Overwhelmed

[FaithMMA]

I am a new grad and the first position I was able to get was at a SNF/Rehab. Most of our patients are sub acute, but the new admits can still have very high acuity. After 4 weeks of orientation, they put me on the floor with a patient load of 11-14 and this is considered low census! On the days that they put me on a specific hallway, I seem to do ok because most of these particular patients I had during orientation, but they move me around everyday so I can get familiar with all the patients. I am so overwhelmed and feel like there is no way I can provide safe patient care as a new grad with 14 patients. Between doing all of my vitals, passing meds, inputting orders, calling doctors, doing skin checks, passing afternoon meds, and charting on everyone, I just can't seem to get it all done. I know I am only 1 week in, but I just feel like this is too much and want to throw in the towel. I come home and think all night about my day, sometimes I just cry in private. My husband knows I'm having a hard time because I'm distant and not my upbeat self. 4 weeks is not enough time and 11-14 patients is too many. All day I feel as if I'm being pulled in a million different directions and trying to answer questions for PT, doctors, OT, and administration that I don't have the answers to. I guess I'm not sure if I should stay or go. I really need a job and it took me almost a year to find this one. I feel like if I quit now, who knows how long it will be before I find something new because no one wants to take a chance on a new nurse. I want to stick it out and I hope I can adapt, I'm just so scared everyday I go in. Thank god for the wonderful nurses I work with who take the time to help me when I need it. If it weren't for them, I don't know if I would have come back after my first day on the floor. I guess I'm either looking for advice, or just needed to vent.

[venousr3tuRN]

Just take a deep breath and let it all out. I know exactly how you feel. I have been working off orientation now for about 5 days and still am struggling on every shift. I learn more each day even though I'm still getting used to all the residents and their intricacies. My facility is 99 bed and I'm in charge of over 25+ patients on any given shift. My second shift on my own was a disaster and I seriously thought about not going back because I didn't get home from work until around 1:30 am and I had to be back at 7 am. I decided to stick it out because I didn't go to nursing school for nothing and I am determined to be the best nurse I can be by learning from my experiences.

The next shift was better as I felt like I got a little more of a handle of my shift from what I learned the night before. It really is a learning curve from school to actual practice but if you stick it out, you'll learn so much and be better for it.

My advice: take your time with your med pass because the worse thing you could do is harm the patient by giving the wrong medication rather than being late by an hour. I know you have a two hour window, but I think 3 hours is pretty standard for new grads just starting. Just focus on doing it right and know that speed will come in time after you've gotten used to everything. I still take about 3 hours but I notice myself getting a little faster each shift.

Don't be afraid to ask for help, even if the other nurses are busy. I also work with an amazing team of nurses and CNAs. They help me out so much when they can. I believe as long as you ask, they will always try to help when they are able to. Ask your DON for help too as he/she is one of your greatest resources as they know every single patient you have. My DON has helped me numerous times on my documentations because I needed help with all the paperwork. She has an open door policy because she wants her staff to be successful, and in turn her facility successful.

Lastly, remember to enjoy in the fact that you are now a working Nurse. It is definitely no small feat getting through nursing school and passing the NCLEX. Your hard work and perseverance has culminated in your first opportunity in the Nursing profession. If you can stick it out, it will eventually open numerous avenues to pursue. If you truly feel you can't or feel like the support is not there at work, then other opportunities will present itself as long as you search for them. I say stick it out. They hired you because they saw something in you. You should start seeing it too.

Good Luck!

[FaithMMA]

Thank you. It helps to just know I'm not alone. My first med pass was 3 hours, second and third were 2.5, but yesterday I started my shift with a patient falling mid report, having to work 2 med carts because of how they split the rooms, a fire drill and 2 new patients whose medications were not ordered stat when they arrived the night before. Neither of these patients meds were available and my DON still hasn't gotten around to giving me a pyxis ID so I had to work on other nurses times to get whatever meds were available in the pyxis for these 2 patients. This ended up being a 4 hour med pass! I was so embarrassed and behind. During med pass and vitals one of my patients BP was 244/99...I almost lost it at that point but my senses took over and I took a manual before freaking out. Manual turned out to be 150/86. Not great, but more manageable than 244. After that, I've just decided to do everyone's manually. I feel like the automatic BP cuffs somehow take longer and are less accurate. I'm thrilled to be a nurse and blessed with amazing coworkers. One of my preceptors was working with me and she grabbed a few of my phone calls and orders for me. I just cant wait for the day when I can return the favor and help make theirs or another new nurses day a little better. I ended up staying quite late yesterday and a coworker just said to me "I notice you pay a lot of attention to details, that's great and don't even lose it". That really just made my day. I'm not a quitter, I will stick it out, and it will get easier. I just have to believe in myself a little more.

[4_Sq]

Hi FaithMMA

I just want to say that you are admirable. Nursing today is certainly not like it used to be (voice of experience)

Nursing has changed, and not all for the better! The patient population has certainly changed. With hallway patients

short staffing and overcrowding, your job is not easy.

Organizational skills will come with time, and you will be able to complete things a bit faster.. but in the meanwhile it is better to be

thorough than fast!

The other thing I want to say is that once you have a couple of years under your belt you will be helping some one else cope with

being a new grad and hopefully you can make their transition to work a little easier.

Good Luck!

[coopman712]

Between doing all of my vitals, passing meds, inputting orders, calling doctors, doing skin checks, passing afternoon meds, and charting on everyone, I just can't seem to get it all done.

I can so relate, especially to this....

I have been at my job 6 weeks and have a year of experience at another facility. Our hospital is acute rehab so patients come fairly sick enough to justify 24hr nursing care but need the rehab. I have good days and bad days. I work nights and find it so hard to get it all done. SO many meds to pass b/w 8 and midnight, plus assessing everyone so I can chart, dealing with pressing issues and treatments makes it a challenge. We are often short staffed at night so I spend a lot of time answering call bells and toileting. It is not that I mindhelping the patients, but it makes it near impossible for me to get my charting, etc done. Plus I like to read what I can on the H&P so I can give a decent report to the AM nurse. My last shift, I left feeling like poo, b/c I didn't get a chance to do that and therefore left unaswered questions in regards to history, etc. to the oncoming nurses.I had 7 patients, but we can get up to 10 or even 12 or more if understaffed. I really want to feel good about what I am doing and am hoping it just takes time to get familiar with routines, processes, etc. Everyone is helpful but they too have their own work to do. Not that it makes me happy but I do see more seasoned nurses feeling overwhelmed with the amount of stuff they have to do and getting out late b/c they are not finished with charting, etc.

Hang in there. It will get better.