When does it get better?

[RNBuggers]

I know this topic has been exhausted, and I have probably read every post related to it. But I think I just need to get it off my chest and talk with nurses outside of work. I am a brand new nurse and I have been off orientation for one week. I have made two errors (thankfully ended up being minor). On orientation I flushed a hemodialysis line. I thought it was just another line I could use, I had never heard of not being able to use them so I didn't think to ask. All the proper steps were taken and the patient was fine. I will definitely never ever do that again! Next on my first night off orientation, I was extremely overwhelmed (obviously)! I had a patient on an amiodarone drip and pca, another with a pca, and one with an insulin drip. I made a slight error with the insulin. I miss understood the order that if the patient went out of goal that they needed to be checked every hour again. I thought it was after two checks of being out of goal that it needed to go to every hour. The patient was fine and I only missed one check and realized the error. everyone told me it was totally fine and that I learned from it! My manager was even really cool about it when I told her. I just feel so bad about these mistakes still. I dread going into work every night and I hate this feeling. I am so scared about everything I don't know and that I will really hurt someone. I know that it takes about a year to feel comfortable, but how soon does the fear go away? I can hardly take it anymore. We are a very stressful unit with patients that should be in the icu and we have a 5:1 ratio. Does anyone have any loving advice for this anxious and scared new nurse?

[jadelpn, LPN, EMT-B]

Deep breath. Use a paper brain (lots of examples on here to look at and use--check on the search function).

Know where your resources are, and how to use them. If there is an order that is unclear (ie: the insulin drip) do not assume what it means, ASK what it means (your charge nurse is a great resource).

Take the time to review your orders and your medications. Make sure you do a through assessment.

Make sure that you write down on your brain when things need to happen. You will get your groove. You will find your niche in how you organize yourself. Best of luck!

[SierraBravo]

Know where your resources are, and how to use them. If there is an order that is unclear (ie: the insulin drip) do not assume what it means, ASK what it means (your charge nurse is a great resource).

THIS!!!!!! I don't know if you're doing it now or not, but just because you're off orientation doesn't mean you can't ask questions. In fact, you SHOULD be asking questions right now; there is still a ton of stuff you don't know. And I don't mean you in particular, I mean any new nurse in your same position. Bounce ideas off of other nurses if you are the slightest bit unsure of something. Right now your threshold for anxiety and stress is very low but that will change once you have gained some work experience. Again, and I can't stress this enough, ASK questions! New nurses that don't ask questions scare me... ALOT. And like someone else said, having a brain that works for you will also help you get through a shift successfully. If I were you, I would also have a conversation with your nurse manager and keep him/her in the loop about how you're feeling.

[Been there,done that, ASN, RN]

I feel for you, I really do. I've been there, done that.

The insulin drip issue? Meh.. no biggie. But, entering a line that you have never been trained on is a concern. "Thinking" it's just another line and knowing what that line is for is a basic difference you need to keep at the forefront.

Why did you feel the need to flush the dialysis catheter, and why did you not recognize it as something you had not seen before?

ANYTHING that is new to you... run it by another nurse before you intervene. That's okay, that's how we all learned.

The paralyzing fear goes away on you own timetable. As for me.. the healthy fear never left.

[ArtClassRN, ADN, RN]

"The paralyzing fear goes away on you own timetable. As for me.. the healthy fear never left."

Precisely. I always try to casually assess in general how fearful new nurses or students are. If they say "Not at all," I well to watch them like a hawk because they have a bad tendency to blunder into things.

Those with a healthy dose of fear are much easier to work with as they will almost always ask before doing something stupid.

Those paralyzed by fear take a lot more support and coaching, but I'll take those over the "Oh, this is no big deal at all" newbies any day.

[MissyWrite]

We are a very stressful unit with patients that should be in the ICU and we have a 5:1 ratio. Does anyone have any loving advice for this anxious and scared new nurse?

If it's true that you have patients that "should be in the ICU" (usually a 2:1 staffing ratio) and you are a new grad, this is a recipe for disaster. Most of us were nervous as new grads, but even an experienced ICU nurse would be in over their head with a 5:1 ratio.

A big part of happiness and success as a nurse is picking a good place to work. It does not sound like you have that. This doesn't sound like a situation you can change with your attitude or anything else -- it just sounds like a bad situation, period. If I were you, I would ask for a transfer ASAP. You'll save yourself and maybe someone else, too. Sometimes the best thing to do is to cut your losses.

Best of luck to you.

[Ruby Vee, BSN]

Everyone is different, but the fear will eventually take a back, back seat. It should never completely go away . . . when you encounter something new and different, you should be just a bit fearful that you might make a mistake. That's what keeps you alert, makes you focus and concentrate and leads you to look things up. That's what keeps you from making a mistake.

As previous posters have said, a newbie with NO fear is a very frightening thing!

[amzyRN]

When in doubt ask. I've never had an insulin drip on a 5:1 ratio. It was always 4:1 in a state that didn't technically have ratios. If you have that gut feeling, listen to it, don't brush it aside. I started on a step down unit and was overwhelmed at first. Thank god for the seasoned nurses I had as guides. If you get an assignment that you feel is too tough ask for a different one.

[anh06005, MSN, APRN, NP]

Sounds like the unit I started on--a cardiac stepdown that (besides CCU) was the only floor to take cardiac drips, insulin drips, etc. We were 5:1 on nights and 4:1 on days.

Anyway one thing I found handy was keeping copies of our protocols handy. We still mostly used paper charts and I used a 3 ring binder to keep my patient info sorted and organized so I just slipped some protocols in the back....

Not sure how y'alls stuff is but it's a thought!!

And all of the other advice is GREAT. You're still brand spanking new so don't be too hard on yourself....put your mistakes behind you and MOVE ON from it (I'm a dweller too so I have to tell this to myself)

[rbramski]

I have been on the floor a year and a half and I still ask questions even if I think I know the answer for reassurance. I felt like I made the wrong career choice at first, but it gets much better. I can't imagine doing anything different now. On a slow night I printed all the protocols I thought I might ever use and added them to a binder and leave them in my locker. Makes it a lot easier to then trying to search for them on a busy night when you have no extra time.

[RNBuggers]

Thank you for the advice everyone, it really has been helpful. I know that I am not the only new grad in the world and that I am not the only one that feels like this. But I can't help but feel alone. I'm afraid that I'll make another mistake, or I won't know what do to or my patient will have an order that is not right for them and I won't recognize that it is bad. With the HD line, it looked like a central line to me and I didn't think to ask about it, because I thought it was okay. Whenever I get them now I make sure the handing off nurse shows it to me before they leave. I promise that I ask questions, I am probably the most annoying new nurse on our floor ! The nurses on our floor are very helpful, but we are all very busy all of the time. I just want to not feel so stupid all of the time and I want to know that this feeling eventually goes away. I spent too much time and money in nursing to give up!

[MissyWrite]

I spent too much time and money in nursing to give up!

Don't give up on nursing!

Every new nurse is nervous, but from what you've said the situation you work in would only make that worse. I'm concerned that you feel 'annoying' because you have to ask for help. You need support and guidance as a new nurse, and if the others are too overwhelmed to help you, that's not good. Personally, I can't imagine having been a new grad dealing with amiodarone drips and insulin drips and patients who would qualify for the ICU. I'm not trying to discourage you -- I'm just wondering if the type of unit you're on, and the hyper-stressful atmosphere due to acuity and staffing, is the main problem.

One tip I have is to make sure you are always giving your complete and total attention to what you're doing at any given moment. When you're overwhelmed and thinking of everything else you have to do next, it's much more likely you'll make an error. You have to make a point of this and keep reminding yourself every time you start doing anything. Whenever you find your thoughts wandering away from the task at hand, refocus. Practicing Mindfulness Meditation can help you with this.

If I were you, I would schedule a meeting with my nurse manager and tell them honestly how I was feeling. If s/he just says not to worry about it, instead of really hearing you and suggesting some solutions, that would concern me. I'm thinking along the lines of several more weeks of orientation, a reduced patient load, or a transfer to a less stressful unit.

Ultimately, it's your mental well-being and your nursing license and career on the line.

Best of luck to you.