Iwander

This is a rather dumb question. But, for you school or pediatric office nurses, if you have to use an epi pen on a patient, I have a few questions: Do you go straight through their clothes like you would educate in a nonclinical setting, or do you bother to pull their pants down first? What symptoms do they have to have to give it, like, are a couple coughs, one sneeze, etc mild enough symptoms to wait or do you still give it? I'm trying to figure this out so that when I am in a clinical setting, I know when to give the epi pen vs not. Also whether to undress them or to just go through the clothes.

I have 3 years experience under my belt as a med-surg nurse, mainly post-surgical. I am actually quite "sheltered" on my unit as we mainly deal with surgically stable patients and not the "medical" part of nursing, such as starting IV's, infections and contact precautions (we move out anyone on contact to another unit to protect our surgery patients), inserting NG tubes, PICC lines, multiple abx (read: infections and sepsis), etc. I have been on the same unit for 3 years, and I still have days where I feel completely incompetent and feel like a "new nurse". I am still a new nurse! In my opinion, until say, I have 10 years under my belt. No one in management has indicated that I am in trouble, this is what my mental anxiety tells myself when I don't know something I should definitely remember after 3 years. Or a skill I should have mastered by now. The point is, although I have managed to do well enough to keep my job and even get patient compliments, I have not advanced myself in my career due to fear and anxiety. Is this acceptable? Another new with less than 2 years experience nurse is already taking a charge nurse position (I was too scared to take it myself), another nurse who hasn't even been a nurse for a year got a one-day surgery position (along with a pay raise I'm sure). I have barely gotten a raise in my 3 years (and I have stayed put, not moving around to other units or hospitals so that is contributing), and the duties and expectations at my current job are starting to burn me out and becoming more stressful. I don't think the grass is greener on the other side necessarily, but I'm feeling incompetent and "a failure" that I haven't advanced my education or career by switching to another position. I guess I mainly wanted to vent but, just feeling very down on myself lately. Honestly, it isn't worth staying in my current job much longer until something changes. Any advice on having confidence to advance my career? These nurses with quite less experience are excelling and exceeding expectations far more than I am. That's how it feels at least. I am bad at comparing myself to others. However, wouldn't I still not be here if I had followed what the other nurses are doing? ~chronically "new nurse"

I am feeling a good bit of low self-esteem and insecurity at the moment, and not really feeling I deserve to be on this site anymore. I'm having acute anxiety so my emotions are more in control than I would like. I have to fill out comments and complete my annual self appraisal forms. This is the first time I've filled one out and it was looking more complicated than I thought. My reactions are, I'm feeling like a terrible nurse, I'm fearing the worst, and I'm having dejavu about being terminated because "I wasn't good enough." This is not true as far as the wording, but I did lose my first job because my anxiety and lack of progression. So a wave of dejavu is coming over me, that feeling right after being terminated that "I'm not good enough, will I ever make it as a nurse." Well, here I am a year later and I still have my second job. I've improved in many ways. But right now, I'm feeling still insecure and negative in a self-evaluation. I don't feel like I'm "good enough" compared to the other nurses on my unit, but everyone is different and this could be the perfectionism and low self esteem part of me speaking. Any tips on fighting these thoughts, stepping back, and writing an accurate self appraisal?

Thank you so much everyone. I did not hand her the medications; she took them herself. I still agree with the poster who commented on purposefully doing something substandard and that this needs to not happen again in my practice. Thank you everyone and I will use my resources more. I must not let hurried situations or any situation be an excuse for substandard care or an excuse for not stopping and contacting the charge nurse (who had printed the patient's discharge papers and was so ready for the patient to leave also). Thanks everyone you helped a lot.

I am still a new nurse and yet I am already falling prey to being burnt out quickly with patients, being tempted to take shortcuts, and actually questioning my own character. Today I had a patient that exhausted me and when she had discharge orders I was so ready for her to leave. She thanked me at the end, told me to thank the night shift nurses except for one whom she criticized, and was wishing me happy holidays. I was thrown off by her criticizing the other nurse and I don't want to ever throw my coworkers under the bus, so I didn't know how to respond and just apologized and stood there awkwardly. Earlier in the day I had let her take some of her home meds that were discontinued (diuretics), whereas nurses prior had lectured her on the importance of not doing it. I finally found out the reason the MD had temporarily discontinued the diuretic was due to a low sodium level, but her potassium level was fine and she was not symptomatic. In my mind I agreed with her that it was important to keep taking it. Then, I got ready to transport her so she could be picked up and go home. I was so relieved to not take care of her anymore. Then I found out, she didn't have a ride. I was unsure what the policy was but I was pretty sure I'm not supposed to let a patient leave and drive on their own. She had had narcotics that same day. But I just let her go. She said (manipulative/lying, or truth?) that the doctor knew she had no one (in her life) and was driving on her own, and that a previous nurse had let her go. I wheel chaired her awkwardly to an area near her car, but out of anxiety that I would get in trouble, I asked her to walk to her car the rest of the way saying "I'm not sure what I'm allowed to do". She said "Don't worry, your responsibility stops as soon as I leave the hospital building." So here are multiple things wrong with this picture: I should have called the MD or someone to let them know she insisted on taking her diuretic, and can it be re-ordered I should have quickly found out if she had a ride available before acting upon transport plans at all. I should have notified the charge nurse or someone when I found out she didn't have a ride, turned around, and wheeled her back to our unit. I should have never never let her go when she had taken a pain pill that day. Surely cameras saw me and I might get in trouble for this later. I should have been clear on the hospital policy about a patient driving on their own (if they haven't taken any safety compromising drugs). I should have never never compromised my integrity, ethics, and what was right for fear of the patient manipulating me/opinions of me, for convenience, for being burnt out, for needing to tend to my other patients, for a doctor yelling at me, etc etc etc. Yet here I am this fresh in my career and I already find that I compromised what was right, that I was willing to lie if need be, and that if I'm not careful it could become a bad habit. How can I be so burnt out this quickly that I'm already a bad nurse. Not to mention the whole category of medication administration, and the high integrity I must uphold but fail to at times. I had to confess that, and was wondering if any of you catch yourselves with this attitude. How do you motivate yourself to continue with good character or cleanse yourself of your actions and maintain integrity? If my character were very good I wouldn't even have to ask that question.

Thanks for the encouragement!

Thanks! And the other day, there were 3 nurses and we each got 4 new patients. Not at once. But in that instance I don't really have the resources to ask them for help much as they are running around busy also. Thanks for your post!

For those of you who don't have too tired eyes, and who can manage some wordiness, here is my time management vent for the day: Well, I've been reading some of the time management threads on here and realizing I'm in the same boat as others. I've been a new grad at this particular job for 5 months now. I work on a busy med-surg floor and on bad days like today, sometimes I wonder will I make it. Do I need to switch to a less fast-paced floor, but no matter where I go, I will always have the time management, prioritization, and think on my feet challenges. Today one of the experienced nurses, who is completely on my side, said that I spend too much time planning out my day when I need to just go do it. After going to allnurses for help, I thought I was making an improvement by writing down the meds for the day and trying to plan my day. Turns out I need to be like Nike and "Just do it". . Silliness aside though, I've realized that I am a slow to medium-speed processor. When I have 5 things to do at once, I can't go rush into action easily after mentally prioriitzing. I have to write down a plan (which takes awhile), try to go do each task, and recheck the computer, all the while not even timing myself to see how long it takes. By the time I write something down, it's too late and there goes the time. I realized today I must just go and do it. But my brain doesn't work that way. In counseling recently we discussed that I might have some minor adult ADD going on, where I can't divide up tasks into their respective times and see the big picture. I have anxiety already which fogs up my brain and slows me down, but I also might have some ADD slowing down the process as well. I tried to stop today and deep breathe to handle my anxiety, but my brain fog had already come over me, I was already beet red (which lasts for hours on me unfortunately), and I was already getting slower and "more stupid". I also lose what little common sense I have when this occurs. I find it hard to just connect 1 2 and 3, if that makes sense. I then start losing my supplies and papers, and realize oh that's right, I was supposed to be organized today. Well thanks for listening to my rant. I hope I can benefit tomorrow from "Just doing it". I do struggle with the 5 things thrown at you at once scenario. Our unit has a quick turnover rate, which means, I can have a scenario similar to this: I'm passing the morning meds. 30 minutes into my shift, I have 2 discharge orders written at the same time. Meanwhile that afternoon (after those rooms are clean and empty), I have 3 post-surgical admits within an hour, and 2 of those come within 5 minutes of each other. They both have a time-sensitive antibiotic due. These scenarios have happened to me before, and instead of getting those post-op tasks and assessments done within say, an hour, it takes me 2-3 hours. I'm still slow at getting the new patient settled. Then there goes any charting time I have and I don't get off work until 9 p.m. When you get those 2 new patients thrown at you, how can you breathe and do just one at a time? You can't wait 30 minutes to go see that second patient. Just wondering how some of ya'll handle those multiple new patients. Because it's pretty common on my unit.

Thank you, this is very helpful. As far as prioritization, I didn't think to do the easy patients first, I actually thought I should visit the complex ones first but as long as they're ok, I see how I should document and give meds to the "easy" ones first to save time. Also, we have our own report sheets for the floor but we have to pass them on to the next nurse for report. So I can't write all over them or that is sent to the next nurse; they are "summary sheets" only, I'm only supposed to write updates. Thus I have these sheets (5-6) plus my own version and that just becomes a lot of paper to deal with. But I'll create my own I think so that I can write as I go. I agree that I should document as I go. We have about 4-5 tabs to fill out besides the assessment, so for us it can be 20-30 mins per patient of documentation instead of 5. I'll get faster eventually :). So like you said, I should just do some vital assessment documentation like neuro, heart/lungs, whatever the focused assessment body system would be. Thank you for your help!

Hello all seasoned nurses, I am a new grad on a med-surg unit in orientation. I find that my two main struggles besides honing my skills are, as always, prioritization and time management. A lot of new grads will stay an hour or so past their shift on my floor to finish charting. Here are some things that bother me: There are days when I go back and forth between patients and don't get to chart a single thing for say, 5 hours. By the time I sit down to chart, I feel I will leave something out. Although this is not the end of the world, I want to be thorough and safe in my charting. Examples that have bothered me: not charting I and O accurately for a patient with bladder irrigation because I couldn't remember the exact times/numbers of the input and output (even though I had some written down it still wasn't correct) giving a new medication to a patient one hour before shift change and forgetting to waste it (our Pyxis lets us "waste later" and I was busy trying to do 3 things at once before shift change). Any time I forget to waste a controlled substance it scares me. I struggle with organization. How do I go for several hours and still have enough notes written down in an organized way to chart accurately later? For example, with the I's and O's, I went in that patient room maybe 6 times with a different I/O each time, yet I didn't have enough paper on me to write down all of that accurately. I hesitate to bring an entire clip board with me into patient rooms every time as I'm spreading around germs, but I guess that might have to be my way for now. Also I used to carry papers around in my scrub pockets but this is actually looked down upon by another nurse. Everyone has his/her own style. I want to make it through my first year. I just need help organizing my notes or being quick enough at skills to chart as I go. I feel that I must give my meds on time, so I don't always have time to chart an assessment as I go. Any focused assessment tips or priority skills on the important things to chart right then? I don't want it to be 1300 and I have 5 patients who don't even have a full assessment charted yet. Any way to become better at giving meds? Even if I'm done within an hour, there seems to always be that one patient that takes an extra 30 minutes of my time and I'm behind again. Maybe I'm not prioritizing correctly in that case? Thanks everyone for listening :)

Thank you! I took anxiety medicine in the past during nursing school and I didn't take it often enough. At the end of nursing school I abused the trust of my prescriber due to depression so now I feel I won't be able to actually be prescribed anything even though I probably need it . I went through the ICU experience with NOTHING. Lol. And thanks for reminding me that of course I'm collaborating with the nursing assistants and everyone on the team, maybe that will help

Hey everyone! If you read any of my previous posts, you know that I'm a new grad who lost my first job (ICU) after only making it through orientation. I have now been offered a med-surg job at a different hospital on an ortho floor. It will be very busy and I am terrified, however I feel that I need to take it. It's been 3 months since I've been unemployed so I feel extremely rusty. I'm scared! I have anxiety issues so my prayer is that I will make it through this time. It is also day shift so it will be even busier as I learn to have multiple admissions and discharges. HELP! So this is mainly a vent about how nervous and yet excited I am. I feel I must try. I need so much help and will start orientation next week assuming I accept the job. Any advice before then? Such as time management skills, priority, how to be in charge of a nursing assistant when I feel they have better skills than I do!!!! (Must be a leader even though will feel like hiding under a rock on the inside). Thank you allnurses for being so awesome!

Thank you to both of you for your refreshing posts. You're right; I lack confidence and am needy. I had an interview for a med-surg job and the interview itself went well; however if I am offered the job I am unsure I should take it based on what you and others have said, especially since it is a surgical floor with a high turnover for admissions and discharges. Maybe I should wait until I get a non-hospital, more predictable job. It just depends if those less acute jobs would train me enough for me to transition from needy to a confident and autonomous nurse.

I'm a new grad who has a (short) 3 months of experience in an ICU setting. However, they let me go at the end of orientation. I had a couple interviews at the same hospital which failed, and I think it was partly because of poor wording on my part in the interview (too honest perhaps). I have another interview coming up. I'm really grateful for another try, I am just scared I'll bomb the interview when they ask me "Why did you leave your previous job?" Which I didn't leave voluntarily as they let me go. I wish I had had the foresight to see what was happening and voluntarily resign. Here is why it didn't work out: I have NO problem with the unit or any of the coworkers including the manager who terminated me!! I think it is an excellent unit. So how do I word that to show that I have no personal issues with getting along with coworkers, I am a person who can get along with a new unit (and get hired!). That would be the positive part of the answer. Now for the negative part... I need to learn how to reword this into something more positive. "During my training period, my educator, manager, preceptors, and I worked together and at the end of orientation we determined that the ICU was not a good fit for me" Here are honest reasons why I was let go: I desperately need help in re-wording them into positives and in which parts to leave out. 1. I had a lack of initiative and autonomy. I wasn't lazy at all I just kept needing to ask the preceptor for help about what to do. In emergency situations, I was unable to act calmly and quickly and to automatically (instinctively) know what to do. I would stand back and watch instead. My personality isn't a good fit for the high acuity and fast-paced environment of an ICU. How do I word this with a positive light instead of "I'm not autonomous and I'm too nervous". Even med-surg floors can be really fast paced so I think I should even leave that phrase out perhaps. 2. Anxiety, anxiety, anxiety. I would leave this part out in my interview. I just don't know if I need to include anything or not. I really would need a preceptor in my new job and someone to really support me while I get on my feet. I ask questions constantly and am receptive to being wrong (admitting when I need help) and to learning. I would like to word that as a positive. However, even with 3 months of ICU experience, I feel like a new grad still with a complete blank slate and am wishing the new job manager will treat me that way by giving me a long enough orientation time and support. Any way to word the anxiety in a positive way? I doubt it. 3. Slow to pick up on hands-on skills. Even foundational nursing skills such as setting up an IV correctly. Crucial for an ICU setting as the patient is going to need that life-saving IV med quickly. In a med-surg setting I'm hoping I would have more time to be "slow" and really master the skills without it endangering a patient. I just take a long time to learn skills and need a lot of practice, and it wasn't making the cut in the ICU. I wasn't good enough. Trying not to take it personally. Is there a positive way to word this in an interview? My strengths do include being a caring, empathetic and gentle person (both patients and families thanked me so I feel I did something right). I am also intelligent and willing to learn. I can learn the clinical knowledge, just the practical application is difficult. Any way to re-word this shortcoming into something positive? Sorry that this post is so long, I just am at a loss how to word things sometimes without an objective perspective. Then others will really give me something helpful that I can't come up with on my own. Thank you so much if you decide to reply to this post.

Hi everyone, I have been revising my resume lately as I am looking for a new job. I am still a new grad with only a few months of clinical experience. I did my preceptorship on the same unit as my clinical experience where I was hired, so the bullet point skill list is identical on my resume. How do I word my preceptorship and my actual job as a RN without having 2 identical bullet point areas on my resume? It takes up unnecessary space. Example=(format is different of course) Clinical Experience Senior practicum at XXXX Hospital, Completed XXX hours. Skill A B C D E RN, XXXX Hospital, (3 months) Skill A B C D E Employment History RN, XXXX Hospital (3 months). I don't list any skills here as it would be another duplicate and just putting the job under this category is repetition. That's an example of part of my resume to give you an idea of what I'm talking about. Does anyone have any ideas on how to word and list this differently?