Please Help! I'm 3 months in and feeling like a horrible nurse

UM Review RN, ASN, RN · Jun 18, 2007

First of all, welcome to Allnurses. Here you will find some of the support that you need.

Your family and friends are well-meaning but they are clueless. And really you cannot blame them - until you started actually doing the job, you also were essentially clueless.

It's difficult because you're putting all the things you learned into practice, and there is really no substitute for experience. In a few months, you'll be able to walk in the door and know, as soon as you hear a Dx, pretty much what to expect insofar as orders, treatments, and potential problems with each patient.

But for now, you're learning. Many new nurses report similar experiences.

Some things will help keep your stress level lower, and these have been discussed here on other threads.

This thread might be helpful: Tips for new nurses. If I can find it, I'll post the link. Meantime, we are very supportive and helpful here, so if you have any questions, we'll be happy to answer them.

Tips for new nurses: https://allnurses.com/forums/f224/tips-nurses-their-first-year-nursing-109924.html

On getting organized: https://allnurses.com/forums/f224/help-getting-organized-128483.html

Oh, and there's also the Health and Stress Management 101 forum. Couldn't resist a plug for one of my favorite forums, since it used to be for Premium Members only, but is now open to everyone, so please feel free to join us! https://allnurses.com/forums/f240/

TexasPediRN · Jun 18, 2007

welcome!

angie has made some great points!

i just wanted to add that if you are questioning your charting, i suggest that every day, on your report sheet, you leave a column free and write down the meds you need to give, and after you give it, make a check mark next to it. do this every time and this way you know "ok, i checked the box, therefore that med is completed".

do this with iv's as well. if you know a pt is going to be discharged, or as soon as you find out, pull out your report sheet and write "iv dc'd". after you do it,check it off.

i did this, and still do it, although not as much now after 2 years. i do however, when i complete a chart at the end of the shift i check off the pts name on my report sheet. this way i know that i have checked the chart, made sure everything was completed, and finished my charting.

its ok that you are anxious just starting out. i'd be worried if you werent. it means you are a good, caring nurse who wants the best for her patients and wants to make sure everything was completed. when you do begin to feel anxious though, just stop, pause, and take a deep breathe. remind yourself that you know what you're doing, and if you have a question, its ok to go ask someone.

good luck with your career, and feel free to use allnurses.com @ any time!

newRN0903 · Jun 19, 2007

Thank you very much for the support, I have really been struggling with feeling inadequate. In the mean time while I work on my charting techniques and reducing the anxiety, what do I do if I did d/c my pt with the IV still in. I feel so horrible about it, and even if it was removed it still shouldn't even be a question.

jjohnsanj · Jun 20, 2007

I graduated last August and completely understand the anxiety that you are describing. I would go through my whole day on my drive home and wonder what I forgot to do. I was assured by the charge nurse when I told her that I mentally go through my patients to see what I forgot and she told me that a nurse can only do so much and to quit stressing over something I cannot fix. As far as the IV thing, how many patients would actually want to leave the hospital with their IV in place, since most of them want it out during their entire stay (unless they are an IV drug user). It is normal to stress out, especially on a med surg floor where there is so much happening. Also make sure to use your resources and delegate other things to make you day go smoother. And ask lots of questions and ask for help when you need it. We go through too much school only to burn out in the first year. With family and friends, it is difficult for them to understand the physical, emotional, mental stress of our jobs. Find a mentor who is a nurse, someone who understands. It will take a great load off of your shoulders. Sorry for the long winded answer but I do understand where you are coming from and could go on forever. It will get easier.

emeraldbutterfly,RN, RN · Jun 20, 2007

I know just how you feel, I'm also a new RN, just off orientation for 3wks now. I feel like its a nightmare, it is extremely stressfull. I expected some stress b/c this is all new to me and I'm working w/human beings lives(as oppossed to computer/something insignificant) As far as trying to remember everything that needs to get done....I've tried this technique, similar to what was said above, use an index card or scrap paper, write the rm #'s and things that need to be done, except your first dose of meds (for me that's 10pm {7p-7a shift for me}, everything after that gets written on my scrap) then check or draw a line through your completed tasks!!! Yay, it makes you feel that you've acomplished things, woo-hoo. I even write down times I need to come back & check on IV bags/or any other drips for replacement. It takes a little longer to get started with your shift, but I feel that it keeps me somewhat sane, at least I know that I've completed what needs to be completed. Also after my note & chart check I put a big circled N & check on my report, this way I know that part is done too. I think it's just gonna take time and lots of experience with many different situations to figure out what works best, try not to stress.... I know, easier said than done, but honestly, those iv accesses (just a hep lock,right) are really easy to take out, and I'm sure if it was still in the pt, he/she took it out all ready, pts are very good that way, they do that all the time!!! LOL

TigerGalLE, BSN, RN · Jun 21, 2007

I'm new as well and I'll tell you what I do to relieve some stress...

I carry one of those little flip spiral note books in my pocket. I constantly make to do lists. At the first of my shift I write all my vitals down and make a to do list. Then I cross things off as I go. I love the little notebook. I don't lose it like i lose scrap pieces of paper.

Also before I leave I sit down and go through all of my charts to make sure nothing was missed. Go through all of my MARS and go through my nurses notes. Then I can leave work knowing I'm finished. I tend to sleep better.

Of course there are occasions that I feel like something was forgotten. But we are only human..

And no one except a nurse knows exactly what we are going through. I have found allnurses to be my biggest and best support group. We have all been there, done that. And it just helps to know that you are NOT alone!!

Cheer up! You can do this! And YOU are making a difference!!

SteveNNP, MSN, NP · Jun 21, 2007

what do I do if I did d/c my pt with the IV still in. I feel so horrible about it, and even if it was removed it still shouldn't even be a question.

Forget it.... you aren't the first and won't be the last nurse who discharged a pt with an IV heplock in the mad rush to free up the bed...... He probably ripped it out at home and slapped a bandaid on it before jumping in the shower. :lol2:

norseman · Jun 22, 2007

Angie O'Plasty is right. Theory without the milage is not worth much. I notice it myself, having worked my first week on my own after orientation at my first job. From colleagues and from this board, I know it is very common to feel the way you do. But, I think it also has to do with how much you feel you need to be in control of everything. It's an individual trait. A nurse at my workplace has been there for a year now, and she basicallly needs to be forced to go home after each shift!

-"Haven't you left yet?"

-"No, I just need to make sure I signed off X.. Oh, did I remember to tell you patient Y is supposed to ..."

-"Don't worry, we will take care of it, now GO HOME!" (said with a smile while gently pushing the girl out of the door)

You'll see this among experienced nurses too. Watch how many hours of overtime they're logging each month. Some clock out right on time while others have lots of hours overtime each month. While some are more ambitious than others, mostly (IMHO) it's about a need of being in control all the time, and that's what causing burnout etc.

Hang in there!

newRN0903 · Jun 27, 2007

Thank You so much for all of your replies. By the way I didn't end up D/C the Pt with the IV in (thank God), but even if I did I realize while it could be harmful, it's not the worst that can happen. I truly love this site, it's a place that shows compassion is the very definition of nursing.. not just to pts but to each other. The people that are on this site are true nurses, not just people who are in nursing for the money. I had a stressful day at work tonight, but I came home and read these replies and it has lifted my spirits. I am also utilizing the advice I am receiving and it has made a huge difference. Thank You everyone.

rn/writer, RN · Jun 27, 2007

Three months in and you feel like your head will pop off with all the things you have to keep track of? You're right on schedule.

Seriously, you're living through the retooling process that the brain needs to convert from theory to application. It isn't pretty, and it isn't fun, but it's absolutely necessary to leave the relative cocoon of academia and emerge into the real world.

Here are some tips:

Design or acquire a really good cheat sheet. Take note of items you repeatedly have to write in and incorporate those into a better sheet.

Leave room for notes. Revise and revamp as often as necessary.

Begin each shift by taking the necessary time to get a thorough report. An extra ten minutes up front can mean the difference between feeling capable and feeling like you're spinning out of control. Check your MARs. Check for, and sign off on, new orders. Look up labs and other diagnostic test results. Make a note of those not yet completed so you know to look them up again later. Jot down anything that you will need to remember. D/C times. Med parameters like v/s. Special requests. Phone calls you need to make. Anything and everything that you need to recall at some point.

Cross items off as they are completed, but do it in such a way that you can still read them and remember what was done.

Chart as you go. It's a horrendous experience to leave charting till the end of the shift and then try to reconstruct the last eight or twelve hours in one sitting.

As you fly through your day, keep adding to your cheat sheet, even as you are crossing items off. It's so annoying to get to the supply room and have to wrack your brain for what So-and-so in Rm 3612 asked you to bring.

Keep a spiral notebook, as someone mentioned and write down questions and problems you encounter. Look these up after you're done working or during a quiet spell, if you ever get one.

At the end of your shift, go over your cheat sheet to make sure every item is crossed off or otherwise accounted for. Use your cheat sheet give report. Develop a pattern for giving report so that you don't leave important things out or jump all over the place and give the oncoming nurse whiplash.

Go over your MARs one last time to make sure you signed out everything or signed that something wasn't given. If you're supposed to write in v/s or other parameters, make sure those are done as well.

There's a reason why we think of things on the way home. That's usually the first chance we've had to be still, and that's when those pesky things bubble to the surface. Take five minutes to sit and just be quiet before you leave, and you might be able to save yourself a panicky phone call.

Before you leave or just after you arrive home, take that spiral notebook, and write at least one good thing that happened to you on that shift. A mistake caught before you did it. A new trick you learned from a more experienced nurse. A compliment paid by a coworker or a patient. A skill you did well for the first time. This is what you refer back to when you've had a lousy day and you are certain you were meant to be a litter collector on the highway of life.

This will get better. One day, you'll be halfway through your shift when you realize that you forgot to panic. And then you'll smile and think you might be able to do this job after all.

P.S. Please remember these days and these feelings for that glorious time a few years down the road when you're precepting some poor newbie who is terrified out of her shoes. Give her the same encouragement that you need now and she'll be forever grateful.

fultzymom · Jun 27, 2007

welcome to the forum!! as a new nurse, you are going to feel very overwhelmed! it takes a while to get everything together and feel like to completed everything that you needed to get done in a day. also, there are going to be times even when you are more experienced that you still wonder if you have done something or forgot it. i have called after i got home to make sure that i did something. i remember one time it was about 3 am and i remembered that i forgot something and called in there. the night nurse laughed at me, told me she would take care of it and to go back to bed and get some sleep. :lol2: none of us have it all together every day that we are at work. we are all human.