Terrifing 1st Day Off Orientation

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I'm a new nurse on a step-down unit. I had 8 wks orientation & a wonderful preceptor. My first day by myself (6:1 ratio) I had three pt.'s on heprin drips, 1 pt. on a cardizem drip, 4 were diabetics & 2 contact precautions. The minute I got report from the previous nurse all heck broke loose. One pt decides to get out of bed unassisted (after being told not to & press the call bell) and fractures an ankle and would happen to be one on a heprin drip. 2nd pt. is bleeding pretty heavy & there was an order for two units of FFP & one of PRBC STAT (not to mention the pt was on 1:1 watch). 3rd pt is signing themself out of the hospital. 4th pt is to receive dialysis in a few minutes & HD nurse is waiting for me meanwhile cardizem drip is complete & the next dose is not on the unit. 5th pt was getting d/c in the AM & waiting with family for diabetic teaching. Unfortunately, there was only one patient care tech so that meant I had to go to pharmacy for the cardizem and then to the blood bank. Xray was closed (weekend) so I had to take the pt to ER for XR because there were no transporters available. Between hanging drips, calling MD's, stat EKGs & XR's, I thought whatever hair I had left after nursing school, it was going to fall out by the end of the night. :uhoh3:

Initially I was upset that I was given the most critical pt.s on my 1st day off orientation, but I had to snap out of it because my feeling were clouding my better judgement of prioritizing:nono:. Of course I ask for help from the other nurses. They wasted no time and assisted me and I managed to survive (& so did the pt's).

I was excited about beginning my nursing career. 3 wks into orientation, I lost the feeling of excitement and I cannot kick the feeling of "maybe I am not cut-out for this unit". How long before you know if the nursing position you are in is right for you or maybe I'm just not right for it?

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Specializes in Emergency & Trauma/Adult ICU.

Deep breath ... you had a challenging first day.

What stands out to me from your post is that your co-workers stepped in to help ... this is a very positive sign. This sounds like an environment in which you can grow.

As a nurse of 2 years I remember that feeling of "how am I ever going to do this, day in and day out?" very well. The full weight of responsibility is a very heavy burden at first. It does get better with experience. Patient scenarios that seem overwhelming now will be less so 6 months or a year from now.

You will be challenged, you will be stressed ... but give it time. An intense day does not mean you're not cut out for it!

Sending good thoughts your way ... :balloons:

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Specializes in post-op.

Welcome to nursing !! :)

I completely agree with MLOS. I also noticed that you said that the other nurses helped you out, that is awesome and that is how it should be. We all have felt as you do now. I am only a year in and the other day I had a new grad with me and she was surprised when I told her that I have only been a nurse for a year, that will happen to you too! It will get better!

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Specializes in NICU, PICU, PCVICU and peds oncology.

What I don't understand is why you had a patient designated as 1:1 AND FIVE MORE!!!! It's great that your coworkers jumped to your aid, but come on... a 1:1 and FIVE MORE! How unsafe. Who was watching your 1:1 while you ran around with your hair on fire?

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That sounds like busy patients considering it was the first day w/out a preceptor. Is there a way you can talk to your manager to see if they can ease you into your full load? Our full load is 5 but I had three for a couple of shifts and then 4 for about a month before they gave me five. And even then it wasnt the busy patients.

Is there a resourse nurse you can ask for help if you get overwhelmed?

6 patients on a stpedown unit sounds like alot.

If that pt who needed the blood was 1:1, then why did you have 5 other patients? Do you mean they had a sitter at the time?

I know what you mean about not having the time to sit there and feel upset that you have too much on your plate but you have to let your charge nurse or whoever makes the assignments that you are new or that you need help. Its the safety on the patients and your license after all. Good luck, I truly hope you next shift isn't as crazy!

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Hi,

Thank you all for your input and support.

There was an aid with the 1:1 and she was doing VS Q15 min. The pt. was getting a PRBC & the SBP was mid 90s-100. Pt was 0x1 & contact precaution.

When I asked about why I received this group, the charge nurse said that the prior RN needed to leave and no one else was available......go figure...... the manager doesn't work weekends so I will get to talk to her today. I'm sure she will look for me from too for too much overtime. It only took 4 hours to chart my wonderful time:-) The next day was better considering my 1st. Today is my 3rd day so I'm starting to take my deep breaths now.

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Tomorrow is my last day of orientation and Monday I start all on my own. I am terrified!

I work on an orthopedic floor and yesterday my boss called because one of my patients developed foot drop and where I assessed it( she couldn't flex her foot i thought it was due to pain) i forgot to document it. I know that it wasn't due to something that I did but it made me think what happens if something like that happens when I am on my own. I mean my preceptor didn't even pick up on it either.

I don't know if floor nursing is for me. I mean I get myself so nervous before I go to work. I mean the nurse to patient ratio is like 8 to 1. and I don't feel like when I ask questions I ever get a straight answer. I feel like if i ask 5 people the same questions i get 25 different answers.

what if I don't like it? what if I don't do well?

I guess I just needed to get that off my chest! Thanks for listening

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Specializes in Utilization Management.

oops. double post. sorry.

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Specializes in Utilization Management.

It's good that you got help, but a couple of things alarmed me:

  • Someone else should've been available to take the patient down to Xray. IMO, it was more important for you to be available for the other patients on the unit.
  • The Cardizem going dry without a replacement.
  • Just my opinion, but I think you had too many patients.

Coming off of orientation is always a difficult adjustment, but I think considering your assignment and your newness, you did great! :icon_hug:

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Thanks Angio O'

According to the staff, this type of situation is not unusual so not only do I have a lot of learning to do but I better eat my wheaties because I will definitely need the energy.

I saw a previous cancer pt. yesterday walking to his car w/family. They all gave me a hug and thanked me for the care provided. With all the stress involved in nursing, I thought this is what makes it worth it.

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