Oh boy I think I did A LOT of mistakes.

nursemike, ASN, RN · Jan 13, 2006

I think you'd be well advised to a.)chill and b.)discuss your concerns with your preceptor/mentor/whatever they call the nurse you're orienting with. In terms of a., while mistakes are never acceptable, at this point in your career they are pretty much expected. If you are making sloppy, careless errors, that's bad. If you are making errors because you have too many things to keep track of and are getting overwhelmed, keep working at it. Some of the stuff that seems so hard to remember will seem almost automatic, soon. From your post, it's obvious you aren't indifferent, and it will get easier for you.

That said, trial and error is not the best approach to nursing orientation. It may be that your orientation is moving too quickly. There seems to be a fine line between being adequately challenged and being overwhelmed to the point that patients are put at risk. If you feel the latter to be the case, I'd say so, making it clear that I did want to carry as much of a load as possible. A good mentor should understand. I have yet to meet anyone who found the transition from student to nurse a breeze. The nurses I've talked to have universally agreed that school prepares you to learn, but the "real world" is where the learning really begins. (Once you get through this panicky part, the knowledge you gained in school will come back to you, but it can seem hard to access when you're busy learning what blocks to check on a flow sheet and where the meds are, etc.)

As for the possibly intoxicated co-worker, that's more a matter of integrity than skill or knowledge. You already know what's right. The question is whether or not you do it. Quite honestly, at one week into my job, I think I would probably have kept my mouth shut and hoped someone else caught the problem. That's horribly wrong, of course, but like you, I had my own problems to deal with, and getting a handle on those seemed like my main priority.

Good luck, and don't forget to breathe.

st4wb3rr33sh0rtc4k3 · Jan 13, 2006

I think you'd be well advised to a.)chill and b.)discuss your concerns with your preceptor/mentor/whatever they call the nurse you're orienting with. In terms of a., while mistakes are never acceptable, at this point in your career they are pretty much expected. If you are making sloppy, careless errors, that's bad. If you are making errors because you have too many things to keep track of and are getting overwhelmed, keep working at it. Some of the stuff that seems so hard to remember will seem almost automatic, soon. From your post, it's obvious you aren't indifferent, and it will get easier for you.
That said, trial and error is not the best approach to nursing orientation. It may be that your orientation is moving too quickly. There seems to be a fine line between being adequately challenged and being overwhelmed to the point that patients are put at risk. If you feel the latter to be the case, I'd say so, making it clear that I did want to carry as much of a load as possible. A good mentor should understand. I have yet to meet anyone who found the transition from student to nurse a breeze. The nurses I've talked to have universally agreed that school prepares you to learn, but the "real world" is where the learning really begins. (Once you get through this panicky part, the knowledge you gained in school will come back to you, but it can seem hard to access when you're busy learning what blocks to check on a flow sheet and where the meds are, etc.)
As for the possibly intoxicated co-worker, that's more a matter of integrity than skill or knowledge. You already know what's right. The question is whether or not you do it. Quite honestly, at one week into my job, I think I would probably have kept my mouth shut and hoped someone else caught the problem. That's horribly wrong, of course, but like you, I had my own problems to deal with, and getting a handle on those seemed like my main priority.
Good luck, and don't forget to breathe.

Thanks so much for the advice. I needed it. :kiss I have wrote a list of duties that I have to do and hope that when I show up for work next Tuesday that I do better. Just scared that something might happen to the patient and I will get introuble.

As on critical errors I know you are right. I am such a perfectionist so for me not doing something correct stinks. Looking at the correct dose of medication on the MAR is a concern. That is where I made three possible mistakes. And the FSBS, ughhh. what happens if she died?

I am going to have to call a person at the job who said we can talk to her at any time. She is suppose to be there for me during my orientation. I won't mention the intoxicated thing. Just the going way too fast for me. Maybe they can cut my workload down, to 1/2 the patients.

Another thing I am thinking about is not going back to school in a few weeks. I really want to focus on being an RN before I jump the gun to get my BSN. Maybe the problem is that I don't work enough hours to get more experience in this career. I want to make it work, because I worked so hard to get this license.

Bijou-Spice · Jan 13, 2006

I think holding off for a semester is a good thing. I just graduated in May and started working in August in critical care. I had planned to start on my master's right away but decide to give myself a year to learn how to be a RN. I am glad I did! I am so wiped out when I get home and know it would have been tough to do both school and work well without getting over stressed. (There is a lot of studying to do just from work.) And don't worry that you are getting too old I am WAY older than you and just started RN work. So relax and focus on the job, and good luck. It does get easier as the months go by!! (I am proof!)

nursemike, ASN, RN · Jan 13, 2006

I planned all along to spend a year working before tackling a BSN. After six months, I'm wondering about waiting another year--not because I think I need to, but just because it's so nice not having to deal with classes!

The thing to remember about mistakes is that most can be avoided simply by thinking clearly, but it's hard to think clearly when you are scared to death. Adrenaline is your enemy! I'm working in acute care, so the patient load is a lot lighter--5 patients is our norm, and 6 is our max. But sometimes they get a lot of meds, including IVs and pushes, and it can get hectic getting all the 2200s done between 2130 and 2230. So as soon as I get my first assessments done, I look over my med list and decide which are priorities. We do a lot of IV antibiotics, and I try to keep them as evenly spaced as possible. Same with cardiac and BP meds. We also do a lot of steroids, and pushing them is time-consuming. Also, pretty much every patient gets Colace and Pepcid, usually PO. Often, I'll have a patient who only gets Pepcid and Colace at ten, so I do them last--what's the difference if they get them a few minutes late?

A lot of times, I'll start with my most difficult patient first, but sometimes I'll do the ones who get 2-3 fairly critical meds, then the most difficult, then the easy one, or if I'm lucky easy ones.

There are a lot of ways to combine tasks--like doing a dressing change and assessment at the same time. Or if a patient calls for a bedpan at 0315, I'll get their 0400 neuro check when I take them off. 0325 isn't 0330, but if they're on q4s, it's close enough.

From my own experience and what others have told me, the first three months are the hardest. The second three are no picnic, either, but things do start coming together, and by six months you can pretty comfortably handle the routine stuff, and even an occassional minor emergency. I still rely pretty heavily on the morse experienced nurses if a patient starts going bad--but that's what I'm supposed to do. I also make little mistakes, from time to time, usually in my documentation, but I try hard not to repeat them.

The thing that most amazes me is that nursing can be a lot of fun, when you're able to take a step back and notice it.

christvs, DNP, RN, NP · Jan 13, 2006

Thanks so much for the advice. I needed it. :kiss I have wrote a list of duties that I have to do and hope that when I show up for work next Tuesday that I do better. Just scared that something might happen to the patient and I will get introuble.
As on critical errors I know you are right. I am such a perfectionist so for me not doing something correct stinks. Looking at the correct dose of medication on the MAR is a concern. That is where I made three possible mistakes. And the FSBS, ughhh. what happens if she died?
I am going to have to call a person at the job who said we can talk to her at any time. She is suppose to be there for me during my orientation. I won't mention the intoxicated thing. Just the going way too fast for me. Maybe they can cut my workload down, to 1/2 the patients.
Another thing I am thinking about is not going back to school in a few weeks. I really want to focus on being an RN before I jump the gun to get my BSN. Maybe the problem is that I don't work enough hours to get more experience in this career. I want to make it work, because I worked so hard to get this license.

Hi! I just want to say hang in there & things will get easier for you with time. I just graduated in May 2005 with my BSN -so I'm a new RN too. I've been working for 6 months now on a med/surg/tele unit in a hospital. And guess which city I work in? Worcester! :) You're my neighbor! :) But honestly it does get better I think, once you get a routine going. I personally am fine with taking 4 or 5 patients but once I get up to 8 or 9 that is when it gets tougher for me to handle all the assessments, meds, treatments, etc. We have team nursing on my unit so me and an LPN tackle up to 11 pts together, but it can still get crazy with the tele & post-op pts requiring a lot of care. Anyhow, han g in there! :)

-Christine

Daytonite, BSN, RN · Jan 14, 2006

The nice thing about working in a nursing home is that you tend to have the same patients day after day, so you get to know them, their medications and treatment orders very well because they do not change all that often. What will happen is that you will eventually come to memorize all that information--you can't help it because you will be working with it every single day. It will help you work faster because you will immediately recognize when there has been a change in the orders.

Are you working on a maintenance unit or a Medicare (skilled) unit? The patients who are Medicare (skilled) tend to be somewhat similar to the patients in the hospital. Their orders change more frequently and they are sometimes just not as stable as other nursing home patients. They often required more attention than other nursing home patients as well.

You hit on a very excellent idea when you said that you were going to make a list of things you needed to do during your shift. This is a very good way to organize yourself as well as a way of double checking to make sure you haven't forgotten to do something. You also want to organize that list in the order that things need to be done. This is where your computer can become a very useful tool for you. You should maintain this list in a Word file so you can make changes to it and save them. You can also print out a new copy of this list whenever you need to. I used to create my own report sheets that I kept in saved files and printed out daily before I went to work, but you may not be ready to take that step yet.

It is just a fact of life in nursing homes that patients will sometimes refuse medications and treatments, or they may be out of the facility, or somewhere else in the facility when you are ready to give them their pills or change their dressings. I've seen nursing home nurses do many innovative things to remind them to go back to these patients later on with their meds or to do a treatment. The most common thing I saw done was nurses placing straws between the pages of a patient's MAR. As long as they saw straws sticking out of the side of the notebook with the MARs, they knew there were still some meds that had to be given. I, personally, used to open the ring binder and move a MAR over one set of holes and then close the rings. That way, I had a MAR sticking out the side of the notebook, so I knew I still had those meds to give, or something to follow up on. To my way of thinking, it was too easy for a straw to get pulled out of place. I did the same with the TARs (treatment sheets).

You are not supposed to do meds and treatments at the same time, but there are some very simple treatments that just lend themselves to being done at the same time you are giving the patient their medications. Things like applying or removing TED hose, applying some cream to somebody's face can be done so easily along with the med pass. Over time, you will learn who you won't be able to wake up late for a treatment. This is where you utilize your nursing assistants. Instruct them to tell you when a particular patient wakes up, so you can zip in there to do their treatment. Otherwise, you just have to mark it as not being done, the reason being that the patient was asleep. That really shouldn't happen too often, however, because nursing home patients are often awake one minute and asleep the next. And, if it is the case, that a particular patient is going to stay asleep, then you will just have to keep in that in mind and make an attempt to get their treatment done before they settle in for the night. This is just part of the challenge of organizing your time in a nursing home.

You were worried about what to do if the alcoholic nurse is diabetic? You need to open up your nursing textbook and read up on diabetes, so if something should happen while you are in her presence you know what to do. Most facilities have some kind of a protocol for hypoglycemic reactions in a patient. You should find that policy and make sure you know it backward and forward--especially if you have diabetic patients. As for the alcoholic nurse--if she should pass out in front of you--call 911. While you're waiting for the paramedics you can do a fingerstick blood sugar on her if you like, but I don't think I'd do anything more than that for her. Let the paramedics take over. Also, just report what you noticed that tipped you off that the nurse was intoxicated to the DON at the next opportunity (smell of alcohol around her, she acted tipsy and giggly). It is not your place to confront her because you are not her supervisor and you have no authority over her. If this was after regular business hours, I would have gone to a more private place and called the DON (or whoever the administrator on call was) at home and reported that Nurse Soandso just showed up drunk. That's how that should be handled. Just so that you know. . .there is always supposed to be someone in a higher management/administrative position that you can call or page at any time you have a problem. If you don't know who it is, ask around. You start by calling the DON. If you can't get the DON, you call the administrator.

It sounds to me that there are some things about the policies and procedures at this facility that you have not been told about yet. It may take a little time to learn about them. However, please be aware that there are policy and procedure manuals somewhere in that facility that you eventually need to read. Don't forget to bone up on diabetes. Good luck!

suzanne4, RN · Jan 14, 2006

Do not blame yourself, but shame on the facility. There is absolulte no reason for you to be on the floor alone when you had just started orientation. What type of orientation did they promise you? And especially as a new grad. Where was the person that was precepting you?

Sorry, but if this is the way that they train someone, then leave. As I keep saying to everyone, and I am not singling you out, nursing school does not prepare you to be on your own right away. It only gives you the basics but in no way should you be left like that. You need an orientation, and a thorough one.

Remember that you are now dealing with your license here, you are no longer a student. Not sure what types of responsibilities that they are throwing at you, but I would thro w them back, or leave. You can lose your license now just as easily, and it is not fair to you.

And if your replacement came in drunk, then managemement needed to be notified about it before you left. There is no reason for you to confront that person, it is the job of the administrators, especially with you begin a new nurse. Where was your preceptor during all fo this?

And how many patients are you supposed to be responsible for?