Struggling new nurse

[Jen0918, BSN]

Hi all, I graduated in May 2019 with my BSN. I passed my NCLEX-RN on my first try in November with 75 questions. I did not take my NCLEX-RN right away due to moving, having some personal issues with family going on, and have extreme test anxiety. I have 8 years of prior experience as a C.N.A. ranging from 7 years of nursing home care and trachea and ventilator care. Then 9 months as a C.N.A. in a hospital. After my NCLEX in November, I couldn't start applying for jobs because my license number didn't go through until December. I thought that I was going to be able to start in the bigger hospitals around where I moved to but they would not hire me due to not being a graduate at the main school in the area, not being employed for eight months, being a new graduate, and at the biggest hospital, it was because I didn't apply to their nurse residency program before I graduated. I ended up getting a lot of job offer for community hospitals that were about 45min -1hr away. I chose one that was about an hour away and similar to a size that worked at when I was a C.N.A.

I started my job at the beginning of March on a general medical-surgical unit at the hospital. I knew this was going to be challenging and that some days were going to be better than others as that is the beauty of nursing. I really wanted to work in the hospital setting and start out on med surgical unit which I am. However, I was wondering if anyone had any tips for me? My preceptor is a fairly nice person but does not really explain how I can fix the issues I am having. Also, I feel that she is talking about me behind my back on how I am not catching on to things. Additionally, I feel that she really likes to take over certain situations. For example, when I am giving a report at the end of the shift she likes to interject what she has to say instead of letting me finish and then talking. She has done this multiple times when we are in patient rooms as well. She has also said that I am having trouble with organization, getting a rhythm down with the day to day, talking with the doctors, and trouble with IV therapy. Does anyone have any tips to help me fix these issues? I am so scared they are going to fire me because I am not up to speed on where I should be and that I am too slow or that I don't have the knowledge/ critical thinking that I should have. Any help would be greatly appreciated!!

[Nurse SMS, MSN, RN]

Time management is key to the survival of a new nurse. First, take a deep breath. You aren't any worse off than any other new nurse, though it probably feels like it.

I always advised my new grads to have a brain sheet. Take a blank piece of paper. Draw columns on it....one for each patient. Put their room numbers at the top. Along the left side, put the hours of your shift, beginning with 7 AM/PM all the way to the following 7 AM/PM. After you get report, get into your patient's charts and notate, one patient at a time, the things that must be done during your shift. You don't need to get super wordy. Start with the eMAR. Mark the times of all your meds due- just put the abbreviation "meds" in the time slot for each patient, throughout the day. If insulin is one of those meds, go in and put in BS check for those who need it. Then circle around for other stuff. Are they due for a Vancomycin trough draw? Write in "vanc trough" to remind yourself to do it before you hang the med. If you have "vanc" listed at 2 PM, you know you need to draw it before then. Write it in. Put in your known tests. If you don't know the time, put them at the bottom like a check box. Same with dressing changes. Times to check on labs. Things like that. Cross stuff off as you do it. If you need to, put a little note by a med that has a special consideration. ie: "dilute" or "push slow". If you give a PRN pain med, write in when to circle back for reassessment.

Doing this will allow you to see gaps in your day when you will be able to chart. This will help settle your mind. As you come to trust your brain sheet, you will free up more brain space for critical thinking. Pay attention to the things your preceptor focuses on when giving report or communicating with patients and families. You may or may not agree, but its one style and you can learn from it. IV starts just take practice.

Your biggest barrier right now is anxiety. Figuring out what is making you anxious will help you mitigate it. Afraid you are forgetting things? Use your brain sheet. Afraid you don't know when you will get things done? Use your brain sheet. Afraid people are gossiping about you? Ask yourself why. Being a new grad is humbling, especially if you were an A student in nursing school. Nobody is grading you like that now. They want to hear appropriate questions and see progress on your time management. Learn to delegate to the techs. New grads have a very hard time with this. Watch how others handle things. Learn to talk to patients in a way that satisfies them but lets you get your work done. Don't get roped into staying in the room chatting. Patients love that but its going to kill you, especially right now, while you are new. It's hard, but you will learn how to navigate it skillfully and kindly.

If you aren't on an improvement plan, you aren't going to get fired. It gets better. Much, much better. When the next batch of new grads start, you will begin to see how far you have come. Hang in there.

[FallingInPlace, ADN, BSN, RN]

I found that picking one area of improvement for myself each day before I started was helpful. For example, if I needed to pick up speed in charting, I set that as a goal. At the end of the day it feels good to have one thing under better control. Other than that, the advice above is excellent. Best of luck and give yourself the grace of some time to develop all these new skills.