I have posted on here several times before, but in short, I am a relative new grad. Only a little over a year out of school. I have failed out of two med-surg orientations. I am currently working at a nursing home and it was going fairly well, up until recently, where again, I am being told I'm not good enough/my assessments are not up to par, I'm basically incompetent. I'm scared and angry..... Everywhere I turn, I am being told apparently nursing isn't for me. This is all I have ever wanted to do. So now I have a nursing degree and very little clinical experience to get into anything like informatics or..... So now I'm stuck. I don't really know what else I have an interest in. I don't know where to go next. I really don't want to be stuck at a desk job or sitting in front of a computer all day. I have a nice nest egg (financially) and I still have my job at the nursing home, (so I don't need to make a decision in the next couple of days) but I don't know if I will be staying. Any other suggestions on where I can turn to? I LOVE nursing. It hurts and breaks my heart to even consider walking away, but no matter what I try, I'm told that i can't do the job.
In your OP, you state you don't have enough experience to get into informatics. A few lines down you state that you don't want to sit in front of a computer all day. Informatics is a computer based job...now, stop focusing on the future, because as a new nurse, you've got to get through the here and now. It's great to have goals, but most new grads don't realize that you've got to get experience to move into these positions. I've seen a lot of excellent advice given, run with it! The only thing I might add is to work with facility educator, ADON, and/or DON to periodically check on your progress and needed skills to keep you on track. Best of luck to you, you can pull through this!
In your OP, you state you don't have enough experience to get into informatics. A few lines down you state that you don't want to sit in front of a computer all day. Informatics is a computer based job...now, stop focusing on the future, because as a new nurse, you've got to get through the here and now. It's great to have goals, but most new grads don't realize that you've got to get experience to move into these positions. I've seen a lot of excellent advice given, run with it! The only thing I might add is to work with facility educator, ADON, and/or DON to periodically check on your progress and needed skills to keep you on track. Best of luck to you, you can pull through this!
I'm not necessarily saying I want to get into those areas. I love the bedside, but everywhere I turn, I'm being told that I'm not competent/cut out for it. My mom was just starting to recommend that I look at branching out, that maybe bedside isn't what I'm meant to do. I don't know right now
I'm not necessarily saying I want to get into those areas. I love the bedside, but everywhere I turn, I'm being told that I'm not competent/cut out for it. My mom was just starting to recommend that I look at branching out, that maybe bedside isn't what I'm meant to do. I don't know right now
May I ask what area you are in? I've walked in your shoes, and have seen this happen to so many other nurses six ways to sunday. What happens around here is that the hospitals hire a whole bunch of new grads but rarely transition any of them out of orientation. Its been going on for years now, and the new nurse does not realize upon hire, that she is there basically auditioning for a job in the future that isnt guaranteed to be available. Their reason for this is that they think somewhere in those first 90to 180 days of your job a staff nurse will resign, go out on leave, retire, etc, and then there will be another nurse already trained and ready to slide into the vacancy. Problem is, no one is retiring, jobs are scarce, nurses who have jobs are staying planted where they are, and consequently the result is the new grad is dismissed before she or he can transition. I have also witnessed and experienced preceptors who sink their new grad on spite, out of jealousy, or for no reason at all. Happens all the time. Happenned to me twice (ER and a step down unit) where the unit manager told me I was useless and to return to nursing school, that "the girls didn't like me", etc, etc..of course we know (wink, wink) that it could not have possibly had anything to do with the bogus sign on bonus they never had any intention of paying out. Very recently, I heard of this happenning again to another nurse, at the same hospital I worked years ago. The guy relocated with his family for a job there, and in 90 days his preceptor pulled the plug and told him he was not cut out for nursing. If you made it through nursing school, trust me, you are not incompetent. There is a special place in hell for managers who already know they have NO position for the new grad to transition to, yet instead of telling the nurse the truth, they intentionally and maliciously strip you of your confidence. Here's what I have learned to do with people like that...take note of their name, put your car in drive, hit the gas, and don't even look in the rearview mirror. Onward. LTC is harder work than hospital work, trust me. Stay put for awhile, then decide where you want to go, and do not let anyone step on your dreams.
It does come with time. I started in the ER at a small, community hospital. 10 weeks into my orientation I was told that I wasn't "getting it" with regards to the critical patients and they wanted me to spend a month in ICU getting more critical care experience. I cross trained and did my time. Then I was told that they wanted me to stay in ICU due to nurse shortage in ICU. I said no and went back to ER, really apprehensive because only 1 month earlier I'd been told I wasn't cutting it.
It took time. I definitely have some stories about getting talking to by doc's regarding not giving them the right info/too much info, etc. I remember I interrupted a doc huddle/transfer patient care meeting to tell the doc that the dialysis patient's (who had missed two appointments for dialysis) BP was elevated at like, 230/145. He looked at me and basically said: "Hypertension is not a good enough reason to interrupt this meeting UNLESS the patient is having a stroke or stroke like symptoms. Is she?" and I was just ah--"um...I dunno?" and backed away. I hadn't done a full assessment of her, I hadn't thought it through or talked to the charge/other nurses about it. I was treating the number, not the patient.
It comes with time, patience, and experience. Give yourself all three of those and you'll be golden!
From your previous posts, I've gathered you are very literal and a black/white thinker. Nothing wrong with that; in fact you can use it to your advantage. Try making algorithms for yourself when you get an abnormal lab value. Electrolytes, hemoglobin, WBC are probably the most common abnormal values.
For example, if you get a low potassium level:
1. Get a set of vitals.
2. Assess for the signs/symptoms of low potassium (such as abnormal heart rhythms) and causes of low potassium (such as vomiting/diarrhea). You can make yourself a checklist so you don't forget.
3. Look at what medications they are taking that might cause low potassium (such as lasix) and that might be adversely impacted by low potassium (such as digoxin)
4. Make sure you don't have standing orders that address this lab value.
5. Call physician with your findings, using SBAR format.
So, your call to the doctor might go like this:
S: I'm calling because Mary Smith in Room 22 has a potassium level of 2.7.
B: Her current vitals are: _____. Her prior potassium level was 3.7, taken on November 13, 2018. She is on 40 mEq of IV lasix BID for a heart failure exacerbation.
A: She is on telemetry and she had 7 beats of v-tach at 0835, otherwise she has been in sinus rhythm. No muscle weakness, myalgia or muscle cramps noted on assessment.
R: Her creatinine is 1.02 and GFR is 54. Would you like to replace her potassium and recheck her potassium level in four hours?
I work in a nursing home too. Day shift is the hardest nursing shift I think. I go with the night or evening. Ask if you can change shifts and you know the work might be different.
Remember that you are not just calling a Dr to "give a heads up", you are doing it to make sure the resident gets proper treatment. You are seeing calling the Dr as a CYA moment instead of being meaningful. You might not know the pt's baseline, but the Dr probably does not, either.
I recommend doing a focused assessment before calling the Dr, including pertinent physical assessment data, VS, past lab results and pertinent meds. The challenge with LTC is that you are likely the only RN (no one to bounce ideas off of), the residents are probably only seen by the MD/NP every month, and they are not getting nursing assessments every shift.
Make yourself a little checklist if you have to. Best of luck!!!
Specializes in Neurosciences, stepdown, acute rehab, LTC.
Hmmmm is it just your assessments? Maybe ask your boss what the specific concerns are and what they think you can do to work on them ? I find it easier to learn things at home, in a controlled environment. You can journal your specific worries, and then that will help you clear up what the problems are (even if there are tons of problems!) if you can specify a problem (or 100) you can come up with plans to correct the issues. I agree with the poster who said to stay there. You can get this job down pat and then be ready for something else later. Nursing is so unnatural for a lot of us. It takes a while to get good at it. Find other nurses you like and trust to help mentor you too
May I ask what area you are in? I've walked in your shoes, and have seen this happen to so many other nurses six ways to sunday. What happens around here is that the hospitals hire a whole bunch of new grads but rarely transition any of them out of orientation. Its been going on for years now, and the new nurse does not realize upon hire, that she is there basically auditioning for a job in the future that isnt guaranteed to be available. Their reason for this is that they think somewhere in those first 90to 180 days of your job a staff nurse will resign, go out on leave, retire, etc, and then there will be another nurse already trained and ready to slide into the vacancy. Problem is, no one is retiring, jobs are scarce, nurses who have jobs are staying planted where they are, and consequently the result is the new grad is dismissed before she or he can transition. I have also witnessed and experienced preceptors who sink their new grad on spite, out of jealousy, or for no reason at all. Happens all the time. Happenned to me twice (ER and a step down unit) where the unit manager told me I was useless and to return to nursing school, that "the girls didn't like me", etc, etc..of course we know (wink, wink) that it could not have possibly had anything to do with the bogus sign on bonus they never had any intention of paying out. Very recently, I heard of this happenning again to another nurse, at the same hospital I worked years ago. The guy relocated with his family for a job there, and in 90 days his preceptor pulled the plug and told him he was not cut out for nursing. If you made it through nursing school, trust me, you are not incompetent. There is a special place in hell for managers who already know they have NO position for the new grad to transition to, yet instead of telling the nurse the truth, they intentionally and maliciously strip you of your confidence. Here's what I have learned to do with people like that...take note of their name, put your car in drive, hit the gas, and don't even look in the rearview mirror. Onward. LTC is harder work than hospital work, trust me. Stay put for awhile, then decide where you want to go, and do not let anyone step on your dreams.
Thanks. Currently LTC. But I don't want to stay here. I want to go back to the hospital or perhaps something like an outpatient infusion center...... just nervous it's going to be the same thing over and over. Two hospitals and now even my LTC are questioning my nursing abilities. REALLY hard to trust/gain confidence that I can actually do bedside when it's the same song and dance
From your previous posts, I've gathered you are very literal and a black/white thinker. Nothing wrong with that; in fact you can use it to your advantage. Try making algorithms for yourself when you get an abnormal lab value. Electrolytes, hemoglobin, WBC are probably the most common abnormal values.
For example, if you get a low potassium level:
1. Get a set of vitals.
2. Assess for the signs/symptoms of low potassium (such as abnormal heart rhythms) and causes of low potassium (such as vomiting/diarrhea). You can make yourself a checklist so you don't forget.
3. Look at what medications they are taking that might cause low potassium (such as lasix) and that might be adversely impacted by low potassium (such as digoxin)
4. Make sure you don't have standing orders that address this lab value.
5. Call physician with your findings, using SBAR format.
So, your call to the doctor might go like this:
S: I'm calling because Mary Smith in Room 22 has a potassium level of 2.7.
B: Her current vitals are: _____. Her prior potassium level was 3.7, taken on November 13, 2018. She is on 40 mEq of IV lasix BID for a heart failure exacerbation.
A: She is on telemetry and she had 7 beats of v-tach at 0835, otherwise she has been in sinus rhythm. No muscle weakness, myalgia or muscle cramps noted on assessment.
R: Her creatinine is 1.02 and GFR is 54. Would you like to replace her potassium and recheck her potassium level in four hours?
You can do this for vital signs out of range too.
You hit the nail on the head for black and white.... it's causing a lot of problems for my "critical thinking skills" which is a problem theme among my previous and current employers....
Hoosier_RN, MSN
3,968 Posts
In your OP, you state you don't have enough experience to get into informatics. A few lines down you state that you don't want to sit in front of a computer all day. Informatics is a computer based job...now, stop focusing on the future, because as a new nurse, you've got to get through the here and now. It's great to have goals, but most new grads don't realize that you've got to get experience to move into these positions. I've seen a lot of excellent advice given, run with it! The only thing I might add is to work with facility educator, ADON, and/or DON to periodically check on your progress and needed skills to keep you on track. Best of luck to you, you can pull through this!