reality shock

mitchsmom · Jul 4, 2006

Give me a week or two and I'll be right there with ya!!

I haven't even started yet and I'm already having pre-reality shock because I know I'm going to need a review of alot of the stuff I already did in preceptorship (in April) & I know they are prolly going to be like OMG you should know/remember this.

Plus I'm also getting paranoid about the 12 week orientation (which I thought was pretty standard) as I'm now seeing that some people are getting 6 mos.!

Judging by my preceptorship, I'm sure I'll be sitting there quite late a LOT of the time doing paperwork (especially since they started a whole new computer system since my preceptorship).

I usually do HR/RR for a full minute, too. Especially in the first hours/day; maybe not always later on. Maybe when I get really used to it one day I'll do it shorter but for now people will just have to wait. In fact, one baby I cared for had a strange irregular heart beat that wouldn't have been detectable with a 15 second listen (it would be regular for about that long in intervals). I had to listen for like 2 minutes to be sure of what I was hearing and my preceptor didn't hear it until I asked her to listen for a full minute, so for whatever it's worth...

I haven't encountered that med situation... yet! Like I said, let me get back to you LOL Hang in there!

grinnurse, RN · Jul 6, 2006

OK so I have been working as a GN since 6/5. The whole first week was orientation etc and every friday is NCLEX review. But I have managed to get some floor time in.
I was working with a preceptor (unfortunately I seem to have many). I had two pts who needed meds, and so I prioritized that pt A needed the meds first and got them ready. I was encouraged by the preceptor to pull both pt's meds to save myself time going back into the med room. The med room is not far away, one is in the nurse's station and there is even another one farther down the hall. She just said it was more efficient to pull more than one pt's med at a time.
I told her that I could not do that. I used the excuse that I am new but I also said that I didn't feel it was safe patient care to carry another patient's meds around in my pocket.
She may have been frustrated but told me ok, to do it the way that works best for me.
So that was #1.
#2 is the amount of nurses who only count newborn's respirations for 15 seconds, and heart rates for 15 as well. I was taught a full minute for each, and that is what I do. It takes longer, but I am new, so at least for now I have that excuse.
#3 is the fact that I had to stay almost an hour late because my preceptor, instead of helping me finish paperwork, show me the computer etc, did some paperwork for the oncoming nurse because she felt bad for her. Ok, I totally believe in teamwork and helping each other. But that is only good when its only yourself you make stay late. I wanted to finish my paperwork! I know that this sounds petty typed up but truthfully, the other nurse said not to do it but she did it anyway.
Anyway, if anyone else is experiencing reality shock, feel free to share.

The first thing I need to say is that it can work to your advantage to have more than one preceptor b/c it can give you different perspectives on things such as time organization and styles of doing things as long as you are not with a different preceptor everyday.

As far as #1 goes I agree that it is not a safe thing to do to carry to pts meds to the room unless clearly marked like maybe in one of those little plastic bags b/c you are checking name bands and all before giving. If you have med drawers on a cart, it is a good idea to pull meds and leave them in the drawer and then come back to get them for each pt. This can save time b/c the med carts can get congested.

#2 keep up the good work and don't fall into other nurses bad habits especially with the newborns!! That is wrong the way the others are doing it. That would be like not counting for a minute on an apical pulse for an adult. I have been at this for a year and I still count for a full minute and when I go for orientation next week for OB and nursery you bet I will be counting for the full minute.

#3 I think you will understand this more once you get on your own. The better thing for the preceptor to have done would have been to help you first and then do the other for the oncoming nurse. For the past three days I have worked on a unit with no teamwork what so ever and it sure makes a difference in how the day goes from not only the day shift that I worked but also from the night shift and I will take teamwork any day over what I just experienced.

Keep on doing what you learned in NS and don't let others sway the way you do things and good luck your first year.

MIA-RN1, RN · Jul 6, 2006

thanks Grinnurse. That is true what you said about having more than one preceptor, I am realizing that as I worked with someone else last night and things went really really smooth and I felt like I learned a lot but was not overwhelmed. (the nursery was rocking last night!!)

We don't have a med cart, so everything is preppped in the med room by the pixys. Its funny--and I guess more reality shock--that in school we learned the whole med cart routine, locking it, carrying the key, etc etc. and I have yet to use one anywhere else but the nursing home I was at in first semester!

I really do love my job tho, and I feel like i am making a real difference, so even with the things that are different than in school, I am feelingreally good about things.

**canoehead, BSN, RN** · Jul 6, 2006

#1 I completely agree with you, it's a set up for a mistake.

#2 That's the ideal practice, but ideal may not make it when you are already two hours behind. Once you do a full assessment you may choose to focus on the problems you've found during the rest of the day.

#3 I wasn't there, but perhaps she was trying to let you do your own work while staying late to be available. Better to stay busy helping someone else than hover over you. the more she lets you do for yourself the faster you will be independent and learn to budget your time.

wonderbee, BSN, RN · Jul 9, 2006

#1 i completely agree with you, it's a set up for a mistake.
#2 that's the ideal practice, but ideal may not make it when you are already two hours behind. once you do a full assessment you may choose to focus on the problems you've found during the rest of the day.
#3 i wasn't there, but perhaps she was trying to let you do your own work while staying late to be available. better to stay busy helping someone else than hover over you. the more she lets you do for yourself the faster you will be independent and learn to budget your time.

agreed about #3. i found it totally unnerving to have my preceptor sitting next to me, with hands folded over her chest in that impatient "i would like to get out of here sometime tonite" sort of way. it was better for me (and probably for her too) when she was somewhere else doing something more productive. of course you should have a basic orientation about the computer and she should make herself available for questions. however, if you feel you need her sitting there next to you, don't be afraid to speak up. communication between preceptor and orientee needs to be a two-way interaction. she's not your boss. she's there to facilitate learning and she doesn't know what needs are specific to you unless you tell her. start off on the right foot.

MIA-RN1, RN · Jul 10, 2006

agreed about #3. i found it totally unnerving to have my preceptor sitting next to me, with hands folded over her chest in that impatient "i would like to get out of here sometime tonite" sort of way. it was better for me (and probably for her too) when she was somewhere else doing something more productive. of course you should have a basic orientation about the computer and she should make herself available for questions. however, if you feel you need her sitting there next to you, don't be afraid to speak up. communication between preceptor and orientee needs to be a two-way interaction. she's not your boss. she's there to facilitate learning and she doesn't know what needs are specific to you unless you tell her. start off on the right foot.

i agree but the problem was that i had no idea how to use the computer at that time so it was hard. things have been going much better lately, i have been working pretty much exclusively with another preceptor and she and i are enough alike that we work well together and think along the same lines. so its going well (except for staying almost an hour late every day!)

teatime623 · Jul 11, 2006

my first 6 months in nursing led me to have work related anxiety & with the help of my therapist i started to cope but until now (the 11th month) i m still suffering & now m on " Xanax " to help me to over come the reality chock as a novice new nurse .

it is not easy at all to be a brand new nurse in a hospital like my hospital so i dont know to where it will lead me , may be to quite the whole proffesion who knows? :eek:

grambograham · Jul 12, 2006

Heart rates, if regular can be counted for 30 seconds or maybe 15 seconds. Newborns need a full minute at all times. They do not breathe or have a heart rate which is regular. They change second by second.

luvmy2angels · Jul 12, 2006

I work at a place where the RN supervisor gives her 2000 and 2200 meds at 1700 becasuse it is "too hard" to get the residents to take them once they are in bed. She has also trained her LPNs to do this too. I however refuse to do it. I haven't work with her yet when I have had this cart but I WILL NOT give meds 2 to 5 hours earlier than scheduled. I understand that there are exeptions when this may need to be done, but she does it purely for HER convenience. My reply when she will no doubt ask me why I am not giving them at 1700 is....would you still be giving these pills this early if the state was here watching you????? I don't think so!!

bigmona · Jul 13, 2006

i think the main thing for all of us to remember is that (if we have passed boards), OUR license is ultimately on the line. do what YOU know constitutes safe practice. of course, easier said than done at times when you have your preceptor breathing down your neck- but still, gotta keep that in mind.

i just started on a unit that is FULL of bad habits and i'm nervous about being taught how to do things the "easy" or shortcut way. i think bottom line is, i need to feel safe to practice, and i'll use my preceptor to guide me both in how i should and should not do things (she openly admits to having some bad habits of her own).