SouthernizedRN

My first two years as an RN I worked in the OR. We had a surgeon who was ADHD. He came flying into the OR to start surgery when his surgical scrub pants dropped to his ankles. I had the joy and pleasure (note sarcasm) of pulling them back up from the back under his gown. He sinched the front and used a clamp to keep them up. Lets just say I could have done without that! At least he wore underwear that day.

First off, Congratulations on passing the NCLEX!!! Second, absolutely you should be looking for positions that will hire ADN's, especially New Grad programs. I've been nursing 4 years under my ADN. I have just a few classes left and I'll have my BSN. Anywhere you can start to get experience is important to springboard you into where you want to be. Searching for jobs with ADN's can be difficult and daunting but keep your head up and perservere. Good luck!!!!

I recently had a patient with Expressive Aphagia who told me to "Get my GD fat f'n ass outta here *****!" Didn't think he had Expressive Aphagia then. He had been yelling so I asked what was wrong. It went from bad to worse from there. I switched patients with another nurse. He wasn't cooperative with her but he was nicer. He told her "you and I had a thing, but you didn't want me. So I don't want nothin' from you." He wouldn't take his meds. When the techs went in to change and clean him up you'd have thought they were stripping in there, "Ooooh you so good." "That feels sooo good." We couldn't help but laugh outside the room. I've been called bad names before but that particular string of words was just nasty. I would love to say that, but the best I've said is "I do not have to put up with you calling names and I won't." They don't care the H out there stands for Hilton and I'm nothing more than someone to order around. I did tell one patient who demanded an ice cream with a BS of 375 that I don't reward bad behavior and not with a 375 BS. He pouted all night then reported me. SMH

I am so sorry you are feeling so overwhelmed. I will tell you as someone who started in a specialty right out of school, you are either cut out for it from the word "Go" or you need a little better orientation into nursing first. That's why so many suggest going into Med/Surg first. I didn't do it either. I went into OR. I couldn't have felt more overwhelmed, beaten down, and frustrated if I tried to work with no arms. I had techs and doctors that hated me, nurses that ate me, and apathetic management. My training also sucked sincerely. I went into Med/Surg after 2 years in OR to get back to basics. I'm so glad I did and I wanted to be a Cardiac ICU nurse. I don't know what the next 5 years will bring, but being the best nurse now is what's important to me. I have had to deal with death in both the OR and on my floor. I have only had 1 patient under my care die on my shift. She came up from ER dying (DNR). I haven't had that one patient that has touched me so much that I cry. I am saddened, but I'm not a cold heart. I can at this point divorce my feelings and understand it is the way life plays out. I will have that patient one day. I can't imagine 4 though. I think even that would bother me enough to hole-up in a bathroom and cry. I understand all to well the Doctors who say "we'll just monitor him" as you see the BP rise, breathing become labored, mottling setting in, and no, the patient isn't DNR. I recently had a patient whose BP went to 172/111, I called the Doctor (I work night shift, so yeah, they just love hearing from me during the night) and he said "We'll just monitor her. She'll calm down." She did, but that's not the point. We've had patients drown in their own fluids because the Doctor didn't think all the crackles, wheezing, and dyspnea was fluid overload and didn't order Lasix that could have saved their life. It is frustrating as hell. Even in my unit I can have patients that are in the same condition as your patients in ICU, although the worse the heart condition they will be shipped out to a better equipped hospital. Just remember that you are new. It will be the singularly most difficult and overwhelming year of your life. Nursing school was cake compared to the learning curve of a new grad. If you do think it's too much now, don't be afraid to take a step back and find a job in Med/Surg and get your feet on solid ground, then go back. There is absolutely no shame in doing that. I love what I do, but I went through pure hell for over 2 years before I got to where I am. Many things will just never be easy about nursing, but how you choose to handle them will determine if it is easier. Good luck!

I totally understand your sense of feeling overwhelmed. When I got my first job in nursing it was in a specialty...OR. I lasted 2 years and moved on to Med/Surg, basically Medical as they are separated in my hospital. I work a very small hospital and at times we can have up 8-9 patients a piece. I had an understanding Nurse Manager who was willing to really work with me. I had issues with fitting in because I wasn't from the State let alone the area. I worked hard. I allowed myself to be vulnerable and asked those I worked with "What can I do that will change how you perceive me?" "What is it I'm doing wrong or can do better?", I found out that certain ingrained non-verbal communications (facial expressions) were perceived NOT as they were meant. If I rolled my eyes it often meant "Oh man, I can't believe I did that." They took it as "Oh man, I know that already." I stopped. I can tend to be loud and when I'm shocked or upset my voice rises. Some considered that yelling. I had to learn to tone myself down. I was close to losing this job because of these misconceptions. I worked real hard to change ingrained habits, to open my mind and shut my mouth. I had 30 days to make these corrections. At the end of 30 days, my Nurse Manager was pleased to see that I listened and made changes. She didn't think I could do it. Next month will be my 1 year anniversary. I love my job, I love my patients, and for the most part I love the people I work with and I work night shift. I had a CNA who charted all Respiration Rates as 20 on all patients. I caught him on it and called him on it (nicely...he was new). I explained you can't do that because a change in respiration rate could mean they are either, dead, dying, or filling with fluid with the end result of death. It misleads me as the nurse in their care and treatment. I also explained that's lying and illegal. It will cost your job. Yes, I also have had p.o'd CNA's that hate their job. Just remember regardless of what a CNA does that patient is ultimately your responsibility. If you don't think they are doing something correctly, do it your self and CYA (CHART IT). I too get crappy morning reports and we bedside round. Again, your responsibility as the nurse coming on shift to CYA. I have a nurse that notoriously does not chart her meds. Thankfully, I know this so I don't worry too much about her, because I know she gave them. She just hates charting and forgets to scan the meds. THIS IS NOT RIGHT! We all know if it's not charted it's not done. Because I know this nurse does this I'm not willing to take the chance and overdose for a "missed med." You will learn these things. I've had nurses leave me with Doctors to call, IVs to resite, meds on their shift to start, new admit assessments to complete even though the patient showed up at 15:00. You will find their are just plain lazy nurses. It's frustrating and aggravating, but unfortunately now it's your responsibility. I do my level best to not leave anything for day shift that I needed to do on my shift. The LOVE to complain to the NM. Now I said all that just to let you know there are things the first year of nursing you need to be aware of...first off, it will be the most overwhelming time in your life. Nursing school was easier than this. Also, there will be people out to undermine you. I had it in both OR and Med, and I still do to some extent. I just choose to do my very best for my patients, that's who I'm there for. With all of this long windedness being said, I do have some tips that greatly helped me. A suggestion my NM made was to create a checklist of the things you will need to do during your shift. We are 100% paperfree (EHR). My list includes the following: 1) Print MAR a. 1st print (I reprint the list after I have given all of my evening meds, so I can make sure the scanner scanned them all). b. 2nd print (This is for my a.m. meds for the same reason as the first. 2) Patient assignment - We can have anywhere between 3-9 patients this is just one way to make sure I have seen them all. 3) Pulled Meds - I use the MAR to checkoff the meds I've pulled, but I mark they have been pulled on the checklist. 4) IV fluid pump check 22:00 & 06:00 - as nurses have to check and clear the pumps 2x a shift for the I & O's. 5) Bed alarms on 6) 24 Hour chart check completed 7) Completed shift assessments a. Morse fall assessment (we do this on night shift) 8) Verify any new orders 10) Patient Summary for chart 11) Closing Shift note 12) Hourly rounding completed & documented 13) Locked reports at End of Shift This checklist keeps my time managed and that I make sure I don't miss important things that are required of my position. Time management comes with more practice and the better you get at what you do and how you do it during your shift. I have only been on this unit 1 year and I can tell you that I RARELY have to stay over to complete charting or to finish a med. My NM doesn't like OT, but sometimes you just can't help it. It will get better. I have almost 3 years of nursing under my belt now. It was a hard 3 years. I dealt with feeling overwhelmed, beaten down, and made to feel like I don't belong. I have fought hard to overcome this. I have been eaten by older nurses. I'm still here and I continue to do what I need to to be the best nurse I can. Be willing to listen to the nurses who do have your best interest at heart. It may not seem like you have any, but you will find one that does. I did. Open you mind and your ears. Avoid saying "I know" even if it's a throw away statement (a space filler, but doesn't really imply you do know). You will get used to time managing multiple patient loads. I can because I also don't allow myself to get rushed. Is it safe to have so many patients? Heck No! But, I don't allow the number of patients I have overwhelm me and their safety. I'd rather be late on a med than give the wrong med to a patient in a rush. In my time I have been placed in the position as Charge Nurse (most RN's alternate this position), but I feel good that my NM thinks I am good enough after a year to take on this position. This was one of her wishes, that I continue to learn and grow. Never be afraid to ask questions, even if you think you've asked it before, or you think it may be stupid. THERE ARE NO STUPID QUESTIONS. Understand many nurses are going to have very different ways of doing the same thing, but analyze what each one does and decide for yourself which one does something that fits your paradigm of patient safety or is more according to hospital policy. There is never any really wrong way if it is safe. If you work smart you will never work hard. Good luck!

RNsRWe, thank you for the correction. That was my understanding for the endorsements I applied for, but I understand what you are saying. The endorsements I applied for seemed to indicate that endorsement was more intricate if you had not been working for two years or were past your NCLEX by two years, maybe that's why I misunderstood it. I know the process was easy for me, but my experience is unique. I wanted to make sure that it was understood that it was unique and that it should in no way imply that some one else's should be the same. I should have used "pass" instead of "score" it is erroneous. What I hear from new nurses is "What did you do?". Also, I hear so many say "I don't understand why I can't find a job." I'll ask so what are you willing to do to get your first job?". Thank you again for the correction. I just wanted to provide some information regarding my willingness to spread myself out to let others know you may have to expand yourself to get there to your goal. Out of my graduating class I and one other student were willing to do this. Everyone else managed to get jobs locally.

When I was in nursing school I remember my instructors telling us that when we were ready to begin the search for our first jobs as young nurselings we would need to consider keeping ALL our options open. For many people those options can tend to be limited by various factors, such as location, family, or opportunity. Many people find getting their first nursing job difficult because of the job requirements. Many hospitals, especially Magnet want BSN AND 2 years of experience. Getting into Residency and New Grad programs can be limiting too, due to the number of times they run the program per year or the number of New Grads they take at any one time. My experience after graduation was not unique, but I was determined and persistent. I began applying to local hospitals even before I had passed my NCLEX (in anticipation). I applied to ALL hospitals regardless of requirements because you never knew what could happen. My only limitation at the time was that I wanted to work in a hospital, not a skilled-nursing facility or hospice. The feedback I got locally was not encouraging, so I began to throw my net out a little farther. I started to apply to hospitals across my state. If there was a Residency or New Grad program I applied for them quickly as they filled quickly or closed soon. I didn't seem to have much luck with that either. I threw out my net a little further and began applying all along the West Coast. In the meantime, I had only been able to muster up 1 interview…locally. As the months moved along I still wasn't getting much interest. I received a whole mailbox full of Thank you, but…” letters. I have family in the South, so I thought…Well, what have I got to lose? I had the flexibility to move. I had nothing tying me to my state. It would be a complete life change, as if nursing school hadn't already been. I applied for nursing licenses by endorsement in 2 states. The one I had family in and the state next door. I wanted them to take me seriously and having the license is as serious as it gets. Endorsement is easy as a new nurse. They use your NCLEX score for the endorsement. After two years to get a license by endorsement the states respective BRN's will use your work experience. I began throwing that net out as far as I could. I had family in 3 different Southern states, so I was never too far away from someone. When I did begin applying in the South, I found I was getting much more interest. I was getting calls to the West coast for job interviews on the East coast. More interview options than I had before. It was at this point I made the decision to move in with family for a while to see what my options were in the South. I had more options for locations and types of positions. I was offered positions in Med Surg, OR, ICU and Neuro ICU. I settled on a position in OR as I saw it as an opportunity that does not come along often for new grads. It was through a Residency program. The program lasted a year, which is an oddity as many Residency programs may last weeks or months, but not a year. Working in the OR was wonderful and difficult. It was a tremendous learning experience and definitely added to my confidence as the nurse I am today. After two years in OR I decided it would benefit me to move into another field to round out my nursing experience, so I took a position in Med Surg and work on a Medical floor in a small hospital. I get to know many of my patients well and I'm able to provide a level of patient care that I wasn't able to as an OR nurse. I love nursing as a whole and I love where I am at now. What I'm trying to say to the New Grad searching for their first job is that there needs to be a real willingness to spread that net far to find that first job. I was told you can work anywhere for two years to get to where you really want to be. I listened to that advice. So if you are having difficulty finding anything local, then you need to be willing to go as far out as it takes to get that job. It took me exactly 1 year and 1 week from graduation to get my first job. It also took me over 300 applications across the country and 2,000 miles to get that first job. I love where I live and I don't feel the need to move back. Not everyone will have my experience and I really hope you don't, but be willing to throw that net far out into that ocean. You don't know what type of job you might land or to what exciting place it may take you. Good luck!!