So much harder than I expected :(

Annaiya, NP · Aug 8, 2012

First off, take a moment to stop and breathe. It sounds like everything you're saying is totally normal stuff. It doesn't sound like you aren't getting the job, you're just overwhelmed with how much there is to learn, which is to be expected. Talk to your educator or manager (whoever is in charge of your orientation) and let them know that you would like a little longer orientation. Talk to your preceptor about how you're feeling and see if she has any suggestions. Then realize that there is NO way you can know everything you need to know when you come off orientation and you will have to rely on your charge nurse and your other coworkers for help. Yes, they are busy, but they will hopefully take the time to help you.

Before you call a Doc, review the SBAR for your conversation, so you know ahead of time what you need to say. Make sure you have all of your information with you before you call. If you're calling to say Patient X had 5 beats of V Tach at 2134, have the strip with you, so you can reference it if you need to. Have their latest set of vitals, etc.

If you are concerned about a patient ask your charge nurse to go in an assess them and give you their opinion on their status. That is what they are there for! My charge nurses trained me in way more than my preceptor. And by the time you've been there a year, you will have forgotten how hard it was when you started. I was precepting a new grad a couple of weeks ago and she was talking about how she always gets Klonopin and Clonidine mixed up. It made me laugh, because I used to do that too, but now it's been so long that I'd forgotten about it. After about 3 months of being off orientation things will feel much less stressful. By a year you start to feel like you might actually be a competent nurse, lol.

One other suggestion I have is don't schedule yourself for more than 2 days in a row when you get done with orientation. I found that I was so stressed when I got home after work I couldn't sleep. So if I did 3 in a row I was way too tired to be safe by the end of that third day.

Just take it one day at a time and you will get there. Good luck!

xxlilkacixx · Aug 8, 2012

You will pick it up faster than you think, everything you are feeling is normal! I know this first hand because I felt exactly like you do a few months ago myself. I started my first nursing job in 2/2012 with no aid experience (only a little experience running immunization clinics as an LPN) Everything you are describing, I was feeling. I cried a lot..at home of course, not at work. I even left work one day and threw up in the parking lot. I absolutely think you need to ask for more time. You will know when you are ready to be on your own (not that you will feel ready, but you WILL know when it's time) I felt "ready" when I got out of orientation, or ready as I was ever going to feel anyway. I wasn't ready when they first asked me so they gave me another week which was just what I needed. Just keep prioritizing your patient's needs. Mistakes will be made, sometimes more than once. You will be yelled at by a doctor, you will make a silly mistake in front of other nurses, in front of your patients, and you will have times when you have to ask for help. As time goes on you will get better, faster, and make less mistakes. If you keep prioritizing things though you can make sure when you do mistakes that they are minor and easy fixes. Before you know it you will be feeling much better and you will love being a nurse!

2ndTime · Aug 8, 2012

Sprintin - I just want to tell you I feel exactly the same way except our tele floor only has 4 patients, and I just cannot keep up. I broke down in front of my preceptor last night. Felt like such an idiot. When I'm giving report at the end of the day I realize how much I missed. Why didn't I call the doc for that 7.7 hemoglobin? Why didn't I give that hydralazine for the 187 systolic blood pressure? The patients weren't symptomatic... but I should be making these things priority. These things get lost on me when I'm trying to keep all my patient's stories straight, and getting their 50 pages of meds on time.

I had a nurse tell me yesterday that it took her until her second year to feel comfortable, and that she just wasn't "following doctor's orders". I hope one day that will come to me too.

Just keep reevaluating your performance, talking with your preceptor, manager, see what you need to work on or focus on. We will get there.

MunkeyLuv · Aug 15, 2012

I feel the same as you, word for word! This is my last week of my 8 week internship... I start on my own next week! In no way shape or form do I feel ready to be responsible for 5-6 patients on a crazy ortho/trauma unit! I've asked for more time and was denied lol. So I guess my manager has more faith in my than I do! The only advice I have is to try to schedule your shifts on the same day as your preceptor even after your orientation is over so you'll have that "life line". If you have a question - don't take a guess and hope for the best! ASK someone! Nothing is more scary than an overconfident new nurse. Being scared is being SAFE. We can do it! Keep me posted on how it goes and good luck! I'll keep you (and our future patients) in my prayers haha!

Rhody34 · Aug 19, 2012

Oh Man! I'm so thankful for this post! I could have written it exactly! I too am on a tele floor, I'm actually in my second week of a 16 week residency program. I too breezed through clinicals- but I am finding the responsibility to be so huge, it is so scary! My biggest fear is talking to physicians and my preceptor has thrown me out there to handle all the calls already. I actually appreciate that because I need to get over my fear- but I never know who to call for what, and I'm always afraid I won't know what to say or how to ay it! I don't really have ay advice, but I did want to say, it's kind of nice to know I'm not alone!

Ruby Vee, BSN · Aug 19, 2012

I need to vent I started my first job a little over a month ago and I am a nervous wreck. I only have 2 more weeks of orienting and I do NOT feel ready to be on my own I knew my first job would be a challenge, but this is just so much more stressful than I was expecting. I'm generally not even a stressed out person, things come easy to me, and I guess I thought this would to. I breezed through nursing school with nearly all A's, breezed through clinicals, and loved my job as a nurse aide and did it well. I did not realize all the responsibility that goes into being an RN and I think it's freaking me out. I work on a telemetry floor and all the patients are pretty much train wrecks with SO many medical problems. I have 5 patients, I'm always behind, I never know when to call the doctor...or even what doctor to call for that matter as the hospital I work at has so many different groups of doctors and I'm just totally confused. I feel like I learn so many new things everyday I'm there from my preceptor, so I'm worried when I'm not with her anymore I'm not going to be able to figure out/catch things on my own. I don't totally hate the job...I'm enjoying some aspects of it but I'm just worried for the patients that I'm not going to know what I'm doing and potentially harm someone. The nurses I work with are generally nice, but I dont want to have to bother them with questions when they're already SO busy. I think my biggest fear is going to be calling doctors that ask me questions that are easy questions, but I won't know the answer and nobody will be there to tell me....nearly every phone call I've had with a doctor I've had to interrupt the call to ask my preceptor the answer to their question. ugh. when will it get easier???????

As a preceptor, I see the fact that you don't feel ready to be on your own as a positive thing. A little fear is a healthy thing . . . keeps you out of trouble.

Nursing is difficult, and there's no way for you to understand just how much responsibility there is until you have that responsibility. Being overwhelmed is par for the course with the first year of nursing. It passes. We've all been through it, and been the better for it.

As far as calling doctors -- they're just people. If you take the time to exchange a couple of pleasantries with them every time you see them, it will make calling them a bit easier. Make sure you have the pertinent vital signs, I & O, labs, etc. BEFORE you call. It all gets easier with experience.

You sound like you're progressing normally, believe it or not. Hang in there. It WILL get better.

sprintin2012 · Aug 22, 2012

wow thanks for the comments everyone! it's been getting more stressful because I only have two more shifts of my orientation before I'm on my own. I'm freaking out, but I know after I work a few shifts on my own I'll hopefully start to get the hang of it and gain some confidence. It's really great to know I'm not alone. I'm the only new grad on my floor so it's hard to find support. I hate telling people how stressful this is, everyone who asks how my new job is going I just tell them "great" because it's hard to admit I'm struggling with something I've worked so hard for and wanted to do nearly my whole life. I just feel alone but I'm thankful for this forum!!!

circularstaircase · Aug 23, 2012

wow thanks for the comments everyone! it's been getting more stressful because I only have two more shifts of my orientation before I'm on my own. I'm freaking out, but I know after I work a few shifts on my own I'll hopefully start to get the hang of it and gain some confidence. It's really great to know I'm not alone. I'm the only new grad on my floor so it's hard to find support. I hate telling people how stressful this is, everyone who asks how my new job is going I just tell them "great" because it's hard to admit I'm struggling with something I've worked so hard for and wanted to do nearly my whole life. I just feel alone but I'm thankful for this forum!!!

I feel like this whole post is verbatim what I'm feeling! I also only have 2 more days of being on orientation before I'm on my own and I'm a nervous wreck! I feel like my orientation was too short for a new nurse (6 weeks). I think I might ask my nurse manager to get a few extra days of orientation. I'm not sure how she'll feel about it though :/

I also hear you about the support thing! I am also the only new grad on my floor, so it kind of stinks there's no one else I can talk to about all the anxiety you experience as a new nurse!

Good luck to you and keep me updated on your transition as a new nurse! Crossing the fingers for the both of us :)

dandk1997RN, MSN, RN · Aug 23, 2012

This post could definitely have been written by me! I feel exactly this way. I sat down with my nurse manager, educator, and third preceptor (there is a preceptor shortage on 2nd shift, which I just changed to two weeks ago) and told them I was overwhelmed and we needed to scale it back a bit. They agreed that though I was doing a fine job, the fact that I am overwhelmed is reason enough to drop one patient for a week or so until I adjust to the culture shock that 2nd shift has been. They have pegged me to be the new charge nurse on 3-11 once I really, truly know what I am doing (this is a second career for me- I was a lab supervisor in the same hospital) so I think they are willing to make sure I am comfortable and don't want to push so hard they scare me away.

I spent a while yesterday during a repetitive lecture making a list of things I am going to do to help make things smoother during my evening shifts. I am going to start carrying a little plastic bag around on my computer with stuff I need occasionally but don't have room to carry in my pockets, like extra pens, my scissors, closed extra IV and oxygen tubing. I am going to print the paperwork I use most often so I don't have to print them fresh every time I need them (we only keep certain papers "in stock" and that doesn't include the most common discharge or admission paperwork. I bought a clipboard that has a notebook inside- I am going to make lists of which practitioners are with which service- cardiology, hospitalist, and other, and put the contact information in there so I always have it with me on my cart. I am going to write a list of the things that need to addressed in different types of notes I have to write in my charting (likes s/s or lack thereof and interventions I have made) so that if I get stuck, I have something to refer back to to jog my memory. I also bought those sticky notes with lines so that can stick it to my cart and make notes on the fly without putting them on my brain sheet. Oh, and I am redoing my brain sheet. After 5 weeks, I have found I need to make some tweaks, so I wrote up a new one up and just need to get it transposed onto my computer.

Everyone keeps promising me it will get better. One can only hope!

Flatlander · Aug 24, 2012

Sounds like my experience exactly, only I got fired/terminated after 12 weeks' orientation, with no warning that would occur. In my final week on the tele unit, I was assigned to three 12 hour night shifts in a row and had patient loads of 4 each the first two nights and 5 on the last night. The first night I had an accidental needle stick with an insulin pen (barely punctured the skin and drew no blood, but required post-exposure blood draw nonetheless). The second night I spiked my finger with an IV spike and had to ask the preceptor for a replacement of the IV med and tubing while I cleaned and bandaged my finger. (Thankfully there was no exposure to the patient.) (I do think the accidents were directly related to my feeling that I needed to work faster and was pushing myself beyond my ability to be safe, which was very unwise.)

The third night, with five patients, I was running crazily trying to keep up, no doubt appearing as one who has totally lost their cool! I was feeling overwhelmed and, admittedly, a little angry that I was running like crazy while others sat and chatted. I believe they felt it was wrong for them to step in to help since I was supposed to start working independently (maybe?). I also went into the lunchroom without telling my preceptor, for just a few minutes, while I choked down some food. No one said anything. And, I ended up having to stay almost 2 hours past my shift to finish my charting that morning. The following week I was let go.

I am not proud of my mistakes and lapses, and I think I could have studied and reviewed more. Had I known that termination was in the cards, I might have been able to pull it together sooner, by asking for help in my weak areas. It bothers me some that I wasn't given that chance. But I'm acutely aware that I am the novice, and the managers have decades of experience, so who am I to say....

I saw a greeting card in a shop today, which I'm going to have to go back and purchase. I will put it on the bulletin board over my desk, where I pursue my new Job Search, and where the hurdles now seem exceedingly high. The card reads: "Everyone has been to Suckville." Dark humor, granted, but it makes me smile. And reminds me that we all struggle and suffer in this life from time to time.

I no longer take anything for granted. I am now a much more serious and determined RN, but one who knows I'm not superwoman. I will be cautious about the next position I accept. In the meantime, I'm redoubling my efforts to review all my nursing knowledge and skills, and everything I learned in my first 12 weeks (which really was a lot), and am studying everything I can find on time management and workload organizing for nurses. I am composing and rehearsing answers to the interview question "Why did you leave your last position?" Also, I've become a regular on this forum, am finding validation and support, and expect to be here for the duration.

I hope to be leaving "Suckville" before too long, too!:)

247RNmommie · Sep 18, 2012

Sounds like my experience exactly, only I got fired/terminated after 12 weeks' orientation, with no warning that would occur. In my final week on the tele unit, I was assigned to three 12 hour night shifts in a row and had patient loads of 4 each the first two nights and 5 on the last night. The first night I had an accidental needle stick with an insulin pen (barely punctured the skin and drew no blood, but required post-exposure blood draw nonetheless). The second night I spiked my finger with an IV spike and had to ask the preceptor for a replacement of the IV med and tubing while I cleaned and bandaged my finger. (Thankfully there was no exposure to the patient.) (I do think the accidents were directly related to my feeling that I needed to work faster and was pushing myself beyond my ability to be safe, which was very unwise.)
The third night, with five patients, I was running crazily trying to keep up, no doubt appearing as one who has totally lost their cool! I was feeling overwhelmed and, admittedly, a little angry that I was running like crazy while others sat and chatted. I believe they felt it was wrong for them to step in to help since I was supposed to start working independently (maybe?). I also went into the lunchroom without telling my preceptor, for just a few minutes, while I choked down some food. No one said anything. And, I ended up having to stay almost 2 hours past my shift to finish my charting that morning. The following week I was let go.
I am not proud of my mistakes and lapses, and I think I could have studied and reviewed more. Had I known that termination was in the cards, I might have been able to pull it together sooner, by asking for help in my weak areas. It bothers me some that I wasn't given that chance. But I'm acutely aware that I am the novice, and the managers have decades of experience, so who am I to say....
I saw a greeting card in a shop today, which I'm going to have to go back and purchase. I will put it on the bulletin board over my desk, where I pursue my new job search, and where the hurdles now seem exceedingly high. The card reads: "Everyone has been to Suckville." Dark humor, granted, but it makes me smile. And reminds me that we all struggle and suffer in this life from time to time.
I no longer take anything for granted. I am now a much more serious and determined RN, but one who knows I'm not superwoman. I will be cautious about the next position I accept. In the meantime, I'm redoubling my efforts to review all my nursing knowledge and skills, and everything I learned in my first 12 weeks (which really was a lot), and am studying everything I can find on time management and workload organizing for nurses. I am composing and rehearsing answers to the interview question "Why did you leave your last position?" Also, I've become a regular on this forum, am finding validation and support, and expect to be here for the duration.
I hope to be leaving "Suckville" before too long, too!:)

Flatlander, your experience sounds exactly like mine! I have never worked so hard in my life. I had no med errors, although I was a little slow with documentation. But so were other nurses who had been there months/years. I was learning! Next thing I know I was terminated because I wasn't a good fit. I had never been so depressed in all my life! Everyone was shocked, even the charge nurses who watched and assisted me. The new intern that was hired to replace me quit after 2 weeks...so that gave me some satisfaction that the problem was not me. But I will forever have that scar on my resume.