Six-month mark. "Is this for me?"

[Barr, BSN, RN]

I have been a nurse for nearly six months.  I still struggle with time management and find a few team members annoyed with me because of it.  It is common to find me working one to two hours late to chart and, quite honestly, I am sick of it.  A nurse was seriously mad at me, reporting me for not starting an NG tube on my shift that was ordered near the end of it. I was so busy that I ran out of time.  She reported me to the charge nurse who wanted me to stop charting at 8PM and go start the NG tube (shifts are 7 to 7).  I have never put an NG tube in, except in a stiff mannequin and my shift had ended an hour earlier.  

I started on day shift knowing it was a challenge for new nurses to manage the intensity of the day shift.  I had worked night shift as a PCT for a few years and just had gotten too exhausted from nights that I really wanted to take on the challenge of day shift to avoid working nights.  The COVID pandemic has been really hard on new nurses.  Our hospital was hit hard and our med surg units were full of COVD-19 patients.  We had started with 4 patients and that turned into 6 COVID patients each.  Now the endemic has slowed down and our unit is back to med surg with 5-6 patients each.   I had two hellish assignments, that included two heparin drips, dressing changes, and gastric tubes, sickle cell needing Q4 meds.  IVs were infiltrated, gastric tubes weren't working, medications weren't compatible, an patients were upset.  I had two nurses tag off to help me start new IVs, get the port needles replaced, change a dressing that leaked all over the floor and bed.  I was so overwhelmed, I wanted to cry but had no time.  Similar shift the following day, neither day did I find a minute to take a sip of water, let alone eat.  By the end of the second shift, I was so spent I threw out the pain meds with the waste and had to start over. The ss patient was going off in the room throwing things and screaming, nurses were yelling, "Give her her medication!!" but it was in the waste container and I needed help.  I broke down and wanting to just walk away from it all.  I felt so alone, that I was to blame and not fit for the job.  

The following day, I texted my manager that I had lost my confidence and was depressed.  I had drifted far away from the excitement of being a nurse and on this unit working the day shift. My manager was perfectly supportive.  However, this is not the case for several team members.  It seems so petty to put down new nurses who are struggling with challenging assignments and it eats at me these nurses and nursing assistants.  

What I am getting to is, am I far behind in the development of a nurse 5 months in?  I work on a busy med surg unit.  I think the pace will start to get to me, esp when I see my paycheck comparing responsibility/stress.  Some of my so-called teammates snicker and make rude comments about my time-management struggles and I have trouble shaking that. 

Am I being hard on myself or do I suck at this?  I do try different strategies to find my system, but on this unit is it a sink or swim event daily.  I am the only one leaving at 9PM and I a tired of it.  Of course, when acuity is low I am done charting by 1PM, but when there are things I have never done (peritoneal dialysis or even heparin drips, for example), I get nervous and work much slower as I process what is needed to get started.  There are many tasks I haven't tried yet which takes time to get use to and apply a system.  I put in one foley months ago, got one IV successfully months ago (ugg) and I have never put in an NG tube.  I wish they would give new nurses 5 patient max during first 6-8 months.

The silver lining is the last 4 shifts I had were much, much easier.  My patients were complete angels.  I loved taking care of them and they were so appreciative.  One patient even brought me a thank you card and gift.  I do get so much reward out of seeing people recover or being there when the news is grim.  

Any insight or inspiration here would be so appreciated.  Thank you all.

[NurseGuru]

I'm so sorry to hear that you're experiencing that- it sounds like alot of the other nurses are not being patient or understanding with you and that is completely unfair. As a new nurse, everyone struggles. 

It wasn't until I was a year or two in that I finally found my flow with time management and felt a little more comfortable. It is really important to seek out a mentor- there has to be someone who is more experienced that would be willing to help you if you approach them. 

I would make it a priority to keep talking to your nursing leadership because they need to hear how you're doing that way if anything comes up (especially if others are going behind your back to report you) then they hear your side first. There is nothing wrong with enrolling yourself into a continuing education program to work on your skills. We aren't supposed to know everything and no one is perfect.

The fact that you took this to heart means you care alot about your job, about your patients and it is so good that you care! That is a really good sign! Be proud of yourself! Lots of people walk away from the profession altogether or start looking into jobs away from the bedside or away from people. 

Don't forget how hard you worked in nursing school.

You EARNED your right to be there, working as a NURSE like everyone else. And it sounds like you are trying your best. You are exactly where you need to be in terms of your learning & development- you're a novice. 

 

[JKL33]

On 10/14/2021 at 12:14 AM, Barr said:

Am I being hard on myself or do I suck at this?  I do try different strategies to find my system, but on this unit is it a sink or swim event daily.  I am the only one leaving at 9PM and I a tired of it. 

Hello.

What you are describing is at least somewhat typical as far as the significant number of new things to be learned and how uncomfortable that feeling is.

I kind of doubt that you are far behind where a typical new grad would be. This can't be judged by what you see your newer-nurse peers doing. Sometimes people look like they're doing great because they have evolved ways to make it look like they are, when in reality they know only as much (or less) as other learners. 

But we can't really judge where you are, either. I don't necessarily think charting after shift is indicative of failure/being behind at the back of the pack; it is often due to many factors such as amount of assistance received/team work, timing of events that occur on the unit, experience vs. inexperience, or a preference for doing a good job vs. getting something done.

1. Review your prioritizing and make sure you are making good decisions on that front. Just because something is supposed to be done doesn't mean it's a priority in this profession. Assess your patients and prioritize based on patient need, legal requirements and ethics. Hospitals' fantasy preferences are last on the list.

2. You may have to tackle things in a little more head-on manner. For example, if that NG order was in before 6 (or so) or was a relatively urgent patient need, then gather the supplies, quickly review the steps of the procedure, and then walk right up to one of these snickerers and ask them to come along for the fun. You give them power over you when you start to detach from the group and feel bad about their wrong behavior. In reality their snickering and other shameful behaviors are about them, not you.

I suspect you're okay. You just need to tweak some things. Don't get down. Do everything in your power to stay positive and proactive.

Good luck! ??

 

[kbrn2002, ADN, RN]

It sounds like you are right where you should be in terms of your development. Sadly new nurses are more often than used to be just not getting the support to become proficient in practice that they need to thrive. 

 

Seems like every floor everywhere is short staffed, especially with experienced nurses so the few that are experienced end up with their already overwhelming workload being added to by the need to support, guide and help their more inexperienced co-workers. Not your fault, not their fault either. It's a system failure that I really don't have an answer to. 

[TippyTappyMeow, MSN]

As a newer nurse who knew bedside wasn't probably in my cards the advice you've gotten has been solid. 

My biggest piece of advice is try to find one or two co-workers who you can trust for support. I found one who I really had to lean on. Whenever they worked it instantly made my shift go smoother. If I had a particularly bad shift without them I'd try to review one or two key moments for feedback whenever we worked next.

I will say as I was leaving I finally felt a little better going into work. I felt like I had "proven" myself to my unit. They knew my strengths/weakness and recognized I'd call upon them quickly when needed.  I worked nights which I'd say was the heavier shift because we did all the admitting and majority of the interventions, but to be fair dayshift had a similar pace. 

Lastly, I've never done some of the skills you mentioned. Placed 1 foley, 0 NGs, and maybe a couple IV's with assistance during my bedside career. I'm now a clinic nurse who has to be trained on IM injections because I've never done that either! 

[Barr, BSN, RN]

I am so appreciative of each of your supportive comments.  The fact that you are on this site providing support to new nurses, or nurses in general, tells me how passionate you are about your profession.  Your insight and wisdom helped me regroup. 

I especially like the comment, "You give them power over you when you start to detach from the group and feel bad about their wrong behavior."  I must add, I find those nurses who demonstrate poor behavior so repulsive, I withdraw from associating with them immediately.  One I addressed privately where they apologized.  They have not worked my shifts or near my assignments since.  Another admitted their wrong the following shift, and a third-person I reported as it was twice in front of my patient and abusive. This lack of cooperation among care team members turns into a safety issue on the unit, as a whole, and therefore a reportable offense.  Fortunately, my manager agrees the behavior must stop and is addressing it.  Moreover, the corporate hospital I work for has a reporting process, as well, for lateral violence. It is so annoying to deal with lateral violence when nursing itself is overwhelming in itself.   Again, thank you all for your supportive insights to help guide to more productive nursing care and time management. 

[Barr, BSN, RN]

By the way, I did offer to place the NG tube with the onboarding nurse, but she is a difficult personality and rude, so naturally she preferred reporting me, chastising me, and refusing to assist me when I offered to place the tube, stating she will take care of it on her own.  I'm sure you know this type. Good grief.

 

[JKL33]

@Barr I'm glad you have focused on re-grouping.

You're gonna be okay.

Let us know how things are going!