Will it ever feel better???

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Hi there-

I am not exactly in my first year after licensure, but second. A little background. I worked part time (per diem) for a year and then had to move out of state. After several months of searching, I was fortunate enough to find another job in a similar setting to my previous job. Again, it is per diem, but I work about 2-12 hours shifts/week.

I still feel very new, (been there for 3 months) have a lot to learn and confidence to gain. Last night I had a horrible shift. :( So often at the end of the shift, I feel like I don't have enough info for report and can't always answer questions from the next shift nurse in regards to patient's history, etc. I always want to read more history on my patients but time gets in my way. With 8-10 patients, a majority of my time is spent doing patient care and charting on my activities. I pass all of my meds, perform care needed, assess and chart and deal with imminent issues, but I feel like there is so much I don't get to learn about my patients in one shift.

My question (s) for any experienced nurses:

When will I start feeling better at the end of each shift? Right now I often leave feeling yucky about myself. I leave feeling like I "didn't do the best job I could". :( I hate that feeling.:( I hate leaving feeling like maybe I could have done more during my 12 hours. I also hate feeling like maybe the next shift's nurse thinks poorly of me. Does my confidence just need to grow? This morning I left feeling awful about myself and want to leave feeling good! Various things kept running through my brain wondering if I forgot to do something. Will this just improve with time? I am starting to feel defeated and while still new, not too new at this! (Plus I am second career nurse, so older with a previous career under my belt. Blow to the ego for sure!)

Thanks for any guidance!

Just wanted to add that sometimes the questions I am asked are not unimportant or about a procedure 10 years ago, but more relevant to their stay. Some I actually eye roll at myself for not knowing the answer to the questions. For example, had a patient the other night in post CABG with a lengthy cardiac history. He was on a liquid diet and I didn't know why...No procedure scheduled, nothing to do with his surgery. When I was asked I didn't know, I tried to find out with the incoming nurse but couldn't even find documentation as to why. So it isn't like the answer was right in front of my face but I felt like an idiot not knowing. I just knew I had to adhere to the plan for it.

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I am not a nurse quite yet but I am in nursing school. But, me being a CNA before nursing school, I get the gist of it. I noticed that when I was working PRN I was feeling the exact same. I didn't know anything about my patients and it's so hard to even remember everything that the previous CNA was telling me when giving me her shift report. She would say names or even room numbers and it was so hard to make it stick in my head, not knowing who that patient actually was. It is hard to feel like you have helped someone when you know nearly nothing about them. Eventually I moved on to more hours and omg I felt SO much better! You know how if you meet a COMPLETE new group of people and didn't know anybody, it is extremely hard to remember everyone's names? That's how PRN was to me except it was remembering their history, what works best with them etc. But you know how if you already know some of the people in a group, you don't have to try to remember so many new people's names? Thats how it is the more and more hours you work. You practically have to remember a complete new group of people every time you come in, that's tough! When you work more days, there's only a couple of new people every day. Working more days more me made everything a piece of cake, I knew what my patients soft spots were and really felt connected to them. I even had some people ask me to tape a piece of paper saying what days/hours I worked each week so that they could look forward to it, and that was so rewarding! It's even the same if you have to float to a different floor for a day, you get very confused and don't feel like you do as good. Sorry that this is so long, I just have been in your position (except as a CNA of course) and I know how frustrating and upsetting it is. I'm sure the nurse's completely understand that you won't know your patients nearly as well as them, I understood when I had PRNs during my previous shift. You completed the same schooling as them and everyone knows how hard you had to work to get there, so no one is looking down on you. Good luck! :)

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If you are busy and did not have time or forgot to question why on a specific order, then the oncoming nurse can simply call the doc to clarify. Don't beat yourself up. My second day alone after orientation I gave report to the bitchiest nurse on our unit.....just thinking of her now makes my blood boil!! She berated me because I could not remember what nare the pt's duotube was in....Last time I checked, duotubes do not miraculously switch nares....the only reason she asked me that question was to make me look stupid. Seriously, stop beating yourself up! and don't let anyone make you feel stupid. Maybe getting a full-time job to increase your clinical hours would help you hone your skills?

Just wanted to add that sometimes the questions I am asked are not unimportant or about a procedure 10 years ago, but more relevant to their stay. Some I actually eye roll at myself for not knowing the answer to the questions. For example, had a patient the other night in post CABG with a lengthy cardiac history. He was on a liquid diet and I didn't know why...No procedure scheduled, nothing to do with his surgery. When I was asked I didn't know, I tried to find out with the incoming nurse but couldn't even find documentation as to why. So it isn't like the answer was right in front of my face but I felt like an idiot not knowing. I just knew I had to adhere to the plan for it.
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I have a four-color pen that I use in report. I take notes in report in one color (usually black) and then I'll take notes during shift in another color (usually red). If I use the same sheet the next day (I know you're PRN but I'm just going to keep my thought going), I'll use green; last day I'll use blue. As stuff changes, I just mark it off as it does. Then in report I know what's new and what's old.

I was thinking that maybe the different colors will help separate 'new' and 'old' information and help you out in report a bit.

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Two facts here. One, there is really no time to learn everything about a patient. You would have to arrive to work hours before your shift to go through and memorize the entire medical records of each of your patients. So do not beat yourself about it and be patient when the reporting nurse does not know the answer to question you have. Focus on learning what is important. Two, nurses regard different things as important and thus focus report and questions on those things, which will differ from what you regard as important. Some nurses LOVE to ask me the gauge of the the patient's IV whereas for me all I need to know is that the patient has a working IV. So I say I don't know. Other nurses get really interested in peripheral pulses: is the left lower limb pulse weak, moderate, strong or bounding? All I need to know is that the patient has a palpable pulse on all four limbs. Do not feel bad about saying you don't know and do not get upset and others cannot answer your questions because each nurse focuses her/his care on different aspects of the patient's condition.

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Specializes in Wilderness Medicine, ICU, Adult Ed..
I still feel very new, (been there for 3 months) have a lot to learn and confidence to gain. Last night I had a horrible shift. So often at the end of the shift, I feel like I don't have enough info for report and can't always answer questions from the next shift nurse in regards to patient's history, etc. I always want to read more history on my patients but time gets in my way.

You have received a lot of good advice here, so I won't repeat any of it. I only want to put a few things on the table:

1. You are going to have horrible shifts some nights. Sometimes it seems like everything is going wrong. However, that is because the work we do is very hard and are patients are in bad shape. Be proud that you soldiered through, even if you did it sloppily, because some nights that is all that anyone can do. Remember; as bad as it was, you were there for your patients. 99.9% of the world’s population would have run screaming to the nearest exit after just an hour or two; but not you. You soldiered on. That is what the other nurses are doing too, even if some of them are better at hiding it, especially during report, where it is very easy to look terrific. Looks can be deceiving.

2. You will never know everything useful about any of your patients. Neither do any of the other nurses. Did you show up? Did you do what you could with the fragmentary information that you had? Did you respond to patient needs as best you could as those needs came up? Those are the only thing that anyone can do. The image of the brilliant practitioner carefully reading every word in the chart, doing online research, and even going to the patient’s house to look to do detective work is TV nonsense. Nobody does that. (O.K., I exaggerated just a little bit, but you get my point.)

3.

Various things kept running through my brain wondering if I forgot to do something.

O.K., a little reality check is in order. You WONDER if you forgot to do something, but did you actually forget something? If so, how important was it, really? What is the reality? Are nurses from the next shift complaining about things that they think that you neglected? Are patients or family members complaining? If you were forgetting things regularly, you would have heard about it by now. Trust me on that one! People love to complain, and some people (including some nurses) will find something to complain about all the time, so do not assume that every complaint is valid. However, if one is talk with your supervision about how to improve. If not, talk to yourself. Remind yourself that you cannot remember neglecting any patient, so you will not be accused of forgetting something. If that does not work, you might gain a lot of benefit by talking to someone else about this. For me it was a psychologist. For you it might be a friend or relative. It does not matter much. What matters is that you talk about these things and check on the reality of your imagined faults. And yeah, you will find that you do have faults, but no more so than everybody else.

coopman712, God did not create you to be the best nurse in the world, He already has someone to fill that slot. She lives in Spain, near the Andoan boarder and sews quilts in her spare time. Until she dies, you are not going to be the best in the world so stop trying. God created you to the best nurse coopman712 that you can be, and that is good enough.

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First of all, as a per diem nurse, the next shift's nurse is not going to expect you to know every little thing about every patient, since you probably do not work with them regularly. Just know their basic medical history, their most important issues, such as why they are there, and what happened during your shift, that's all. If the on-coming nurse asks something you can't answer, grab the chart and the two of you can look it up together.

What are these things that you are forgetting? As long as all the patients were assessed, got their meds and proper treatments, and you didn't kill anyone, then I don't think you should be too stressed. Where I work, they are big on signing out meds - so I don't forget to do that. It's the old saying "If it wasn't signed, it wasn't done". Make a list of the things that are important not to forget at your job, and go over it before you leave every night. And don't be so hard on yourself if you do forget something. You are a human, not a robot, and we are not all perfect. If it is something really important, call when you get home and tell the nurse that took over your patients that you didn't do it and ask her to. I have done this, just did it 2 nights ago, and it is usually not a big deal.

We all have bad nights. There are nights when I want to go in the bathroom and cry every 10 minutes. Nights when I cry on the way home. Nursing can be stressful. But it doesn't mean you are doing a bad job. I am grateful to work one floor, with the same patients every night. At least I know them, and know what to expect, and that makes my job somewhat easier. Just do the best you can and hang in there. Certain things DO get easier as your confidence builds - and this can take a lot of time in nursing.

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I know what you mean! I've been trying really hard to know everything pertinent about my patients to pass on to the next nurse but no matter what, they always end up asking me some obscure question and then acting like I'm a total idiot for not knowing.

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Have you tried seeking feedback from your supervisor? Then you can know if you really are making the mistakes you fear, etc...I think everyone feels insecure about their work when they are out of their comfort zone, i.e. starting over in a new career. Hang in there! Just do the best you can with the resources you have :)

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Thanks for all of the encouragement everyone. Last night wound up being A LOT better. I got most of the same assignment except for 2 patients which were different and the day nurse when I came in and when I was leaving this AM were the same as the previous day so the continuity was great! Being PRN (per diem), I do work typically 2 nights a week (12 hr shifts), so I feel more like a part timer than traditional PRN person. Last night I had some time to chit chat with the other nurses and it was interesting to hear some of these experienced people sharing similar stories. I too use the 4 color pen. ;)

As for my supervisors, they are great, and I am open honest with them when they approach me but I am saving the venting and feelings of insecurities for here or peers. ;)

I am back this weekend, let's see how it goes!

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It will get better. Part of the problem with being per diem, which is what I started at in the hospital, was that I almost always had new patients each day. Once I went fulltime and had my patients for 2-4 days in a row, it was such a relief! You have already learned a lot about them the first day which makes the second day so much easier, and then the third day, etc. It definitely does get better - I think my first turning point came at about 18 months, so hang in there!

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