j_tay1981

Hey all! I am an RN, BSN that has been working just shy of two years in med-surg at a level-one trauma center/teaching hospital. First I was in Neurological Sciences, and currently I am in Orthopedics (different floors). I had a rough time getting started as an RN out of school; adjusting to the fast pace, constant multitasking, and dealing with the general feeling of 'What the hell am I doing?' that comes with being a newer nurse. I feel like I'm in a better place than I was even a few months ago as a nurse. I have less anxiety, and a better sense of what I'm doing. But I still feel like something is lacking - namely interest in my job. I went into nursing to become a MH nurse practitioner, mainly due to my own personal experiences with mental health issues. I did well in my psych rotation at school, and have also had the dubious honor of spending a week at an inpatient facility as a patient as well (self-checked in, FWIW). I did med-surg right out of school because I'd heard it was a good foundation specialty upon which you could go many other places. But now I'm thinking about psych nursing again. I'm not new to psych patients; I've worked with detoxers, addicts, MDD, severe anxiety sufferers, schizophrenics, BP's - you name it. But I've only worked with them on a med-surg level, not psych specific. In short, though, I'm nervous about leaving med-surg and taking on something almost totally new. I'm also concerned about not liking it - I'm okay with not caring about ortho, but if psych was an initial career goal and I hate it, I'd feel stuck. There are no crystal balls or guarantees in life, but still...the devil you know is better than the devil you don't. What are the biggest differences? VS are taken less, and med passes weren't as frequent as they are on my two floors from what I recall. What should I be prepared for? What advice do you all have for me?

Another issue I deal with in regards to my job is nervousness. As I mentioned, I have a history of anxiety and depression, and I get very nervous before going to work. Like hours before it starts. If I leave my apartment at 6pm to go to the hospital, around 11am, the anxiety sets in. It makes it very difficult to nap prior to a shift. This has improved somewhat since I started over a year ago, but it hasn't gone away. It's very uncomfortable! Sent from my iPhone using allnurses.com

Thanks to all who replied to my post! I find that the part of my job that I really do like is talking to the patients (I don't always get to do this since I work nights and I have so many other things to do). I had a patient who had a terrible time with anxiety (a secondary problem from the one he was admitted with), and since I have a personal history of anxiety, I spoke to him and his wife about things I do to work through it. He was readmitted a couple weeks later and I followed up with him. He told me that the stuff I told him to do really worked and to keep on doing what I'm doing. I felt more satisfaction from making that connection with him than I derive from doing more technical things (like starting IV's) that I had initially loved in nursing school.

I ask this because I seem to have some sort of intolerance to professional nursing. It's my second degree, and I was one of those odd people that actually enjoyed nursing school (not the piddly projects or reflection papers, but rather the exploration, putting the pieces of the puzzle together - everything seemed new and exciting). Then I became a nurse over a year ago on a neuro floor. I'm doing well there, and have had patients write the manager positive comments about me. But I absolutely hate it. Neuro patients are difficult, and many don't want to help themselves. I find it angering to be held accountable for outcomes when the patient couldn't care less about his/her safety or health. I work nights, and I try to nap prior to a shift but I generally get very nervous before work (this has improved, but its still palpable). I recently floated to an ortho floor and although I realize they gave me cake patients that night, I enjoyed the atmosphere. The floor had an opening that I was going to apply for, but it has since been taken off the HR site. I thought perhaps I should try another unit because maybe its just my neuro floor (the people on ortho said they pitied me for having to work on neuro so likely its not just me who hates neuro). I got into nursing to avoid a soul-crushing job, but I seem to have found just that. I just feel 12 hours of constant stress, being on edge, emotional fatigue. My physical fatigue is non existent on the job (strangely), but I feel worn down, anxious and depressed. Because the hospital is short staffed, management has allowed for bonus shifts where we can make an extra $15 an hour. With any other job I've worked (including as a care tech in the same hospital) I'd be all over that. But not as an RN. It simply isn't worth it to me. Neither is getting involved in UBC or extra curricular activities. I get crazy-bored on my nights off sometimes, but anything beats the feel I get going to work. So I guess that's it. Sorry for the melodrama - But not only am I frustrated, anxious and depressed, but I'm also confused. Everything fell into place for me when I started nursing until I became a nurse. Now I fantasize about leaving the field. And that truly saddens me. I've considered trying to become an NP to make more money and get into a clinic setting, but I don't really want to go back to school. Any thoughts or advice? Am I alone in this? Should I try another unit, or is this common across the board?

Ekramona: I'm 32, and nursing is my second career. I've held up to nights better than anticipated and enjoy all the pluses you state. But that feeling of isolation and constant sleepiness is wearing on me. I can't see myself rocking a night shift for the next decade! But for a newer RN like me, the slower pace and lack of admins hanging around is appreciated. Sent from my iPhone using allnurses.com

Oddly, I'm usually very awake for night shifts. I hit a wall around 4am, but it won't last long. But, WeepingAngel, you pretty much described my nights off perfectly! Sent from my iPhone using allnurses.com

I can switch to days pretty easily. My floor is very busy, and most DON'T want to work days on it! However, I am considering it. If I have too many days off in a row, my body flips to a day schedule automatically, making returning to work (like I just did when I first posted this) tough. I'm also just feeling depressed and lonely since my friends and family all work 9-5 jobs Sent from my iPhone using allnurses.com

Is it possible for night shift to catch up with you? I've done it for a year so far as a new BSN. I thought I was handling it well. I liked the differential, the covered shift parking lot, the pace. But I'm back to work after four nights off. They were lousy. I was too sleepy to stay awake for more than a few hours. I missed out on some socializing. No matter how much I sleep, I can't get enough. Sound weird to revert to anti night shift like that? Sent from my iPhone using allnurses.com

I've been a BSN, RN for a little less than a year. First, congrats on getting here! If you're like me, you focus a lot on your deficiencies instead of your successes and strengths. So for starters, try and get into a habit of complimenting yourself. It's not arrogant to do so and it feels better than berating yourself! One thing that has bugged me as a new nurse is how little I actually know about my patients. In clinical as a student, I had one patient who I spent hours uninterrupted studying before meeting. As a nurse, I've got five patients and just enough time to check out orders, meds, quick history etc before I start work. Sometimes I feel like I simply do tasks and don't make a connection. It's tough because I wanted that connection, but its the nature of the beast. Now at the nine month mark, I feel large improvements in my job performance and confidence. But I have so much left to learn. Breathe, ask for help and be open to learning as much as you can from even miserable situations. We'll get there! Sent from my iPhone using allnurses.com

I've had terrible anxiety most of my life (I'm 32 now). I've also battled depression and am currently diagnosed with type two bipolar disorder. I take a few meds including lithium, Celexa and Wellbutrin ER, but nothing specifically for anxiety. I was on clonazepam daily but it seemed to adversely affect my short term memory. As a new nurse, anxiety is tough. A few hours before I start a night shift, I'm a wreck. I have gotten behind on my work because I've been too nervous to go into a new patient's room (I always felt like they could tell I didn't feel confident in there). In my personal life, I've declined invites to hang out with friends. And dating? Forget it! I did like a book by Edmund Bourne. It was a workbook, but I don't recall the title. But I will say this: You owe it to yourself and your personal and career goals to try everything. Pushing yourself in inherently uncomfortable situations is anxiety producing. Anxiety sucks so we avoid it. But that actually makes our anxiety stronger. The relief we feel is a temporary illusion. One of the hardest things to do I'd soldier on with terrible anxiety in crappy situations. But exposure helps. Get a second opinion. Try a different med if these aren't helping you. What good is paying money for meds if they aren't helping? I'm preaching to the choir here, but trust me. I've been there. My anxiety was debilitating. And in some ways it's still very limiting. But I'm ten times better off than I was ten years ago. It took awhile, multiple meds, docs, trial and error. And even failure. But it's worth it. Sent from my iPhone using allnurses.com

Thanks! I'm impressed you spend so little time vein hunting. I've had some patients who don't look like they even posses veins in their extremities :) Sent from my iPhone using allnurses.com

I'll check that out. Thanks! Sent from my iPhone using allnurses.com

I've had marginal success with starting IV's, but lately it has been quite a dry spell. I think I may be overshooting the veins on some. Do you guys and gals have techniques for starting them? At what angle do you insert the needle? How far? And how do you get invisible veins to pop up? All sage advice welcome! Sent from my iPhone using allnurses.com

Thanks for sharing that - point taken! A nurse told me once that nurses in their second to third year of practice are even more prone to making mistakes then when they started because they begin to develop that false sense of security that they lacked as a new grad. It kept them on their toes and they didn't realize it. As someone whose had anxiety issues for years, it's not exactly comforting to think that a constant twinge of panic each shift might actually be ideal

Good advice. I've gotten back into running, and it is a huge stress reliever for me. If I had a particularly nasty shift, I tend to run further since I can channel the pent up emotions. So, it does have its plus sides

Ktliz, I am actually on multiple meds for anxiety and depression. I have a lengthy history of it. I've had a couple more shifts under my belt since I started this thread. I feel like I'm just not getting this stuff yet. I'm better organized than I was day one on the job, but there is too much 'gray area' on this floor! Actual policies aside, I can never get a straight, consistent answer from other nurses on what to do in certain situations, especially when dealing with unpleasant or insulting patients. I look at my peeps I need to see at start of shift and try to prioritize them, but they all have extensive meds or cares that make the order I see them nearly a moot point. What scares me though, is how quickly I became the type of nurse I never wanted to be: bitter, resentful of my patients at times, short tempered, suspicious of patients that I feel may be narc-seeking. I'm not even at my one year mark off orientation yet! My shifts having me feeling like I'm holding my breath for twelve hours straight as tasks pile on me, and relief is the only description I have for knowing I don't come back the next night. Not 'hey, I get a day off, what will I do?' But actual relief that I can mentally and physically be disengaged for an evening. All I do is race from one task to another, not fully absorbing the reasons WHY my patient is having certain symptoms or getting certain tx. I'm already tired of the constant battle of wills with patients, their families and on coming nurses that question every little thing you did or did not do over night. It's exhausting. But...I still have much to learn, and this is a good floor to learn on. So I stay. Also, I'm not convinced any other place would be any better. But right now, after less than a year as an RN BSN, I can say that if I could find a warehouse job that paid me the same, nursing would be a distant memory. End rant, as they say.

I always get very anxious prior to the start of a shift, especially if my group of patients is new to me. I'm always nervous about possibly having to float, or maybe needing to give blood, etc. While at work, I'm nervous to walk into patients' rooms, and feel self conscious while in there. I had this problem while in nursing school clinicals too. It doesn't seem to be improving, either. I used to take a benzo for anxiety but felt like it adversely affected my short term memory, so I quit. I've been off orientation for approximately six months. Any advice?

I can't fault your insight here. You're pretty spot on :) Improvement in my job performance is definitely noticeable. My manager stated that he had heard good things about me and that I was improving when we had a sit down for my semi annual review. And I can feel improvement too. I guess I not only hold myself to high standards but I also look at other new grads and feel like they appear more in control during a shift than I. Maybe I'm also just really impatient with myself. Nursing is my second degree and it is easily one of the most demanding jobs I've ever done. I feel kind if disappointed that after all this time at school I can't say immediately that I love it, but I think a lot may be suffering through the 'new guy' syndrome and balancing my expectations with reality. And, yeah, I do feel a bit better after venting :) Thanks!

I'm a bit embarrassed when it comes to posting my ratio since, compared to many other hospitals, it's quite low. On nights, I can take a max of five patients. There's talk of us getting a sixth, but nothing concrete has come of it. Personally, a sixth patient would have me reeling but that seems to be where things are headed. I should add that another thing I dig about my floor is the sheer variety of medical issues and situations I see. Every day I work I literally learn something or see something new. I can't even count the number of times I've seen something my patients presented with that I didn't even think was possible. My floor IS a tremendous learning experience.

That's great advice. I have tried to focus on the positives of my job (and honestly, there are a lot): My coworkers are a ton of fun and very helpful/patient with me. I've gotten lots of positive letters and feedback from patients and their families, and I got nominated for that DAISY award at the three month mark (which surprised the hell out of me, frankly). And yes, I'm making more money than I ever did in the past so more doors are open to me in terms of where I can live, trips I can take, etc. The biggest for me is the simple fact that I am an RN at all. Before this, I kicked around at odd jobs. But now, since becoming a nurse, I've had friends and family tell me how proud they are of me. My friends seem to regard me with more respect than before. I'd be lying if I said that my current position is lacking in intangible benefits.