NurseKate

Thanks for the belated wishes! Congratulations to you! Good luck with your career. ~kate

Hi Anna: I read your reply and kept thinking, "I felt that way, " or "I still feel that way" while reading it. When I first graduated I wanted to be Superwoman (and sometimes I still strive for that). I want to know everything about my patient, do everything perfectly, and manage all the paperwork, etc. At times I find myself wanting to be the best nurse my patient ever had (ok, that's unrealistic, but I want to do a good job). Is all of that realistic? No. Am I Superwoman? Definitely not! I continue to struggle with the paperwork and many times don't know the right thing to do or say to a patient who is dying, upset, etc. I still have a lot of questions I need to ask my nursing supervisor or other nurses on my floor. There were so many things that I didn't get to experience during my orientation, but had the challenge of dealing with for the first time while I was "on my own" (e.g. patient dying, patients "gone bad," etc). It definitely is challenging when these situations arise, but I ask for help because there is no way I can guess my way through these things. Then the next time that situation arises I will be more prepared, have a wider knowledge base, and will ask for help if I need some more. When I took the NCLEX it seemed so easy to pick out "This is the right thing to say to someone out of these four choices," but it's harder in real life when you don't have four choices in front of you to pick from. Every day is a learning experience. As time goes on things get a little easier. Even though DNR patients will still bother you, you learn how to care for them a little better each time. I think that's good that you aren't emotionally blunted like that other nurse was who saw the dying patient in terms of "paperwork." Just remember when your patient dies you know that he or she had/has you as a caring nurse. Know that you have tried your hardest to make him/her as comfortable as possible. Their death may not be "perfect" like you had hoped for the patient, but you tried your best. Afterward you can ask yourself, "What would make this better next time I am in the same situation?" I think it's so very important to re-evaluate our practice so we can make improvements (but don't be too hard on yourself!). Does your unit let you "debrief" after someone dies or when a stressful situatioin occurs? If not, it's important to make sure you can debrief afterward...to talk about the situation with someone after it happens so you aren't wondering what the heck happened, etc. It gives you time to get your emotions straight. When you feel like you're unsure of what's going on with your patient, asking questions is the best way to start finding the missing piece of the puzzle. Some doctors are really great about teaching and answering questions. If you have a Clinical Nurse Specialist, then ask him or her questions! Here are a few suggestions that have worked for me: I take a book with me called Lippincott's Pocket Manual of Nursing Practice. I rather like it, but there are so many books out there that may suit your needs better. I have the book near me so when I am getting report I can look things/conditions up that I am unfamiliar with. It clues me in to areas I should focus my assessment on and possible complications, as well as patient teaching. When I have time I read the patient's History and Physical to get a better understanding of the current illness and past medical history. Sometimes looking up lab values in a lab book is helpful as well because it gives the explanation as to what could be an underlying factor in abnormal labs. Of course I am saying this to you as if you have all the time in the world to sit and look things up. I know that in the real world the unit can be chaotic and you may not have a chance to sit down at all! I recommend trying to look things up here and there when you have some time. That way the next time you get an abnormal lab you will already know what could be causing it...or when a patient reports an unusual pain you can know if it's a complication of the disease or procedure. Just a a suggestion, of course. You will gain more confidence as time goes on. There isn't really a magical point. Some nurses I work with say they felt confident after a year. Some have been working on the unit for 5 years and say they still don't feel confident. I feel confident about some things (like NG tubes and central lines) and not-so-confident about others (the list goes on and on). Each day though is a new learning experience. I worked last night and was faced with a few new challenges (cardiac related, ehich scares me to death). I did not feel confident but I asked other nurses a lot of questions, called the doctors, and got through it all. Now when I am faced with similar situations in the future I will feel like I know a little bit more. If you start dreading going into work or are having extreme anxiety about it then you may want to consider going into an area that fits you better or that you like better. Don't destroy yourself in an area that you hate! There's nothing wrong with saying, "This isn't right for me. I need to switch." Sounds like you are giving it your all. Just be aware of how work is affecting your life. Sometimes I dream about work, but that has subsided a bit. Someone once told me that "When you start to do things automatically and not think or be cautious in what you are doing...it's time for you to get out of nursing." You can't be complacent in nursing because that can easily lead to trouble. Sounds like you are continuing to learn the ropes, have normal concerns and fears, and are doing a great job in trying to improve upon your nursing practice. I commend you for seeking out advice, help, and support from others. If I were a patient in your hospital I'd feel comfortable having you as a nurse because you're aware of your limits and you really care. You don't have to "know everything." It's ok to tell a patient, "I don't know" when they ask a question, but important to say, "but I will find out the answer for you." Feel free to PM or email me with any concerns or questions. I hope my long stand on the soap box here has helped in some way. Best wishes! :)

Well, I have been out of school for a year and do not consider myself "experienced," but I have worked both surgical/trauma and med-surg and would be happy to be a sounding board for anyone who wants to talk. I know that the transition from student to RN is challenging (I had plenty of challenges with it), but I know we all have to be supportive of one another. So let me know if I can be of any help. Also the med-surg forum on allnurses can be used as a sounding board. People post their experiences there and usually many nurses (experienced and new) reply and offer support when needed. I think your idea is great. Let me know if I can be of any help.

**WARNING: Long-winded post** I started on a surgical/truma unit right out of school when I moved to NC. Like you, when I was preparing to graduate I heard "You need at least a year of experience on med-surg before specializing." BUT...I also heard, "If you know what you want to do, then go for it." I decided to take the latter (although I was most interested in women's health) and went for a specialty area. I had three months of orientation before being set out on my own on the SIU. I learned A LOT, but realized that unit wasn't the right fit for me (or me the right fit for it) after about 4 months. I ended up quitting, moving back to MA, and now work on a med-surg floor in a smaller hospital. I love it. I have taken my SIU experience and use a lot of it here on med-surg (although we don't get people on vents, drips, etc here). However, my med-surg experience has broadened my knowledge base and I will be able to take all of this knowledge with me to where ever I may go from here. You WILL ALWAYS BE LEARNING SOMETHING each day in your career. You just have to do what you feel is right for you. The great thing about nursing is if you feel you're in the wrong area, you can switch. Most specialty areas now have extensive orientation/preceptorship programs for new grads. Check them out and find out which place seems like the best fit. If it's a med-surg floor...GREAT! If it's the ICU, CCU, pedes, or whatever...GREAT! You really won't know until you try. Just do a lot of research, ask a lot of questions before you accept a job, and make the decision you are most comfortable with. :) Best of luck to you and congratulations!! :balloons: P.S. AND...there's nothing wrong with switching units during your first year out of shcool. Don't destroy yourself by "toughing it out" if you are absolutely sure that it's not the right fit for you. -Kate

Definitely ask your preceptor for help!!! Your preceptor is there to help YOU. If there is something you have not done before then you need to ask for help. Maybe say, "I learn best if I watch it first and then do it." or "I learn best if you're there talking me through it." etc. As a nurse it is not important to know everything...it's important to know what your limits are and seek help for the things that you are unsure of. That's part of what makes safe nursing practice. Even if you have done the skill before but still feel unsure then maybe say, "I have done this a few times before, but I would feel more comfortable if you could watch me this first time in case I have questions..." I have been off my orientation for some time, but I still see things I have never seen before and still have to perform tasks I have never done before! The way to deal with situations like this is to ask for help, have someone who knows how to do the skill show me what to do, read the policy on the procedure, and even ask my nursing supervisor for help. You don't want to go in feeling unsure and just start doing something you are unsure of. It is overwhleming, but you will get through it! Good luck to you on your new career! :)

I concur with what the previous poster stated. What you're feeling is normal. Confidence comes with time. I think med-surg will be a great place for you to work (but maybe I am biased being a med-surg nurse myself). Try it. If you don't like it then you can always switch into something else, but the information you take with you will be invaluable. You'll most likely find that you will be learning a lot of information and skills that you can take with you to the critical care setting or any other setting that you may go into. You will have time with a preceptor where you can ask a million questions. as time goes on you will start doing things on your own and have more autonomy. The key to a good oreintation is a good preceptor. If you ever feel like your orientation is not going well or are having difficulties with a preceptor, MAKE SURE YOU LET SOMEONE KNOW SO ADJUSTMENTS CAN BE MADE. This orientation experience is for you...so make sure that it's a good experience for you. You will find that you will continue to ask a million questions after orientation, but that's NORMAL. Your career is a a continual learning experience. People I work with who have been in nursing for years still ask questions about things they aren't sure of. Just remember the importance of knowing your limits and not trying to be stoic for fear of looking stupid when you ask someone something. Knowing your limits is key to safe practice! Something I have noticed about you already is that you have already mentioned areas that you aren't as strong in. That's a good start because you already have some idea of things you should focus on during your orientation. I think you're already off to a good start! Nights may be a good shift for you depending on if you can sleep well during the day, etc. It really takes some time to get the body used to the switch. From my experience there are less medications to be given during night and sometimes the pace is a little slower. However, some nights will be VERY busy because contrary to popular belief there are a lot of people who don't end up sleeping during your shift. Don't be afraid to ask for help if you are feeling overwhlemed. Hopefully the bunch you work with will be supportive, resourceful, friendly, and helpful. When prioritizing always remember your ABCs (airway, breathing, circulation) and watch how your preceptor prioritizes. Ask him or her for tips on things to remember or things to think about when prioritizing. It doesn't come naturally at first for most people. Use your orientation time to get help with prioritizing. It takes a while to get the hang of. You may also find that you will constantly be re-evaluating your practice and thinking, "Next time I will do this differently and see if that helps..." I'd also suggest that you set up support outside of work. You may want to get a group of friends (who are new-grads) together every so often to form a sort of support group. It's a challenging transition from student to nurse, but you aren't in it alone. There are so many other people who are experiencing the same doubts and concerns you are feeling right now. I felt the same way when I started, too! It takes a while to adjust, but keep telling yourself that you can do it because you can! P.S. Also, other forums here on allnurses.com are very helpful, so feel free to ask questions on the forums as well. :) Good luck to you and congratulations on getting through nursing school!

Like quite a few students, med-surg scared me and I had no interest in it after I graduated. After graduation I worked on a Surgical/Trauma unit at a Level I trauma center and absolutely hated it! I learned a lot and got some great experience in the short time I was there, but I started feeling like the unit was not right for me (or I was not right for the unit). I ended up moving out of state and went on to work on a small community hospital unit that consists of patients who are med/surg, pedi, and/or medical behavioral (it was the only unit that was hiring and would consider me with my minimal experience). I was hesitant at first, but I tried to keep an open mind and I feel as though I have finally found my niche! I have learned so much on the unit and feel like it's the right fit for me. Overall, I have done internships in a birthing center, worked in my critical care setting, now work med-surg/psych...and I haven't found a unit that I mesh well with as much as med/surg. I feel as though all nursing areas work hard, so it's not fair to say that med/surg nurses work any harder than OB or OR or Tele, etc. Each area has its own challenges and obviously everyone has their own tastes. Med/surg is definitely not for everyone, but I don't think people should knock it without actually trying it or at least being open-minded to it. I feel as though med-surg does can be a great experience for those who work it and widens a new grad's (or even an old grad's) knowledge base. I learn something new every day and experienced nurses on the unit state they are constantly learning as well. (I am sure that is also true for other units.) Yes, some days are extrememly challenging, but it's like that in any unit. I guess where I am going with this is try not to make up your mind about med-surg just because it seems hard. I was one of those who didn't have an open-mind about it until I was faced with seeking employment for a second time. Now that I have been working on this unit, I wish I had considered it from the beginning because I am enjoying both its challenges and rewards. :) Maybe it will be the right fit for you, maybe not...but at least you tried it to find out.

I worked on a Surgical/Trauma unit right out of school and ended up feeling so overwhelmed and discouraged after a few months. I began feeling as though I was not the right fit for that floor (or maybe the floor wasn't the right fit for me). I weighed my options, spoke with my manager so she was aware of my concerns, tried a few interventions, and tried to tough it out. Eventually I made the decision that that unit was in fact not right for me, so I asked to transfer. The hospital said that it woud take at least "several months" before I would be able to start interviewing for other positions because holidays were coming and reviews were appraoching. According to the people I spoke with, "managers felt it would be unfair" to me if I switched units and had a review shortly after by someone who wasn't very familiar with my performance. I didn't really buy that and I didn't believe I could last "several" more months on a unit I was so frustrated with. Maybe that was normal, but I had to do what was best for my mental well-being and I was reconsidering changing careers at that point. In the end, I put my notice in and quit before my 6 month milestone. I am now working an a med-surg floor (which I dreaded doing when I was in school) in a smaller hospital and feel like I have finally found my niche. You have to do what is best for you. Be honest with your manager or preceptor. That way they can help you figure out what might help you feel more confident and ways to address the issues you may have. If that still doesn't work, then it may be best to switch units. Good luck to you. Please keep us posted. :)

PCS ( a company in TN) reviewed the licensure paperwork and verified my other license, etc. Once the paperwork was in it took maybe less than two weeks for them to notify me that I had met all of the requirements and they were going to let the MA BON know. Then it took a few more days for the BON issued my license. I am working in a small community hospital in Western MA. I worked at a huge place in NC before and ended up hating it, so I figure a smaller place was the right fit for me. Where are you planning on going in MA? The Boston area? Good luck to you and best wishes.

Hi there. I just received my MA nursing license by reciprocity. I used to work as an RN in NC. I found a job in MA while my application for my MA nursing license was being processed and reviewed, but I could not start actual work until I had the MA nursing license issued to me. So you can definitely go job hunting and let them know your MA license is pending, but you may have to wait a little bit before you can actually start working.

Is anyone a psych nurse here in NC? If so, how do you like it? What don't you like about it? I am unsure if it's an area I want to go into, but it's an area that has always interested me. Anyone here work at the state hospitals? I appreciate any information you may have. Thanks.

Sounds like your friend is stressing you out...and from experience I know that you don't need any more stress than you are probably already going through! I didn't get any new format questions and I passed in July. The computer gives the next question based on whether you answer the previous one right or wrong. It doesn't penalize you for taking time to understand what the question is saying or how much time it takes you to answer a single question. The only time when "time" is an issue is if your 5 hours are up and you're not done with the test. You gave it your best shot and will find out shortly. Don't worry about the types of questions that were asked right now. I didn't get any new format, got about 7 medication questions, was asked about disease processes, teaching, and prioritization. I talked with other people who passed and their test consisted of very different questions. Each test is different and you gave it your all! Good luck to you and keep us posted. Maybe a paper is coming to you soon with RN after your name!

I read your post thinking, "Wow, this sounds just like what I have been thinking and feeling." I am coming off orientation soon and I am terrified! I worry about the same things and feel the same way you do. It was so reassuring reading your post because I know that someone else is out there feeling the same things I am feeling. Thank you for your courage to post all of your concerns. I know that sometimes it is hard to admit when we are feeling like that. Just know that you're not alone and I am sure there are lots more people feeling the same things. :)

I read your post thinking, "Wow, this sounds just like what I have been thinking and feeling." I am coming off orientation soon and I am terrified! I worry about the same things and feel the same way you do. It was so reassuring reading your post because I know that someone else is out there feeling the same things I am feeling. Thank you for your courage to post all of your concerns. I know that sometimes it is hard to admit when we are feeling like that. Just know that you're not alone and I am sure there are lots more people feeling the same things. :)

:):balloons:CONGRATULATIONS!!! :balloons: :) Good luck with your career as a new nurse! Best of wishes to you.

GOOD LUCK!!!! :)

:):balloons:YAY! CONGRATULATIONS! :balloons::) All of that hard work has paid off and you did it! You should be real proud of yourself. Congratulations again, RN!

Yes, people do pass with 265 questions on their second try. As people have stated in other posts...if you go to 265 questions it means you fluctuate right around the passing standard and the computer has a hard time telling if you are at the standard or just almost there. Obviously the second time you were consistent and it went all the way to 265 to try and figure it out again. You will find out in due time, but just think that maybe this time you were at or above the standard with that last question! You can do this and maybe this time you passed! If not, then maybe three time's a charm, but just because you got 265 on round two does not mean anything "bad." Good luck to you and keep us posted!

I was nervous and scared too. How long have you been studying? How have you been doing with your review? Are you setting time every day to practice and study? It's a trying experience, but you will get through it. Have you used other resources when studying like other review books or CD Roms? It would be good to review the areas you are weakest in and focus on those as well as focus on prioritizing patients. There are A LOT of prioritizing questions on the real exam and some delegation questions. I can't do much more to help calm you because I don't know how well your studying has been going for you. Do you feel prepared? Have you taken any predictor tests? Take a deep breath, review content you are weakest in, take time to do something for yourself before the exam, don't study the day before, and believe in your abilities to do well! Have some faith in yourself! You can do this! :)

first question, how long have you been on orientation and how long do you have until your are on your own? if you are starting out then your confidence should come with time. the good thing is you are recognizing that you are being real dependent on your preceptor. the thing you should probably do now is talk with him/her and figure out a plan and some goals for yourself so that you rely less on them and more on your own thinking. if you are near the end of your orientation and aren't feeling quite so ready then talk with your nurse manager or education person (whoever is in charge of organizing your orientation) and request that you feel as though your orientation should be extended. in most cases they should honor that. i know how you feel because i am in the middle of my orientation. i was having some issues with my preceptor because she would just throw me into situations without showing me what to do first. for example, "go in and change that central line dressing." well, i had never seen one changed and even if i had a the policy right in front of me i felt it would have been helpful to observe it first, so i told her so. there are a lot of situations where i still don't know what to do and i call out to her, but i have found over time that i am starting to do more critical thinking on my own and each experience is a learning experience. the good thing i hear you saying is that you are asking questions. right there you are recognizing that you don't know everything and you really want to know the answers. the bad thing i hear you saying are that the questions are "dumb." you are learning and this is where you start pulling loose ends together and things start really clicking for you. obviously you are unsure about some things and you ask questions to make sure that you know what's going on. that's not a bad thing...it's just what your orientation is designed to do--answer your concerns, questions, and help prepare you for working independently. so, what do you do when the patient doesn't have a chair alarm? now you know, so if you have a patient who doesn't have one then you know how to manage it. the thing is to be able to recognize a bad situation, do what you can do in a safe manner to help it from getting worse or make it better, and get help when you don't know what to do. give yourself some credit here. you recognized a potentially dangerous situation, you had probably maintained the patient's safety while in the chair, and then got help with what to do next (where to get an alarm or who to call to get it fixed or whatever). see, you're doing great all ready. this is the only lengthy orientation of this kind that you are going to get. after this orientation and this job you will be considered as having experience and your next orientation will be a lot shorter for your next job (if you move or whatever). so...this is your time to have someone with you answering your questions, showing you what to do, and helping you develop your critical thinking skills. as for asking your nurse manager...it seems like you are unsure of your performance and where you stand. perhaps ask for a performance review to see how your orientation is going. you can sit down with your preceptor and nurse manager to figure out what needs to be changed or what is going well. it's just a suggestion. your confidence will come in time. make the most of this opportunity and ask a lot of questions. it sounds like you are going through the normal feelings and emotions of starting a new career in nursing. good luck to you and keep us posted.

I am still on orientation and have about 6 more weeks to go, so I am not aware of what the feeling is of being alone without a preceptor and all that. However, I work on a Surgical Intermediate Unit, which is considered critical care and have only 4 patients on vents, tele monitors, etc...you name it and I still get overwhelmed with a preceptor around to help! I can't imagine what it's like for you and your 6 or so patients! There are days where it seems that there are just not enough hours in a day to get everything done. While I can relate on some issues you bring up, there are others that I can't yet. I'll try my best to offer support and advice... Anyway, if you have been on your unit for three months and are not somewhat happy then maybe you should consider transferring. Nurses will always have something about their unit they don't like, but it sounds like there are some real issues at hand on your unit so maybe it's not a good fit for you. Do your research about other units and see what people are happy or unhappy about and see if it's really greener on the other side. Hang in there, though. Just know that you won't reach a dead end. You are doing the best you can do now given the situation and your experience. What has your nurse manager or charge nurse done to help the situation? Are they aware of your feelings about the lack of resources and support? This issue could very well be a pressing problem for other nurses on the unit and really needs to be addressed. Nothing will get changed if they aren't aware. Be civil about it (as I am sure you would be anyway) and say that there are some things concerning you and maybe they can give you help regarding resources or other ways of how to handle the situation. Offer suggestions if you have any. This is a real important issue if these things are compromising the safety of your patients and/or the quality of care you are able to provide. I'd say don't just get it in your mind to transfer until you have tried to address the issues. If that doesn't work and you aren't getting happier on the unit, then a switch may be best.

No, unfortunately for me my state doesn't participate in that. It took me 11 days of hell until I found out my results.

I agree with what everyone is saying...focus on what's in front of you right now and make the most of it. You will find, however that your education really builds on itself. There will be things you will learn and not retain, but there are so many things that you will hear over and over again or see so many times that it will just get stuck in your brain. The tendency is that you will learn new things that will build off of your previous knowledge. The thing about nursing is you learn so much while at the same time find out that there's so much more out there you don't know. There's constant learning in the field. It may be helpful to study in small groups with people to really get the information stuck in your head. That is usually helpful to those who are able to concentrate in small groups. Other suggestions are to make flashcards of meds and basic concepts you need to learn. Sometimes hearing some else's perspective on the material makes it all click better so it sticks in your head. I'd also recommend that you don't wait until the last minute to start studying for the NCLEX. As you go through your nursing courses study out of the NCLEX prep books or CD ROMs so you start reviewing the information and get used to the NCLEX format. Our professors also helped us by including NCLEX prep questions on their exams for class. If your professors don't do that then maybe you could suggest that they try including some if you think it will help. Good luck to you. Seems like you don't have to worry about the NCLEX now seeing as you are working through your pre-req classes, but try to retain that information because it will come back to haunt you later as a nursing student and even in your career. :)

I agree with breastfeedingRN. Do not study the day before. I had been studying right along and paying close attention to the rationales of the questions I was getting wrong. I gave myself a break the day before the exam by going out to lunch, watching a movie, and just doing some "relaxing stuff." I was still nervous and had anxiety while I was trying to focus on other things, but I figured I had been working hard all along so my poor brain really needed a break before the big day. I took the exam and passed with 75 questions. I was still nervous when I went in to test, but once I sat down I felt a little more relaxed about it, refreshed, and prepared. Do something nice for yourself the day before. Get a pedicure or a facial. Go get ice cream or treat yourself to some nice treat. You will be freaking out until you get your results, but give your mind and body a break from the stress for at least a few moments. Good luck to you and please keep us updated.

I had waited for 11 days to get my results from NC. It took a few more weeks after I got them back to get my license because, as someone else has said, the criminal background check takes so long. I took my test July 19th and was issued a license August 6th. They sent a letter saying I passed but it would be a while for my background check to come back. I know what the wait feels like, though. Just know it's normal for them to take a while. Also, the NCBON only issues licenses on Tuesdays and Fridays. You should get a letter soon! Good luck!