Post 4-mo. Orientation, On My Own Now.

[SkateBetty]

Well, I survived the 4 months of orientation, training, and floor preceptorship, and have done 3 nights on my own in my unit, Trauma Step-Down. The last night was the best, and I managed to get everything done before change of shift. I lost my first patient on my 2nd night by myself (a 96 yr old medical over-flow pt with pneumonia, and CHF), and although it was sobering and the code was scary, I got through it. (I have done a lot of thinking about it since, though, such as what I should have done differently.) I am finally better able to organize tasks so I go in a room once and get a list of action items finished right away. In that way I am not chasing from one end of the hallway to the other all night long. My thoughts are more organized, and I feel more calm. The nurses are joking with me now, and I'm starting to feel like a member of the staff, which is such a relief, because during preceptorship I felt like an outsider. Looking back, nursing school did very little to prepare me for the hospital, and skills lab only scratched the surface in helping me perform technical tasks. The board was so random I have no idea how those questions helped them decide I should be promoted from student to R.N. I still feel like a student, but on my way in to work the other night I had a rush of realization that I made it. I am a nurse now, and it's real. Wow! When I started out with my prerequisites it seemed like I was on an impossible and almost ridiculous journey at 42 years old and retired once. It went fast, though, and has given me a source of pride and self esteem I would not have had otherwise. It was worth it, and wanted to say so. :wink2:

[zaggar]

Congrats. I've read a lot of people's posts who are struggling, so it's good to hear that someone is having success their first year. Keep up the good work.

[grinnurse, RN]

Congrats OP. :balloons: :balloons: :biggringi :balloons: :balloons:

[wonderbee, BSN, RN]

Congrats on coming into your own now. I so agree with your statement that nursing school did little to prepare us for the realities. Clinicals always felt to me like weekly visits to a foreign country or another planet. We were outsiders, tourists. I remember a particular teaching by our instructors to clamp off a foley if a pt. was putting out more than a liter of fluid to prevent hypovolemic shock. When I told that one to my preceptor, she laughed her butt off and told me NEVER to clamp off a foley. You might recall that teaching. In practice, clamping off a foley can lead to some pretty nasty outcomes as we now know.

I've been on my own for nearly a month now but the more experienced staff are never far away and are always watching out for me. We're there now, on our own and part of a team. It is a good feeling.

[Indy, LPN, LVN]

Yeah, we regularly have people who can put out 3-7 liters of fluid a day if they're in CHF and the diuretics are working. I can't imagine clamping a foley on one of those! I only clamp to get a sterile urine sample.

To the OP: I'm glad to hear you're doing well. Keep up the open-minded attitude!

[SkateBetty]

I remember a particular teaching by our instructors to clamp off a foley if a pt. was putting out more than a liter of fluid to prevent hypovolemic shock. When I told that one to my preceptor, she laughed her butt off and told me NEVER to clamp off a foley.

I've been running into this type of situation often, where Nurse B sees you do something one way, and she tells you it's wrong, but the reason you were doing it that way is because Nurse A told you to. Even in one department people have opposite approaches to tasks and theory. Just yesterday a floating nurse from ICU came in a gave us the standard speech about 'hypoxic drive being obliterated by too much O2 on a COPD-er', like we all hadn't heard it dozens of times before. But a couple weeks ago, during my Critical Care course, the head of repiratory did a presentation and said that whole thing about hypoxic drive is an absolute fallacy, a myth in every way. So now, when I am comfortable with my own approach to a task, I listen to the logic of the nurse grabbing my wrist, and if it makes sense to me I implement it, and if not I put it on the back burner and proceed.

[utahliz]

I've been seeing that, too. Sometimes I let them know I was taught by Nurse A (don't usually name names) to do it the way that Nurse B is saying is wrong. Often, I get an explanation. What I find frustrating is the nurses that cut corners telling me to do it a certain way, w/o explanation why they feel it's OK to do so. I want to learn, not just be directed to unhook A, connect to B and 'do it quickly' so nothing bad happens. I survived my first night off orientation in a busy SICU last night, and I can see that there is still so much to learn. There is tension between the super-nurses and the minimalist nurses, and I'm still working on ways to learn w/o alienating or sounding like I'm complaining, since they're all potential resources to such a newbie.

[CarVsTree]

Congrats! I also work Trauma Step-Down and I LOVE it.

[Fairlythere, ASN, RN]

Betty, thank you for your post. I am 48 and doing my orientation on med surg, week three. They already want me to get ready to take my own load after 120 hours. Seems like not enough and I was questioning my whole reasoning for the career change, etc by the end of my shift.

Your post gives me hope. Thank you.