck!

[OnlybyHisgraceRN, ASN, RN]

I'm currently in orientation for ICU and I know exactly how you feel. ER and ICU are apples and organges. What has helped me is getting to work early ( so I don't feel rushed) so that I can atleast review some stuff before shift starts.

Never be afraid to ask for help.

Yesterday my NM told us interns that we have to learn how to walk and chew at the same time, and that only comes with time and experience.

Good luck to you.

[HM-8404, BSN, RN]

I am not a nurse but I have had jobs where I felt I was drowning at times. Often we are our own worse critics. I would suggest talking one-on-one with another nurse you have worked with quite a bit and tell them how you feel. Tell them that you are considering applying for a med-surg job and see what kind of reaction you get. See if this person tells you not to because you are doing fine or if they agree with your decision. I have a feeling you are no worse than any other new nurse starting in the ED.

[Greenkji]

First of all, Congratulations on getting a job! That is a big accomplishment in this economy. I am also a new grad (with no job), but I just graduated at the end of May, so I'm hopeful. From everything I have heard, what you are going through is completely normal. In fact, I copy pasted this advice for you from another post:

"Now remember...no matter where you work. YOU WILL BE OVER WHELMED. You will feel that you aren't cut out for this job and will probably cry in your car in the way home...a lot. YOU ARE NORMAL. It takes a minimum of a year to even think you might survive."

One piece of advice is work on what you can control and that is time management and prioritizing. Getting to work a bit early might help with this, but I think the more organized you are the less frazzled you will feel. Believe in yourself! Clearly you are already a strong nurse. It just takes time to feel like one :)

Good luck!

[KellzBellz]

newsn,

i love you for saying this!:hug:

i am a gn (took boards today) doing an internship in the er. we get 2 days in class and 2 days in the er a week. i'm in week 3 and cried the whole way home from my shift last night! i'm no wuss - i worked as an lpn in corrections for 6 years.... but i'm completely overwhelmed right now. even skill i know how to do feel impossible! my preceptor is on vacation, and i was so nervous in front of my substitute preceptor i couldn't even open the wrappers!

your post said everything i've been feeling, and i hope you take as much comfort in that as i do.

we're going to be just fine.

[julianne.00]

Hey there! Don't give up ship yet :) I started in the ED right out of nursing school, as I had no desire whatsoever to work on med-surg, so I jumped right into the madness. I had awesome preceptors (orientation in my ED is 16 weeks) and thought I was ready to be on my own when the time was up. That being said, I felt pretty much exactly how you do now when I took off on my own! The ED can be a very overwhelming place to be as a new grad, but I promise... it will get better. For me, it took a good 6 months post orientation to actually feel some confidence in my practice, and figuring out prioritization is a huge part of that. It's easy to rattle off what you *would* do in any situation, but when the nearly-tipping-over-the-edge sensation starts to creep up on you, it's totally different. I think that it all comes with time, so don't get too frustrated. There were several times that I can remember getting to my car and crying after a crazy shift... but now, when things get hectic, all I do is think... this will only last so long, and it WILL get better. The frequent fliers will come and go, the traumas will roll in and (hopefully) out, and you will carry the black cloud over you at least once a week (or more)... But remember, all things come to an end... including your shift :) Once you figure out *your own* way of doing things, your assessments and procedures will flow along much better, and you'll be quicker and know what to look for--- what to do-- in certain situations. So keep a sense of humor, and don't worry ---- you'll feel at home in no time :)

[Nurseadam]

I'm also in your shoes, but i'm still on orientation. I'm pretty confident in myself as i do everything right now with my preceptor just sitting around and chit chating to people.

One thing i learnt when i'm behind is to DELEGATE. I don't know about your ER, but ours have nurses either covering lunches, nurses doing nothing and their pts stable, or float nurses that just go around asking if anyone needs help. When you're behind, delegate to one of those nurses or the ER techs.

One more thing I learnt was ask ask ask ask. If you didn't know something, ask a question, there's a lead nurse to help you out. our charge nurses are so helpful, well almost all of them.

i hope this helps and good luck

[sserrn, BSN]

My first day off orientation was January 2nd of this year. And some nights I still don't feel like I'm cut out for ER nsg! lol. Even good, experienced nurses have nights like that, I think. Some nights you are going to be behind...I try to remind myself I can only do one thing at a time, and only care for one pt. at a time, no matter how many I have. I only have two hands. That's my pep talk for myself. :-)

[hiddencatRN, BSN, RN]

This is normal. I finished orientation and the most detailed feedback I got was "keep doing what you're doing, because you're doing great." Initially off orientation I felt ok but then went through a period of feeling really, really insecure and uncomfortable and so, so aware of how little I knew.It gets better. Really. When you're overwhelmed, take a breath, and ask yourself what the priority is RIGHT NOW. If there are multiple priorities that are all RIGHT NOW things, you need to ask for help. It's ok- experienced nurses do it too. If everyone else is completely swamped with RIGHT NOW THINGS and they can't help, just do what you can to and work your way through it. But there's usually people to help in the most dire situations. For everything else, just do your best. I had minimal trauma exposure when I was with my preceptor- it just didn't work out for me to get a ton of traumas. Off orientation I felt like an idiot in them for a long time (and sometimes still do!).