The Uncertainty of it all

what you are experiencing is what we all experienced when we were new grads working as hospital nurses for the first time. it is a culture shock! a good part of what is happening is that you need to learn to organize and prioritize. and, that is something that you learn over time and by learning from making a few errors in judgment.

one thing that you have to realize is that freaking out is hurting no one except you. you have to mentally tell yourself to calm down. this is a mental statement that you have to take the time to remember to tell yourself when you start to feel panicy. you can only do one thing at a time. this is where you have to look at priorities. you usually have time leeway on giving meds and ivs so you can put them off for a bit. admissions need to be looked at and assessed asap because you don't know what kind of condition those patients are in and you don't know if there are any stat orders that need to be carried out. discharges are also something that can be put off--those patients are stable and unless they are chomping at the bit to go, they can wait a few minutes while you assess a new admission.

you have to also realize that as a newbie it is going to take you some time to become a master at doing the various hands-on skills you need to do. nursing school only exposed you to them. now, you need to hone in and master them. practice, practice, practice. you will get experience and get better each time you do them.

as for putting iv pushes into piggybacks. . .that is something that many hospitals i worked at was a policy. we pushed nothing except during code blues. everything was mixed in a piggyback and dripped. you might want to take some of your free time and check your hospital's nursing policy on giving iv pushes. it saves the time of standing at the bedside and watching your watch while you are pushing the drug. also, many of these drugs are very irritating to the veins, so mixing them in a small bag of d5w or ns is doing a service to the patient's veins. there is also the threat of a patient having an anaphylactic reaction to a direct iv push. almost all iv medications can be mixed in d5w or ns and dripped. if you ever have a question about a drug, call the pharmacy and ask one of the pharmacists--that's part of their service to the nursing staff.

i want to tell you about this business of starting ivs. when i first started as a hospital nurse it was one of my major problems. if i had one or two ivs that needed to be started during my shift it ruined my whole day. i went to work hoping that the issue wouldn't even come up. after 6 months of struggling with this, one of my supervisors had been suggesting to me that i should take the same iv certification course that the lvns here in california take to learn more about the skill--and it is a skill. i finally did it despite the fact that i felt embarrassed to be an rn sitting in a class with lvns. however, unlike my lvn classmates, i could go back to work and practice what the instructor was teaching us--they couldn't because they were restricted from doing anything until they actually got their certification, but i was already a licensed rn. what a difference this class made for me. i started taking every opportunity that came along to start or re-start ivs. my improvement started showing within 6 months and i was on my way to becoming a real pro at doing ivs. i not only learned about starting ivs but how to maintain and manage the iv drips from this course. i went on years later to become an iv therapist and become nationally certified in iv therapy. iv's are a difficult skill to master and not as easy as some people might want to fool you into thinking it is. it took me years to master this skill and when i hear people toss around their "skill" at it after only a few successful sticks i know it is only their ego talking.

if you haven't been told this already, let me be the first. it takes at least 6 months to even start to feel like you have some control over your new role as a hospital nurse. and, in reality, it will take 2 years or more before you will start to feel really confident in what you are doing. now, you can go back to ltc if you want because that is what you know. however, i also started out in ltc and went to the hospitals. to become a hospital nurse you just have to stick it out and put in the time. it does get better as time goes on. you are merely in a very intensive learning phase right now that we have all had to go through, so just hang in there and keep putting one foot in front of the other and try to stay calm. you will have good days and bad days. as time goes on the good days start to outnumber the bad days.