Some words for new grads.

[CardiacDork]

A fair warning: I am by no means articulate or expressive. I hope my spiel does not induce a coma!

Well, I've been a nurse for a little over 1.5 years now.

I came into nursing extremely scared and humble. I came with fear in my heart and worry on my mind. I endured sleepless nights and crying fits in the utility closet. I was a young, quiet, shy, and naive nurse.

All that began to change at about the year mark. My confidence began to blossom. I was steadily relinquishing my fear to the past. I reflected on my mistakes and rather than allow them to undermine my self esteem as a nurse, I integrated valuable lessons into my practice.

My communication with physicians improved. I noticed that I began to suggest interventions. This in turn increased my confidence. I began to become assertive when needed for the wellbeing of my patients.

I remember, once as a new grad nurse I hung up on a physician - not because I was being rude intentionally but because I was frozen with fear and forgot what I was going to say. I couldn't imagine this occurring now. Rather, I speak with poise and confidence and openness with my colleagues.

Reflecting, I'm also astonished at how many near misses I've caught. How many deterioration I have halted. How many times I climbed the chain of command until my patient was safe from harm.

I just want to tell all new grads that matters will improve. Do not give up. Find a trustworthy mentor.

Your new grad status is NOT permanent. You will GROW. You will BLOSSOM. Before you know it you'll be a preceptor to student nurses AND registered nurses.

Please remember that you are NOT the only new nurse to cry on the way to work. You are not the only new nurse to question your intelligence or abilities.

I'm proud to conclude this post by saying that I'm currently cross training on heart transplant/VAD unit. Being able to learn to titrate drips and learn all the beautiful things about cardiac has inspired me once again. I DO feel like a new grad all over again - but I will refer to MY very own post and remind myself that this too shall pass and that I can & will.

Oh... and my awkward and nerdy love for cardiac has finally pushed me to apply for my spring classes again so I can finally become the Cardiac Nurse Practitioner that I SO want to become.

Cardiac Dork, RN

[Itwasjustadream]

Sun0408

I kept telling my new grad orientee the same thing. Keep it up, one day it will click. You can do this, you are doing this. Give yourself credit!! Self- doubt can destroy you or help you to be both better and safe. Please new nurse take the better/ safer end and turn it into something great!!!

This is great advice! I have been filled with so much self doubt these past few days and it's been difficult. I will continue to work hard and give myself credit for trying to be better everyday.

[vbarger28, BSN]

I have been a nurse for almost 3 years now, and as an LPN have been fortunate to work in urgent care with 'the big boys' as they sometimes say. My words of advise, and I mean this in the nicest way possible, would be "toughen up" I can't tell you how many nights I wanted to cry at work because I was always picked on and blamed for things I didn't do because I was the 'new grad' and considered 'dumb, inexperienced' and being 20 years younger than everyone, I was fresh meat. I have learned over time to thicken my skin up a little and not to take everything personally and to ignore that a* hole doctor(s) we all have who live for power trips. I wish when I was in nursing school they would have made more of an effort to forwarn us about the 'eat your young' mentality in the field.

Head up buttercup, it will get better in time :)

[CardiacDork, MSN, RN]

I have been a nurse for almost 3 years now, and as an LPN have been fortunate to work in urgent care with 'the big boys' as they sometimes say. My words of advise, and I mean this in the nicest way possible, would be "toughen up" I can't tell you how many nights I wanted to cry at work because I was always picked on and blamed for things I didn't do because I was the 'new grad' and considered 'dumb, inexperienced' and being 20 years younger than everyone, I was fresh meat. I have learned over time to thicken my skin up a little and not to take everything personally and to ignore that a* hole doctor(s) we all have who live for power trips. I wish when I was in nursing school they would have made more of an effort to forwarn us about the 'eat your young' mentality in the field.

Head up buttercup, it will get better in time :)

I cannot reiterate how much a tough skin is important. It is necessary for your mental stability. You have to let things slip off your shoulder and also know when to stand up against bullies.

Here's a recent conversation between me and a doctor.

----------------

Me: Doctor, patient isn't feeling well saying she feels suddenly sob and anxious. She's alert oriented times 4 however she's experiencing some shortness of breath, she's satting at 97% with 3L of oxygen via NC the rest of her vitals signs are.....systo-li-

Doctor: Get to the point I'm busy

Me: Excuse me? When you signed up to be a doctor part of it was to listen to my assessments. My assessments are to help you BUT if you want I can just talk to the attending... yes?

Doctor: Oh no that's okay. Please continue.

As I suspected pt had a PE. =/

But my point is...yes tough skin is necessary and will benefit both nurse and patient.

[FinallyRNStatus, BSN]

Hi CardiacDork:

"I came into nursing extremely scared and humble. I came with fear in my heart and worry on my mind. I endured sleepless nights and crying fits in the utility closet. I was a young, quiet, shy, and naive nurse. .... Please remember that you are NOT the only new nurse to cry on the way to work. You are not the only new nurse to question your intelligence or abilities. "

Thank you for posting this. It is reassuring to hear that someone else that started out as a timid, inexperienced, self-doubting new grad has advanced to a confident SICU/MICU RN (from what I understand from a different recent post). It sounds like you were on a surgical floor for about 2 years prior to transferring to the ICU. Do you feel like 2 years on the surgical floor was enough to prepare you for the ICU?

My story is I started as a new grad orienting on a telemetry unit once I passed my boards, and continued to finish my last semester for my BSN while working during orientation. I think being a new grad in orientation was stressful enough, and school just made it much more stressful!!!

I had a horrible orientation experience at my first job. My manager asked me who I would like to orient with since I knew the nurses from nursing clinicals, and I was confident a certain preceptor was a good fit. Another preceptor requested to orient me and I was placed with her and they gave the preceptor I requested to the other orientee. My first 6 weeks of orientation were almost completely non-exisistent, as my preceptor spent all her time eating in the break room or helping everyone else on the floor but me. I could never find her to ask questions, or clarify concerns, or get teaching on tasks I had never performed before. When I was able to find her to ask a question, she would briefly review the steps, and send me on my way without overseeing me, saying you got this! I was annoyed that she used the preceptorship as an excuse to do almost nothing and even came in hung over a few times. Since day one I was completely on my own stressed out with 6 patients. A couple times I had a declining patient, and being a new, very overwhelmed, inexperienced nurse I did not catch the early warning signs. Since my preceptor was not following me to assess the patients, she was clueless when someone was declining as well, until one day I had a patient who had been admitted with SOB, come back with a critical ABG who had anasarca and needed an immediate ICU transfer. She replied to the intensivist "I'm so sorry I didn't catch that, I have a new orientee who didn't know better and I should have followed up on her assessment." However she continued to not follow up on anything I did.

Whenever I asked how I was progressing I was praised by my preceptor and manager for being able to take all six patients. So although I felt very overwhelmed, I figured I was being too hard on myself as I naturally am. Then I switched to night shift and I had a new preceptor who was fantastic but also more involved. Her constant supervision in contrast to the other preceptor made me nervous and I would doubt myself, my instincts and performed tasks nervously. At week 7, a week prior to the end of orientation, I was told by my manager in a nonchalant way I think you could use 4 extra shifts. Before I saw shift 4, I got a call that I was terminated from my first nurse job. I was never given any indication I was doing poorly enough to be fired. I was heartbroken and any little confidence I had gained was shattered. Now I doubted everything I had ever done and repeatedly questioned if I was competent in any aspect of nursing. As a new nurse, it's hard to know what you don't know.

Later I got a job with a 6 month nurse residency on med-surg and ortho units. Somehow I was able to start the position with more confidence than my first job. I think I decided on the mantra "fake it until you make it" but I was scared s***less inside that I would fail again and be terminated. My preceptors were always involved and able to address patient concerns with me. They actually printed hospitals policies for me to review prior to tasks/procedures and showed me the first time I had something new. The nursing culture was more inviting and other nurses gave me a lot of positive reinforcement. I think that is why I was successful.

Fast forward to present day. I just hit my 1 year mark. I would say around 9 months I started feeling a lot more comfortable in my role and at the 1 year mark I now rarely feel anxious prior to starting my shift. However, there are days with 5-6 patients that I become very stressed out especially with admissions or changes in my assignment when a 8 hr nurse or float RN leaves and I have to pick up more patients. Giving report still stresses me out on the med-surg patients as I'm worried I'll forget to share some vital information. Change of shift report has never been something I look forward to! Some people want tons of details and others basically want a head-to-toe assessment with shift updates. It's frustrating! Slowly I see myself getting faster and more confident! :)

My goal for the future is SICU like you, but in the back of my head there is a voice that says "Play it safe. Stay where you are. If you attempt ICU everyone will see once again you're incompetent and you will fail again!" I hate that little voice.