Week 2 of orientation OMG

hlfpnt, BSN, RN · Mar 19, 2007

Very normal!!! It all comes with time & practice...I've been on my job for almost 7 months & am just now finding something of a comfort zone. I still have a very long way to go! I wouldn't worry about it too much (easier said than done, I know!)...your co-workers know you're new & they know it will take time. They'll help you. Hang in there & just remember it does get better! :)

DolphinRN84, MSN, RN, APRN, NP · Mar 19, 2007

Definitely normal. I've been working as a nurse for about 4.5 months now, and I still feel the way you do! People tell me I'm doing great too....sure don't feel like it. You'll make it!

TraumaRN1983 · Mar 20, 2007

I just graduated in December and I am currently on my 6th week of orientation and I still feel like I am missing "the big picture." I too feel so focused on tasks that I often miss important things and it scares me. I think that being a new grad is incredibly hard and there is such a focus on time management and organization that is easy to get good at those things and forget about the entire clinical picture. What I believe though, is that those skills will come with time. Since you are only your 2nd week I wouldn't worry about it too much, you really do sound like you are doing well! Good luck!

Ariesbsn · Mar 20, 2007

Ram8836,

Take a deep breath or 2. You are doing just fine. It is normal to feel that way. It takes a while to get the tasks of any job down pat and let me tell ya, nursing is very tasky. What area of nursing are you working in? How are they doing your orientation? Are they just sort of throwing you in with patients and a preceptor or is there relevant education too?

Personally, I find that the concept of "the big picture" in nursing is confusing, especiallly to a new grad. I find it more helpful to look at a patient like you are looking at a Bev Doolittle painting. Click on the link, and look at the pic

http://www.galleryak.com/IBS/SimpleCat/Product/asp/product-id/25925260.html

It is a nice, detailed pic of a Native American, isn't it? The artist is talented, isn't she? Look closer and notice that the rock formation the person is standing on looks like a bird's head. Keep looking and you will see a ram and a deer in the rocks below the escarpment. There are 34 (some sources say 36, others 40) animal and bird spirits incorporated in this pic. Some are in the rocks, some are in the trees, some are in the stars and clouds. Some are obvious, some you have to really look for, and some, IMHO, you need the guide that came with the print to find.

It doesn't matter if you don't find all 34/36/40 spirits the first time you look at the print. It doesn't matter that someone might have had to point out to you that there are pics with in the pic. It doesn't matter if you have to use the guide to find all 34/36/40 animal spirits. However, in the future, you may be looking at framed print on a wall somewhere and notice that there is a face in the trees, or hidden animals pop out and after looking at it for a few minutes, you'll think with certainty "That's a Doolittle!" and you'll be right.

As a new grad you are, in my opinion, looking at the big picture. You see the over-all state of the pt be it respiratory distress, hip fracture, having a baby, burned, beaten, or psychotic. You see, in essence, the Native American standing on a rock formation. You also see some of the obvious things that make up the clinical picture (b/p, hr, sats, rr, level of agitation) just like in Prayer For The Wild Things, you can "see" that some of the rocks look like animals. If you have a good preceptor, they will help you to look deeper into the clinical picture and see the things that you need to see like specific symptoms or which meds are used at which doses for a particular clinical pic as well as the side effects of the meds.

If your co-workers are telling you that you are doing fine, believe them. Ask them for time saving tips with the tasky stuff and how to improve your routine. The first couple of years will be uncomfortable, but you'll get it. Welcome to nursing!

jjjoy, LPN · Mar 20, 2007

Ariesbsn - I love your analogy! Newbies hear again and again about what they didn't do and didn't see and can feel very disheartened because despite all their efforts, there always seems to be something missing. It's heartening to hear someone say that new grads ARE getting most of what they should and that while there's a lot of other stuff that they "miss" one shouldn't expect them (or themselves) to "see" everything without experience and assistance. In school, students are held to perfectionistic standards, so they don't really know how to judge their own performance when everything's not done "perfectly" in the real world. What is "good enough" in nursing care is very elusive to newbies.

roosmom · Mar 20, 2007

Ariesbsn, that is one of the best descriptions I've heard to describe the many aspects of a patient's overall "look and feel". As new nurses we are trained to focus on someone's admit diagnosis or his/her change in status. It's usually not until we have more experience that we can move away from the concrete to get a better look at somebody's condition as a whole. We have several new nurses on orientation at our facility that are so eager to see things that they think they're missing. (I think they're doing great!).

This will be a great way for me to help show them how the big picture cannot be complete without all the subtle innuendos in the background, ones that often can work their way to a patient's foreground. You don't necessarily have to know every detail, but being aware of the possibilities will sure make it more clear when changes do occur - ones that may not have been picked up on before. This will sure help me too. I'm keeping this one!

Ariesbsn · Mar 21, 2007

Thanks jjoy and roosmom. I hope it helps Ram8836 see that s/he is doing just fine.

BBFRN, BSN, PhD · Mar 21, 2007

As a novice nurse, you are learning in a completely normal manner.

http://www.sonoma.edu/users/n/nolan/n312/benner.htm

Patricia Benner did a study regarding how nurses learn and wrote a book about it called, "From Novice to Expert." According to her, there are 5 stages of clinical competency. You are at stage 1, right where you should be. See link for more info. You're doing just fine.

Tweety, BSN, RN · Mar 21, 2007

I agree. You sound like a typical new grad nurse to me. Hang in there.