misha

I personally find it annoying but I don’t exactly see what could be considered “inappropriate” about it as long as they are respecting patient privacy. It’s just human nature to show off sometimes, not really a big deal imo. I doubt that it’s the main reason they became nurses/nursing students.

Hi, things have been a little better. Thank you so much for your reply. This is something a professor of mine told me to, stop focusing so much on others and just focus on yourself and giving good care to the patients. Sounds obvious but surprisingly difficult sometimes. I'm still struggling with my confidence but I've been more aware of my body language and speaking up. Thanks again for your advice and encouragement

It was really comforting to me to read that I'm not the only one in a situation like this (although I'm sorry you don't have as supportive of a team as you used to!) Thanks for your encouragement. Thank you ?

Thank you so much.

Hello, Thank you everyone for your advice and words of encouragement ? I really needed it and it meant a lot. I am still having a lot anxiety at work and my days off, but my last shift was better and my coworkers do seem more friendly and encouraging than before. That's a good point, I will try not to take it as personally. Thanks for the reminder!

I recently moved to my second nursing job and I am very discouraged. My orientation was extended two more shifts. I think I made a mistake coming here. I could really use some words of encouragement right now from nurses specifically. I have been struggling with my mental health for a while. social anxiety/general anxiety and depression. I feel like I’m always on the brink of crying. I am working on it with therapy and medication, but it’s a long process. Nursing is not the cause of course, but it’s definitely putting it’s toll on me. I came from my first nursing job at a very large teaching hospital. High acuity patients, we drew all our own labs, lots of bed bound patients etc. in general busy place to work. constantly understaffed and pressuring me to do a bunch of overtime. but, tons of new grads like me. new job is a smaller hospital. More support staff like CNA and phlebotomists. More walky-talky patients and elective surgery patients who go home after a night. More down time, for sure. But there is new stuff I have to learn, for example I never really had stroke patients or ortho patients before bc they used to go to specialized units at my old hospital. I applied here after only 10 months of experience at my old job. I wanted to change jobs so I could be closer to my support system (my parents) and I thought a smaller hospital that didn’t have nurses do overtime might be less stressful, which I think may have been a dumb idea. I think I made a mistake by leaving so soon. I left after only 10 months of experience. I should have stayed until I felt more confident as a nurse. I felt so overwhelmed & constantly busy at my old job, but the culture was great and I was surrounded by other baby nurses who understood as well as experienced nurses who looked after me and were always willing to help me and teach me. The hospital I work for now is not used to new nurses. I am by far the most inexperienced on the unit. during my orientation I lack confidence, especially with the types of patients I’ve never had before. they are treating me like a new grad. They extended my orientation which I think is making things worse in a way because I get very nervous from hovering. I think I could do better with some space but they don’t agree. Then more nervous I appear the more they hover and take over my job for me. I was trying to admit a patient but they wouldn’t let me do it, they interrupted me, kept saying I have to do this first no this first why haven’t you started asking her questions yet etc when I was just trying to get her settled in. Later that shift the patient didn’t want me to start her IV because she didn’t know if I should do this by myself since “all the other nurses were telling you what to do earlier” I’m decent at IVs but after she said that I felt so defeated because I knew she didn’t trust me. I was so nervous when starting hers my hands shook. Yes I lack experience. I am soft spoken but I’m trying my best to improve my communication skills. I think I am a competent nurse. I’m kind, I am thorough, I’m safe, I check all the orders and make sure things are done. I ask when I don’t know something. I’m a little slow doing admissions but in general my time management is good. I need to improve on some of my knowledge, for example get better at performing stroke assessments. Really there is a ton I don’t know yet I admit, but I’m wanting to learn. And I think there’s a lot I do know, like maintaining insulin and heparin drips, chest tubes and trachs etc that we never get at this hospital. I don’t think I’m in an environment where people are as willing to teach me anymore. They expect me to know it all and give me this look when I don’t, I’m very discouraged. I am frustrated and tired. I am so disappointed that my orientation was extended, other nurses are treating me different now. I try to remember the good things about myself but I can’t help but feel like a stupid nurse. I can’t help but take on the doubts other nurses have of me. I am so anxious thinking about work I can’t relax on my days off. I feel like I made a mistake leaving after only 10 months. I know I need to be strong and be more confident to get through this but I’m feeling defeated right now. My mental health is at an all time low, I can’t be alone bc my thoughts get to me too much so I have a very hard time at night when my parents are asleep and I cry a lot. If anyone has similar stories or advice or anything to offer my right now I’d be really grateful.

You're right she's not a new grad, but she's had less than a year experience in both of her acute care jobs. I'd say it's pretty normal for her to be struggling with a lot of the same issues a new grad does. And at the time of her first job where she got negative feedback, she was a new grad. I acknowledge that it is concerning that she's gotten negative feedback from all three of her employers, but without more details about what she's doing wrong I fail to see anything she's doing is fire-able. It may be she's struggling more than the average nurse, but without more info imo it sounds like she hasn't been getting proper training either. Her first job she worked from July until October before she resigned, she wasn't fired. And it sounds like that ruined her confidence, which then affected her performance in her next job. The second med-surg job she didn't clarify if she was terminated or resigned. There are plenty of new grads I work with that need extended orientations because of similar concerns, they get it, and then they do fine and are now good nurses. She only worked July through October in her first job before resigning!! If OP is able to practice safely and ask for help when she doesn't know something, I don't see why her employers have these issues. I feel like i'm missing some information.

I'm a new grad too, 5 months experience in step-down. To me it doesn't sound like you aren't cut out for bedside, rather you haven't had a solid base of experience with good support. Are their any details you left out? Is their some incident that happened? Because a lack of critical thinking, delegation and prioritization skills sounds pretty standard for a new grad. I'm confused why you've been getting such negative feedback. Neuro med surg/step down is a really difficult unit! Did they offer you more orientation time? My opinion is that you should get a solid year of experience in a lower acuity unit (like med surg, telemetry) before going to ICU. This isn't because of the feedback you've gotten, or because I think you're dumb or not good enough. It's because if you go to the ICU now, when your confidence is shot, you just aren't going to make it. There is SO much critical thinking in the ICU, trending labs and vitals, checking complicated equipment, managing several drips, monitoring hourly I&Os, thorough assessments. On top of this, the patients are often total care and you don't have a CNA. You will be asked a lot of questions about your patient from other nurses and docs and expected to be an "expert" on your patient. It's really hard, there's a reason there is a ratio of only 1:1/1:2. It's because each patient you have is very time consuming. Even experienced nurses feel overwhelmed by the ICU. If your dream is acute care nursing don't give up on it yet! You can do it. And when you get comfortable with that, you can move onto ICU confidently. You just need more time. Try to apply to some teaching hospitals! You'll probably get more support. The hospital I work for is constantly training new grads and is really good at supporting them. And sometimes one new grad finishes orientation early, sometimes they need a couple more weeks. Nothing wrong with that! Some tips! -if you aren't sure about something just ask another nurse or your charge nurse. even if the question is really basic or you feel like you're annoying people. ALWAYS ask. I call my CN every single shift. -if you are running out of time, take a second to make a list of things you absolutely have to do. then ask your colleagues or charge if they can do some of the things on your list so you can focus on the bigger tasks. -after a shift write down the things you did well, and things you would do better next time. and then try to move on and do something to distract yourself from thinking about your job and obsessing about your mistakes all the time (something i'm guilty of!)

I was hoping to get some advice on what to say in the following situations and how to answer some difficult questions. I don't always have the best communication skills and kind of stumble through my replies to these types of questions and statements. sometimes I think I do ok, sometimes I can tell the patient is frustrated with me. "Is doctor ___ going to see me tomorrow? What time? Why can't they see me now?" I don't know which specific doctor is going to round the next day and I don't really know what time, I give them an estimate of 7-8. I want to say they can't see them now because their primary team has gone home and the in house hospitalist is too busy to come to bedside just to answer a patients questions, but I don't want it to sound like i'm saying they are not important. "How many more days until I get to go home?" "Am I going to die?????" how do you respond to patients who are angry that their procedure isn't scheduled until the afternoon and they don't want to be NPO that long? Once a patient asked me when his surgery was scheduled, I looked it up for him, told him it's at 1 pm, he got so angry I had to step out of the room. When I came back he was drinking water and said we would just have to deal with it. usually their response is not THAT extreme, but they often are upset and ask if they can have the surgery moved up etc. which I know isn't possible. How do you respond to patients who are angry that another patient (confused, etc.) is making too much noise? Are their any other difficult questions you get a lot that you've gotten good at answering?

This is good to hear because I probably call the charge nurse at least 2 times a shift...sometimes over really small things. I sometimes feel like i'm supposed to be more independent by now. I wish I had called them this time though ?.

Yes the house officer is the in-house hospitalist.

You're right maybe I should say interesting instead of strange! And confusing to me because I don't always know the reasons determining one pt treatment from another. I don't really like giving IV hydralazine, I once gave it to a patient as ordered and they dropped much lower than I expected and made them slightly tachy as well kinda scared me even though they were ok ? but i suggested it since that's usually what is given for htn at my hospital. I hadn't thought about the consequence of having to hold the home BP meds! That's very true, it could through off someones regime. I've also noticed that sometimes pt's who require hydralazine PRN in the hospital may not have any changes made to their home regime by discharge, i'm curious if then their BP continues to rise when they leave the hospital.. anyways thank you for your insight!

That's really good to know! It's strange because sometimes patients will have standing orders to give a PRN for a BP as low as 150/something. Then other times they've waited until the systolic was in the 200s before ordering something. Last time I had a patient with a BP this high the nurse didn't blink an eye. this time the nurse was upset. Very confusing!

Yeah I wish he would have stepped out of the room before mentioning that too ? what made me kind of upset is that other nurses on night shift gossip about this nurse a lot and nitpick at his charting etc. and it always gets on my nerves and I try to say nice things about him instead. but then he did this to me, oh well.

I asked for hydralazine, but lately I've noticed docs are less likely to order it, not sure why. Anyway he said he'd prefer to adjust his clonidine in the morning over giving a PRN. Wow we don't usually notify a physician for a BP of 160/100 at my hospital unless it's a big jump from their norm...I think we'd be constantly having rapid responses if we had this protocol! but I did write a note. Not sure if it is a side effect. Patient wasn't receiving the anti fungal, I heard they were going to try and give it to him again possibly the next day which is why they wanted him on the monitors but it wasn't ordered for my shift.