Overwhelmed doesn't cut it

[anxiousADN2020]

Hi everyone,

I'm here for advice and a bit of venting. 

I'm a new grad RN, licensed as of July 2020. I had my first job all figured out, was gonna work a small med/surg floor in a community I was familiar with and had worked at before. But life happens and I moved to another city, where the commute to that small hospital just wasn't reasonable nor safe. So, because of COVID, the first of very few jobs that opened up to me was an OR circulator position at a level 1 trauma center. I was excited, interested, and thought I knew what to expect, so I took the position. I mean, surgery?! So cool. I only lasted two months before I put in a notice and left. Before I was even close to finishing my training, I had surgeons asking me to do things that I had no idea how to do, as the circulator frequently left the room and the scrub was already sterile. I also found that ORs are louder than I had imagined. Often, someone would be talking to me and I couldn't hear them. The anxiety of asking a surgeon what he said for a third time just didn't make me feel great. So, I felt like all eyes were on me, I was failing, I couldn't hear people properly (something I've got to get checked out, sure) and I was crying as soon as I got in my car both to and from work. I had a pleasant conversation with the manager and she told me she understood completely, that OR just isn't for everyone and that's OK. She made me feel better, but I can't help but feel the disappointment that comes with not landing that perfect-fit job. I put so much pressure on myself to fit in and learn faster than I'm capable just so others won't see me as incompetent. Looking back, I wonder if I let the anxiety get the best of me too soon. Should I have stayed? Am I a quitter or justified? These things plague me. 

Soon after, a med/surg position at another hospital opened up and I took the job. I told myself I had already tried the "not everyone has to start with med/surg" approach. I told myself I needed the basics down before I deserved to look at another specialty again. So, I am still here, working on this med/surg tele floor that is also open to oncology patients. Our ratio is 1:6. I have been here for about 3 months. I am finding again that I feel overwhelmed. I ask myself if I should have become a nurse, should I have chosen another field, etc. 6 patients is so much for me, but I look around at these other nurses doing it, so I keep trucking along. There are moments I want to quit. When I have 2 high fall risk patients, confused, bed alarms going off, while I'm trying to start a blood transfusion on my pt who has a critical Hgb, my other pt is actively vomiting, soiled, and another is threatening to call the supervisor if I don't get her pain meds this very second.. It seems hopeless. It is blatantly unsafe. The staffing has major issues. There are nights that I work with a group of travel and float nurses I've never even seen before. Most nights we have one aide for around 30 patients, but there are nights that we have no aide. Between vitals, sugars, meds, assessments, documentation, communicating with docs, putting out whatever fires come up...I just don't feel like a nurse. I don't feel like what I do is making a difference. I feel like I have to wear so many hats that I can't safely be who I'm meant to be. 

I don't mind hard work. I don't care if I rarely get to sit down. I just want to feel safe, like I won't lose my license within one year of getting it. I want to feel competent. I want other nurses to see me and hear me when I'm struggling. I do ask questions. I do ask for help. But still I feel like it's so much. And often, there isn't anyone to help me because they're all busy dealing with their own work load. I want there to be a safe amount of staff for our pt's needs.. I know, wishful thinking. But is this really what nursing is? I've read so many posts on here, so many blogs. Some people say buckle up, some say maybe it's the unit, some say maybe nursing isn't for you. I am not looking for crotchety healthcare workers to tell me to get over it.. I need some enlightenment or something. I need to feel like I'm making a difference. 

Also, worth a mention, there are two nurses on dayshift who seem to love interrogating me and making me feel small in report. Report alone is a skill. It takes practice and experience. But grilling me for not knowing answers to some of your questions is unprofessional. It's so easy to be kind. Which I guess is part of why I'm struggling. Pts are unkind. Docs are unkind. Other nurses are unkind. It's draining. A polite suggestion, such as, "I think it would be good for you to know ___ when you give report. Let me show you where to find that info" would go so much further than staring a hole in me and creating the most awkward tension in front of the pt. Some people love power trips I guess. I don't feel like I have time to prepare a good report. I admit that I need improvement and I try to get a little better each shift. But I also feel that these two nurses in particular aren't giving me the respect I deserve. I am new, I have a lot to learn, I admire those that have seniority over me, but I am a person and I deserve respect. I've wanted to be ugly in return so many times, but it's just not in my nature. 

So, I thought I cried a lot when I was in the OR position, but this med/surg job has me reaching new heights of anxiety and depression. My poor boyfriend, who I live with, has seen me turn from this full-of-wonder new grad to an anxious sack of potatoes. I have anxiety attacks often before shifts. I cry so much. I am experimenting with my schedule, trying 3 shifts in a row vs. 2 on 3 off etc., to see if that helps. I am awaiting a doc appt to address the anx/depression. I do have a history of those, it just seems that becoming a nurse has exacerbated them. I even look up other careers, just daydreaming about a job where I don't have the same worries as I do now.

I've spoken with family friends who are nurses and they suggest outpatient settings where acuity isn't so intense. So, I've applied to more than ten different places, but don't hear back because they want nurses with more experience. LOL. I got so ecstatic when I found a listing for a clinic that works with low-income, underserved populations. But was passed up again. I think that I would thrive in that area. I grew up needing those types of services, so I get lots of satisfaction helping those in that position.. 

If you've made it this far, thank you for reading. I would appreciate any advice or words of encouragement. I fear I have lost my empathy so soon. 

 

[JadedCPN, BSN, RN]

I am not sure exactly what to say to you, but I do want to say that I admire how hard you seem to be trying and your desire to help your patients and provide safe care. Even though it doesn't feel like it at the end of your shift, you're making a difference in their lives. Also remember even the most horrible of work experiences in nursing will give you amazing job experience that you will always take with you throughout your career.

[anxiousADN2020]

On 12/20/2020 at 5:35 PM, JadedCPN said:

I am not sure exactly what to say to you, but I do want to say that I admire how hard you seem to be trying and your desire to help your patients and provide safe care. Even though it doesn't feel like it at the end of your shift, you're making a difference in their lives. Also remember even the most horrible of work experiences in nursing will give you amazing job experience that you will always take with you throughout your career.

I've been waiting so long for someone to respond, so thank you. It is nice to know that someone heard me. 

[another_nurse]

I understand how you feel, I been working on med-surg between 6-12 months and I can relate to most of what you are saying. It sounds like you are surviving at work so I would keep going! Personally, I am staying at this job to further my own goals. I try to ignore what other people are saying if it’s negative. 
 

I was being evaluated during my orientation period but after that I realized it didn’t matter what people said anymore. I have a few coworkers that spread drama and negativity but it’s not worth my energy to entertain it. If there is a serious problem, the manager will bring it up and that hasn’t happened to me. If there is a question or something like that I address it and move on. No time to wallow. 
 

My plan is to get a better job but I know I need to stay at this one for 2 years to be marketable. I floated to ICU step down and enjoyed it more. I’m planning my job transitions slowly. 

[anxiousADN2020]

On 12/25/2020 at 7:35 PM, another_nurse said:

I understand how you feel, I been working on med-surg between 6-12 months and I can relate to most of what you are saying. It sounds like you are surviving at work so I would keep going! Personally, I am staying at this job to further my own goals. I try to ignore what other people are saying if it’s negative. 
 

I was being evaluated during my orientation period but after that I realized it didn’t matter what people said anymore. I have a few coworkers that spread drama and negativity but it’s not worth my energy to entertain it. If there is a serious problem, the manager will bring it up and that hasn’t happened to me. If there is a question or something like that I address it and move on. No time to wallow. 
 

My plan is to get a better job but I know I need to stay at this one for 2 years to be marketable. I floated to ICU step down and enjoyed it more. I’m planning my job transitions slowly. 

I feel like the more I do this, the less I care.. It's a tough, dangerous pill to swallow, personally. Would I want a nurse who didn't really care? Heck no. I'm considering other healthcare options that aren't nursing. I don't know. It just doesn't seem to suit my personality. Not at all how I envisioned it. I'll stay until I have another job at least.  

I'm proud of you for having a plan, though! I wish you the best and hope you reach your goals. 

[bitter_betsy, BSN]

There is a such thing as caring too much and you have to find the balance point.  Your happiness cannot come from someone else or somewhere else - it has to come from within.  You are the only person that can control YOUR happiness and when you attempt to base YOUR happiness on any part of any one else - you will fail every time.  What I mean by this is - your patient is going to report you for not giving them their pain meds RIGHT NOW - they are going to be miserable no matter what you do and complain about something or anything and you can't control their actions BUT -- did you give their pain meds within the allotted time frame - did you recheck to ensure that it was controlling their pain and if it was not, did you notify the doctor to rectify the situation?  If you did those things then be happy - YOU did the right things for the patient and should be happy about that.  If you were late giving the meds, then this is where you make a note to yourself and try harder but still be happy with yourself because you did your best in the situation.  These are the little goals you make everyday - not trying to make others happy.  People are confused, people will get soiled, people will set bed alarms off and fall.  People will always be miserable.  My grandmother is still angry with my grandfather who died over 20 years ago - she will never be a happy person!

From another new nurse - you have the right attitude about where you and your skill set are - these nurses should be helping you but they suck.  They will say "we have burn out" or whatever, but it boils down to they just suck.  A good nurse who cared about helping other nurses would stop and take that time even if we didn't ask.

I am in the ER and I had a very critical patient the other day.  I spent a lot of time in his room and with respiratory, but my charting did not reflect that.  The particular nurse that took over for me is a preceptor (she just wasn't mine) and she took time to guide me in how to fix my charting this time and how to do it better going forward.  These are the kinds of nurses that we need to help us become better versions of ourselves, but they are like tiny specks of unicorn dust in the sunlight and we rarely find them.  Without guidance like theirs, we just have to learn over time.  As a new nurse you will never get anything done or ever feel like you are ahead.  They say that eventually you catch up, but I've been on my own for about a month and I feel like I'm 2 months behind.  I do however realize that I've taken a new learning moment home each shift - either something I will never do again or something that will actually be helpful in future shifts.

Let me give to you 3 tips that help me that may work in your situation.

1) When I come on shift, I make sure my patients are stable and as long as they are - I don't even put eyes on them at that moment (most of the time they are on spacelab and I can see them from our nursing station).  I take 5 min per patient and write down why they are there, their meds, code status, dietary, procedures due and their meds. In your situation the doctors would probably be helpful too.  I have found that I can get so in the moment that I will never find time to do this and when I don't I feel like I always miss things.  I missed an order for a MRDO swab because it was thrown in with admission orders that I figured I would get to later, but I never got to it later.  Sure -that wasn't an important thing, but what if it was a repeat lactic or a type/cross - something that was important - that was my lesson for the day - don't acknowledge admission orders without reading ALL of them.  I have a dry erase book that I made and use for my admitted patients, but usually I just use a single sheet of paper divided in 4 (because I have 4 patients in the ER). This also helps me give better report.

2) on a single sheet of paper divide it into 12 boxes and write the hours of your shift in your boxes.  Any meds or procedures or times that are in stone go in those boxes (I make a dashed line so any :30 things are in the bottom half of the box).  I don't write it all out as the whole things goes on each persons paper instead - this is just a quick reminder of things that have to be done within a certain time frame.  The other side of the paper is used for reminders - ie gave pain meds at 0100 and need a recheck at 0200.  0200 #15 pain recheck goes on that paper as a reminder.  Make sense?

3) The last thing I do is tape my medication vials to my syringes when I give them (this is sort of a middle step).  There are many times when I give multiple IV medications to a patient that take a minute or 2 to push for each one with flushes in the middle.  I don't want to make a medication error or get distracted by my patient talking or asking questions, so I ask them to give me a minute while I prepare their meds.  I explain what the med is as I prepare it and answer questions specific to that medication - then I tape the vial to the syringe so I know what is in that syringe.  Once all are done, then I can lay them out in order and have a conversation with the patient while I'm slowly pushing all those meds and answer any other questions and do a reassessment on the patient.  In the beginning, I was trying to draw up, explain and push each med individually, but then after all the meds were pushed, I'd still need to reassess the patient and I felt like everything was just a mess and my patients never had a chance to lead a conversation.  I probably don't end up with any extra time doing it this way, but I feel like 1) I have done part of my nursing job by explaining the meds and answering questions and 2) we can now move on to their questions and I can focus on their answers while they drive the conversation.  Most of the time they feel like they have my undivided attention that way.

Coincidentally this situation worked well with a particular critical patient who had lots of questions.  I said - there are a lot of things going on right now and everything is going to move very quickly in just a few minutes.  I need to get an IV in you and get some bloodwork and medications going - if you can give me just a couple more minutes to get everything together, I will be able to sit here with you and answer as many of your questions as I can.  I realize that you don't have the benefit of getting to sit with a patient for 5 minutes while you get a line, label their labs and start their meds, but my point is that sometimes their perception of your time is all they need.

The last tidbit I will leave you with is - hug that boyfriend every day!!  Thank him for everything he does for ya'll and appreciate the moments that you get to spend with him.  When it is your time with him, do not let work interrupt.  My hubby doesn't understand how much that hug when I get out of the shower means to me and I don't care if he ever knows.  But when I hug him - work just literally falls away.

You are doing the right things for yourself and your patients - you can do this and you can succeed!  Stay until you get that experience you need to go elsewhere.  Your goal for every day is to make YOURSELF happy!

 

 

[NurseShamshey, RN, EMT-P]

I'm so sorry to hear you are going through this. I used to work at a place like this and it was absolutely horrible. I left and took a pay cut eventually, that's how bad it was! I'm currently a new grad as well but have lots of healthcare experience. I've been in my nursing job for about 3 months and I am so freaking bored honestly. I was excited to start, working on a pediatric acute care floor. Until it got converted to the covid unit. Im not learning anything only taking care of respiratory patients all the time. I mean we had 1 patient on the entire floor a few nights I worked. I was on orientation still but begged to be floated. 

 

The first thing I thought of while reading this was why didn't the hospital give you the choice to transfer to a more appropriate position when you were failing in the OR? I'm in a nurse residency program, that was mandatory, and they said they will transfer us before they want us to ever consider leaving the hospital. There is such a nursing shortage everywhere and it looks horrible when nurses leave within their first year. That is absolutely crazy to me that they didn't even give you an option your manager was just like ya OK bye. And your new job sounds completely overwhelming too. And frankly, I've been a paramedic in and out of adult hospitals for years and I've found a lot of nurses are really mean for no reason. My coworkers at the pediatric hospital are seriously so nice. I have straight up told them I'm bored and want to transfer and they find stuff for me to do. They are supportive and would never talk to me the way your coworkers do. That is toxic AF. 

It's hard to find a really supportive environment though bc hospitals are understaffed and need people. So managers ignore the bullying. I would bring this to the attention of a manager though. The fact that you're overwhelmed as a new grad with a 6 pt assignment and the constant bullying and make it obvious that you will leave if they don't make it a more supportive environment for you. There has to be people who work in nursing admin that can help advocate for you if the manager blows you off. This is never OK in nursing.