6 weeks into my 12 week orientation and freaking out.

Nurses New Nurse

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so here's my story:

graduated two years ago and finally landed a job recently in the ED. I was hired with a few other people.

first off, i got my orientation manual about 3 weeks after my first clinical day after repeatedly reminding the lead charge nurse. Second, my new grad orientation class does not start until my 9th week of clinicals.

My preceptor is nice and tries her best to teach me the routines while checking off competencies. The thing is i get flustered when i'm doing certain interventions and she comes in the patient's room and asks, "what's taking so long?" I know i have to work on my time management. Its been a two weeks since i've been given a three patient load and last shift I had my first full load of 4 patients. I am trying my best to get everything done, but i feel my preceptor still helps me out a lot finishing tasks. i feel like after i get one task done, i look at the tracker and the other patients have 4 more things to do. That is when i start panicking. i get tunnel vision, i feel my heart pounding, my forehead sweats, and i feel a knot in my stomach. i still get stuff done, but i hate that feeling.

I am wondering how I can handle 4 patients after my 12 week orientation is done and i'm having anxiety just thinking about it. The thing is, the other new hires are already handling 4 patients well without much help from their preceptor. However, these new hires had prior nursing experience in various floors. I know i should not compare, but my preceptor stated it doesn't matter that i don't have experience. Its 12 weeks for all new hires. So basically, its sink or swim.

I am happy i have this opportunity and i want to make it, but am afraid that i might be let go if i don't improve soon with my time management. Any tips with time management? how do you calm yourself down when you notice there is so many tasks left to do, nurses asking why your rooms aren't moving, preceptor reminding you about the time, doctor's shouting, etc?

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Oh so sorry! You sound like me 8 months ago. I sense from your post that like me, you are working to the best of your ability, you know you aren't going "fast enough", and once you are reminded of this from preceptor/doctor/whoever you go into fight or flight. And unfortunately, that mind state overrides ones ability to think and prioritize, thus the tunnel vision and sense of being completely overwhelmed. I would like to make several points:

1) You are a new nurse.

2) Being overwhelmed, unsure, feeling incompetent is a normal state for new nurses.

3) When you fall into the trap of "the other orientees are doing better, going faster..." remind yourself that it does not necessarily follow that they are/will be better nurses than you. The practical learning curve in those first few months is huge and we are all very individual in how we incorporate the vast amount of information into our practice. Think tortoise and hare. Keep plugging away.

4) At some point, I predict you will reach a watershed moment where you are able to say to yourself "I am doing the best I can and freaking out, panicking is not only getting old...it's not helping. It will all get done." (This actually happened for me about 3 months in...I think I simply got tired of being overwhelmed and panicking. When all hell broke loose, I started to shrug my shoulders and mutter, "Do one thing at a time...there is only so much about this within my control." It helped.

5) Once again: You are a new nurse. You are doing the best you can do. What you are expressing is so normal and an exceedingly common experience for new nurses. Numerous posters on this site attest to the reality that it took them 1-2 years to feel comfortable in their jobs. You can do it!

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Specializes in PICU.

Really, this is a conversation you need to have with your preceptor. Talk to her about this and what you're worried about and how to improve on it. It is HER JOB to help you be successful and teach you in the areas you need help with. No one can start orientation and already be perfect. If you don't feel your preceptor is someone you can talk to about this stuff then request a new preceptor that is more nurturing. I know it is awkward to request someone else, but your success or failure could depend on it. My biggest regret about orientation was not requesting someone else to precept me. I got no help from her and was left to sink or swim on my own. I survived but it did not need to be so hard. You need a preceptor who will help you develop the skills you need, not just say totally unhelpful stuff like "what's taking so long?" She should be there with you seeing what's taking so long and offering suggestions to help you get faster.

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Specializes in PICU, Sedation/Radiology, PACU.

Did you feel like you were ready to be a nurse halfway through your nursing program? Not a chance.

Right now, you are only at the halfway mark and already managing 4 patients with some assitance.

In six weeks, you have gone from no job, to caring for 4 patients in the ED. That's a huge accomplishment!

Now you have six more weeks to learn how to manage your time, prioritize, and be most effective.

Look at what you have accomplished, rather than how far you think you have to go. There is no use worrying when you are only halfway through your orientation. Give yourself time to learn and grow. Panicking is not going to help you be more organized, so learn how to control those feelings and focus on what you need to do.

You're in a new position, you're busy and you don't know everything and that's NORMAL. Allow yourself to not be perfect. If you are still having trouble a week before orientation is over, then it's time to talk to your preceptor about it. For right now, just concentrate on learning and improving for the next six weeks, not on worrying about the what ifs. I think you'll be surprised at how far you come in that time.

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Specializes in Psychiatry, corrections, long-term care..

While I haven't even completed (or started, for that matter) nursing school, I do have experience with some fairly nasty anxiety attacks. A psychologist I saw once suggested this to me:

Take slow, deep breaths in and out through your nose. You can feel the cool air go in at the back of your throat and the warm air go out. Just focus on that temperature change and nothing else for a few breaths (even up to 30 seconds if need be) and try to refocus on your next task.

It also works great for my temper but that's another story! ;)

Good luck!

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thank you for all your responses. it has helped me greatly. i'm at the end of my 7th week and i'm seriously thinking of going to the lead charge RN and asking for a preceptor change even if it hurts my preceptors feelings. I think she tried her best, but having 3 years of experience in the ED, i think she might not be the optimal nurse to train me as a new grad. I had another nurse for a couple of hours and she was constantly teaching. it was a different experience. too bad she has a preceptee of her own. I should look at my accomplishments and to do that deep breathing technique. It just sucks when you do something right and you don't get acknowledged, but when you forget something or do something wrong, the preceptor is on your butt. but that's for any work and its life. thank you again for all your support.

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Let us know how it goes if you go through with it. I am curious to see how you feel after you complete the training. Stay strong!

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i will vegasmomma. thank you again for everyone's support.

my preceptor, lead charge nurse, and i talked about switching to night for the last two weeks of orientation with another preceptor because my shift after orientation is 3pm-3am. i asked if i could start next week and have a full month with nights. the lead charge nurse has to check if the new hire who is working at night would want to switch with my current schedule.

at the moment i'm trying to do a 4 patient load, but i'm hella slow when it comes to IV starts (half the time i'm successful, but when i miss it eats up a lot of time), triage and nursing assessments. i do get behind and i feel the preceptor only comes in to tell me what orders i missed and that it was ordered an hour ago or so. her shadowing isn't really teaching me anything and i still feel like a chicken running around without a head. i'm trying my best and i hear that it does get better with experience, but right now its really a struggle at work and at home. its a struggle at home because of all the stress work causes and at the moment i dread going back to work. i hope one day soon its just gonna click and i will look forward and be excited about work.

on the brightside, i really like the trauma rooms and absorbing as much as i can as a recorder, med nurse, or even doing chest compressions. that adrenaline is fun. i just want to get to that place where i know what i'm doing, what exactly needs to be done, and do it correctly in a timely manner without missing anything including charting or paperwork.

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Specializes in PICU.
i just want to get to that place where i know what i'm doing, what exactly needs to be done, and do it correctly in a timely manner without missing anything including charting or paperwork.

I have been told by a nurse with 20 years of experience, who I consider to be one of the best nurses I've ever met, that she has never felt like she has gotten to that point. However, it will continue to get easier. The stress will lessen, and you will have more time to enjoy the parts that are fun. Instead of dreading going to work, maybe try giving yourself goals for the shift and focusing on really improving those one or two things. For example, I keep trying to remember to get a temp at midnight and 0400, because I seem to forget at least once every shift. (It just isn't part of my normal routine, but in my new unit I need to get them.) Some nights I've remembered all of them and some I haven't, but I'm getting a lot closer to it being part of my routine, because I have been so focused on it. Now I've moved on to other things that I need to improve on. There is always something you can do better, but start with the basics.

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i will try and make some kind of routine. the ED is a bit different from the floor. everything is stat and the only routine i can think of establishing is getting a quick triage and primary nursing assessment down and maybe chart everyone's reassessment every hour on the hour. thank you for the advice.

two day shift starting tomorrow. wish me luck! goal: faster, better assessment on patients. try and get urine as soon as possible and work on those IV starts. =)

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quick update. had a small off the ER meeting with the other 3 new hires as well as the lead charge nurse. it was just to see how everyone was doing and how far along we were in our orientations.

I learned that the ones that had previous floor experience while getting a lot of stuff done and knowing how to manage their time, still have difficulty grasping new concepts or interventions. Also, one of the new hires is also a new grad. It was a relief to hear her stories and how she feels about not knowing a lot of things. it makes me feel like i'm not alone and she's on the same boat.

its a sink or swim opportunity and the meeting made me realize that I could swim if I just believed in myself. yes i'm slow now with interventions, but if i keep on pushing through eventually i can be fast and time management would not be a problem. its still a stressful experience, but i am just going to take it one day at a time. learn from the past days but don't dwell on the mistakes.

i just had an elopement the other day where the pt still had the IV cath in. preceptor got mad because i assumed the pt was at CT or ultrasound and didn't chart for an hour. did what i had to do which was call the PD and write it on the nursing notes. its all a learning experience. i just keep telling myself that.

my first time alone will be august 20. yikes! it coming fast!

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Specializes in PICU.

Thanks for updating us, and I'm glad it sounds like you are doing as well as the other hires. You definitely will learn a lot, and some day you will get to the point where you feel like you can handle anything that walks in the door. You just have to get there one day at a time:)

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