Struggling with orientation and nursing itself

RedhairedNurse, BSN, RN · Sep 8, 2008

It will get better, just give it a little more time.

Breathe!! And take one task at a time.

NurseFreshMeat · Sep 8, 2008

I feel just like you. I graduated in May 08 and I always feel behind. I was an average student and felt guilty for not holding a job during school because of family obligations. Clinical skills were okay. What makes things scary is that orientation is suppose to end in one week (after only 8 weeks) and I don't feel ready. From what I read on this site, I don't know if I'll ever feel ready. I just set a goal to not make any changes yet until I've been on the job six months.

My preceptor keeps complaining that I'm spending too much time in the pt rooms because of forgetting supplies or just talking/listening to pts. I have a decent system of organizing my day. I stuck by it twice and I actually left ontime.

Even if you change jobs, the same time management problems may occur.

hikernurse · Sep 8, 2008

Nursing school is nothing like nursing. During orientation a year ago there were several times I found myself wishing I were back in school, mostly because school was familiar and real nursing definitely wasn't.

Give yourself some time. It really takes several months to a year to where you feel comfortable in your new role. Assess yourself from time to time in the next year. If you are aware of what you are doing, you will realize that you are doing things you couldn't do two months ago.

Truly, give it time. I've been an RN for about fifteen months now and I don't always feel like throwing up on the way to work now. That's a huge improvement right there :rolleyes: .

RedhairedNurse, BSN, RN · Sep 8, 2008

I feel just like you. I graduated in May 08 and I always feel behind. I was an average student and felt guilty for not holding a job during school because of family obligations. Clinical skills were okay. What makes things scary is that orientation is suppose to end in one week (after only 8 weeks) and I don't feel ready. From what I read on this site, I don't know if I'll ever feel ready. I just set a goal to not make any changes yet until I've been on the job six months.
My preceptor keeps complaining that I'm spending too much time in the pt rooms because of forgetting supplies or just talking/listening to pts. I have a decent system of organizing my day. I stuck by it twice and I actually left ontime.
Even if you change jobs, the same time management problems may occur.

You're right. You'll never feel ready to be off orientation until you're off. I've been off for two weeks and I love it. I didn't feel ready to be off orientition, but you'll be surprised as to how much better it will be. You won't have anybody breathing down your shoulder, you can work at your own pace but other nurses are still around to ask. Be sure to ask if you are ever unsure of anything. I wouldn't listen to a preceptor that tells you you're spending too much time listening....that's wrong. When you're in the pts room, look at everything, the IV bag, what supplies you'll need, etc. But listening????? You should always listen to a patient.

generalhospital · Sep 8, 2008

I can relate. I just graduated in June 08. I have my first job. The only orientation that I have had was to learn the EMR system of charting. I love the job but I don't know how to get organized. I have had no on the job preceptor training at all. I was thrown in and left to sink or swim. I know that this is not the normal way a new job in nursing should be. I work the evening shift so the administrative people are not there. I feel overwhelmed and unsure every day with every task that I have to do. I have managed to learn how to do the med pass on my own but other than that, I have all kinds of work undone when the night nurse comes on and she is a new grad also so we are both kind of winging it. Is it suppose to be like this?

casperx875x · Sep 8, 2008

I can totally relate. Nursing has a huge learning curve and can be really tough at first. It's a lot more mentally exhausting than the general public thinks. I, too, graduated May 2008 and felt sooo overwhelmed at first. I had 2 patients and was thinking, "how in the world could I handle 5!?" The past 2 or 3 weeks have really been eye-opening and I feel that I've really started to be able to put 2 and 2 together. It's not as horrific as I thought it would be. I've been able to handle a heavy patient load and keep things together. I had 10 weeks of orientation, and they ended yesterday. I am feeling pretty good. Nervous of course, but feeling good.

I agree with one of the other posters that time management will be an issue that will follow you wherever you go. I'd say to give it some more time - you will eventually find a system that will work for you.

I also have to say that evening shift is really tough. You are following up on things from earlier in the day and are cut right up in the middle of the patient's day. I would much rather work a day shift and run around like a chicken with its head cut off.

You will find your way! :)

doglover1 · Sep 10, 2008

I empathize with everyone. I am in my 10th week of orientation on a cardiac PCU unit with 2 more left to go. The difference for me is that I really have supportive nurses, management etc., a good ratio of 4:1 but I still am making so many stupid mistakes! My preceptor is always finding out that one of my patients telemetry monitor has been off for the past 2 hours and I haven't even noticed, or forgot to check BP before giving a beta blocker and other really important, no-brainer stuff. I know better!! These things are soooo important but I feel so swamped, overwhelmed that I go around in a daze all day long while trying to beat the clock at the same time. Then when it comes to give report at the end of the day, I have it so messed up and look like a complete idiot because I can't even keep my patients straight!!! I feel that I don't have time to look at the whole picture of the patient because I'm just so focused on passing meds, doing blood cultures, changing bags of K+, keeping up with insulin and heprin drips etc. etc. I'm just so embarrased and feel so stupid, old and too inadequate to do this job. I have so much invested. I left a high paying corporate job to do this, and made my husband and children sacrifice while I went back to school. I can't even admit to them that I'm having trouble and :cry:that I am totally stressed out. Please help with any advice.

RedhairedNurse, BSN, RN · Sep 10, 2008

I empathize with everyone. I am in my 10th week of orientation on a cardiac PCU unit with 2 more left to go. The difference for me is that I really have supportive nurses, management etc., a good ratio of 4:1 but I still am making so many stupid mistakes! My preceptor is always finding out that one of my patients telemetry monitor has been off for the past 2 hours and I haven't even noticed, or forgot to check BP before giving a beta blocker and other really important, no-brainer stuff. I know better!! These things are soooo important but I feel so swamped, overwhelmed that I go around in a daze all day long while trying to beat the clock at the same time. Then when it comes to give report at the end of the day, I have it so messed up and look like a complete idiot because I can't even keep my patients straight!!! I feel that I don't have time to look at the whole picture of the patient because I'm just so focused on passing meds, doing blood cultures, changing bags of K+, keeping up with insulin and heprin drips etc. etc. I'm just so embarrased and feel so stupid, old and too inadequate to do this job. I have so much invested. I left a high paying corporate job to do this, and made my husband and children sacrifice while I went back to school. I can't even admit to them that I'm having trouble and :cry:that I am totally stressed out. Please help with any advice.

Okay now, you need to admit to your family you're having trouble. I did and came home crying every day for the first 4-6 weeks. You need be able to talk to someone and if you can't communicate with your family, who can talk to? YOU ARE NEW at this!!! You'll be alright. You can't expect to know what a seasoned nurse knows. Making mistakes is part of the learning process. I too have forgotten to take BP before giving a blood pressure med, but I don't forget any more. Once you forget something, you learn to never do it again. That's part of the learning process. In the end, you're patient is still alive, the mistakes haven't killed anybody, have they?

Relax, don't be so hard on yourself. Prioritize and take one task at a time. Don't try to beat the clock. After orientation, you'll see that it gets better. It's nerve wrecking to have someone stand over your shoulder all the time asking you questions.

marilynmom, LPN, NP · Sep 10, 2008

I am a new grad as well and have been working since June. I work in a pediatric ICU and it is *stressful* to no end. I get sick to my stomach and can't sleep a lot of times before I go to work. But I do really like it and have to take it day by day. I feel like throwing in the towel and quitting and feel overwhelmed a LOT though. But I trust all my nursing friends who tell me everyone feels that way and I have to just stick it out and after a year it gets a lot better. I also know that everyday I am becoming a more experienced and better nurse.

ICU might be a better fit for you but there are days when one of my patients is soooo sick and literally on the verge of a code all day long (and I'm in there pushing all sorts of drugs, doing compression or bagging them, intubating, extubating and then sometimes emergently re-intubating, etc) that my other patient gets totally ignored basically (I have time to literally run in give drugs and leave the room). So it might be only 1-2 patients but they are *very* sick patients and I have gone 12 hours with no eating, etc. BUT I wouldn't trade it for anything else! I'm just saying that having 1-2 ICU patients is not easy at all. We also have to respond to all the codes on the other floors in the hospital so that is very stressful too. Deaths in the ICU are also very common. I see and do death care on dead children and babies more frequently than I would ever care too. Seeing children come in the from traumas, child abuse, burns, car accidents, drugs, near drownings, etc. It is very hard emotionally and I have to detach myself from them.

I also think what your going through and feeling is VERY normal, because I feel the same way and almost all the new grads that I know feel very overwhelmed and stressed out, etc. I'm actually going to the Dr on monday to get something to help me during this first year with my anxiety (so I can at LEAST sleep the night before work). I'm also switching to the night shift in Nov and I think that will help (no Dr's rounding at least!). I think that you should stick it out for the first year, unless your being treated horribly or just in a bad hospital (sounds like your not in a bad work environment), your just going to go from one stressed out new nurse job to the next.

mama_d, BSN, RN · Sep 10, 2008

Take a deep breath...it gets better, I promise! We all felt that way at the beginning, and sometimes still do!

I work oncology as well...try to take comfort in the fact that you were there to ease their suffering at the end.

Have you sat down and made a list of all the things you need to accomplish in a shift? When I moved up to a higher acuity setting, I found it helpful to have a list of must-dos and when I needed to do each one by; made copies and checked off as I went along until it became second nature. Also, if you are able to start off organized, it will help if things start to go wrong. As far as BP meds go, when I write on my report sheet when meds are due, I'll put a star next to the time if I need to verify VS before giving; after my assessments are done I'll go through and jot down BP and HR next to the stars, so when I go into the med room to pull up meds I have it all there. You'll learn little tricks to help you be more organized as you go along.

You'll always be tweaking your routine as you learn or see better ways to do things...I recently (after five years on the same floor) tried doing my rounding a little bit differently, based on what I saw one of the newer nurses doing...decided to give it a try and see if it worked better. I ended up with a cross between my old routine and how she does it, and it is saving me time.

PennyNickelDime_RN · Sep 11, 2008

Being a nurse was a lifelong goal/dream for me. I excelled in nursing school and could barely contain myself while waiting for my new career to begin. However, now that I've started working, I feel like all my longtime dream of being a nurse, as well as all the intense studying I did while in school, was for naught. I'm so overwhelmed and stressed out! My 2 preceptors are awesome, but I just can't grasp time management, staying organized, multi-tasking, and staying on top of charting while trying to care for patients of varying acuities, handling discharges/admits, passing meds, performing procedures, calling doctors, checking charts (which I always forget to do!), etc... let alone attending to the emotional needs of my pts. I feel disillusioned with nursing.... I feel like all I do is push pills and fiddle with the computer and phone.
I work PM shift on a 28 bed Medical-Oncology unit. I graduated nursing school in May and begin working in August. My manager has noticed how stressed I am. Oftentimes, we are so busy that I don't get to eat until 9pm or later (and I'm severely hypoglycemic to boot!). I'm currently at 4 patients, but I can barely handle three.
I hate not knowing what happens to my pts if they aren't on the unit when I get back from a day off. And the pts that pass.... well, I still haven't gotten over those cases. I'm not one who can easily detach herself from her pts whatsoever!
I know I need to give this more time, but maybe this unit isn't the right fit for me... maybe acute care isn't where I should be. Perhaps ICU would be a better fit, where I can focus on only 1-2 pts (granted, they are more complex, but I wont have to worry about juggling a handful of other pts as well). I like the thought of long-term care (I LOVE establishing relationships with pts), but I don't want to work in a nursing home. I've always wanted to work in peds too, but those jobs are hard to come by.
Any thoughts as to what type of nursing might be better for someone like me? I'm so lost..... :-( I love nursing and feel so horrible that everything is going so wrong.

I feel exactly the same way. I too work on an Oncology/BMT unit . I was hired before graduation and started in June, failed the NCLEX the first time in July and just returned to work yesterday after waiting 45 days to retest and passing.

I was on the unit about a month before I left and during that time I felt completely overwhelmed and stressed. It feels as if I am never going to "get it". I'm worried that I chose a unit that I am not equiped to handle right now and am scared to death once off orientation. I feel as if I am completely starting over again in addition to being gone for 6 weeks. I am so exhausted from attending classes and working that I can't think straight and this post probably makes no sense.

The purpose of it was to give you support and tell you that you aren't the only one that feels this way. I hope things get easier and you become more relaxed as time goes on :)