When does it all come together?

[Biggredd305]

I find myself going in to work feeling so motivated to be a good nurse but there’s always something that I’m missing such as critical lab values or sometimes catching a bump in continuity of care that needs to be straightened out. I currently work on a stepdown unit and the line is a little long to get up to the ICU but I’m trying to stand out as much as I can to be included in that number when our director decides to move / float nurses up to the ICU . Any suggestions on how to enhance my skills or critical thinking so I can become more competitive? I bought books but sometimes I feel so overwhelmed from how big they are LOL. I was thinking maybe getting a tutor but all they are trying to do is get someone to pass the NCLEX. I have my license already and I have been a nurse on my own since October. I do receive compliments here and there about my care but I still feel like I’m missing things. Any advice is welcomed! 

[Nunya, BSN]

So you've been off orientation about a month, maybe two?  Give it time.  Like a year, at least.  You don't learn in school how to be a nurse all at once, you don't learn on the job how to be a nurse all at once.

[Sour Lemon]

I've always heard that it takes two years to be okay and seven years to be really okay. Ten years in, I believe that to be true for most people.

[supernurse3177, ASN, BSN, LPN, RN]

Congrats on your new career in nursing!

No matter where you start out (Med/Surg, ER, ICU, Step Down), there is going to be a big learning curve and it just takes time. I went from housekeeper to CNA in nursing home to LPN in a clinic to RN on Med/Surg to BSN in the Cardiac ICU. My best advice is to give yourself 6 months -1 year of "free nursing". What I mean by that is, you show up to work, you make mistakes, you learn, you cry, you ask lots of questions, you look up all your meds because you can't remember them, you go in and out of that room a thousand times because you forgot to do something, etc. Think of this time as an extension of school -- like a true and final clinical. You're a nurse, yes, but really you are still a student now learning to really be a nurse. Let yourself still be a student in your brain. This will help your brain chill out and take some pressure off.

After the 6m-1y mark, you won't be able to recognize yourself and will probably be asked to be a preceptor. At this point, start saying "yes" to all the new opportunities. Join a unit practice council, become a preceptor, train as charge nurse, float to other units with a good attitude (even if it's Med/Surg!), start helping out other nurses when you have down time, take some classes if you haven't already like NIHSS, become a trained super user of a device (like the pumps or the charting system), etc. This, in my experience, is what gets you noticed. In my experience, no one is really expecting you to do fantastic when you're new, they don't really "have their eye on you" for a promotion until your first 6m-1y are under your belt. So take advantage of this time to learn, grow, get your nurse legs under you, and become known for being a team player and invested in your unit. When the time comes for you to apply for the ICU, you will have glowing referrals from your manager and they will say you are destined for great things.

This is normal for every job, I think nursing makes it feel more intense. Being a new 5th grade teacher, accountant, mother, father, or any other "new career" has a big learning curve. All new things take time for our brain to absorb and become proficient in. You can't rush this. Press into the pain, embrace your learning brain with kindness. You will have a very long and exciting career in nursing and all experience is good experience. Be kind to yourself and give yourself time. It will come together, you will get into the ICU, you will go where you want to go, I promise!

["nursy", RN]

Supernurse gave a really great answer, the advice is spot on.  The only thing I would add is that without a "brain"  I would have been lost.  By "brain" I mean a worksheet (or whatever you want to call it)  that guides you through your day.  You can find templates, but I made up my own.  You kind of have to create your own shorthand so you're not carrying around a book, but it includes pt, dx, hx, current labs, scheduled tx and  meds, etc.  You list what needs to be done, and check it off when it's completed.   Then instead of constantly thinking about "OMG I know I forgot something"   you can focus on critical thinking.