Overwhelmed and Exhausted

[TweedleDee]

Hello all....In my 7th week of an 8 week orientation as a brand new nurse on a med surg floor. Orientation was originally 6 weeks, but I asked for more. The past 2 shifts have been a nightmare. Both days, with my preceptor encouraging me to take the whole group, have been incredibly inconsistent. While I'm aware and try my very best to 'roll with it", these past 2 days have seen a shuffling of patients just about every hour. Day one included a patient death with a shift of patients mid day that I knew very little about (received a mini-report from my preceptor) but I still felt clueless, then one of my pts. pased away (my preceptor and I worked this one together as it was expected, but happened faster than we originally thought). As this was a first, I felt I earnestly tried to take advantage of the learning opportunity here..ie how to care for the pt in the final minutes, how to assist the family, what phone calls needed to be made, etc. all the while dealing with my own emotions. I felt that the charge nurse should have reassigned the other pts in my care, so that I could properly attend to the situation. The second day, I received report on a pt that I had care for the day before and was told that the pt "did not look good". Made her a priority and found her to be more than just not "looking good". Notified charge and Dr and recieved a whole host of STAT orders. Charge reassigned my pts to my preceptor, who assessed 2 of the 5 and gave no morning meds to. After my one pt was stable, I found myself once gain trying to play catch up. Pt was later found, after numerous tests, to be in CHF and a potential N1H1. Pt was assigned to my preceptor as I did not pass my fit test and am unable to wear an N95 respirator. Needed to do IV restarts on 2 pts with altered mental status, missed with my first pt and she wouldn't let me come near her the rest of the day. Pt reassigned to another nurse by charge, nurse accepted pt..sort of. Find out at the end of the day, RN didn't actually take pt much to my suprise. Received new admission I wasn't told about until pt was on the floor, needed surgery consents for other Altered Mental Status pt signed by daughter and of course needed to chart (which I was horribly behind in) and take care of the other 5 pts I had. My preceptor asked me if I needed help, which I did, but I didn't even know what I needed help with. To compund all of this, the CNA was not reporting to me unstable VS on one of my pts. So at 7 pm, during change of shift report, I look up all my pts vitals and find an unstable BP.

Is this a normal day and/or days on a med/surg floor or am I just an overwhelmed new nurse?

[mappers]

This does not sound like a normal day. Does your preceptor take patients as well as your team? Our precptors don't. A team is not assigned to an orientee at all. Now the preceptor may have you take the whole team and should, but they are alwasy there as a back up.

With the H1N1 patient, we would have Rapid Responsed her and most likely she would have gotten transferred to another floor.

It sounds like your orientation process isn't being well managed at all.

[Ayvah, RN]

Well, deaths are by far not the norm. Sounds like you had a rough two days. While that is not a typical day, that also may not be an uncommon day depending on your facility (except the death part). Unfortunately you can't always count on your techs bringing unstable vitals to your attention, so its got to be made a routine part of your day to look up vitals as close to when they are taken as possible. For the other things, hopefully you have a charge nurse who doesn't have a load of their own so that they can help you when the going gets rough. It is rare to have a day without any problems.

Sounds like your preceptor dropped the ball a couple times too.

[TweedleDee]

mapper and Ayvah,

Thanks for replies. I too had been feeling like my preceptor should have been there a bit more to back me up. She's been very good, but she too is still a relatively new nurse with two years under her belt. My preceptor has been giving me the whole group for the past couple of shifts. Managing 3-4 pts I've got that pretty well under control, but add in another 2 and well... it becomes quite chaotic. Our charge does not have a pt load of their own and she was great in helping me deal with my N1H1 potential pt earlier in the day when she was SVT @ 243 bpm. I'm spending some time this weekend reorganizing my paperwork..ie, how I get report, how to keep track of things throughout the day, etc. Ironically, a nurse that was my preceptor for the day a few weeks back (yes, there's been iconsistancy with preceptors as well) made the comment "that her worst day in the ER (she's charge in the 5th busiest ER in the country) is better than her best day on this floor", so maybe its just the nature of the beast. Thanks again for your reply.