Why is it that I come early and I still finish last, and am the slowest at handles :( (nic

babyNP., APRN · Oct 28, 2017

If it's been 7 shifts of 12s, that's only a little over 2 weeks. Cut yourself some slack! You're learning an entirely different world.

jennylee321 · Oct 29, 2017

You are slow because you are new, everyone is slow when they are new. Even though you did med surg it's a completely different knowledge base and type of time management. Think of yourself as a new grad again.

jennylee321 · Oct 29, 2017

I just realised I gave quite a bit of advice on your last thread but wanted to add in this.

For those of us new at any speciality we often hear we are slow from others or tell ourselves this. But "slow" is not very constructive, because how does one stop being slow. Instead reject on the shifts you have had and ask yourself, "what tasks am I slow at?" "What happens that derails my time management?". Then work specifically on these skills. If you are going along nicely for time but then it takes you a really long time to do heel prick bloodwork so you get behind on everything else, then you need to focus on this skill during your orientation.

tmjwe3 · Oct 29, 2017

Hey thanks a lot for writing back to me... I'm on my 8th shift and I'm still kinda drowning. I ask stupid questions that I know the answer to. It's almost as if I'm so anxious that my mind fogs. I know the disease I know the complications, I know why we do what the checks, the feeds, but putting it all together becomes hard. I become so focused on changing, or charting. I forget that my mind needs to critically think and be in so many places at once. For example today was bad, a nurse said she checked a blood label and I drew the same she said to chart it and send it. Turns out it was fkrthe wrong baby..? My preceptor even added afjcose on it when she handed it to me. I usually come in and check but she said it's fine we know. Now that SOR got called on me cause my name was on it and yes I should hve checked I'm not blaming anyone but the rushing got me off track. When I'm working with another baby my preceptor will come in and say hey ur moms here she wants to feed and I rush there, it's hard for me to time manage when a bunch of things are happening at once I can't be there. I cried so much h in the washroom cause I've never got a report done on me. I was super depressed. I'm still beating myself about it. I feel like I'm too slow minded or something idk... like the bigger picture isn't processing. I'm only working with two babies so it's not even supposed to be hard in a level 3 area. For example today I worked with a gtube, Salem pump, IV weaning and add lib breastfeeding, weaning feeds adding formula. Nipple Sheilds. Like so many new things. Just even the basics don't put the dirty stuff there, don't do the bp first, take the blood first. My mind isn't thinking about the whole task it's focused on ok clean the brief but what else watch sats, what position will help breathing, etc. I need to look at the bigger picture. It's taking a while for me to register it all cause I'm so focused on jus the basic tasks which is so bad:(

**NICU Guy, BSN, RN** · Oct 30, 2017

Time management is the key. Figure out what needs to be done next and focus on one task at a time until you can multitask. Just because a mom says she is ready to feed, does not mean that you need to drop everything at that moment to help her feed. Also, sometimes people helping are not really helping. Sometimes it is better to do it yourself when you have a solid game plan in your head. Another person helping requires you to alter your plan and can cause mistakes or actually slow you down even more.

Semper_Gumby · Oct 30, 2017

You're brand new in a brand new specialty. You're getting hundreds of pieces of information thrown at you all at the same time. It'll take time for all the pieces to really come together. It's like putting together a really big, complicated puzzle. You WILL get there, you just have to be patient with yourself. I came from healthy babies and still found it a hard transition because it's a completely different set of priorities and time management. If a mom comes in and wants to feed but you're finishing up another baby, she'll be fine to wait a few minutes. Maybe she can take a temperature and change the diaper while she waits, if your unit does that. Running back and forth between your babies will cost you time. You're only one person and you can't be everywhere at once!

Does your unit do alternating schedules (8-11-2-5 and 9-12-3-6) for cares and feeds? For example, if you have two on the same schedule and have a baby whose feed drips over a longer period of time, try to do them on the earlier side of the care time so the feed doesn't get started late. Does your unit have lactation consultants? Both places I've worked, they're the only ones who prescribe nipple shields and they can, at the least, teach you the basics of using them and assisting with breastfeeding (you'll get the hang of it!).

One thing that helped me starting out was to make a list of everything that needed to be done during care times and go over it and over it in my head and go through the list as I did cares. I still recite a list in my head on my way to work of what I need to do to get started on my shift (get report, scrub in, check orders, prep feeds, get meds, etc.). It can be a challenge when things are chaotic around you, and you'll have to figure out how to focus on what you're doing in spite of the external "noise." Like Guy said, focus on one thing at a time for now until you can do more. You've only been there two weeks. You are a novice! Have grace for yourself. You can do this. Also, maybe think back to when you were a brand new nurse and think about what helped you back then, figuring out your routine on the floor, and see what principles you can apply from that experience. Maybe chat with your preceptor about how you learn best (do you know?) and what things they can do to support you learning so many new things.

You've got this.

Semper_Gumby · Oct 30, 2017

Oh! Forgot to add--absolutely make taking a break a priority. Sometimes getting out of the unit for five, ten, fifteen minutes, taking a breather, getting a drink or snack, is all you need to be refreshed to keep going for a few more hours. It can help clear some of the frustration too. And I, personally, do not work well when hungry as it gets hard to focus after 8 hours without food--your brain needs some fuel! Ask someone to watch your babies, however your unit does that, and slip out for a few minutes so you can gather your thoughts and re-focus. Take care of yourself.

kaylee. · Oct 31, 2017

Think about in terms of neuroscience: When you are learning a new skill, be it learning an new instrument, or new nursing tasks, each step is taking alot of mental energy, you have to remember what to do next and then coordinate the actual motor activity. Unfortunately these same areas of the brain are needed to critically think and other higher cognitive functions. If you are trying to learn the guitar for example, you are still remembering where to place each finger and then getting your fingers to do it. That is why its so slow...

Then once the tasks, and motor skills begin to sink in, you dont use those higher cognitive areas for these things anymore, they feel like second nature, which in fact means they are now taken over by subcortical brain areas, and the cognitive regions are freed up for complex thinking and this is when you start to feel like, wow, now im getting the hang of it!

So if you dont know the task, you have to spend thinking power on it. Now it really gets tough when you add anxiety on top, because that is the limbic system which is also subcortical and automatic and competes with complex critical thought (for survival purposes).

The thing that trips you up is the comparing and thinking, "I should know this by now" because then the anxiety kicks in and then the task learning that you are thinking so hard to learn gets slowed.

So try to focus on not worrying and remember how if you do it will invade and make it all worse. Zero in on one thing at a time. Let the learning happen. I know easier said than done but its part of the journey! Im sure u are moving along at a reasonable pace while not overwhelmed. Hang in there!

tmjwe3 · Oct 31, 2017

Wow your post made so much sense... I really loved how you gave me a physiological approach on it. I do feel that way. I start to get anxiety when I'm learning something new and my brain fogs and I totally blank out. Especially when my preceptor questions me on it and I only know bits and pieces. I know it will take me time, but I'm a perfectionist and when I don't know things or I do them wrong I think my brain wants to go back to what I feel is comfortable and what I can do without anxiety. This running back to what is comfortable is not good because then I'm not engaging myself in new things and new learning opportunities.

My preceptor said I'm being too hard on myself and that I did a pretty good job but throughout the day I could feel the tension in her voice almost as if she wanted to scream out ****ggg..? R u dumb. When I feel this I get discouraged and then I get more anxiety. I'm learning is all which is nice but I hate my mentality like I have to be the best or need to be perfect, I'm not. I'm coming home and just legit in the books so I feel like I'm not taking a break I want to succeed in this. It's my dream job. But I also don't want to mess up to hurt these little babies at all I'd never forgive myself for it I started a journal and wrote how my day went and searched for what I could improve in.

tmjwe3 · Oct 31, 2017

Hey :)

I really appreciate your kind words they have really given me motivation. I guess everyone learns differently. The peers that started with me have surpassed me in most skills and are progressing really well. But then I have to think that my peers also had a rotation in nicu and one had exp working in postpartum with babies and breastfeeding. For me this is a whole new world coming from med-surg. I'm honestly so fresh. Even my exp in med-surg was 7 months I graduated in 2016. I shouldn't compare myself to others. I need to be more confident and just progress in whatever way I can. Our unit does have alternating schedules. Some feeders are every 2 and some every 3 hours. 4 babies and their parents can be overwhelming. I'm going to deff make a list to go through and then just focus in on what to do. I honestly appreciate ur kind words so much make me want to cry because everyone has taken the time out of their schedule to reply to me. Thank you so much it means a lot

Semper_Gumby · Nov 1, 2017

Hey :)
I really appreciate your kind words they have really given me motivation. I guess everyone learns differently. The peers that started with me have surpassed me in most skills and are progressing really well. But then I have to think that my peers also had a rotation in nicu and one had exp working in postpartum with babies and breastfeeding. For me this is a whole new world coming from med-surg. I'm honestly so fresh. Even my exp in med-surg was 7 months I graduated in 2016. I shouldn't compare myself to others. I need to be more confident and just progress in whatever way I can. Our unit does have alternating schedules. Some feeders are every 2 and some every 3 hours. 4 babies and their parents can be overwhelming. I'm going to deff make a list to go through and then just focus in on what to do. I honestly appreciate ur kind words so much make me want to cry because everyone has taken the time out of their schedule to reply to me. Thank you so much it means a lot

Four babies is a lot! And confidence will come with time. One day you'll be in the midst of a task you previously found hard and think, "I know this!" and you'll feel really proud of yourself for getting to that point. If you never had a NICU rotation or preceptorship and never had newborn experience, that adds to the learning curve because you're learning assessments and babies at the same time as everything else. I knew babies pretty well but hadn't had much experience with IV's or NG feeds or TPN so I was pretty slow with them. I'm faster now and know that speed comes with time as well. Juggling the alternating feed schedules can be a challenge but you'll learn how to best prioritize for that. :)