RN faces serious challenges at work, seeking answers

[Monkeytoes]

I've worked as an RN at night on a busy med-surg floor for a little over a year. As much as I love being a nurse, it has been an extremely difficult this first year! It seemed as though the first 6 months went ok, then I began to regress. The more mistakes I made, the more I lacked confidence in my actions.

There have been lots of errors I've made-mostly being unfamiliar with hospital policy, procedures, or with paperwork. More recently I made my first real medication error. Fortunately, I have never harmed a patient and have always been honest with my mistakes. I'm terrible with IV starts. I have made a lot of effort to improve my IV starts, yet still find myself frequently asking my colleagues for help.

I was just notified by our night Charge Nurse that she's writing me up up for the numerous errors made in the last few weeks including recent my recent medication error. She has reported everything to my Nurse Manager. In addition, she told me there is impatience brewing amongst some of the night nurses when it comes to helping me start IVs. She also stated a couple of day nurses think that I "don't get it" without specific complaints made. This CN reassured me that she thinks I have lot of potential, but I lack confidence. I respect my CN's decision because she's ultimately concerned about patient safety. I admire her honesty and concern. I have had a few meetings with my Nurse Manager about my performance in the past, and she will be speaking to me again about this writeup. I'm horrified to think about what's coming my way.

I never imagined that I would have such a difficult adjustment. I had a very positive experience in nursing school. I have a wonderful supportive husband, family, and friends. I get along well with the staff and I'm very open to constructive criticism. Always dreamt of being a nurse. I'm very concerned about patient safety and the direction of my career.

I am hesitant to be open with friends and nursing colleagues about my challenges at work. Feeling really hurt learning that some of my co-workers aren't being straight forward with me about their opinions. In the same token, I really enjoy many aspects of my job and don't want to give up when the going gets rough. I'm unsure about where to go from here or how to respond to my CN. Any advice would be greatly appreciated.

[DogWmn]

The first thing I see is you've been at work for over 6 months and are still not familiar enough with policy's and procedures...hmmm? It is YOUR responsibility to familiarize yourself with these even if you do it on your own time before or after a shift. IV's are a skill, in many states there are IV courses for LPN's maybe you should take one or do you have an IV team you could work with to improve your skills? If you have become a burden to other staff because you lack good IV skills YOU need to become pro-active and do something about it and not wait for others to 'fix your skills'.

I'm an LPN, graduated in '72 before we were even allowed to start IV's, when the laws changed I took it upon myself to become proficient seeking out help from my NM before classes were even offered. Together we arranged a short program that would educate myself and all other LPN's working at that time. It became the basis for the hospital's program and eventually was approved by the BON.

I don't mean to sound harsh but ultimately you are responsible for yourself. I went to school at a time when we had tons of clinical hours (more than the ADN and BSN programs at the time), we had skills that we HAD to be proficient in BEFORE we could graduate. Book learning/theory is all well and good but if after 6 months you can not even insert a peripheral IV you need to 'take the bull by the horns' and fix it yourself.

[JemJ]

Monkey, I'm so sorry to hear that. I had a similar experience when I first started. I was struggling so badly and finally made a couple of big med errors. The patients were ok, but I got hauled in to my DON's office. What happened there was probably a huge blessing. Instead of firing me, they transferred me to a new unit, gave me a fresh start. I flourished there. Part of what may be your problem is you've already beaten yourself up so much that every time you move, you're scared you're gonna mess up again, which makes things even harder. And we all know how people talk, which makes the environment uncomfortable. You may want to talk to your manager about perhaps transferring units, maybe to one either less stressful or one more specialized. Work shouldn't be terrifying or make you sick to your stomach. And if you're worried about your IV starts, the best way to fix that is practice. Depending on what happens, you may want to ask everyone on your unit to allow you to help with their IVs until you get the hang of it. Is there anyone you feel close with or trust? Anyone at work that might let you practice with them? Keep your head up, honey. And Good Luck! I'll say a prayer for you :)

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Recently it seems that new grads come with less and less clinical experience, especially invasive procedures. You didn't say, but I'm assuming you're a new grad. Nursing jobs are like clothing. Sometimes you have to try on several before you find a good fit. Some people have a harder time finding a good fit than others (my shoe size is 15EE, trust me). Good luck.

[grandmawrinkle]

If you've been working for a year on med-surg on the night shift you should be more up to speed than you are, IMO. The IV stick thing can be hard for everyone and if you don't get a lot of practice, I wouldn't beat yourself up about that in particular, but the rest of what you described should be resolving by now. It it concerning that you feel that you are doing worse, or at least not making any progress. I am not sure if you are being realistic with yourself or unnecessarily hard, though -- hard to tell from a short blurb and not actually watching you.

If you think you have a realistic assessment of the situation, I would consider getting out of hospital nursing. Med/surg just may not be the place for you. There ARE those that cannot keep up -- we've all had them on the units from time to time. I've had to orient some of them myself. To be a ward nurse, you need excellent time management, assessment, prioritization skills in addition to proficiency with basic nursing skills (like IV starts) and you need to be able to multitask. Realistically, policies, procedures and your unit's routine is something that you should have gotten a basic grasp of on orientation. If it's been a year and it hasn't come, it might not.

People that couldn't handle the workload in my area have gone outpatient (dialysis centers, home care/hospice) and into areas like psych (if they are excellent interpersonally) and have been very good at it. You need to go where your strengths are.

[esrun00]

Sorry you are having such a time. Go to your nurse manage now and ask for help and guidance. They have spent time and money and would prefer to keep you. Do you have any friends that work with you? Or any other friends that are nurses to ask for help. It sounds like you need help with time management skills. You do need to know your facility's p/p but you don't need to memorize, just know how to look up if have a new procedure or of unsure of something.

As for the iv starts, I was also horrible. It took me almost a year to get decent at it. What I did was come up with a little ritual, I can't remember everything I did, but everytime I had to start an iv I did it and it worked. I think it just gave me the confidence. You could ask the NM if maybe you could volunteer in ER/surgery for a couple hours and just start iv's. You might not be able to volunteer, it would probably have to paid time, but if you suggest it has a way to help, or maybe in labor/delivery-they all get iv's.

I hope things get better for you.

[ADPIE10]

I'm also a new grad, I think that it's great that you found a job. There are so many variables that I don't know, thus it's impractical to give advice.

I can encourage you not to become discouraged. Confidence is a big aspect of everything that we do. My recommendation is that you find a mentor and start celebrating small successes. You can only try your best, and your best must always be good enough to you!

Communicate with those that you know love you. Contact your former instructors and seek their advice. Trust people that have a vested interest in your success.

Good luck.

[HappydayRn]

I struggled during the clinical aspect of nursing school at times. What helped me was one simple mantra "fake it till you make it." Confidence is a huge part of nursing, I know if I don't feel confident I get overwhelmed and shut down. All of my prioritization skills, time management, everything would just fly out the window. I'd put on my smile say to myself I know what I'm doing and I'd act like I did, even though inside I was a ball of jelly. At some point I wasn't faking it anymore it was real confidence.

Try to figure out what's bogging you down, make a list of things (procedure's and policies) you should know. Then make sure you read through them each and learn them systematically. If you are unsure about paperwork, look up the policy before you complete it. You also might want to ask if there is a mentor program at your hospital. Even using the EAP if you have any.

Do you have any personal stressors that are interfering? Are you getting enough sleep/food/stress release to function well at work. Did something happen at the 6 month mark?

[shoegalRN, RN]

I understand what you are going through. I went through something similiar when I started off in the ICU.

Is it possible you can ask to go to the GI lab a couple of days a week and do nothing but IV starts? I work in the GI lab a couple of days during the week and we get nurses there all the time who were "sent" there to just start IV's only. They are floor nurses, but they are sent there to get more IV practice.

I would sit down with the CN and ask for "specific" situations or incidents that your co-workers are complaining about so you can correct them.

Good luck to you!

[jacrabbitrn]

Monkeytoes,I can completely relate to your situation and felt the same most of the first year and a half. I was lucky to have a seasoned nurse befriend me and mentor me through. She was always willing to hash things over and help me figure out how to improve. I am finally start feeling more confident and like a "real" nurse. It's the little victories that come more often, getting a few IV starts in a row, sinking the NG the first time. Sometimes the nurses would get tough with me and it would be time to buck up. But after I saw a few experienced nurses crack after a particularly hard shift, I realized I am human and learning. Your heart and instincts will help until you gain much needed experience. I like the fake it till you make it statement, lots of wisdom there (just make sure you get help in the critical situations) Of course this site helped and still helps. Step back, take a breath and regroup. Maybe take a LOA if possible and see if the smoke doesn't clear a bit.

[Scarlette Wings]

sounds like you are having a really rough adjustment time. med/surg is physically the hardest work there is to me of all the areas that i have worked. i loved it but learned when to back off and make a change for a few years and then return. not everyone is designed to work med/surg and that is okay. hospitals have many different departments and units and each speciality is different. the pace and intensity is different in each area as well. usually by a year you know if med/surg is right for you.

i would advise one thing though. do not evaluate yourself as a nurse or yourself as a person by only the one area of experience. that would be too limiting and may clip your feathers just as you are about to fly. talk with your nm and cn and ask for a transfer. icu is more hi-tech but does more one-on-one patient care. ratio may be 1:2 but even so, there is a difference. the lines in icu are more often than not central lines, art lines, swans ganz lines. nurses do more line care tasks thained wonderful experiencen peripheral sticks.

there are just so many areas nurses can go into, please don't get down on yourself. you have learned a tremendous amount and have gained a huge amount of skills that you are not giving yourself credit for.

you have wisly recognized your weaknesses, now focus on what things that you do well at onthe floor. what do you enjoy doing? what job interest you. i would see this as a positive opportunity foe growth.

don't worry about the iv thing, experience give that. rome wasn't build in a day. consideer this a learning process, one of many on you walk in life. you will make it. look for what you are intersted in and good luck.

[rn4ever?]

Sorry to hear that you are going through this. It’s good to be honest about your mistakes. It’s also good to learn from them and not commit it again. But also, be careful who you trust in the work place. Some may be helpful and act like a friend who is concerned-----but watch it, that “friend” might just be backstabbing you and giving all negative feedbacks to your CN or NM. Do your best. If you could find one experienced and knowledgeable person who would genuinely agree to be your mentor (rather than ask around for everybody’s help), then that would be fabulous!