When will I feel comfortable in my nursing role?

[DAMomma]

I am in my 2nd year of school, and I am an Extern on my 2nd midnight shift on a busy med-surg floor. I feel like someone who doesn't know squat. Nursing clinicals are not like the "real deal". Man, I could do 1-2 patients all day long. I will answer your call light before you even push it, I will fluff your pillow and I will talk about your grandchildren if you needed. I can pick apart everypage in your chart and I will know your consults back to the 1900's Book knowledge no problem. Running with the Big Dawg....wow! My second night at the hospital, 12 patients! One was confused in restraints (taking cheap shoots at the staff), one was psych and MAD, one patient's HR went down to 44 with a pulse ox of 80%, BP 90/something. This was after the nurse gave the pt morph(patient's daughter at bedside saying her mom was moaning in pain). Rapid response was called, they had to give narcan to reverse the effects of the morph, intubate and down to CCU. Talk about a heart stopper, since I did the assessments on the patient, I had to give the doctor a down low on the patient and make sure everything went down to CCU. As I am walking down the hall to get on the elevator, I am wondering why all of the patient's doors are closed.......transporting a dead body! (I never saw that on my fluffy day shift clinical)

Need I mention the charting? What happened to our FULL head to toe assessments, counting 5-35/min bowel sounds, yada, yada, yada? One nurse was like, "Honey, you are not in nursing school, this is the real deal, you need to go faster, you GOT stuff to do!" I am working with an RN since I can not pass meds.

Eight hours flew by like crazy, I did not even realize I did not get to the bathroom. Lunch? I don't think this group takes lunches. Then 10 or 5 minutes to 7AM, another patients IV alarm kept going off....air bubbles, occlusion. I fought with that darn thing till after 7A. I finally got the nurse who had that room for the day shift. I stood there with her for another 10-15 minutes. She ended up going to a new IV site.

It was a learning experience. I have been keeping a journal outlining what I learned and what I would like to do differently for the next week. I have been working with some awesome nurses, should I leave them little thank you notes?

Back to my original question......WHEN will I feel like I know exactly what the heck I am doing and not 2nd guess myself after it is over? I can not sleep playing my night over and over in my head. I am to would up to sleep:yawn:

[llg, PhD, RN]

Research shows that most people feel comfortable 6 to 12 months after graduation. I'm not kidding. You may become comfortable as a student in 6-12 months. But when you graduate and start actually practicing as an RN, you will very uncomfortable again -- and it will take 6-12 months to feel comfortable as an RN.

[snortzmom]

I am at month 8 post graduation, and I am amazed at how much I have learned so far.. Sometimes it blows my mind how much I have learned... Still not comfortable, but getting there.

[DAMomma]

The charting is what really gets me. I know how critical it is. I just worry that I am not conveying something correctly, or if I missed something.

I hate being the new kid on the block.....I hope my time as an extern will help me grow into my RN role easier.

When they tell me I am being helpful, do they really mean it or are they being nice?

[llg, PhD, RN]

When they tell me I am being helpful, do they really mean it or are they being nice?

Probably both. You probably ARE being truly helpful (at least a little bit) and they want to be nice and encourage you to keep doing those things. They are trying to give you some positive feedback so that you continue to do those things that contribute to the work of the unit.

It's both practical, honest feedback ... with a little extra effort made to be "nice to the new person." Consider yourself lucky to be working with people to who make the effort to give you that kind of feedback. :typing

[jjjoy, LPN]

While it may feel miserable at times, thank your lucky stars that you have this opportunity to see the "real world" as a student/extern. Many a student graduates never having witnessed as much as you have already. Even those working as CNAs may not see as much because they so many of their own responsibilities and can't spend as much time with the nurses.

You do a good job of comparing nursing school clinicals versus the "real deal" and I wish more students could have more introduction to the realities before being a new grad full-time staff RN with a zillion other new things to learn and process in addition to trying to process the difference between what they experienced as students and what they are expected to deal with as full-fledged nurses.

[nursekatie22, RN]

i'm about 8 months out and i'm feeling okay about it now, for the most part, but there's always something that you haven't seen before, heard of before, administered before. i showed a nurse with 5 years experience something that she'd never done before and it was good for me cause it seems like i'm always the one asking her questions!

bottom line, i've learned a few important lessons:

1) you'll never know it all (duh)

2) you can't always get everything done.

3) it doesn't help to stress yourself out. rushing really doesn't help you much in the long run....it makes you look spastic and gets you amped up even more than you already are. be cool, man:smokin:.

[randomramblings]

Welcome to nursing! That's exactly what it's like in real life. When I worked in medical hospitals I'd wake up over and over again thinking the call light was going off because they'd been going off all night. :) It's quite the wake up call, isn't it? You're so focused on learning the overwhelming amount of material you need to learn while in school that you don't realize how idealistic your clinical experience is! By the way, I'm sure those nurses would appreciate a thank you note more than you could imagine, so I say go for it. :) Unfortunately, nurses get that kind of appreciation far too little.

Anyway, it took me about 6 months or so to finally stop feeling like I was constantly struggling to keep my head above water. After about a year, I suddenly realized that I didn't have to stop and ask about everything anymore, and that I wasn't doubting every single thing I did. I remember thinking when I first graduated "am I ever going to feel like I know what I'm doing?" It hit me one day at work, and I realized I was able to get through my shifts on a regular basis without having to stop and ask basic questions. My questions had become more sophisticated--i.e. about complications or unusual circumstances, not about basic nursing.

And I agree that you never know everything. Even nurses who've been RNs for 30 years will stop and ask other nurses questions, because everyone's past work experience is different and no one knows everything. The best nurses--from the most to the least experienced--know this and will ask questions instead of trying to look like they know everything.

[pagandeva2000, LPN]

When I compare how I was when I first started a year and a half ago versus now, I am fascinated on how much I actually learned. It still is a struggle sometimes, but I am thinking more for myself and gathering my own conclusions, making my own clinical decisions. Each time I face a new challenge, now, I look forward to seeing how I handle it, what I learned. And, you will always need someone to assist you. We can learn from each other.

[drenched08]

When I compare how I was when I first started a year and a half ago versus now, I am fascinated on how much I actually learned. It still is a struggle sometimes, but I am thinking more for myself and gathering my own conclusions, making my own clinical decisions. Each time I face a new challenge, now, I look forward to seeing how I handle it, what I learned. And, you will always need someone to assist you. We can learn from each other.

yup. each activity that you do on your floor is a worthy lifelong experience and we learn better if we have someone to share it with..it becomes a memorable experience.

[JanetCCURN]

New grad in CCU where we recover everything and anything ICUish. Feel okay but not enough, need lots of structure but I cannot expect that in the unit because anything can happen. Just making room for something messy is hard to do but I try. Taking only 1 stable pt is time consuming because everytime I sit down to chart, I get pulled aside to help some out so I can't fully focus. Which leads me to thinking I am forgetting something and then I feel incomplete with my work. (Only 2 Months in)

Everyone keeps telling me, it will come, it just takes time so don't worry. but I do worry cause I am a new grad who cannot see what they see and that takes time. IMPATIENCE aggghhhh. I want it all. :-)

[LADYBUG RN]

I understand how you feel. I am a new grad too, graduated in May 2008 and took NcLex in July. I work in the ER which I LOVE and feel pretty comfortable in many areas - I especially love assessment....the not knowing anything and trying to put together the puzzle. Sometimes I am right on the money, sometimes I miss it and it turns out to be something else. I am usually exhausted at the end of the shift from using my brain so much....thinking, thinking, thinking....

What I am NOT comfortable with yet is codes, people coming in via EMS in full arrest. I have only been in three, 1 respiratory, 1 cardiac, 1 pediatric respiratory. I have stayed in the room, charted, watched and tried to learn as much as possible. They tell me it will come in time, that feeling of not being overwhelmed..........

my only idea for myself is to keep a notebook of things that happen that I want to look up or meds that I want to research, which will prepare me for the next time I hear it, need it, etc......

I am told I am doing very well, to the point that I am being taken off orientation two weeks early.........big breath, dig my heels in and do my best work has become my mantra.....and ASK FOR HELP........

Any advice from the experienced ED RN's on what a newbie should do to not tick off an experienced RN when a code comes flying in?