Overwhelmed, questioning nursing, PLEASE HELP

bionicscode · Jul 17, 2014

I don't know what I could say to ease your distress. For me nursing school was a much more distressing endeavor. I was sick all the time: I had a chronic cough that would cause me to deSat in the 80s and I would pass out. this is when I wasn't projectile vomit. The university clinic ran $2500 worth of tests before it was determine I was having acid reflux due to stress. Thankfully, I graduated and got a job where I intern as a nurse tech and did clinicals as a student, so I was familiar with most aspects of the EMR.

Being around the environment for two years help me acclimate to procedures and cultures. It has helped a lot. Some staff thought I was a LVN before I graduated. but im still terrified of the doctors. Some are arrogant. A lot are foreign born, so I have I cant understand them to save my life. Im afraid to answeriung their questions wrong or not know vital information. So I changed my gameplan to coming in 90 minutes early to look at the patients' charts (H&P, latest orders and labs, drugs, VS...) and make a schedule for the day before I get report from the night nurse. I wont get pay extra but at least I get to keep my sanity..

My advice: if your mgr is a reasonable person, set up a time to discuss your concerns. Don't go in there a rambling mess. Discuss your concerns in an analytical, dispassionate fashion. let the mgr know that you are concern that you won't succeed professionally when you are having so much trouble with their systems and culture. Have a plan on how to be successful ready to present to the person and a list of things that you need from them ready (write it down if you need to). If the hospital has an education nurse or staff member that regularly audits the charts, requests training with them. Also, ask for "cheat" sheets so you may find common charting needs in the EMR.

Second, be confident with the doctors and try to make some kind of connection: let them know that you're a recent grad trying to get acclimated with the hospital. let them know you'll have to confirm their orders so you want make an error.

Lastly, find yourself a mentor. Try to get on the same rotation with them. COmpare notes once a week, so you can get input.

If all this doesn't work, change your game plan. with you being an FNP student, you may be taking on too much. Maybe school should be your priority. You may need to find a job that is not as demanding until you finish your program. Nurses aren't superheroes. Don't overload yourself and set your self up for failure. Sometimes delaying your goals (i.e. working in a teaching hospitals) can be advantageous long term.

sunny1230 · Jul 17, 2014

Thanks for your reply. As I mentioned I have applied for pretty much everything. Unfortunately that's not an exaggeration. Also my school requires employment in acute care so leaving the hospital environment is not an option for me. I would love to work for a teaching hospital with more support but after applying a million times to several of these facilities and never even getting an interview, I'm discouraged (to put it lightly).

Also, in LA most of the doctors are foreign and while I love diversity they can be extremely difficult to understand. I definitely get worn down from being yelled at.

sunny1230 · Jul 17, 2014

Also I forgot to add we're not allowed to be on the unit not clocked in. It might even be a law here bc it was the same at my old job. I wouldn't want to anyway; it's too busy people would be asking for help and I can't put myself in that situation off the clock.

iPink, BSN, RN · Jul 17, 2014

What nursing school fully prepares you for the real world of nursing? These schools are designed to give you the basics to prepare you to pass the NCLEX.

How long was your orientation on your new unit. I transferred to my current unit after being on a critical care floor for a year so I had a 6 week orientation vs the standard 12. I had a slight advantage because I was already familiar with the system, but if I wasn't I would be jotting down how to chart things in my pocket size notebook for reference. During orientation did you go over things like what you stated above? Med errors are a big issue but you should have asked how to view what new orders have come through. Seeing it 6 hours later is not acceptable.

Your coworkers may not hold a lot of conversation with you but at least they will answer any question you ask, so you need to ask lots of questions to prevent major mistakes. Moving to a different specialty/hospital will always come with its challenges, but to survive as an experience nurse is to not be afraid to question things. Keep a folder of unit/hospital protocols, etc. You can't expect to learn a new system in days but writing down how to navigate through it should be done.

I have certainly been there trying to understand orders from a doc whose first language isn't English. If I have read back the orders twice and I still can't understand that's when I enlist help from an experience nurse who may be familiar with the order especially if its commonly ordered on the unit.

Your previous unit sounded rough. However my hospital was located in a good area yet we still got unstageable wounds, narc seekers, ETOH withdrawals, behavioral health patients (bioplolar, schizo, etc.), patients who needed to be on 4-point restraints, and list goes on and on. People need help in the good and bad areas.

Good luck.

Sent from iPink's phone via allnurses app

MissM.RN, BSN, RN · Jul 17, 2014

Sunny, I'm so sorry you're feeling alone in what sounds like a NOT nurse friendly environment.

Please try not to worry about charting. I'm sorry, but there are simply too many expectations. for me, something has to give, and it's my charting. I prioritize my charting, meaning I never leave the unit without inputting hard data (I/O, vitals, assessment) but that's it.

Stay where you are as long as you can, simply because job hopping on a resume doesn't look the best. Keep up with your old work friends for support. You are not alone. I felt the same way about my school, and others do too. We are not prepared well enough with clinical experiences, especially ahead of time in the program so students can truly decide if nursing is right for them.

In future, refuse to accept verbal orders. if your hospital has an electronic MAR, then it is the MD's responsibility to use it. refusing verbal orders takes a little bit of guts, but when I do it, I simply push my computer over to the MD and state "you put it in" and walk away. it will get easier with time.

LadyFree28, BSN, LPN, RN · Jul 17, 2014

What nursing school fully prepares you for the real world of nursing? These schools are designed to give you the basics to prepare you to pass the NCLEX.
How long was your orientation on your new unit. I transferred to my current unit after being on a critical care floor for a year so I had a 6 week orientation vs the standard 12. I had a slight advantage because I was already familiar with the system, but if I wasn't I would be jotting down how to chart things in my pocket size notebook for reference. During orientation did you go over things like what you stated above? Med errors are a big issue but you should have asked how to view what new orders have come through. Seeing it 6 hours later is not acceptable.
Your coworkers may not hold a lot of conversation with you but at least they will answer any question you ask, so you need to ask lots of questions to prevent major mistakes. Moving to a different specialty/hospital will always come with its challenges, but to survive as an experience nurse is to not be afraid to question things. Keep a folder of unit/hospital protocols, etc. You can't expect to learn a new system in days but writing down how to navigate through it should be done.
I have certainly been there trying to understand orders from a doc whose first language isn't English. If I have read back the orders twice and I still can't understand that's when I enlist help from an experience nurse who may be familiar with the order especially if its commonly ordered on the unit.
Your previous unit sounded rough. However my hospital was located in a good area yet we still got unstageable wounds, narc seekers, ETOH withdrawals, behavioral health patients (bioplolar, schizo, etc.), patients who needed to be on 4-point restraints, and list goes on and on. People need help in the good and bad areas.
Good luck.
Sent from iPink's phone via allnurses app

Agree

To add: how about taking a step back and honing your practice before taking on graduate education?

It was a HUGE learning curve when I transitioned from LPN to RN; I felt as though I had reached an impasse because my first hospital job did not have a great fit as a new grad, either; however the positives I saw were the acuity and helped me regain and build upon my practice for the future. I have learned so much in my two years where I JUST got comfortable in my practice when I have bridged the gap with my past practice to my current practice; and I know I STILL have a LOT to learn.

Step away from the open positions and job hunt and right this ship-do self-study, learn the EMR, don't be afraid to ask questions and get people to repeat themselves when you don't understand until you get it-advocate for yourself-SBAR SBAR SBAR-and learn how to organize your care and your practice by using a brain sheet...there are plenty here on AN to select from.

Again, you can right this ship, even if it means deferring your FNP studies to do it...your practice follows you to every position, so think about that instead of looking for another job for now-your priority is to hone your practice-you are a novice nurse ALL over again.

Best wishes.

sunny1230 · Jul 17, 2014

How long was your orientation on your new unit. I transferred to my current unit after being on a critical care floor for a year so I had a 6 week orientation vs the standard 12. I had a slight advantage because I was already familiar with the system, but if I wasn't I would be jotting down how to chart things in my pocket size notebook for reference. During orientation did you go over things like what you stated above? Med errors are a big issue but you should have asked how to view what new orders have come through. Seeing it 6 hours later is not acceptable.

My orientation was 4 weeks. I did ask a lot of questions in orientation and I have several pages of notes typed for myself. I'm not disorganized or irresponsible. The med error wasn't from not seeing a new order - it was because his home med didn't carry over to visit meds and I didn't even know that was something to look for (he had been admitted the previous day so another shift had already missed the same thing).

I do use a brain sheet, the same one I made for myself two years ago and I've been updating it as needed.

I know these mistakes are unacceptable which is why I lose sleep over it myself.

I don't understand how others with the same education and work experience seem so adjusted and I'm anxiety ridden all the time afraid of making a mistake

wooh, BSN, RN · Jul 18, 2014

Instead of focusing on the next ship, spend some time focused on righting the one you're on. When you're spending time focused on NP school and job hunts, you simply can't focus the attention needed on doing your current job right. After some time getting settled, sure, go back to those things. But a new job takes a lot of focus and attention.

SU2013 · Jul 22, 2014

Here is my take without knowing you personally. First above there will always be some sort of issue anywhere you go because no where is perfect so stop internalizing everything. You need to develop a more thicker skin when working in hospitals setting. Secondly, I notice that some people are book smart but can not actually apply their skills well. My sister is a CNA for 3yrs and can run circles around RNs and my other sister was a clerk for less then a year and was helping RNs do their jobs properly. My point is that sometimes hospital nursing isn't for every one and sometimes nursing isn't for everyone. Maybe you should first try working outside of the hospital setting and see how you manage.

SU2013 · Jul 22, 2014

Also, I wanted to add that some of us are not multitasked and some of us learn different from others. Myself for example I can't catch on by some one telling me what to do. I do better with taking notes, show me how to do it and then I do it myself. Once I understand the concept and procedure I'm ready. I also like to pace myself...but understand that working in the hospital that other nurses either don't have the time nor are willing to help you. It's good if you can find a buddy to work with you. I do agree you should have stayed at your old job where u atleast had support...but oh well move foward.