Support Stickie for New nurses who are not coping

Mahage, LPN · Dec 2, 2008

Wow, have I ever found the thread where I felt I fit. I now have a whole 5 months of experience as an RN, but I still feel so very incompetent. I've already posted another thread... I feel like I've exasperated all the other night nurses on my unit, with all my questions. Doubtless many of my questions, the nurses were thinking, "why don't you know that already?" and they showed their distain when answering. (Makes me think twice before asking anything, which I don't think is fair. I'm waaaaaaay too new not to be able to ask questions. Even if I had 20+ yrs experience, I would still have questions some days. But even more-so with so little experience.) I was a CNA on the floor where I work now for 2 years before I became a nurse. I did just fine in nursing school (grades). But within the last month, I have had 2 separate nights that I just couldn't seem to get things together, and it could have cost 2 pts their lives. Thankfully, nothing happened to either pt; everything came out just fine in the end... but it's the "what if's" that torture me. I can't sleep very well, even when I'm off. I dread going back to work, because I am so afraid I'll have a "brain fart" again & this time may be the big one. I love nursing, I hate it when my pts are suffering, even more so when it's my fault. Even while writing this post, I'm crying. I so desperately want to be a good nurse. It's just that sometimes I feel like there's no light @ the end of the tunnel. Anybody have any words of wisdom? I work on an OB/GYN unit with med/surg overflow whenever the hospital deems it necessary (almost every day for several pts). HELP!!! I feel like I'm drowning & nobody wants to throw me a life preserver.

Latina, Don't worry about exasperating those more experienced nurses! It is their job to help you and teach you. I ask tons of questions and I asked even more early on. I know it bugged a couple of them, one who was my charge and she was horrible. That is thoroughly discussed in another thread however. What I did, was I looked at the schedule every evening before I went to work and I knew who I was going to be working with. I started avoiding asking questions of those who were not good about answering my questions in the past. I would instead ask someone totally different, whether I had ever talked with them before or not. I got to know all the nurses that way and found some who were just wonderful about helping me and teaching me other things I didn't know. There are some who have been fantastic and have proven themselves to be the kind of nurse I want to be. If you can't find anyone supportive, remember it is especially the charge nurses job to help out everyone who needs it.

Also some of my newer colleagues have had some experiences which I have not at times. Example: I had to hang TPN one night because the day nurse had not done it. I knew there were some guidelines, but didn't know what they were. I couldn't find anyone readily available to get to help me with it, but I ran into one of the newer nurses who I had precepted for a few nights. She knew the guidelines for TPN and we hung it together. She had spent quiet a bit of time orienting on day shift and had worked as a Nurse tech on days so she had been exposed to it, though she hadn't done it before. We double checked with the charge to make sure we had done everything right and we had. So use anyone and everyone as a resource.

If they are not very accomadating, skip them next time if you can find someone else, but if not, BE PUSHY! It is their responsibility to help you. I believe the only stupid question is the one you didn't ask, when you should have. We all make mistakes, I have but fortunately it wasn't anything that harmed anybody. One of the reasons is probably because I don't hesitate to ask if I am not sure. I am by nature a very nice person but boy can I get wound up and when I do, I get pushy. You have to be tough to make it in nursing without loosing your self.

So don't be afraid to be pushy. Keep watching out for your patients, they deserve the best you can give them. None of us know all the answers but we sure can find someone who does. If they don't want to give us time, TOUGH! I also made the decision that patient care was my priority and that I would do my paperwork AFTER I give report if I have to. Now I don't have to do it this way too often anymore but if I do, I do. We had a memo that we couldn't do that anymore, but guess what, they can't make me clock out and do it, it is against the law, they also can't tell me not to do it! I haven't gotten my one year eval yet, and I may get marked down for it, but if so, I will deal with it then.

Anyhow, I am really likeing my job and I look forward to going to work. I do get tired before my 3 day run is up. I don't sleep good on those two days between shifts either, but that is okay, it is just a three day run and if I can sleep 5 hours between each shift, I am alright. Rock Star does wonders, LOL! Also you will soon notice that suddenly, things are getting easier for you. It is about the learning curve. It is super steep I think for the first 6-8 months then starts easing up a bit. Hang in there, find your support system.

Mahage

odori · Dec 3, 2008

I'm a new second career nurse and I am so glad to hear I am not the only person to come home crying after a shift. I am on a med surg floor and still can't cope. I have all 3 shifts and sometimes 12 hours. I never get out on time because my paper work is always the last thing to be done. Usually an hour late. I'm so afraid of screwing up that I can't sleep the day before I go in. Our RN's are usually very helpful but I have been on the receiving end of nasty remarks. Then I don't ask for help, get behind and in trouble again for not asking for help. I hope it's true about the 6 months. Thanks for the outlet. My husband doesn't get it. :eek:

Mahage, LPN · Dec 3, 2008

I'm a new second career nurse and I am so glad to hear I am not the only person to come home crying after a shift. I am on a med surg floor and still can't cope. I have all 3 shifts and sometimes 12 hours. I never get out on time because my paper work is always the last thing to be done. Usually an hour late. I'm so afraid of screwing up that I can't sleep the day before I go in. Our RN's are usually very helpful but I have been on the receiving end of nasty remarks. Then I don't ask for help, get behind and in trouble again for not asking for help. I hope it's true about the 6 months. Thanks for the outlet. My husband doesn't get it.

Odori, Just make patient care your priority. Don't worry about the nasty remarks, and DO keep asking for help when you need it. It is your right and responsibility to ask for help. If you make sure you do the best patient care you can, you will do just fine. Don't let your dread of approaching someone stop you from doing it. Notice who helps willingly and who is nasty. Try to approach the nice ones, but if they aren't available approach the nasty ones and make it clear that you must have their help. The charge nurse is supposed to be available and willing to help anyone who needs it. It took me a while to figure that one out, funny that noone told me.....but they didn't. There are lots of little secrets that noone will tell you. You just have to observe closely and use what works and is safe and legal.

Then the simple stuff like gathering all your feeding bags and lines on one trip to the pyxis, getting your prn meds when you know your patients will need them in one trip to the med pyxis. Check your patients room for peroxide and saline and trach care kit and supplies on first round and gather the items you will need for your patients in one trip. If you have a med cart or rolling computer cart you can load them on it. If not find yourself a box or a bag to gather them in. Day shift is notorius for not leaving our wall cabinets stocked, so usually I start the 1st round with a pocket or two full of saline flushes, fill needles and alcohol pads. Saves a lot of steps and some degree of frustration.

I have started doing my trach care and tube feed changes right after midnight rounds instead of waiting till 4 or 5 in the am to do them because inevitably I will be busy hanging electrolyte replacements and cleaning poop at that time. This may cause the trach to look less than tidy, but I try to change out sponges again if needed just before shift change.

I try to make electronic notes of any major issues as they arise, but I don't always remember to, and sometimes my computer will not function in the charting program. I try to note particulars on the SBARR and then I can chart the specifics around 1:30 after sending off my lab draws. I have noticed some of the newer nurses are much better organized than I am regarding their notes and patient information. I am trying to learn from them. We are changing to doing SBARRS more specifically than we are currently and I dread it, but once I learn the process it willprobably be better for me, because I tend to take too many shortcuts on the paperwork.

I hope some of these things will help you and possibly others. Yes it should get better for you around 6-8 months. That is what I experienced and have been told by others just a little farther along than me.

Mahage

Jean1313 · Dec 3, 2008

Hi!

Thanks for the reply! And, like everyone is saying on here, I really appreciate this forum. Many nights I lie awake.

I wish that I could give helpful advice too, but I'm only a month and a half in...

I think that (if I can make it) 6 months *will* probably be the time that I start to feel comfortable, but I really don't feel that I enjoy the type of nursing I do...

So that leaves me still in the position of "How long do I have to stay?" I'm truly interested in the employers perspective... Will I look like a poor investment? Will they think that 6 months of med-surg is "not enough" experience?

Has anyone else here known anyone that made a switch (between any types of nursing) at that point? Made the switch themselves?

Am I the only person that is in a type of nursing they don't have a true interest in?

Thanks again!!!

MMARN, BSN, RN · Dec 6, 2008

I never thought I would say this, but after about 6-7 months of complete hell at work, it HAS gotten better. I always thought it would be the same horribleness each and every time I went in to work. I still make mistakes, and I'm hoping they're not too bad, and I'm still getting grief from some of the night nurses, but all in all, it's getting MUCH better. This is a great thread, though. I wish I'd have found it months before now. :)

dsoginer · Dec 6, 2008

Love this thread! I am finishing my 3 mth orientation on a Peds floor next week. I hated, hated my first 3 wks because the preceptor used my mistakes as fodder for laughs from other nurses. I was then switched to nights with a new preceptor and have learned so much. I learned that the mistakes of the first weeks were common mistakes and I have watched more seasoned nurses make the same all the time.

I just had my orientation and the nurse manager thanked me for coming to work for them! NOW I feel like a real nurse. I no longer sweat the small things. Wish that first preceptor had admitted that I was not messing up terribly.

flyakite80 · Dec 7, 2008

I am soooo glad I found this thread! I have been feeling everything mentioned here and then some. I graduated in May 08 and started working on a telemetry floor in July. I am currently headed into my 4th week off orientation and most days I go home feeling like a complete idiot and all I want to do is curl up in a ball, cry, and forget about it. I wanted to be a nurse so badly and now I ask myself where those feelings have gone. :cry:

I work 7p-7a and night shift is a lot different from days, but definitely not easier or less work! I get the feeling the day shift nurses think we do nothing all night and leave everything for them. There are a select few seasoned day shift nurses who I dread giving report to because no matter how much I did overnight, they will find the one thing I did wrong or didn't do at all. It is SO frustrating. I keep telling myself not to let them get to me but they do..and it doesn't help that I worked with these nurses for 3 years as a secretary while I went to school, so I expected them to be more understanding. They were always so nice and encouraging before, what happened??

I run myself ragged all shift just trying to survive only to discover at the end of the shift that I failed.

I feel the EXACT same way! I am always running around like crazy while the experienced nurses sit chatting, all caught up, and I wonder WHEN will I ever get to that point? :confused:

Also, staffing on our floor is not the best. Most of the time we're short, and we only have one tech split between two sides of the floor. I haven't had any major issues with techs yet, most of them are pretty accommodating and helpful, some more lazy than others. I do have support for the most part as far as the other night nurses go. I know I ask a lot of questions and some of them are more receptive than others. And some nights there are not enough experienced nurses, that's scary but we do have the rapid response team in case of situations that are quickly going from bad to worse. My first night off orientation I had a patient go bad on me and had to call an RRT. She ended up intubated and sent to the ICU. Of course I beat myself up over that, thinking what did I do to make that happen or what didn't I see that I should have??

Adjusting to working nights has been hard enough. But to come home every morning feeling like I did a horrible job, that I surely missed something or did something wrong, it's almost to much to take any more. :no:

Mahage, LPN · Dec 7, 2008

I am soooo glad I found this thread! I have been feeling everything mentioned here and then some. I graduated in May 08 and started working on a telemetry floor in July. I am currently headed into my 4th week off orientation and most days I go home feeling like a complete idiot and all I want to do is curl up in a ball, cry, and forget about it. I wanted to be a nurse so badly and now I ask myself where those feelings have gone.
I work 7p-7a and night shift is a lot different from days, but definitely not easier or less work! I get the feeling the day shift nurses think we do nothing all night and leave everything for them. There are a select few seasoned day shift nurses who I dread giving report to because no matter how much I did overnight, they will find the one thing I did wrong or didn't do at all. It is SO frustrating. I keep telling myself not to let them get to me but they do..and it doesn't help that I worked with these nurses for 3 years as a secretary while I went to school, so I expected them to be more understanding. They were always so nice and encouraging before, what happened??
I feel the EXACT same way! I am always running around like crazy while the experienced nurses sit chatting, all caught up, and I wonder WHEN will I ever get to that point? Also, staffing on our floor is not the best. Most of the time we're short, and we only have one tech split between two sides of the floor. I haven't had any major issues with techs yet, most of them are pretty accommodating and helpful, some more lazy than others. I do have support for the most part as far as the other night nurses go. I know I ask a lot of questions and some of them are more receptive than others. And some nights there are not enough experienced nurses, that's scary but we do have the rapid response team in case of situations that are quickly going from bad to worse. My first night off orientation I had a patient go bad on me and had to call an RRT. She ended up intubated and sent to the ICU. Of course I beat myself up over that, thinking what did I do to make that happen or what didn't I see that I should have??
Adjusting to working nights has been hard enough. But to come home every morning feeling like I did a horrible job, that I surely missed something or did something wrong, it's almost to much to take any more.

Dang Jenny, You sound EXACTLY like I felt my first 6-8 months. I can't remember exactly how long it took for me to turn my feelings around but it started around the 6th month. I would find myself thinking of all the good things that happened at work, not just kicking myself for all the things I did wrong. Now I still make mistakes, don't get me wrong and I still hate looking like an idiot. I made a big booboo this week, one which I could get in trouble for or worse yet, make some trouble for a very nice young resident through my mistake not his.

I called this particular trauma resident about a patient who didn't have effective pain relief, he told me the patient wasn't his, I found that the patient was indeed a plastics patient. I called the plastics resident who gave me an order to increase the guys scheduled percocet. I wrote the order TORB but used the trauma residents name. (They were almost the same.) The next day the plastic resident on days made rounds and told the day nurse that was a stupid order (too much acytemenophen in the percocet) and that the particular doc had no business giving me an order anyhow as he was trauma, not plastics!

Wow did I feel terrible. To top it all off the patient had been transfered out to the floor off IMCU. I talked to my charge nurse and she told me I should go and mark the order as an error and write the order just as it was but using the correct residents name. I went up immediately and corrected it. I haven't heard anything about it yet, but I could. The last thing I want to do is get anyone else in trouble or loose the respect of this resident. Chances are nothing will come of it, but I still feel horrible. I won't make that mistake again, but it is particularly bad when it makes someone else look bad. I also put a note in the nurses notes about correcting the error in name. Residents give stupid orders all the time, and I should have caught that one, but I didn't. I just hate that I wrote the wrong guys name, but things happen. It was a hectic night and even experienced nurses make mistakes.

Last night, I had a patient develope "flash pulmonary edema." Her sats dropped, and she was literally foaming at the mouth. RT and I had to pretty much continuously suction her, we called MD on call and ordered stat EKG and Chest x-ray, cardiac enzymes, troponin and the doc came in and ordered Lasix. We had a heck of a time getting her blood as the PICC was a hard draw and she had no veins available in her upper extremeties. My charge nurse finally got the picc to draw and we got a tiny amount of blood. The lab ran the test on the childrens equipment. Her urine output picked up and I was suctioning her about every 2-3 min. then every 10 then 15 minutes or so. I went to see another patient and did his meds, came out of his room, heard her alarm going off, and went in her sats dropped fast to fifties, I was doing my best to get the inline suction in her, and couldn't, yelled for help and bagged her. Then couldn't force the O2 in her tube because the secretions were so bad. A coworker managed to get the suction catheter in her, suctioned her quickly then I bagged her again. We got her sats up, I gave her some ativan and she calmed down a bit. Poor thing was scared to death and who could blame her. Drowning in her own body fluids and being fully concious and with it. That has to be hell. We kept working with her and finally she got to the point that I could leave her for a few minutes. I had my coworker keep his ears open for her alarm while I took care of my other two. Of course one was on the other side of the hall.

My experienced team members were wonderful. They prompted me on what I needed to do, and had my back all the way. The team work was wonderful. I have still have not had a patient code and I hope I don't freeze up when I do, but I only hope I can have supportive coworkers around like last night. At the end of the day, I feel like I gave really good care and had great support. That is what nursing is all about.

I learn more and more. I learn from what I do right and what I do wrong! I don't feel as stupid most of the time anymore, but of course I do some of the time. If I get in trouble over that order, I will deal with it. I mainly don't want to cause the nice young doc any trouble by putting his name on an order that wasn't his service. I too envey the experienced nurses who seem to spend so much time at the desk or on computer playing around while I am running my butt off, however at times I get down time now too! Believe it or not I have actually had a couple of nights recently when I didn't have enough to do. I get hyper and don't like that. I try to find someone who needs my help.

It will get better. Just know the learning curve is steep. Nursing is very complicated.

Mahage

blaaveispiken · Dec 7, 2008

I am always running around like crazy while the experienced nurses sit chatting, all caught up, and I wonder WHEN will I ever get to that point?

You mean they don't offer to help you? That is just wrong...I feel for you so much. I've been in an unsupportive nursing environment before and it is so not worth it. I hope you have good family/friend support although I've found people don't get it (the stress of it all) unless they are nurses themselves working in a hospital setting.

Just remember what this is like for you and when you are the seasoned nurse and the newbie starts on your floor you can be the one who sets the example on how to support a fellow nurse, especially the babies.

I really believe the nursing shortage is partially due to the fact that nurses can be downright mean to new nurses. It is a strange phenomenon unique to hospital nursing. I don't get it...

Anele07 · Dec 8, 2008

It helps so much to see that I'm not the only one feeling less than adequate. I just graduated in May and I work in the ICU where our patient population is really really noncompliant. I'm okay with the sick stable patients, but when they start circling the drain I lose my head. I've been on orientation for 5 months and I have one more month to go (I also realize I'm pretty lucky to get a long orientation). It seems like just when I feel that I'm catching on, that one patient comes and throws me off. My first couple of months were so bad that I would come home and cry because I felt so overwhelmed. I finally came home one day and after a mini breakdown, I told myself that I'm not going to know everything and that it's okay to ask questions. It's just a matter of figuring out how things are ran I guess. I laugh now because I think of all those NCLEX questions that have the answer that always seems to be the wrong answer "call the doctor". What the heck else am I supposed to do when the BP is 0/0 (that's a little extreme). I feel like everything needs an order and I don't want to do the wrong thing. Situations like these are the reason I wish I could skip the novice stage and take the first train to expert city.

All in all, it has gotten easier, and I'm trying to take it day by day. I just can't wait for the day that I feel competent *sigh*

flyakite80 · Dec 8, 2008

You mean they don't offer to help you? That is just wrong...I feel for you so much. I've been in an unsupportive nursing environment before and it is so not worth it. I hope you have good family/friend support although I've found people don't get it (the stress of it all) unless they are nurses themselves working in a hospital setting.
Just remember what this is like for you and when you are the seasoned nurse and the newbie starts on your floor you can be the one who sets the example on how to support a fellow nurse, especially the babies.
I really believe the nursing shortage is partially due to the fact that nurses can be downright mean to new nurses. It is a strange phenomenon unique to hospital nursing. I don't get it...

Some of them offer to help, but not all of them. Some of them will say "You okay?" when it's obvious I am not, then continue to go about their business. There is one nurse who asked one of the other nurses to help me because he didn't have time but he saw I was struggling and really behind on everything. She did help me. I just wonder how they get done so quickly and I'm always hours behind!

I will definitely remember this feeling...I swear I'll never be like that to a new nurse.

flyakite80 · Dec 8, 2008

Wow, Mahage - I was sweating bullets reading your post. It sounds like you did a great job. I agree, having the support makes all the difference in the world! Thanks for sharing your insight.