oh for petesake!

[PeepnBiscuitsRN]

I'll try not to write a novel out of my tale of woe (please don't stop reading after you see this is a tale of woe). I graduated from nursing school in May of 2010- got my offical RN license shortly thereafter. 1 week before graduation I (and oddly enough 3 other ladies in my class) found out we were with child (started celebrating too early I guess:D). We graduated right before the great MN nurses strike of '10 and faced the same issues that many are facing now- no job, and the interviews I did have came when I was obviously pregnant (who would hire a 26 week pregnant nurse?)

I finally got my big job in April of this year. It was at the hospital I really wanted to work at, in telemetry, which, while it's not where my sights are set in the long run, is still really cool and I think I'm learning plenty. The problem in this story is that I got off to a very rough start- orientation was not so hot for me. I had 4-6 weeks of orientation, started orienting on days (I work straight nights) and had, oh, 6 shifts on days and then went to nights and the second night (my 2nd night ever) I had to float with my preceptor to a different unit. I don't know if it was that most of my preceptors and I didn't have compatible personalities or learning/teaching styles, or if it was because I was still a fairly new mommy (she was 3 months old when I started) or if it was the year of no nursing work that got me...but it was a disappointment to say the least. I felt like someone who was jazzed up to run a marathon, was all ready and at the starting line and *BANG!* I take two steps and fall on my face, then tried to get back up, and then went 2 steps more and fell again, in front of a bunch of people who slapped a metaphorical "X" on me. I felt bowled over, overwhelmed, disorganized, scattered...like I had no idea what was going on- started with a patient load of 3 and then by next shift was expected to have the full load of 4. By the end of my 6 shifts I was expected to know how to do admits and discharges too. My nurse educator took me aside and chewed me out for having to extend my orientation for an extra 4 shifts and for being disorganized and not progressing. I felt like my job was in major jeopardy.

I try to figure out what went wrong. I know a few of my preceptors (I had a different one pretty much each time) just blasted through how to do stuff (like admits and discharges, and ordering things, and loaded me up with pamphlets on how to troubleshoot pacemakers and tele packs, and how to chart pt education and charting on the EMR). I realized that they were doing it all for me, and I wanted to do it myself, but I felt like it wasn't my place to insist...they're the preceptor I needed to be...I don't know... gracious. I DO know the 2-3 preceptors I had that I felt really helped me and made me feel confident and competent were the ones who just let me do it myself and then gave me pointers afterwards.

So now it's been 6 months. My educator has told me I've really improved, my nurse manager said she was really pleased at how I "dug my heels in and really made it work". That should bring comfort to me, but instead it made me feel like people were looking at me like I was lazy or not trying and had a bad attitude! Any time I try to explain any rationale for anything I did that either wasn't correct or could have been done different/better I feel like I'm being looked at as someone who is just making excuses for bad behavior, or a plain idiot. It's never my intention to seem like I can't take criticism! Please, tell me what I can do better! I asked in the beginning (and still do) but in the start I never got feedback- *I* never got feedback, my educator did- then I got it from her, too late for me do anything about it. I have stretches where I feel real good about how I'm doing, and then I get taken down. There is one charge nurse in particular who I hate to say, I think she just doesn't like me. I think she thinks I'm an idiot. I asked her one day how I was doing, if there was anything she thought I could do better on, and all she gave me was this kind of creepy cheerful "I have some concerns..." but she could specify! I talked to my educator after that just to touch base and see if anyone else had concerns but she pretty much said "you can't please everyone". I feel like this one charge is just scrutinizing me to death. I hate to even ask her things. That's another thing...I feel like I'm asking too many questions or asking really stupid questions. I don't see any other new nurses I work with asking nearly as much as I do. I feel sometimes like I'm still (and PLEASE FORGIVE ME I MEAN NO DISRESPECT) like I'm still in clinic LPN mode. Where I can't do much independently based on assessment without MD approval. Whereas in the hospital- I'm kind of the one who has to do all the interventions first. I feel like I can determine if something isn't right, but then I sort of draw a blank in what to do next. (Not in all cases, I learn each time, unless I have someone telling me different things each time I ask, which has been common so far).

So, ok I wrote a novel. I'm feeling really low, I'm paranoid that I'm going to lose my job, and the kicker is that I wanted this so bad, and I'm trying, and I feel like I'm looking pretty dull. No matter what. I'm trying to be confident, trying to focus on when people give me positive feedback, and trying to take the negative feedback as learning oppertunites, I just don't like looking incompetent to my colleagues.

[TriciaJ, RN]

Do not be afraid to ask lots of questions, even if you think you look like an idiot or annoy people. I have concerns about new people who make major blunders instead of just asking. In fact, I think that is a major red flag.

Also, when a mistake is pointed out to you, don't try to give a rationale for what you did; it's usually not relevent and makes you look unreceptive to feedback. Just accept the feedback.

I think you're on the right track. If they're giving you credit for getting it together, give yourself a big pat on the back. We all ate $***burgers for the first year; goes with the territory. Good luck!

[Simply Complicated]

Do not be afraid to ask lots of questions, even if you think you look like an idiot or annoy people. I have concerns about new people who make major blunders instead of just asking. In fact, I think that is a major red flag.

Also, when a mistake is pointed out to you, don't try to give a rationale for what you did; it's usually not relevent and makes you look unreceptive to feedback. Just accept the feedback.

I think you're on the right track. If they're giving you credit for getting it together, give yourself a big pat on the back. We all ate $***burgers for the first year; goes with the territory. Good luck!

Thats a good point! When someone points out something you did wrong, unless you did it wrong, because you have a different rationale that you feel should be discussed, that makes it look as if you are being defensive. Best thing to do is just say thank you for correcting me, and leave it at that.

[AnonRNC]

First of all, I think you're doing fine...see what others have said above me. If they want to "blame" the early difficulties on you not the orientation situation, just let that be water under the bridge.

Secondly, you MAY be asking for reassurance too much. Don't go looking for generic feedback (at least not often). Don't ask the charge nurse "how am I doing?" Instead be more specific: "What are your thoughts on how I handled this particular situation that occurred tonight?"

Similarly, make sure that when you ask questions/ask for help, you also present the thought process that you are using. Instead of saying: "What do I do about Mr. Jones?" say "I'd like some feedback. Mr. Jones has these symptoms, and I think I should do this, but if the problem is that, then the other would be more appropriate. Where would you go from here?" Using this process shows that you do know something, but also respect that there are nurses who know more than you. I've been a nurse 12 years & I still do that sometimes.

Good luck and don't give up. I graduated school, had a baby (and almost died of hypertension), passed the NCLEX, got a noc shift RN job, bought our first house & moved into it, got an evening shift job, and later a day shift job at the same facility all in less than a year. IT WAS HARD! The first year is always hard, but you sound like you have a good head on your shoulders. Hang in there!

[PeepnBiscuitsRN]

Is this really just about work? I suspect being a new mom and juggling family and work is a double whammy for you. Do you ever find time to catch your breath?

Oh that was a huge factor at first- we have a 3 year old at home, as well as our baby who is now 9 months old, I'm working and completing my BSN, (one night a week cohort, started before I got the job) and it was hard- my husband works from home and so he is able to take the children during the day when I sleep- but sometimes I do feel like I'm in a thousand places at once!

Instead of saying: "What do I do about Mr. Jones?" say "I'd like some feedback. Mr. Jones has these symptoms, and I think I should do this, but if the problem is that, then the other would be more appropriate. Where would you go from here?"

Yes, I actually do try to present it this way- I generally say "so and so is experiencing this or that...I think I should do but I'd like to make sure I'm on the right track". Now generally I get feedback that is supportive and tells me yes, that's right, or no that's not right. But this one particular charge nurse (the one who has "concerns") often gives me the impression that she thinks I should know all this already, which is where I start to feel like it was a dumb question to ask- you're right I also think sometimes I'm asking for reassurance too much, and it in turn makes me look incompetent.

Thats a good point! When someone points out something you did wrong, unless you did it wrong, because you have a different rationale that you feel should be discussed, that makes it look as if you are being defensive. Best thing to do is just say thank you for correcting me, and leave it at that.

Right, I've generally gone to just saying "thank you, I'll remember that for next time" and writing it down in my little notebook I carry with me. The only time or reason I say anything else is because I wanted to explain where my mind was going so we could both see where the train derailed, so to speak.

As for anxiety- yeah. I'll be the first to admit I'm an anxious person. If something doesn't go right I tend to dwell on it, and replay it over and over, and then it basically snowballs. I need to let go of things. For example this morning I had a guy, who was baseline confused, who was admitted 2-3 days ago with a glucose of 50, and very hypotensive and then diagnosed with pneumonia. His big problem over the last shift before mine was his sundowning and also a lack of urine output. Blood sugar was essentially stable. He was conversational with me as I and the PCA changed him (he was a 1:1 patient so the PCA was in his room all shift) he ambulated to the potty, had long conversations with the PCA and was generally fine. So imagine my shock when lab calls me with a critical glucose of 37:eek: I have never had this happen, but my first thought was "he's alert and still talking, lets get some OJ in him" and a fingerstick- FS was 36- so I grabbed the charge nurse who walked me through pushing D50, and not 2 minutes later the guy is ordering breakfast.

I dwelled on that all morning on the way home. Did I miss something? I mean- there were NO symptoms!! I had the PCA to attest to the fact that the guy was totally baseline, that should give me some peace of mind but nooo I just had to replay it over and over and over (and I'm done now, point is the guy was fine and was treated.)

[ErinS, BSN, RN]

You are SO new! I know it seems like you have been doing it for 6 months and should have it down. I have been nursing for 5 years, and still feel new, and unorganized, and like everyone is watching me and waiting for me to fail. But guess what? That is my inner paranoid psycho nurse coming out. I have to put her back into the closet and take positive feedback and hold onto it, and negative feedback and learn from it. Also, stick with tele- it will give you a good base. Do it for about 2 years. If you still don't like it, move on. Most people in nursing do not end up liking what they though they would love doing. I thought I wanted to do ICU, but here I am in hospice and love it. Good luck!

[nola1202]

I don't interpret what the nurse mgr said as suggesting you were lazy. I take the dug in your heels and made it work comment as she recognized there were a lot of factors that created a difficult learning environment. (even perhaps the person precepting you.) I get a mental picture of you riding a bucking bronco for the full 15 seconds then leaping to saftey and maybe the grand prize!

I see a person who is stubborn, smart, determined and hard working. I think that may be what your boss sees too. At any rate, so far as I'm concerned I'm only as good as my last shift.