Please help new grad very anxious and upset.

[spiritual_RN]

I am a new grad and I just started working on an oncology unit in tri-state I only had four days in through my orientation yet I am really nervous, anxious. I committed many mistakes. So many things are going on and I am always exhausted. I cannot sleep throughout the night because I keep on thinking about all the mistakes that I have committed. I will be evaluated by the manager by the end of the week and I am terribly terribly nervous. I have done many mistakes that a prudent nurse couldn't do. I received my associates last year but I never had the chance to use my clinical skills for a year- instead I just took online courses to finish my bachelors degree. I am so screwed. I know I was not good with my clinical skills anymore. I completely forgot all of them.

On my first day I observed what an oncology nurse does. She oriented me to where almost everything are- protocol folders, lab machine, med room, etc. My preceptor asked me to remove an IV from a patient who is about to be discharged. I did my IV class but I have never removed an IV from a real person. I removed the IV as carefully as I can. I put pressure for three minutes and put a band aid on. Well guess what- the patient started bleeding to the max (his bed was very bloody) because the patient was on anticoagulation meds. Oh I was so ashamed. How could have I let that happen? I know that I should apply pressure to the patient's arm- how come I did not press that long? Did I press hard enough? My preceptor was very supportive she said that next time I should ask the patient to put pressure themselves for five minutes. I was really exhausted by the end of the day because I was just running all over the halls. Good thing I have the day off the next day.

On my second day, I was just about to crack but I still stayed with it and encouraged myself that I can do this. I asked for this job- I earned this job. I have no choice but to finish it. I was assigned one patient. One of the patients have a tube feeding. I had to look for many things like the bandaid, tissue paper, the pill crusher or the stop lock for the IV drip. OMG it took me so long because I could not find anything. I do not know where everything is. I kept on removing IVs from people because they were all discharged. At least I saw how to do discharge people. I like discharging people. It is a relief it is like asta la vista babe. I am happy that they were better.

My third day I was assigned to a patient. I was able to assess the patient, give blood transfusion, learn about anti-coagulation therapy and give out meds. I am really slow at assessing patients. I keep on looking at the assessment sheet and then looking at the patient. It is very sad. I feel hopeless. I am glad that I was able to give blood transfusion. But it is a lot of hardwork. I forgot to chart Passero Opioid Scale. OMG I am such a bad nurse. I had to give meds to all the other five patients. Change their IV and bags. I am really overwhelmed because I am so slow. I took out several IVs and that took me like ten to fifteen minutes (most likely I'm exaggerating) but I had to remove many IVs. I accidentally clicked that I have given an antibiotic even though the antibiotic was not available yet. Oh I am so screwed. My preceptor called me at home; to verify if I have given it. I told her I did not. I accidentally clicked the order for the antibiotic. I am not sure if I accidentally clicked the narcotics too. I am really slow. I get really nervous and start clicking stuff because I feel like I am in a hurry. I feel like I have to be like my preceptor. I have to be quick I have to know everything, I have to be a good customer server to five to seven patients. I have to act really fast. I told myself that tomorrow I will be faster. I should be able to multi-task.

My fourth day, I had three patients. I discharged and admitted patients, I hang heparin, accessed a port and did all the other stuff that I did the previous days. It was a very hectic day. I could not stop thinking about what I did on the third day. I charted wrong. Well on my fourth day, I put a neutropenic patient on a bed pan and asked him to use the call bell when he is done. I promised him that I would come back to him really quickly because I will be bringing his medications back. Well, when I stepped out of the room I was looking for the CNA assigned to the patient. Then, we had an admission, a discharge and one of the patients in isolation was crying out of severe pain. I completely forgot about the patient on the bed pan and was very upset. I did not delegate well to the CNA. I should have told my preceptor. I should have not left the patient on the bed pan. I should have stayed there and finished the business. But I did not. I made the wrong choice. The patient refused me and my preceptor and was very upset with the way we treated her. I thought giving her the call bell was enough- I guess I am wrong. I should write everything down so I would remember.

Can anyone give me an advice so that I could be better? Am I going to get fired because of my mistakes? I am crying every night ever since my fourth day. Tomorrow or two days from now the manager, assistant manager, patient advocate and other higher ups might talk to me about my performance and that incident. I am so screwed. I do not know what to say. I really need help. Please help me. I feel like I have no focus. I should write down all the important events that happened. I shall learn how to prioritize. Help me please. I feel very incompetent. I am so stupid. How could have I've done those mistakes? Am I not thinking? Am I going to be fired? Am I going to lose my license? I am really scared.

[wooh, BSN, RN]

Breathe. Keep in mind you can only do one thing at a time. Keep THAT in mind as you move through your day. Do one thing. If you have to stop midway through, WRITE DOWN that thing on your brain sheet so you'll remember to go back to it. If you don't have a brain sheet, do a search for them on allnurses, and pick one that works for you. Make it your best friend. Refer to it CONSTANTLY. Depend on it, not your memory.

You are NOT going to lose your license. You might get in a bit of trouble with your work. Your best bet is to say what you said here, with a little less on the hysterics. (It's ok here, this is where to do it. It's not ok for work.) You ARE a bit overwhelmed, the break since school has been a bit tougher than you expected. But things are coming back to you and you've got a plan to improve. You will: INSERT HERE YOUR PLAN.

Include things like you've created a good brain sheet to help you stay organized. Lack of organization is what will KILL you on the floor. Tweek that sheet until you get it where it works for you.

Get to work a bit early, not to clock in, but to start off without being rushed. Sit in the in parking lot, eat a little breakfast, drink some coffee. Start off calm, cool, collected. Walk in as early as you can clock in. As you walk in, make your plan for the day, the things you'll focus on. Things like I said, breathing. One thing at a time. Get your patients. Make a plan for the day. The things that have to be done at a certain time, then the things that need to be worked in around it.

Your plan will change as the day goes on, but nothing beats starting the day off on the right foot.

But most importantly, BREATHE. It's hard. It's hard when you've been doing it for a while. You can do this. Believe you can. Fake calm and collected until you believe you ARE calm and collected.

Some of the worst new grads on my floor have turned into some of the best nurses. Nobody remembers the bad. If we do, it's to say, "Wow, they've come a long way." You CAN turn this around. You just need to start now with the attitude that you CAN do this, you WILL do this.

[amzyRN]

SoldierNurse22 gave some good advice. Make/use a good brain sheet and write things down that you need to do. With passing meds be fully present when you are giving meds, thinking about what you are giving. What I do is come a little early and write down meds I need to give and cross them off when I'm done that way I know what I've given. Definitely know what meds you have given. With IV removal, do have the patient hold pressure on the site with a gauze or roll a piece of gauze up and put it over the IV site and tape it tightly to create pressure on the wound. Recognize that everyone starts not knowing how to do things, your confidence will improve with practice. Keep a small notebook during orientation for questions and also important things you should know and keep it with you at all times. Have flushes, alcohol pads, tape, and med cups with you. Know your labs well and what you should be watching out for. Know what labs you need to watch, like with heparin it's the platelets, with lasix it's the potassium, etc. It sounds like you are just going through what most new grads go through in the beginning. Try to just relax and breathe, people will help you, and most importantly ask lots of questions. Never be afraid to ask for help if you need something or don't know something. Review stuff if needed. It's good to study on orientation after work, brush up on skills you are rusty with and such. Seek out new learning experiences; jump in and take the bull by the horns!

[spiritual_RN]

Thank you so much. I CAN turn this around. I CAN do this. I WILL do this. Is it usual that I have done all of those stuff on just my fourth day on the floor? I feel really overwhelmed - how am I going to feel when I am by myself? My manager is very scary. I heard rumors that she eat people alive with her words. I hope I would not cry but I know I would cry after I've talked to her. How can I answer- so how do you feel when you work on this floor or something in that sense.

[spiritual_RN]

Hi AmzyRN thank you so much for the reply. I do have a small notebook to put things that I asked questions on or things that my preceptor have told me. On my second day, I felt bad to my preceptor because it seems like she is always in a hurry and that I am bothering her work. Until now I feel the same way so I opt out not to ask too many questions. I ask too many questions and I feel like she thinks I'm stupid. I talk out loud all of my procedures so that I could remember them but it is frowned upon because the patient would know that I am incompetent. I just don't want to make mistakes but I do. I keep on making mistakes. I hope I will be better. I do not want my patients to suffer.

[minniebrown]

I think everyone is nervous when they start a new job. Don't psych yourself out yet. Try to go in everyday and do your best. You are still new. You will get the hang of it with time.

[Esme12, ASN, BSN, RN]

First......SLOW DOWN! Take a DEEP BREATH in.....now let it out slowly. ((HUGS)) we have ALL been there!

Remind them that although you graduated a year ago you have never worked. Remind them that you are a new grad. Go over procedures before you enter the room even if you have to you-tube them online. Organization is key. I have given you some brain sheets to look over that I have collected, made and some made by a dear member...Daytonite (RIP).

Any IV can bleed after removal and some will more than others...blood happens. Go in calmly clean it up make sure you don't fuss and make a big deal. Re-dress. Move on. I sometimes will take a 2x2 and fold it into a triangle on top of the puncture with a good band-aid. You are not a bad nurse...this will happen once in a while for your entire career. remember to breathe!

The first year actually working on the floor is the hardest. Your manager needs to be reminded that you are a new grad with NO floor experience. Talk with the educator and ask for advice on how best acclimate yourself to the floor. They are giving you too many patients for your first few days on the floor as a new grad...that you have NEVER cared for a patient......gently remind them they need to go slower. If you had one patient assignment the first day......why did you have to give meds on five other patients? It took you a long time because YOU ARE NEW!!!! You can't possibly know where everything is......every nurse even those with experience will find they flounder a few weeks until they get the lay of the land.

Don't go over your "mistakes".....go over what you learned and how can you do it better. Look you accessed a port, you have given blood you have discharged Giving the call bell should be enough unless there was some reason he could not use it. I mean really....put the bell on for crying out loud. He complained because she now knows you are new and wanted to play DIVA. The one thing don't promise patients to be right back.....tell them to put the light on when they are done as you are going to finish other tasks. YOu can't stand there and wait for every patient to use the pan. He was in bed and safe and alert...put the light on for pete's sake.

You need to be organized but they need to give you time.....talk to your educator and let her know that you have never worked ever as a nurse on the floor. Use these sheets as you like change them if you want.

mtpmedsurg.doc

1 patient float.doc‎

5 pt. shift.doc‎

finalgraduateshiftreport.doc‎

horshiftsheet.doc‎

report sheet.doc‎

day sheet 2 doc.doc

[sunmaidliz]

WOW. Even I felt anxious when I read your post. It reminds me of my first job. Man, I was so nervous about messing up that I would mess up a lot. I psyched myself out of that job.

Calm down and breath, honey. One thing you need to do is spend some of your personal time at home thinking about your shift. Run through your day mentally. Write down a schedule as a backbone of your day. Think of all the possible skills and tasks you do during your shift. Write them down in a list. THen write down next to each task how to do it. The more prepared you are for your shift, the more confident you are. It's kinda like being back in nursing school and you are ready to take an exam. You wouldn't take it unprepared, right? You know what's basically on the test but you don't know the exact questions. That is what your day is like.

A nursing brain is great. It helps you organize yourself. I have to rely on writing EVERYTHING down, including what I am doing incase I get interrupted by someone. But that's me. YOu need to find your own groove. Sit down with yourself and ask yourself what the problem is and what you need. Also, get a couple of books on Oncology or even med/surg nursing. Watch YouTube videos where med/surg nurses give advice about their day. Prep yourself before your shift. And relax. Trust yourself.

It's like you have in your mind that you are a terrible nurse and it's becoming a self-fulfilling prophecy. Do you think others think you are? Well, it doesn't matter what others think. You could be Florence Nightingale and SOMEONE will think your nursing skills suck.

Go grab yourself a notebook and a pumpkin spice latte and spend a few hours doing some homework about your job. Figure out how to make it work. You are doing a good thing by reaching out for help. Best of luck.

[PMFB-RN, RN]

Relax! I was way worse than you when I started (although I didn't beat myself up like you do). I was a disaster for my first three months and barely acceptable for another 6 months. Two years after I started I was running the place! Charge nurse and most experienced nurse on the shift in a critical care unit with very high turn over.

Follow the great advice you have been given already in this discussion. Don't be so hard on yourself. As already mentioned you are not going to lose your license. Maybe a talking to about the bed pan situation by your managment.

[Bringonthenight]

Ok you need to take.a.breath.

Your brand new on an oncology floor (all in patient oncology floors are intense and very busy) cut yourself some slack!!

The IV removal story with the bleeding- happens to everyone it's not a big deal. It just looks scary.

The bed pan story: once again it happens from time to time, now you know to delegate or wait with the patient until they are finished.

Like what previous posters have said, you need to find/make a brain sheet. These are critical particularly for a new graduate nurse on such a busy floor. They'll keep you sane and organized.

Do not compare yourself to your experienced preceptor. Ofcourse you will not be as fast as she is!!