Tips for nurses in their first year of nursing

chichi3 · Jul 17, 2006

I don't have any tips, but more questions. I graduated in December of 05 and I am in my second job, and could leave it today!! What is wrong with me????

I can't explain it. When we were graduating I didn't know what kind of nursing I wanted to go into, it was suggested by many peers and cllinical instructors to go into ER. So I did. I liked it but I didn't get the patient contact I enjoyed. It was go, go, go and I would get into trouble for talking to patients. It was stupid, there wouldn't even be anyone waiting but we had to move them out! I felt like I was in prison when I was there and I was so burnt out in 3 months, that it was a relief when I got into a car accident and had to take some time off. However, they played dirty and I found another job.

Now I am with woman and children (the one thing I really wanted to do). Well, the politics and the people I work with are horrible. My lead is TERRIBLE and again, I feel miserable at work. I have never been so stressed out. These places play so dirty and are so dishonest and I find that really hard as well. I don't want to quit because I think it will look so bad I will never get a job, but what do you do when you are not where you feel happy and it's early in your career? I am just waiting for my 90 days to move to another department.

Is something wrong with me??

happytobehere · Jul 18, 2006

thank you from a new grad!

cardiac mama · Jul 22, 2006

I completely understand how motolady feels, I too have had a rough going since graduation and passing boards, I was hired on as a GN on a med surg unit, I have had in 4 weeks a different preceptor every shift, and have been rotating from days to nights every week, that is why I am still awake at 4 am even though I am on days this week.I also have been trying to take care of a team of 5 to 8 patients and feel inadequate and when I do have a question have a hard time finding my shift preceptor to ask so I worry that I will make a major mistake by trying to figure it out for myself. I feel that I cannot establish a working relationship with a person I only work with for one day and then the next shift I have to start over again. I am considering switching jobs but have the same thoughts of what if it is the same way, then what have I gained. The experience I believe I am getting is good, however, I haven't gotten any feedback from anyone and I am too shy to just say so how did I do today I suppose I need to get over that and start asking. Any suggestions would be greatly appreciated on how to launch a successful practice under these learning conditions. Thanks for letting me vent without repercussions, yes I have talked to my educator and manager and no changes have occurred yet. :uhoh3:

ZASHAGALKA, RN · Jul 22, 2006

I posted this in another, similar thread:

Until you know your way around practical pharmaceuticals, never give more than two of ANYTHING: vials, pills, etc. without double checking w/ a more experienced nurse.
Some of the biggest med errors in new nurses that I have encountered had something to do with "I didn't know 3 of them were too many". And let's face it, doctor's aren't known for clear handwriting and intent with their orders. . .
(There used to be a chemo med that required 10 pills per dose. After the FDA approved it, the off-label use required a much higher dose. There are times when 4 or 5 or 10 pills IS the right dose. But, you're better off being able to say, "I checked the dose with the charge nurse.")
~~~
At the end of a shift, decompress the shift before you leave. Spend 10 minutes going over everything you did and didn't do. Critique how you 'time managed' with the goal of learning from what you did right - and what you did wrong.
Then, give a follow-up report if needed (so you don't have to call back) and THEN, let it go.
Nursing can be so stressful you HAVE TO LEARN when to leave work at work.
~~~
More than anything else you learn, learn to chart as you go along. Consider having to 'stay and chart' to be a time management failure that you have to work on improving.
Too many times, you have 10 things to do at any given time, and that will completely take over your shift. Charting must be a higher priority item in that list.
Besides, I find that, by taking 'time outs' to chart, I can get a better handle on the chaos. Humans work better when they can take a few minutes and decompress and reanalyze their situations. A few minutes here and there charting does JUST THAT FOR YOU.
If you want to learn to 'work smarter, not harder', then learn to chart as you go. DECIDE that 10 minutes of every hour is 'charting' time and ONLY pain meds and emergencies can invade in that sacred time slot.
~~~
Find an older nurse or two you trust and enlist them to be a 'mentor'. Not a 'preceptor', but someone you can turn to to help you analyze a situation. Someone you trust there is no 'stupid' question you can't ask.
~~~
Respect your contribution. You can only work so hard. Work diligently and learn and be proud of what you are doing.
All of us have situations that overwhelm us. Just don't let those situations overwhelm the value YOU place on your efforts.
~~~
Don't get so caught up in your own routine that you can't find the way to observe the 'learning' stuff that happens on your unit. Get in to see the codes, the central line placements, etc. Watch not just in awe, but with an eye as to the nursing roles you see going on about you.
~~~
Start every IV you can. Make sure everybody knows that YOU will try their IV first. My first job, I was REQUIRED to try twice on every IV on my unit before anybody else could look: no matter how busy I was.
Stressful to be sure, but 500 IVs my first year as a nurse, and hey, I'm fairly good at it.
~~~
Ask nurses from other job types (OB, ER, OR, med/surg, etc.) about their jobs. Learn not only what they do, but get to know THEM. Network. It'll make you a better known nurse around the hospital, and it will give you insights about where you might like to end up.
~~~
Grab all the certs (ACLS, PALS, TNCC) and CEUs you can. Your hospital will probably even pay for most of them.
~~~
Volunteer for committees, especially P&P (policy and procedure) committees. Being a voice there will not only help you make a real difference in YOUR job, it'll give you insight into WHY things are the way they are. Besides, your manager is always looking for such volunteers: the brownie points are just a bonus.
~~~
Smile and never seem hurried in front of pts. I won't go so far as the goofy "how can I help you, I have the time" campaigns, but nursing is as much acting as it is caring.
Spend 2 minutes 'acting' the calm unhurried part (even though you're frazzled and falling apart) and the reassurance you give your pts is worth hours of your time.
I can't tell you how many times I hear in report, "so and so was on the call bell ALL DAY". When I get out of report, sure enough, call bell. I'm johnny on the spot. Five minutes later, call bell - johnny on the spot again. Now, once that pt knows I'll materialize when called, they don't feel the need to hit the button NOW JUST IN CASE they need something in twenty minutes.
It never ceases to amaze me how the pts that are 'always on the call bell' never bother me again after that 2nd or 3rd call that I promptly answer.
~~~
Nursing as acting: never admit you don't know something to a pt. Their confidence in YOU is based on your competence. Always front that competence. If a pt asks me a question I don't know, I'll say something like "give me a sec to take care of xxxxx, and I'll come back and explain it to you." Then, I go look it up.
~~~
ON the same topic: never give a med if you don't know what it does. Always look it up again until you learn it. Nothing is more deflating than a pt asking you what x pill does and then getting a blank stare from you.
After all, if YOU don't know what it does, why are you giving it to ME?!
Exactly.
~~~
When a new med comes out, ask the pharmacist to send you a package insert and read up on it. You can learn all kinds of things that way.
For example, did you know the molecular wt of Viagra is 666. Don't believe me, look it up!
I'll think of more next week when I get back from camp.
~faith,
Timothy.

One more: when I first started out, on a medical unit with 10 pts, I organized myself into 3 first rounds. The first time through, I just introduced myself and stated I would be back soon.

That way, I could make sure that everyone was where they're supposed to be (not on the floor) and nobody was in acute distress (my first priority on everyone).

Then, 2nd rounds: I'd go back through and do my assessments.

3rd rounds, med pass and taking care of 'creature comforts'.

I found that those 3 'first' rounds organized my shift better, highlighted the priorities more soundly, and gave me time to 'impress' my pts. Nursing is at least part an acting gig. You can't 'take the time' with x pt when you don't know anything yet about 'y patient'.

I never stopped until my 'first rounds' were complete. But, at that point, my shift was well organized.

~faith,

Timothy.

Underbedmonster · Aug 11, 2006

Thanks to everyone who posted. This stuff is priceless. I'm a Dec '05 grad who's had a very rough time of it so far. I'm looking for a new job, but also combing the allnurses boards to help figure out what exactly went wrong, and what to do about it next time. This is by far the most encouraging and informative thread. Again, thanks to all the vets who took the time to share. Blessings.

SillyLilly · Sep 18, 2006

I never stopped until my 'first rounds' were complete. But, at that point, my shift was well organized.
~faith,
Timothy.

This entire thread, and this particular post by Tim is INVALUABLE to me right now. I plan to use the advice when I start next month. I already have butterflies in my stomach.

RNKay31 · Sep 26, 2006

Ever have an "I wish I was told this" moment? Well, we all do as nurses regarding school. Here are some things I wish they told me nursing school (and some I wish they had emphasized more)----and what I told another new BSN nurse in a different thread (and it would be the same advice I would give any new nurse/grad):
You have achieved a great thing, graduating and earning your degree (BSN, ADN , LPN or Diploma). Now, the REAL learning begins......
Don't ever pretend to know what you don't. Be a sponge---watch and listen to what is going on around you. Take mental notes. Find mentors and emulate their good habits. Take note of the bad habits and avoid those.
Listen to your patients; they know their bodies better than you do.
Have integrity----be honest with yourself and others.
Stay out of the gossip game/circle. It goes nowhere and brings down morale, including your own.
Be on time! EVERYtime. When you are late, so am I. And I don't like to be late!
Stay organized as possible. Keep up on your charting and tasks as they come up. Dont' save it all for "later"---there may not be time, "later".
Do it right the first time, even if there IS "no time". Believe me, there is no time to "Do it over", either.
Plan for the worst; hope for the best.
Be someone they can rely on---and rely on yourself!
Take good care of yourself; eat well, exercise. It's the only body you got and you are gonna need it. Nurture the self. Nurses have a tendency to martyr themselves and neglect their own needs. Don't be one of them; it's a fast superhighway to burn-out.
Nourish the mind. Plan on spending a LOT of time investing in your continuing education as a nurse. The world of nursing/medicine is changing faster everyday. You are going to have to make a conscious and concerted effort to "stay abreast". It's more work than you imagine right now.....plan on it.
Learn assertiveness if you have not already. Lots of good books and conferences/seminars exist. Learn early-on you no are NO ONE's doormat. Also, know there is a difference between "assertion" and "aggression".
Work hard, yes, but don't forget to PLAY hard too! Have hobbies you enjoy. Your life is NOT your work, and while being a nurse is part of who you are, it need not *define* you.
Believe in your self and good instincts. Sometimes, "instinct" is what lets us know something is amiss or wrong with our patients. Never ignore that gut instinct. It's very often right! BELIEVE IN YOURSELF!!!!!
After 8 years in nursing, these things are things I have learned the "hard way"; hopefully you don't have to.
Warm, hearty congratulations to you and all new grads here. I wish you all good things in your new careers.

That was really great, thanks for sharing.

hica19 · Oct 11, 2006

Thanks for all the advice! I am a new nurse who has been on the floor for 4 weeks. There are times when I get really flustered, and have made a few mistakes already (one time I accidently dropped medication in a line that was not already connected to the patient. Luckily the fluid in the line I dropped the medication in was also compatible with the medication, so I just needed to make the extra step to switch the lines). But in the end of the day when I think about it, I am learning everytime, especially from my mistakes. One thing I know I really have to work on is speed. Especially since I'm working in a high acuity, fast paced floor. I know there are many things that are slowing me down, and I know I need to work on them. One thing has to do with tape sticking to gloves. Usually when I have to use tape to lets say, tape a g-tube port, I take off my gloves. However this past weekend, I had patients on contact precautions with MRSA. I know I have to wear gloves and gown on when going int othe rooms to do things. But whenever I have to use tape to tape down a dressing or to tape a g-tube port, the tape keeps sticking to my gloves and it's really me down. In this case, would it be ok if I take off my gloves to tape things even though the patient has MRSA?

SillyLilly · Oct 11, 2006

For those of you who are just hired, and your hospital (or hospital system) offers classes that pay for you to attend, or that you are required to take, SIGN UP FOR THEM IMMEDIATELY. Contact the educator ASAP.

Im dissapointed that I am on a tele unit and will not get any classes in until December. Perhaps if I had called 2 weeks ago, instead of waiting until my first day, I would have gotten insooner.

tiggerforhim · Oct 24, 2006

Something else to do if you are having problems finding your 'preceptor', is just start asking questions of all the other nurses on the unit. You will discover that some people (like me) love to teach and love answering questions. Some hate it and will bite back. Don't take it personally, just hook up with those you know will answer the questions even if they aren't your preceptor. You gotta get the info from somewhere and sooner is usually much better than later. Keep trying and take advantage of the new grad status - you don't know everything and others may have great insight. Just keep in mind if it's funky, check with the charge nurse and/or P&P if you have time to make sure you're not doing something seriously wrong. Also, too, remember you can take more time to talk to patients later rather than when you start out on your shift, even make another round as Timothy put it so excellently. Sometimes all you can do is get in, give'em a name/face, and get out to deal with crisis x/y/z. Good luck, it does get better!!!!!:welcome: :welcome: :welcome:

tiggerforhim · Oct 24, 2006

Thanks for all the advice! I am a new nurse who has been on the floor for 4 weeks. There are times when I get really flustered, and have made a few mistakes already (one time I accidently dropped medication in a line that was not already connected to the patient. Luckily the fluid in the line I dropped the medication in was also compatible with the medication, so I just needed to make the extra step to switch the lines). But in the end of the day when I think about it, I am learning everytime, especially from my mistakes. One thing I know I really have to work on is speed. Especially since I'm working in a high acuity, fast paced floor. I know there are many things that are slowing me down, and I know I need to work on them. One thing has to do with tape sticking to gloves. Usually when I have to use tape to lets say, tape a g-tube port, I take off my gloves. However this past weekend, I had patients on contact precautions with MRSA. I know I have to wear gloves and gown on when going int othe rooms to do things. But whenever I have to use tape to tape down a dressing or to tape a g-tube port, the tape keeps sticking to my gloves and it's really me down. In this case, would it be ok if I take off my gloves to tape things even though the patient has MRSA?

No, it's not ok to take your gloves off. Do you really want to potentially spread MRSA to other patients on the unit and cause potential problems? Do you tear off the tape first and put it on the bedrail before you change the dressing? Something you might want to do is find some gloves that are skintight or very small for your hands. That way there is no extra glove surface for the tape to stick to, and just go slow, don't feel like you've got to rush through it.

Indy, LPN, LVN · Oct 28, 2006

One thing you can do is make a habit of having the tape, whether it be the tape in the room or in your pocket, have a "tab" on the end. You know, where you fold the end over a bit. If you do this, you're more likely to have something to grab onto with at least one of your hands where it won't stick to the glove.