plea for collective wisdom -- new grad RN nurse struggling badly

[vespera186]

Hello all,

I'm a new-grad nurse on a crazy-busy med-surg floor, and I'm really struggling. REALLY struggling. Like, I'm-scared-for-my-job struggling. My super-nice preceptor is getting more and more openly frustrated with me, and that suggests I'm on the thinnest possible ice.

It's been a really humbling/humiliating experience. I've always been the one other people came to for a little help, and now it feels like I'm beyond help. I'm not generally a screw-up, is what I'm trying to say. But I'm one now and I want to fix it.

Yet I can't sort through the chaos to see the order. My preceptor can rattle off three blood sugars taken by someone else an hour ago, the lowest BP a patient had two days earlier, where everyone's PIVs/PICCs are and when they were placed, etc. I know this is all vitally important information, but I can't keep track of it all! It's a jumbled mess in my head and I'm constantly writing things down and looking things up, slowing me down. Or I get try to speed up and then I make mistakes, which is even worse.

And I don't want to skimp on the other things, like calming down an anxious patient, ensuring pain control is adequate on a patient with dementia too severe for her to express herself, etc., without getting behind on tasks.

So ... how did you adjust? How do you keep track of things? What tasks do you prioritize over others? How do you calm down when you get rattled? If you have any wisdom you could share I would be very grateful.

[katie6126]

How long have you been there? I think many new grads starting on their first RN job, regardless of the floor, can relate to you. You should not compare yourself to your preceptor because she/he has have years of experience already and obviously that is how come they can do what you described with that speed and efficiency. A few years down the line, that will be you as well but keep in mind even the most experienced RNs probably have things that they struggle with. You learn by struggling, and I am sorry for the attitude they are giving you now but try not to pay so much mind. It is always better to ask how to do a certain task, etc. then to not ask and just do things blindly. They should be more understanding that you are just starting out. I might be a bit biased because I am not usually one to tell others to just quit, I would give this job more time and if you truly still feel uncomfortable look into another job of nursing but keep in mind stuff is ALWAYS hard when you start off ANYWHERE. Perhaps in the meantime you can figure out how to de-stress as best as possible when you are not working catch up on your sleep, exercise, read a book whatever helps you clear your mind so you are not going into work with an anxious mindset. To keep track of stuff at work you can maybe carry a little notepad and pen and jot down things to remember and if you are ever feeling nervous step aside and take a few deep breaths, count to ten, whatever helps.

[vespera186]

Thanks so much for the encouragement, and I hope you're right. You've given me a lot of great advice (and a little bit of hope :) ) I've been there five weeks. But I do have classmates working on the same floor who seem to be doing much better than me. And I can't say anyone's been unkind (the opposite, actually), just that the anxiety makes it hard to THINK, and that as a result I'm truly not performing at the level expected even of someone straight out of school. I try to take it one step at a time, but have had trouble cracking the code, on the fly, of what IS the next step, out of a zillion items needing doing. And I seem to be getting the answer wrong a lot. Sigh.

[Farawyn]

Clinicals and classroom are very different from actually doing it, isn't it?

I've felt like you as a new nurse, and I gather many of us have.

Slow down. Breathe. It's okay to write things down. Don't compare yourself to others or worry about what they are doing.

I would sit down and talk to your preceptor and ask, specifically, what are you weaknesses? What are your strengths? Come up with a plan together on what you can do to improve.

Good luck and keep us posted.

[AJJKRN]

Do you have a brain sheet for each Pt?

[suanna]

It's been a LONG time since I was a new grad, but what I advise the staff I'm precepting is that the day is way too big to focus on. Ask yourself "what do I need to get done in the next 30 min?" If you get those done, you can focus on secondary tasks or get ahead on your next 30 minutes. I'm not saying you don't ever look at the big picture, or you are going to come up to some 30 min bites that are going to be way too much to handle.

[icuRNmaggie, BSN, RN]

People enjoy doing what they are good at and you are not there yet because you're in the learning curve. As you get your rhythm and routine your anxiety will subside. It will take about a year until you start to feel comfortable and at ease at work. When you become good at it you will actually start to enjoy your work.

[Postpartum RN]

OP do you use a brain sheet for your pts? I use an organized brain sheet where I write down all that info during report. Also on med surg I used to come in early (like 30 min or more, on my own time ) to prep on my pts and that helped me tremendously...find a way to organize yourself and it will get better. I like the previous posters idea of thinking in time blocks also...good luck it will get better :)

[jadelpn, LPN, EMT-B]

As others have suggested, a brain sheet. Use a pen with three colors on it if you need to organize further. There's even people (and I am not suggesting me, AHEM, cough cough) that fold the brain sheet so that information is listed on different parts of the paper as well. The sheet should have the patient name (or initials) the room number, the diagnosis. And then whatever information you deem appropriate--most current labs, or any and all studies, does the patient need P/OT/speech swallow? Location of access, when it needs to be changed out or dressing changed.

You need to know any treatments (dressing changes on PICCs for instance) You need to know any "weird" medication times (if the usual is 9 and 9, you write down--in red--alternate times that meds are due. You need to know who has finger sticks, and who needs coverage before breakfast (lunch, dinner). How does the patient move? When was the last time patient was medicated for pain? What is the plan for the patient? Is there any new orders that need to be obtained from the MD? Write it all down.

Take one patient at a time, and chart as you go. You have to look at charts, see if there's new orders. Then your insulin people. While you are in there, you are going to assess, to chart. Take a CNA with you to get the person set up for breakfast, do vitals, that kind of thing. If there are treatments, you will do them when you come back with morning medications. Also at that time, you can start doing education in preparation for discharge. if the computer generates patient education, then would be the time to generate it.

If, in all of this you have an admission or a discharge, use your resources. If you have a charge who puts in orders, organizes stuff, use it. Do your initial assessment, and tick off anything that needs to be done right away.

Pop into each person every hour or so. With the CNA--"do you need the bathroom, how is your pain", etc and again, chart as you go.

You will get this, you will get into a routine. And I am sure that you are not the only one feeling overwhelmed. But focus on what you need to do. Regardless, your goal is to be efficient, organized, and on point. Start looking at the whole picture of each patient.

You WILL get this. Don't become discouraged, just change direction a tad.

Let us know how it goes, and best wishes!

[annie.rn]

You havengoter

[annie.rn]

You havengoter

So sorry about this. I think I fell asleep while posting and just now saw it. It's been too long to edit.

[brownbook]

I can spend 30 minutes with a patient, giving good patient care, leave the room and not remember which arm the IV was in, and why in the heck does it matter? It is in their arm and it is running well!

I can take a patient's vitals, chart them, and immediately forget what they were, why would I memorize them?

I may remember a blood sugar, but it sounds dangerous for any health care professional ( except for Super Nurse) to trust their memory with three different patient's glucose.

That is why we have charts and computers, to look things up!

It is better to know what intervention to do if a patient's blood pressure or glucose is to high or low!

Your preceptor may have a photographic memory, but us mortals use pen, paper, and computers!