Please help I need guidance New orientee:

totoro · Oct 31, 2008

first of all which unit/floor do you work at? i precept students/interns all the time. maybe i can help you. 1) which unit do you work at? 2) do you have one preceptor or do you have several different ones? 3) how long was your orientation? 4) what do you feel is lacking (other than time and experience) 5) how long have you been working as RN? 6)can you identify your strength and weaknesses? if so, what are they? 7) do you or did you feel comfortable enough to share your feelings with your preceptors? if not, how about manager?

Barlan · Oct 31, 2008

1) i work in a med surgical floor.

2) i have one preceptor and she has 18 years of experience, well respected among her peers.

3) my orientation is 10 to 12 weeks long. i am on my 4th week.

4) i lack time management, experience, knowledge about most meds, the different types of iv pumps, machines, cannot remember where everything is, the various paper works

5) i recently passed my boards and have been working as rn for a 6 weeks

6) one of my strength is that i have good interaction with the patients and family, a team player, someone who is willing work hard and learn.

my weaknesses are i am getting intimidated very easily, terrified of making mistakes, very slow at everything, whether is passing meds, triple check meds before and after drug administration, mortified someone will die on my watch because i don’t understand what i am doing.

7) i feel comfortable with my preceptor, i share a lot of my concern with her and she usually replies welcome to the real world of nursing. i don’t trust my nurse manager as most of them are backstabbers who mostly look at for management.

what i’ve realized is that the hospital care more about how many patients you can take each week, more about speed rather than safety.

ps. thank you for your quick response. looking forward to your post.

Medic09, BSN, RN, EMT-P · Oct 31, 2008

I think for many new nurses the first few months are like the first exposure in combat. Sure, you've been taught and trained and even had some controlled practice. The real thing is one huge shock to the system. I often say about my years as a combat medic that we were too young and stupid and busy staying alive to realize we couldn't do what we indeed did every day.

Since no one is trying to kill you, you have time to realize the magnitude of our responsibilties and the scope and pace of our work loads. DO NOT DESPAIR. It can take quite some time to get just fairly proficient at this job. It doesn't sound like your preceptor is worried. Is your knowledge base okay? Notice I said okay; you don't have to quote the textbook. Are you acting responsibly? Are you using common sense? Do you distinguish between really urgent situations (the patient is gasping and turning ashen), and those that can be done a bit more slowly? Are you asking questions when you don't know? If you need a bit more time, will they give it to you? Will they slow down the pace of increasing the patient load by a week or two?

Remembering all the 'stuff' (how to, where to, when to, which...) only comes after months or more of repetition. I've been almost a year on my job now, and I still ask 'can I hang this to gravity or is it a longer infusion time needing a pump?' Every single shift I have to ask how to do something. Nobody seems to mind. We all have a learning curve. Apparently I'm far enough along on mine that I can work as long as I show repsonsibility and common sense.

The truth is, ALL healthcare personell learn to be proficient partially at the patients' expense. There is no other way. Ask your preceptor what she honestly thinks. You may not be doing so bad if you display the core abilities required to keep patients safe in the meantime while you continue to learn and grow into the job.

You sound like your heart is in patient care. That is a very valuable asset. When you learn to be a little more proficient, that heart will make a real difference. It will never be this hard again.

RedhairedNurse, BSN, RN · Oct 31, 2008

I felt the same as you during week four. After six weeks of orienting on days, I decided to go nights. IMO, night shift is much more conducive to learning. It can still be busy, but not so overwhelming. I think I could go back to days now and handle it very well.

About your assessments......a focused assessment shouldn't take you long at all. You can do that when you're giving meds. You really should be doing a focused assessment, at least. No need for head to toes unless it's admission. But to protect your license, you must start assessing.....you're a nurse and assessment is priority. Plus, charting can be an issue and if there is no assessment, how do you know what to chart?

Learning time management takes time. I've learned that when I'm in the pts room, I look around.....do I need new tubing, IV fluids, secondary lines, etc. Don't worry, you'll get on the right track before long. Just be patient and most importantly, do your assessments!

I don't think you should go to LTC. You will be more or less on your own. At the hospitals, there is always a much more experienced nurse, so if things go south, you'll have HELP. You won't have that in LTC. I was offered a good paying job at a LTC, but I have to learn what I'm doing before I become the only RN on the floor.

mondkmondk · Oct 31, 2008

LTC can be just as hectic and fast paced, I've learned over the years. The evening and night shifts are the best to start off with in my opinion so you get the opportunity to know the 20, 40, 60-some residents under your care. I've never done med surg. in a hospital but I do wish I'd have done that for a year prior to going into geriatrics. Also, with LTC, one seldom gets weeks of training...more like days. I'm experienced and took 2 days and this weekend it's just me, but I'm confident I will be fine.

My advice if you are asking it, is to stay where you are for a year and if you still feel overwhelmed, etc. then go to another specialty.

Blessings, Michelle

BrnEyedGirl, BSN, MSN, RN, APRN · Oct 31, 2008

Barlan my love,....breath,.deep, long breaths,..in through your nose,..out through your mouth,...repeat. Okay,...6 weeks is way to soon to give up! We all felt this way in the beginning and anyone who says they didn't is either lying to you or were too stupid to realize what was really going on around them. Nursing school gives you the basics,.now for all the fine details and gaining experience and self confidence.

I am a firm believer that 2yrs on a med/surg floor is the best way to "become" that great nurse you've always wanted to be. That said,..I also believe that generally speaking most med/surg floors are horribly understaffed (most LTC's are worse in my experience) and many things we are taught and "know" are the "right" way to care for our pts, gets half-done or missed all together. This is how we all learn to prioritize.

Try to get into a routine. As best you can, try to do things the same way every shift. Over time, you will find what works for you and eventually you'll find yourself doing several things at the same time! Start planning your shift in report. Mrs Jones in 322 needs a pretty involved drsg change, 324 will be going to radiology (better give her pain meds first), 325 had some trouble with her blood sugar dropping last night, I should make sure she ate and peek at her am accu check,...etc.

I found that one of the most time saving things I could do at the beginning of my shift was to go to each room, and quickly say "Hi I'm RN-Cardiac, I'm going to be your nurse until 7,.I just got here and wanted to make sure you didn't need anything that just can't wait until after I've had time to get myself organized a bit." While I'm doing that I watch my pt,.is he pink warm and dry, foley, urinal close by, talking in full sentences, appear to be SOB, any O2, lethargic, c/o pain, etc. You can learn a lot about your pts in that 3 minutes! If I get tied up later, at least I know what was going on when I got there. It's also okay at this time to say "I have a lady down the hall that's going for surgery and I'm going to be tied up a bit with her, so if you need something and don't see me be sure to use your call light and someone will find me".

It's also okay to say NO. If someone asks for your help and you are in the middle of something, it's okay to say "let me finish this and I'll be right with you".

Use your resources, med books, co workers, pharmacy, lab, etc. If you don't know the answers, find them! I'll bet that you find that you know more than you're giving yourself credit for!

Hang in there,.everyone of us has been in your position. It takes time and 6 weeks is just the starting point. If you feel that you need more orientation then tell your manager. Remember that even after orientation you're never alone. There is always someone to ask, someone to call, a book to look something up in etc.

Tough it out,..keep doing the best you can and try to find your routine. I bet in 6 more weeks we'll be having a different discussion!

Good Luck

Keep us posted about how you're doing!

Pink8079 · Oct 31, 2008

:heartbeat I just want to say thank you so much for your post!! I am a new orientee as well and I'm going through the same feelings and situation as you seem to be going through. I feel literally sick to my stomach almost every night before I begin my shift. I'm trying to stick it out and be patient, but it's easier said then done (as I'm sure you know the feeling). Anyway, I just wanted you to know that you're not alone. That's why I was so glad to see your post because I was feeling very alone in how I feel. I hope it gets better for you.

Pink8079:redpinkhe

locolorenzo22, BSN, RN · Oct 31, 2008

Let me tell ya. I am SO glad that our instructors taught us one very easy way to do a head-to-toe assessment. It's very easy. You listen to heart/lungs/stomach...while feeling stomach and asking about tenderness, ask about last BM. Also, check hand grasps, strength, and pedal pulse in one fluid motion. You can get a lot of assessment by looking at the patient, and also talking to them.

Meds-wise...you just have to get comfortable with what you see. I bought a 12 buck guide from barnes and nobles, it has 1000 common medications...and I have had maybe 1 medication in 3 months not be in this book. I always look up whatever meds I don't know, just in case the patient asks.

Also, I go see each patient before I start assessments, just so I can introduce myself and see what I need. If you have to, do the assessment right before you give meds.

Tell them that you feel you are struggling...if they want you, they'll work with you.

The concern I have is that you are newer and you already seem to have that "chip" on your shoulder. How do you know everyone is on the lookout for management? Does your floor have the reputation?

Personally, I feel that you should do the job you KNOW how to do. Is there that risk of someone dying? Maybe...but you sound terrified of that. Nursing is a big responsibility, but you know it takes a lot to kill someone. Just watch your b/p and HR for those meds, and don't give anything you don't know what it does. Maybe some NCLEX med questions to study would help?

GL to you, and take it a day at a time.....

Pudnluv, ASN, RN · Oct 31, 2008

Hang in there! Just remember, nursing school prepares you to learn to become a nurse. Being out there is what really teaches you. Please remember, it takes a at least a year to even start to become comfortable. You have to learn all the specifics of your floor plus you have to learn how to be a nurse. Time management, prioritizing and organization all come with time. No one should expect you to be able to do all at the beginning. You are only 4 weeks in. Give it time. With persistence and patience, you will be the nurse you always wanted to be.

rita359 · Oct 31, 2008

Its your 4th week. There are a lot of things new employees have to learn. You are surely not the only one or your orientation would not be so long. Haven't had time to check med orders since the time of little medication cards which has been years. Are you hired for day shift or another shift? Agree with another poster that night shift is a better shift to start because it has a tendency to be slower-usually no discharges, fewer admits, more time to become familiar with paper work. I went to nursing home for awhile and orientation and med passes were a nightmare compared to hospital. It will take awhile but all the learning you did in school plus what you learn everyday will at some point jell and life will be easier. Just know that learning continues all your professional life. Its not like you get out of school and know it all. That new licence means that you passed the test and are at least minimally competent to care for patients. Every one of us has learning to do every day. Welcome to the profession!

Spritenurse1210, BSN, RN · Oct 31, 2008

Dont give up. I think medic09 gave some great advice and i agree with him (her?)