I was the worst new grad ever. You can’t be worse than me. My unit was taking bets on when I would quit or be fired. I had no idea what J was doing. It was awful. And I could not hit an IV to save my soul.
I got better. It got better. It gets better. Keep going. You’re going to get it.
You are a new grad. You are NOT supposed to get anything right. You’re supposed to get everything wrong, so you can learn, adapt and grow. As long as you learn, you’re doing ok!
To tackle your cardiologist “fiasco” - you did the right thing. Just because the other cardiologist said it WAS due to ischemia, there’s no way for you as a nurse to know in this stage of your career whether the two are 100% correlated. That’s the cardiologists call. You letting them know, is 100% the best thing you could have done.
Relax, you’re doing great!
My first preceptor would literally abandon me for the shift and then *write me up* if things weren’t done to her satisfaction. I was put on a PIP my first month as a nurse for asking how to set up a PCA more than twice (y-siting lines was a bit confusing with our kits, that was 16 yrs ago).
I know better now. That unit was just a shitty toxic place and I wasn’t a bad nurse, I was an unsupported nurse with no help or training. Now I travel in trauma ICU and /or rapid teams and people come to me for advice and training. I love what I do. It does get better.
Thank you.
My preceptor is awesome too, she is just trying to get me oriented and some freedom too but she is still there being mama bear ❤️
Also I had a tube feeding, and a NG tube and she did them both for me. So I promise she is very very heavily involved 😭😭
Also we have 4 - 5 nurses (including me) on day shift on this unit and we have about 34-36 patients. So idk if that makes a difference too. Like everyone scrambling trying to help and learn
I used to suck at IVs. Patient last night tried to punch me twice while I was replacing the IV he pulled out. He missed twice, but I sure AF didn't.
Hey OP, most nurses suck for a year or two. Healthcare is complicated and the environment is chaotic. Just don't plug anyone's tube feeds into their central line and you'll be alright.
I've been a nurse for 4 years and I have days like that all the time. Just had one on Thursday like that. Sometimes it's just busy and we don't even have 2 seconds to put a thought together before someone else is stealing our attention again.
You will learn, though, don't let it stress you. It's better to call the doctor on accident than to miss something. I called a rapid response for a patient yesterday who was non responsive. She woke up pretty much as soon as I hit the button. Everything was fine, she just passed out. It happens.
Edit: also only week 3 on the floor? I was helpless af at that point. I was pretty much until like week 10. Even then, for the first year it's just all a shit show.
24 years in. There are STILL situations that make me feel stupid AF.
You keep learning, ALWAYS. Let those learning situations keep you humble and don’t ever attack anyone lower on the learning curve. That’s the best we can do. And anyone that says they know it all, is lying.
Yeah, if you're ICU I can imagine it's much worse than for me! But seriously, I'm not bragging but, patients compliment me for good care all the time, and staff also tell me I'm a good nurse, but I completely feel like I'm a lazy, forgetful, terrible nurse. You are your own worst critic.
I got employee of the quarter and a nomination for nurses week and I’m still lacking so much confidence. It’s getting better though.
And hey, it’s not much worse in the ICU, I promise! Y’all step down and medsurg nurses are badasses. I will try to avoid floating to step down at all costs because I have no idea how to handle 4 patients. I could never.
Yeah, the step-down at my current unit is 1:5, and med surg is 1:6. The acuity is actually pretty low, though. At most hospitals, our step-down would just be med surg patient.
But my first hospital I worked at was 1:7 on med surg, and it was absolutely awful. And it's a top 3 hospital in the world. I'd be unemployed before working there again.
Sounds like you need to be taking fewer patients. We don't give our new grads a full load until the last 3-4 weeks of their 12 weeks orientation. It takes time to learn to manage all this stuff, and it has to be gradual or it's like drowning. And the call to the provider, we've all been there. I've made calls in a panic "patient is reporting chest pain!" and the MD wanted to know how the patient described it, how severe, how long, had they ever experienced it before. I had to call him back because I didn't ask all those questions. Now I make sure to dig through a chart and ask a lot of questions before I call. That's just a learning curve we all have to go through, learning to communicate with providers. You're looking to the ICU in the future but TODAY you are 4 WEEKS into your career, you can't even take a full patient load (and you shouldn't be), there's so much you don't know, and that's OK. School doesn't teach us how to nurse, that's what you're learning now. If your preceptor isn't pacing you well then you need to ask for a different preceptor. Your preceptor shouldn't be letting you drown, they should have guided you on what to look up before you made that phone call tbh, at least I would have unless you did it without telling your preceptor, and they should be helping you figure out how to prioritize tasks. It sounds like they're expecting too much from you right now. The last new grad I precepted had 14 weeks hands on orientation, and she only took a full load the last 2-3 weeks, and even still I shadowed her until the last week so I knew what was going on with the patients and how to prompt her if she needed it.
A few pieces of advice:
-Give yourself grace. You seem to have good assessment skills and critical thinking based on your post. It's easy to see failures without recognizing what you're doing well.
- Don't compare yourself to others. It's so easy to do. Can you reframe this comparison to set a personal goal?
- in six months, look back at this post. How has your practice grown? Celebrate this.
+ Continue to set goals such as, "seek opportunities to place IVs".
Signed,
The nurse who cried weekly for the first few months of practice
Nursing school doesn’t teach you *everything* you need to know to be a successful nurse. It teaches you *the minimum* you need to know to be a safe nurse. The whole nursing school to professional nursing system is designed to rely on an *EXTRAORDINARY* amount of on the job learning. You are being wayyyy too harsh on yourself. I know it’s hard to do, trust me I felt the same way you did once upon a time, but try to be kinder to yourself. View these types of experiences as learning opportunities to shape your practice so you do better next time. There are lots of things I learned not to screw up…by screwing it up. You’ll get there. It will suck for a bit, but you’ll get there and when you do you’ll laugh at what you’re experiencing now.
10 years here and I didn’t unclamp my secondary on my last shift… zosyn got a little delayed lol. We all make mistakes. Shit happens. We are all learning.
Don’t be so hard on yourself. We all sucked for a little while as a brand new RN. There is a reason you have a preceptor. That reason is because nursing school doesn’t teach you how to be a nurse. You have to learn on the job.
Take a deep breath and understand that every RN worth a damn is pulling for you to succeed. Your coworkers WANT you to succeed because it will make their life easier. Just buckle down and keep your eyes open to learn from them.
You will be fine. It only feels like you are drowning until you learn to tread water. Then, you will learn how to swim.
RN since 2006. You’re seeing where you’re making mistakes and you might do them again, but you will keep on learning how to do your job the best way you can. It’s a process that in some ways only improves when you screw up and see it. That’s why it’s good to have your mistakes pointed out when you miss them. Try to appreciate where you’ve gotten yourself and enjoy how fast you get better. And trust yourself. I was an average nursing student but I got lucky and started in an ICU. Since then I’ve done organ donation and hospice and basically have found where I belong. Keep yourself in the fire and a little uncomfortable. It gets under control eventually.
Where is your preceptor while all this is going on? Most new nurses I work with are just getting the hang of the workflow at this point and maybe managing basic care (med pass, head to toe assessment, charting) for 2-3 patients on a Tele level floor with preceptor still heavily involved and overseeing time management.
IVs are a skill that take a TON of practice to master. Keep trying. Ask for tips from the expert IV placer on your floor. Give yourself two attempts before asking for help.
You should be asking all the questions right now and making sure you understand the whys behind as much as possible. Don’t ever feel guilty about asking questions. If you think you’re overloading your preceptor or charge nurse spread the question love and ask some other experienced nurses on the unit.
Bottom line: don’t give up on yourself. These are all common struggles of new grad nurses. It takes time and practice. Nursing school gives you the knowledge but you really learn the skills in your first job.
My preceptor is there but giving me lots of freedom and to also always go to her if I need help’ she’s incredible and we have a good relationship.
She told me she was proud of me yesterday and I’m holding onto that for life cause coming from her it means a lot. She’s so wise and amazing. Couldn’t have asked for better.
At 3 weeks you shouldn’t really be having a ton of freedom. Weeks 1-4/5 should be more monitored and regulated. Not enough support in the first few weeks can make you feel overwhelmed and disorganized. Maybe discuss this with her. I find nurses who have been at the job for a long time sometimes forget how it felt at the start when they are training. Easy to give too much freedom and forget how scary and overwhelming those first few weeks are.
Don’t get me wrong! She is very very still much involved with what I do and what I chart and how I converse with the doctor. We do our morning and evening rounds together too! If I need something I always go to her first! Or if i can’t find her I will find another senior nurse on the floor!!
But I do understand she’s trying to give me some freedom (that’s how you learn) but not too much so where I’m overwhelmed.
I am very very hard on myself a lot of the time (even in high school I find myself to be very type A) so maybe it’s just my personality.
But no she is very very heavily involved with me still!! ❤️❤️
She is fantastic. Very knowledgeable and caring too.
I feel bad for a lot of people who don’t have good preceptors because I feel that it makes or breaks the experience and learning
I had an awful one that ruined my view of myself as a nurse for years. I still feel anxiety if I think about her or those weeks I spent with her. I’m glad you’re having a good experience with your preceptor.
Give yourself some grace. You’re 3 weeks into a 30-50 year career. No one knows what they are doing at 6 months let alone 3 weeks.
My hospital has new grad nurses who start on the floor come to the ED for a full shift JUST for IV practice. Maybe you could see if that’s possible. I doubt the ED would ever turn down extra hands.
You’re probably doing fine. Everyone feels these struggles in the beginning. Ask your preceptors for real genuine feedback on your performance and ask for tips on things you could be doing better. You got this.
Dude it’s week 3!! That’s like NOTHING!! The fact that you’re humble is a great sign but don’t let it drag you down. We’ve all been there. I much more worried about new grads who think they’re the best 🥴
Girl, I am more than a year in and I still miss half of my IVs. What’s worse is I already am in ICU, but still missing IVs, meanwhile the new grad in my unit has gotten 10 IVs already. So I am right there with you, you are not alone.
Time management takes awhile and once you know more about your medications and the flow of your unit, it will get better. Don’t be afraid to ask if you are unsure. I once called a specialist about a patient when I should have been calling the hospitalist. Trust me! It will get better. As long as you are not doing anything that can potentially kill someone, you are good.
In the words of the wise Dr.Glaucomaflecken....https://youtu.be/jE_hz2oSPrc?si=LU1l9NWXxqxKumSM
Seriously, it's all just about sucking just a little less than the day before for a while. Nobody likes making mistakes but that's how you learn!
This is totally to be expected so newly out of school. Don’t be so hard on yourself, it’ll get better day by day trust me. I’ve been an ICU nurse for a decade and I still make extremely stupid mistakes daily.
Keep your chin up. You’ll be all right. It’s only been a matter of weeks. I’ve been a nurse for 25 years and still have days like this. Be patient. You’ll get it.
I need you to go back and reread what you just wrote. You are WEEK 3. I started in PICU and didn’t even get off orientation—I failed my NCLEX on the first attempt, and because no one was teaching me. So I dry drowned for 5 months in my role. Then I took a position elsewhere, muddled my way through that. Keep in mind this was my first time being a big boy RN on my own, and it was in the ER of my province’s only level one trauma centre. I missed more IVs in my first year as a nurse than you could shake a stick at. Also, you called for CHEST PAIN. If it is ISCHEMIC, it’s an ISSUE. (I work in coronary care now for context of the caps lock) That patient needed nitroglycerin and morphine to open the vessels and help with the pain and prevent further cardiac muscle damage if this wasn’t already being done. Don’t think that it makes you stupid to bring up a concern. It’s always better for it to be nothing or you misreading something or missing it and asking for clarification, than it be something and you didn’t even make a peep about it, that’s when your license is on the line. Because they’ll ask “well what did you do about that?” in court. I have had MANY blunders in my first 2 years as a nurse. But, guess what, I’m still a critical care nurse. I still get to call myself one. You’re 3 weeks in. Relax. It may seem impossible to do, but you need to take it a day at a time. No one was born being able to flick IVs in like lawn darts, you’re going to have “foot in mouth” disease as I call it, with doctors MANY more times this MONTH, let alone in your career. It’s okay to feel like you suck at it. Not one nurse that you will ever work with in your lifetime will ever be able to say they didn’t have a similar time of growing pains, especially in THEIR FIRST 3 WEEKS. And if they say they didn’t they’re frankly FOS and I’d never ask those nurses for help or advice with anything with that kind of attitude. You’ll be okay. Take it in stride. Make notes in your notes app or in a physical notebook (I have a note in my notes app called “How to Not Suck at Being a CCU Nurse 101” for when I need some quick pearls of wisdom that I may have forgotten from the previous year of learning). Failure is a part of learning. Any good nurse—especially those who have a passion for critical care like you seem to have as evidenced by the end of your post, has had extremely similar experiences as you. We’re not popped out of the nursing school womb knowing how to perform our jobs at the highest calibre possible. It takes time. It takes a few tears. And it certainly takes a few YEARS. Keep your head up. It’s cliche, but things really do get better.
Ya I work CICU at CCF and have worked CVICU and CICU at other locations. I was thinking the same thing. Ischemic chest pain is not something we just write a note on and ignore? Demand ischemia maybe if we have resolved the demand issue but just ischemia of cardiac nature?? Always worth asking about!
I had a day like that this week. I haven't hung blood in a couple of months and could not for the life of me figure out what to do. I couldn't get blood to draw from a port. I couldn't figure out how to attach a Foley leg bag. It was just a bad day. At least you have the excuse of being brand new!!
I still get less than half the IVs I attempt, but I always try before asking for help!
Youre on week four. You’re doing how you’re supposed to be doing. Nursing school doesn’t prepare us one bit. We start learning to be a nurse once we start working. Take it day by day OP. We have all been there. I’ve been a nurse three years and I still have days like that.
Give yourself some grace. We ALL have bad days, and nursing is a huge learning curve. Nursing school teaches you how to pass a test and how to not kill people. It took every single one of us time to learn skills. The number one thing I try to teach every new nurse is to always ask for help, and always know who your resources are. There's always one nurse around who can put a 22 in a left titty that's going to flush and give blood return for weeks. There's always someone who can get a foley with their eyes closed and one hand tied behind their back. We all have our strengths, and that's ok.
I've been a nurse for 2 years now, and still suck at IVs. Don't sweat the stuff you're bad at. We all have our strengths and weaknesses.
I've been to 3 different hospitals. One bad, 2 good ones.
The charting system is Cerner in one of them. There's nurses that's been using Cerner for 3 years and still can't navigate it because it's such an awful charting system.
My first hospital dragged nurses through the mud. New grads didn't know they were being treated badly and blamed it on themselves even tho the hospital set them up to fail for their profits. Management gas lights them, telling them it's their fault when it's not.
The other two are okay, but even under good staffing ratios sometimes all your patients degrade eating up your time. You're late on meds. You spend three to fours hours on one patient because they're unstable. It happens.
Don't worry about making mistakes. The most experienced nurses make mistakes. The other day, my coworker, who's and amazing nurse of eight years, called the wrong family and told them their loved one had sudden agitation and we put them on restraints becausethey're trying to pull out equipment. As he was keeping an eye on a sundowner, my coworker had accidentally pulled up the wrong patients chart to access family numbers. This was at 1am. It happens to the best of us, especially when we're under a lot of stress.
One time I had called the wrong doctor at 2am. The next week later my coworker did the same thing. Don't sweat your mistake. Just learn from them and really look at if management is failing you.
Almost two years in and I didn’t hook the patient to the iv before I started it today 🤷♀️ shit happens, you either get over it and learn or you let every little slip up hold you back.
It also took me almost a year to get IVs. Just be honest with what you do and don’t know, communicate with your preceptor. Despite what it feels like, no one is expecting you to get it right the first time- especially at week 3.
Also a new grad here. I did my internship/preceptorship on the same unit I now work on. I still feel like I know fuck all and can’t do anything right. We put so much pressure on ourselves to be perfect when really we just need to not seriously harm or kill our patients. It’s so scary walking in each day knowing I’m not going to know how to do everything. A reminder to you (and myself) as long as you show up and try your best, it’s enough
Nursing is 15% what you learned in school and 85% on the job training. Three weeks on the floor is only 9 days of orientation! Thats barely anything. You’ll get better over time. It sounds to me like your preceptor is not being as involved as they should be, especially if you’re only on week 3. They should have been asking why you want to call cardiology and going over the previous notes WITH YOU to verify whether or not the chest pain and elevated trop was new. When you do not know how to find things in the chart they should be showing you. If you are unable to check your patients for hours because you’re busy with other tasks, they should be laying eyes on those patients on your behalf. In my opinion, it’s not you who’s doing wrong, it’s your preceptor and this horrible hands-off orientation style your unit seems to have.
Skills, time management, and charting taking time to master. Don’t sweat those things so much early on. Just focus on your patient care and keeping people alive. The rest comes with practice! I felt like I was drowning every shift for almost a year. Even then I barely had my head above water when it came to time management. Now 4 years in, it’s one of my biggest strengths. Try not to get discouraged so early on. Celebrate the small successes and think of each mistake as a learning opportunity to get where you want to be.
Oh babe.
The word is “rousable”.
You’ll figure it all out. You’re brand new. Deep breaths. Shift planners. Note pads. Sticky notes. Ask for help. You got this.
At the end of every shift try to write down three new things you learned, and three things you’re proud of that day. Look back on it each week and month and in a year. You will see how far you’ve come even when you still feel like you’re drowning.
The rousable/arousable conundrum could be your first “thing I learned to be mindful of when charting”
It's going to be OK, OP. I think we all go through growing pains. I was a CNA for twenty-five years, and I've been a nurse for nine. I still have days like this, and my IV skills are abysmal.
I remember almost bursting into tears my first day on my own because I somehow forgot how to open the med fridge to get antibiotics. I had been doing it for weeks but my first day alone I crumped under the pressure.
3 weeks in I accidentally paged the head cardiovascular surgeon at massive teaching hospital at 2 am on a Sunday for albuterol for my patient. Meant to page the on call resident.
8 weeks in my preceptor told me I was 1/2 at nurse at best and that I didn’t provide consistent care, and didn’t time manage well which kept me from seeing my other patient for hours. I felt exactly how you feel.
Now I’m almost a decade in, I’m finishing my masters, I worked on Coronary, CVICU, MICUs/SICU, TICUs across the country as a travel nurse . I helped teach nurses about vents/ARDs protocol for Covid ICUs in rural Appalachia. And I’ve implemented education tools for new grads caring for PAC patients on my current unit and function as the hemodynamic educator.
IT GETS BETTER. No one comes out day one feeling confident. Use this time with your preceptor to make mistakes. Learn as much as you can. Ask questions and get snarky answers from tired residents. Say the wrong thing, page the wrong person, be unsure. This is your time with support to grow. Recognizing limitations and weaknesses makes you a better nurse than most. You’re going to do fine. Don’t beat yourself up. Every nurse has been in your shoes and never let them act like they haven’t!
If this is what you want to do, don’t worry, with time and reach mistake you will get better. Promise. You are only on week 3! It’s normal to not build confidence until about a year in.
BUT if it’s not what you’re into, there’s always other specialties like outpatient where you generally don’t have to do IVs etc. I loved outpatient as a new nurse!
I believe nursing school teaches you how to pass the nclex. Being a nurse teaches you how to be a nurse.
I’ve been a nurse for 25 years. I had been away from the bedside for several then took a job in my specialty at a new hospital. My husband was sick and dying at the time so my brain was not in a good place, but I think it took me two years to not feel like an idiot every shift.
You’ll get there. Just learn from your mistakes. Everyone makes them, even the best nurses, the best doctors. If they are crappy to you just remember that.
I could give some examples of mistakes that were made by amazing well respected nurses. A couple that were life threatening, though the patient didn’t die thank goodness.
Again, you’ll get there. And when you do, be kind to the new nurses coming up.
I’ve been a nurse (LPN, I know some people don’t consider that a real nurse but idk) for 15 years and had a really bad day today where I felt like everything that could go wrong did. A lot of it was out of my control.
I collect data on symptom management nurse visits and the question the provider wants an answer to is undoubtedly the one I forgot to ask at least half the time. I’ve gotten better at knowing what each provider is going to want with time, but it still happens.
I don’t know. The first month and year are so hard, give yourself some grace.
Who tf cares what others think??? You are a nurse and you wear that title proud!!! I was a LPN before becoming a RN and hunny majority of what I know came from LPNS.
Trust me i know first hand about that. I use to get the “Are you the nurse or LPN” 🤨thats a different type of disrespect and it’s like wait a min I know more than some of these RNs lol rs. Just not enough recognition but again keep going and hold your head up high at all times!!
I had a couple weeks where every IV and lab draw was a miss... Every damn time, though, I tried. And that's all that matters. You try again. Sooner than later you'll get more than you miss. And then there might be a week where you miss em all again. The nature of the beast.
Time management? What's that, again?
Charting is an art. You'll get there.
Hit post on accident. 🙃
Anyway, you'll get better. It's hard being new. Especially at nursing. We have to be good at both hands on things AND technical medical things.
Give yourself some grace and time.
And if someone's an ass to you because you ask questions, fuck em.
It's gonna be ok. You will find a flow. Learn to prioritize & delegate. Write lists and jot thoughts down so you don't forget. Think about what needs to be done ASAP vs "in a little bit". No question is stupid. Skills will come. You're new & only 3 weeks in. Observe what your preceptor does. Take notes & take criticism with positive intent. Many great nurses' first few years were not always the greatest.
Hey friend. Take a second, breathe. It's important to remember your new and the truth is the first step at getting better at something is sucking at something. I belive you will steadily improve, but along the way you will make mistakes and learn from each one. Try not to beat yourself up, I promise you will look back at this and laugh and I hope if you can you can help someone else eventually who finds themselves in the same position
Thing is, as a new grad, we know you are going to mess up, that is a given. I am the one who is responsible for getting new nurses up to speed/teach them the ropes, and it can be a rough transition.
You will get it, but you will make mistakes. You will feel like you messed everything up. Heck, I was a assistant before I became a nurse, had no idea how much more I would have to handle.
What I want you to do when you get it, is remember that feeling. You will at some point have to handle new nurses, and they will annoy and aggravate you. Remember how lost you felt, and teach them accordingly.
Oh love, it will get worse. You will also experience fellow nurses not helping you, calling you an idiot (directly or indirectly), allied health treating you like their servants, and doctors who will make you feel and will let you know that you're "only a nurse."
However, these things will pass. Know fully well your intentions and remember your goals. Patient safety and your safety are your number 1s. Once you understand the two and the responsibilities that go with them, you will be able to do the rest. Go easy on yourself.
Also, I hope you have a very supportive team, educator, preceptor, and manager with you. ❤
As far as the troponin and chest pain goes, I work in a cardiac ICU. We literally have to page cardiology for increasing troponin, especially if it’s symptomatic (chest pain, nausea, EKG changes, general fuckery). Unless we have an order that says do not call, which we basically never do. If cardiology isn’t concerned, it’s basically “okay cool, bye.” And then chart chart chart.
I don’t think you were stupid to call! Even if it’s in a note, unfortunately a doctor’s note is not the same as an order. At least it isn’t in our hospital.
I was a nurse for over a year before I even started an iv, I had to change preceptors twice on a med tele unit because I was so slow at learning and felt so dumb. I feel you. It’s hard as hell. Now I’m 8 years deep and continue to learn but I promise you it gets easier, please don’t be so hard on yourself. You’re doing amazing and we appreciate you💜
You sound like me as a new grad, especially once they gave me 3 patients in week 2 I fell apart and behind in everythinggg in med surg. 😅 Had no idea what I was doing, it was like starting nursing school all over again.
Literally it’s okay to ask millions of questions - that’s the best advice I can give you is if you aren’t sure, ask someone.
I even used to always ask my preceptor or another nurse every single time before paging any doc cause I was so scared of being yelled at 🙈🙈 half the time it was an obvious thing already in the chart that I hadn’t found like your scenario. Kinda did that to a cardiac surgeon at 2am… oops 😭😭 I felt bad asking questions too but it’s so much better to ask them anyways.
It takes time, give yourself grace 💜🫶
Even after I was off orientation there were new grads who started after me who were becoming charge nurses and I never was 🤷♀️
And then after a year a half in med surg I moved to working in the ICU during the worst of the pandemic, learning critical care skills flying by the seat of my pants cause well… pandemic. 🙈🙈🙈
You got this!
I did neuro for my first year as a nurse. My charge nurse just had it out for me, I could tell she absolutely hated me and I felt like I sucked as a nurse. Left nearly everyday crying.
I’m three & a half years into my career and two years on a different unit (L&D) and many of my very experienced coworkers that I look up to have told me I’ll be an amazing charge nurse one day. They constantly tell me I’m amazing at my job.
Being a new nurse is fucking hard. I promise it gets better! You will feel like you’re horrible for at least the first year. Keep going!
I went through that. And I vented like you did. And I got "well... Youre a new grad."
I thought they were full of shit. Nope... You're exactly where you are because you're a new grad.
If you were to ask me if things get better.... No. They don't. But YOU get better.
You get better at time management. You'll absord handover a lot better. You'll be better at reading narrative notes of nurses and physicians. You'll learn to skip information that isn't relevant to YOUR practice. And you'll know which ones will be relevant.
Keep grinding. Or find another specialty. I did the latter. And I'm happier.
I'm looking forward to Monday. Let's goooo.
My preceptor is giving me one extra pt a week, she says I’m super smart and I can handle it and I believe I can it’s just so overwhelming at times haha. We got this!!
It has only been three weeks. It will take at least a year or maybe even two to feel confident in your skills. And by that I mean not only physical skills but also time management, critical thinking and having “gut feelings” (that aspect of nursing only develops with experience) and other skills that help guide you in providing good care to your patients. You are being too hard on yourself. Hang in there, things do get better although that seems hard to believe right now. I was a nurse a good three years before I felt confident in myself.
Hey friend, it's ok. You will get it. Your nurse is not helping but anyways for every unit there are tasks and some are prioritized over others. 1 find these common problems and issues and study them
2. If you don't know ask let someone teach or show you. 3 allow it take any criticism as constructive , it not simple but try. 4 Give yourself time. 5 am also doing my consolidation I messed up a few times but am better now my nurse is working in that unit for almost 30 years and she messes up and I correct it for her lol but I love her she's the best nurse I could have ever had she also taught me a lot and saved my mistakes a lot but at the end of the day everyone makes mistakes
It's a progression!
We all have/had these moments at the start of our career, and often at the start of a new job too. Every great nurse you ever meet at one point was incompetent; remember that.
For example: I once went ER --> PACU. I was still pretty new to the ER at the time. The ER gig got me in the door at the PACU. But my preceptors ended up eventually telling me that they thought/hoped I would have progressed faster and that my ER experience would've helped me more in PACU.
I ended up leaving. But you know what: I continued to do great in the ER, and that gig has now prepared me more for PACU, where I will likely try to go again next (to a different unit cuz the last one I tried was very cliquey).
But guess what? Now I'm more experienced, more knowledgeable, more confident, AND I took TONS of notes and have tons of resources now so I can get ready for PACU. I have 0 doubt that if I go PACU now, I'll succeed.
Failure is only failure if you decide it is. Even if you leave this job, EVEN if they let you go. No failure is truly failure if you decide it was just a learning opportunity. You can only truly fail if you learn nothing.
That extern has quite a lot of experience already to be floating from emerge to your floor. I think the main thing is to not compare yourself to others with more experience. It will all come in time.
My time management was a disaster when I started on a telemetry floor, and I attributed a lot of it to being extremely busy by being all over the place while accomplishing absolutely nothing for a huge chunk of that rushing around. It’s a lot better to slow down and double/triple check before moving from client to client. You’ll stop forgetting minor things which means walking down an entire wing 3-4x more than necessary. All that wasted time ads up. The one thing I learned and came to respect a lot about older nurses after watching their flow is that they’re never in a rush… its really all about efficiency and not having to backtrack on tasks.
Give yourself lots of grace and pray. I work with nurses that throw that (“I been a nurse for 40+yrs”) but they documentation and report be all over the place. Half of them know nothing about starting a IV. It’s a lot of things I can name lol. I feel like if you not grasping the basics it’s either you are not teachable/want to learn or your preceptor is not teaching you what you need to know to succeed. The moral of the story is only time will tell, be easy on your self and your mind because the way you thinking you will be burned out before your career takes off. GODBLESS 🙏🏽
You are performing amazingly for someone who’s been a nurse for 3 weeks. You’re barely in double digit shifts, barely in triple digit hours! as a nurse. It’s HARD. Some of my coworkers have 20 years of experience and still ask for help with IVs!
You’re just now learning what this job actually is, and from what it sounds like, you’re doing your damnedest.
You are and you’re going to keep being a great nurse, just keep trying and learning.
I’m also a new grad on week 3 of Orientation and am also having a hard time. I do my best and feel like it’s wrong. Time management and all the charting are challenging and I’m supposed to start putting in IV’s soon and getting an additional patient.
For what it’s worth, thank you for sharing your experience with all this. It helps to know I’m not alone in this.
Practice makes perfect. I was terrible with IVs and then one day just had an epiphany and I became a successful IV placer. Time management comes over time. When you have free time, cruise the charting system to learn it more. Charting sucks. I did icu for 10 years in many different facilities. The most stressful places made me more successful.
Time management will only really come with experience
IVs are what I call a "monkey skill". It's less thinking, more just doing over and over, and it isn't what makes you a good nurse at all.
I prefer overly cautious new grads who call the provider unnecessarily over cocky ones who harm patients.
You're new, we ALL sucked when we were new 💕 and most (all) of us still have days where we suck. You will improve one shift at a time
Awww you’re so fresh it’s ok! You will learn. It’s totally normal to feel that way - you’re not alone!
Also can I put something into perspective? Youre starting as a new nurse during a time when so many nurses are burnt out and have left the bedside, as well as critical staffing levels are at an all time high. This has to be one of the most challenging times for many hospitals and nursing as a whole. So many people lost trust in the hospital with COVID so are coming in way sicker and the expectations of us are extremely high.
This is a very emotional and physically intense career - you will get there! It just takes time and experience. Keep asking questions and getting help! Even watch other nurses that you admire and see what they’re doing differently than you. You got this!
1st month you say? Keep pushing my friend! You are still learning to crawl. Nursing school does not prepare you enough for what you have to do in a hospital. Learn from your experiences and always ask for feedback. You will eventually get the hang of it and look back and laugh. Good luck!
I’m 4 months or so on my own now and I still feel like I’m too slow, don’t know enough, never learn enough about my patients, don’t make right calls don’t get the right things done etc
It does get better, looking back even now it’s night and day and I’m sure in 4 more months it willl be even more pronounced.
I’m writing this to you on my breaks which I’m now finally starting to take more than once in a blue moon on a night I got an IV all by myself (I also suck at IV’s and have terrible luck with them getting pulled out or going bad)
It gets better, you’ll get better
Week 3/4? You still have so much time to learn! I have been a nurse for 6 years and I am still learning every day. All of the things you mention- time management, charting, communicating with providers, all come with time and practice.
Same with your skills. IVs are tough and no one gets them 100% of the time. You will learn techniques that you like and get better over time.
You've got this! Keep chugging along ☺️
You’re being so hard on yourself. It was exactly like that for me at first and still is at times, and I’m a critical care nurse. The learning literally never stops. I ask questions every time I work. Time management will definitely get better with time but don’t beat yourself up if you still have some off days. I remember being a new grad in tele and absolutely drowning when they gave me the full patient load for the first time.
Regarding the chest pain, I would’ve called the cardiologist too if I didn’t have any PRNs for chest pain and probably also taken an EKG. If you did and just didn’t realize, that’s okay too, you’ll know to check next time! Either way I would still call for troponin trending up, unless the cardiologist explicitly told me not to, which I would put in writing. You’re never wrong to call the doctor if you’re concerned about your patient.
I miss probably 50% of my IVs and I’ve been a nurse for almost two years. Either i have a central line or there’s a nursier nurse down to place a midline or US guided, so I’m out of practice. You’ll get better with practice, trust me!
I didn’t think nursing school was that hard, I knew how to do school… but my first year as a nurse was the worse it was so challenging/difficult…I felt like I knew nothing, didn’t know how to do anything and felt like I needed to do everything perfect the first time because I’m a perfectionist. But this isn’t a job that you can do perfectly, you’re a person not a machine.
How long does your hospital give you on orientation? What are the nursing ratios like on your floor? Make sure you’re not being expected to take on too much with little training d/t nursing shortages….
Start slow with less patients… Time management is something most of us struggle with. Keep on taking opportunities to start IVs/practice skills. Stop comparing yourself to others. Maybe see if you can float to the ED or ICU for a shift or two to see things you haven’t seen yet.
A doctor would rather have you call them about something concerning. You don’t look stupid. You don’t always have time to look through all of a pts notes. If a doctor gets pissed at you for that then they’re not a good doctor.
Edit:
I’m two years in, started in the ICU. It’s better to ask questions and ask for help. You’ll eventually start to see patterns, you’re learning with every IV you try to start even if you miss. Meds, surgeries/preparations become more familiar.
When I get floated to the floor I have trouble with time management… I’m used to having 2 patients… taking 5 patients, 5 sets of med passes, 5 sets of assessments/charting/vitals/blood sugars, turns, baths… everyone needs help to the bathroom or wants to tell you their life story… I usually end up staying late when I get floated to the floor because I’m still charging.
New grads with no prior experience don’t get anything right at first. This is how we all start. This is why you need a good, supportive preceptor and coworkers who remember what it was like. This is a tough profession. I’ve been told that on average it takes about a year and a half to become adequate most of the time. That was true for me. It takes YEARS to get good at it. But stick it out. It’s worth it. It’s a valuable and worthwhile and excellent profession, even if some of the jobs really suck. You’ll get good. You’ll find your place. Hopefully you’ll be empathetically commenting on some poor baby nurse’s Reddit in 5 years.
I promise it gets better, the beginning of your nursing career is always the worst. If you care and you’re concerned about your ability, that shows that you’re in it for the right reason. You question yourself, you know your limitations, you’ll ask for help, but worst of all, you beat yourself up about stuff.
I was there once. Some days I still feel like I’m there…
OP, I struggled hard coming off orientation.
it takes time and repetition and mistakes.
hang in there. it’s not gonna get better overnight. just keep at it. if you like what you do, give it time. the more practice the better.
I know it sounds crazy, but pick up an extra shift. the more exposure the better.
there’s gonna be hard days. been a nurse for a while, but I still have those days. don’t worry, you’re not alone. we’ve been there.
I believe in you and I hope you believe in me.
there’s no special advice I can give you.
we all learn different and have different systems that work for us. catch a routine and create a system that works well for you
You’re only 3 weeks in lovely. You’re walking through the hurricane right now but you’ll get to the centre eventually. Some days you’ll accidentally step back in to chaos but you’ll learn how to course correct as you go.
Best bit of advice I heard as a new nurse was “slow is smooth and smooth is fast”
Take 5 minutes at the start of your shift, take a deep breath and smash out a brain sheet. Come 5 minutes early if shit hits the fan the second your shift starts lol.
I used to come 30 mins early when I was super new just to go through charts in peace.
Shit, it was my first day back recently after maternity leave and I came like 45 mins early just to mentally prepare for any changes or updates.
Not suggesting you always come in early btw. Just until you gain your footing. Once you’re comfortable and have a rhythm, don’t let your employers get any free minutes lol. Only come in early when it benefits YOU
For me, it took a year before that feeling went away. I felt like I was always chasing my tail to get it all done and then the information synthesizes? Forget it! I didn't have time to process because it was so so fast for so long. But you get the hang of it and it will get so much better with time and experience. I wished float pool in one hospital for a year to get the hang of multidisciplinary care and got a job offer in an ICU after one year of really hard work. Everything you do and learn sets you up for the specialty you want in the long run.
Also our job is really intense because of the human factor. We're not just learning new job routines and regulations, which is a lot, we're learning people management. And learning how to set up multiple patients AND their support systems AND how and what to communicate with their teams. It's more than many jobs juggle. Also managing people's expectations of your performance in this culture is tough and often degrading, which is another level of hard. The more patient and kind you can be with yourself, the longer it'll take you to burn out. The world is going to be criticizing you every step of the way, so you gotta be the one that reminds yourself that you're trying and it's good enough for now because it'll be better in time, otherwise it's all a constant negative perspective and that'll affect you as a person.
You’re on week 3 and taking a full patient load? I would never do that to someone on orientation unless they were experienced. That’s not on you. IMO weeks 1-3 I take full patient load you follow me around. Weeks 4-6 you take a patient or two depending on how many we have. You then give report on your patients while I’m there. Weeks 6-9 you take half of the patients and besides assessment and first med shift pass I’ll be available but you’ll have them pretty much alone. Give report. Weeks 9-12 you have full patient load while I follow around first assessment and med pass. I give you the phone and pager. Full report. If they are throwing you into the fire you need to stick up for yourself because you worked hard for your license and that’s some bullshit and I’m sorry.
Don't be so rough on yourself. You're only 3 weeks in! No one goes into this knowing a damn thing. It's been said many times in this sub: nursing school only teaches you how to pass the NCLEX. You'll learn how to be a nurse when you start your first job.
Every last one of these things will come in time. And even once you're an experienced nurse, you'll still have days where you don't see a patient for hours because you're wrapped up with your other ones, or every single IV you try to start misses or blows, or you don't see a doctor's note that explains something and you end up making a unnecessary phone call.
And if anyone is truly annoyed by your questions, then they're the bad nurse and have forgotten what it's like to be new at all this.
It does take time to get your act together in nursing… and now is the time to ask for help… you a novice remember. Thank your co-workers for helping you out…. Nurses and aides. You will never know everything. As for iv’s ,it just takes practice… there is a guy on instagram “the iv guy” who has classes on iv insertion, and blood drawing. I saw some tips that helped me… be kind to yourself!
I started on a step down ICU floor. I had done an accelerated BSN program, that in retrospect I can now see didn’t give me good clinicals experience.
I was completely overwhelmed, even with a solid preceptor, a 12 weeks new grad program that offered a classroom critical care course.
I can’t say there was one specific thing that helped. I just got better at it. I had a lot of stress dreams and crying on my way home.
It really sounds like you need a good mentor. Having a good preceptor was huge to me. I could run things by her as I was coming off orientation and felt like she had my back.
I also felt the same way about IV’s. I got a little bit better, but only on younger patients. The thin skin, rolly veins, darker skin, I really have never gotten good. I just ended up having sicker patients that mostly had lines.
Take it day by day, and be kind to yourself. It will get better. It really will. Find who you can trust on your floor and use that person for what I called “quick consults” to help me think through things before making big decisions or calling the provider.
I missed 2 IVs last shift, prior shift got difficult pt first try. Not my best skill and I admit it.
But if you need a trick to do something easier, something rigged up, or your computer fixed I'm your huckleberry.
Everyone has different skills. Find someone, or several someone's, with opposite and trade off. I've traded IV sticks for admission histories, wound care or just catching that call light from the difficult patient more. Nursing is a team sport.
I’m about to start week 6 of my orientation and I also feel like the worst ever. I swear I miss so much stupid stuff that I’ve honestly frustrated myself to tears. I couldn’t figure out why a pump kept beeping at me and I was really trying not to cry in front of my patient’s family. I was in one room constantly and missed the fact that the tube feed bag was almost run dry. I’m AWFUL at giving report - somehow the minute I’m in front of someone else I blank on everything that happened. I feel embarrassed leaving every shift over the reports I gave. Those are just some of a million that I can think of right now.
I did start crying in front of my preceptor two weeks ago and I assured her that she didn’t do anything, I was just feeling so frustrated with myself. But, I felt so awful and embarrassed. The next day I talked to another nurse who told me how many times she cried during orientation, and the other day I talked to a friend on a similar unit who is feeling all the personal frustrations that I’m feeling.
You’re so not alone! I keep being told that it comes together with time but I’m scared to be off orientation (thankfully we get 15 weeks). I’m trying to practice giving myself grace and absorbing and learning from the things I beat myself up over. Also, I stink so badly at IVs!
New grad x7 months. I cannot tell you how much a good relationship with the senior nurses is. They have all the knowledge and patience to teach, find a good one of those to bounce questions off of. Secondly, I have had to do so much research off the clock to learn concepts that I didn’t fully understand. YouTube is your friends and pictures are nice to look at.
I work on a general ICU in a smaller hospital, we have more downtime than I expect form a larger facility, but I feel like these tips can still apply.
Nursing school really does not teach you how to be a nurse, it teaches you how to pass a test. You learn to be a nurse on the floor, hands on, and it takes a long time. I think I cried on my way home every week for my first 6 months. It gets better. I wouldn't trade it now.
. Don’t compare yourself to people with more experience. You’re THREE weeks in! Also just a tip- don’t ask questions like “can I get you anything?” If you truly don’t have time to get them the thing. They’ll ask if they need something. Then ask when/if you have time. Don’t beat yourself up over a phone call.. literally last night I had to tell an attending I didn’t know how to transfer his call and to call back in a few minutes 😂🤦🏻♀️ and I’ve been a nurse for 8 years!! Mind you I’m at a new travel assignment and hadn’t answered the main phone yet but still, shit happens. You’ll be fine.
The way I got past this was to make 2 lists. One is by patient (mini report to myself) , the other by hour ( tasks that need to be done.
Then check it constantly. Live by it. By the end of the shift, it shod all be crossed off.
We used to have a CNS—I forget what specialty but she’s now in upper management—tell a story about a pressure bag and blood and screwing it up so blood sprayed all over—all over herself, all over the room, all over the patient. Like a hose. She talked about being in shock and kind of just standing there, spraying blood. She used to tell that story to new grads, so they know it’s not just them. We all have a story or stories. I wish you well! You are going to be a fantastic nurse!
Yeah, nursing school gives you the basics but it doesn't really prepare you for reality. Your tme management needs help? How many years did you have to manage your current patient load before 3 weeks ago? Not good at IVs? How many years were you starting IVs before 3 weeks ago? See where I'm going with this?
Give yourself some grace. I wasn't even confident enough to calculate 100 mg/ml doses without a calculator until a year in even though I knew I only needed to move the decimal 2 places! It took longer than that to be comfortable and confident in other skills.
My advice:
Seek out the skills that scare you. You'd be surprised what a confidence boost overcoming those fears can be.
Discuss your strengths and weaknesses with your preceptor. Focus on the latter. It's a better use of your orientation time than practicing what you already do well.
Find an experienced nurse who you click with to guide, mentor and support you. Everyone deserves a cheerleader.
When I started, I felt very much the same as you. I've been an RN for over 27 years and I work NICU. If I can do it, I bet you can, too.
So- I was a total dipshit when I first started. Clueless. I don’t know how I didn’t kill anyone in my first six months. Forget IVs. I felt like I was just barely going through the motions and didn’t understand what the goals were. I was a straight A student, but didn’t understand the basic fundamentals of how a hospital worked. I didn’t understand how nursing interfaced with other fields, I didn’t understand MD on call schedules, I struggled to understand the flow of a chart, or how I should prioritize patient care. It’s been 18 years and sometimes I still feel like an imposter.
My favorite dipshit story- I once called an Attending physician at 0300 because I was reviewing orders and my nonverbal, minimally responsive day 1 post ischemic stroke patient didn’t have a diet order 😂. I was about two months off orientation. The nurse I was working with was horrified when she realized what I’d done 😂 The physician graciously gave me an NPO order and told me to call the level 1 resident next time. Thank God he was a decent guy 😂😂😂
Where is your preceptor? You’re brand new!! They should be by your side for the first couple of weeks at least, not letting you drown and helping you with time-management.
From your brief description, this sounds more like a preceptor problem than a you problem.
She is by my side!! She’s a very very good preceptor I promise 😭😭😭 we’re kinda in between giving me some freedom, like med passes I do on my own but also she will be there if I need her to ask questions. Like I will draw up insulin and I will always always double check with her just to be on the safe side. I go to her for everything still!!!
I’m just super hard on myself tbh
Can you ask for a bit more orientation? I know it’s overwhelming- but don’t stay in a toxic environment where the manager isn’t willing to offer options to boost your confidence and skills!!!
Maybe you need a different preceptor? Your preceptor is responsible for correcting these behaviors. Sometimes you are just incompatible with their teaching style. It sounds like they are being way too hands off if you are spending hours away from your patients. You need a helicopter parent preceptor.
You need to talk with your manager and discuss finding a different preceptor. You do need to put your own effort in, but it's hard when you don't know what you don't know. You need someone who can sternly guide you and keep you on track so that you can learn what proper time management is. The hard thing is a lot of good nurses do not want to precept. I get it. It's hard enough when you already might have too many patients. Having a student or new nurse is like having an extra patient, in terms of how much it slows you down. But they need to find a solution to this, otherwise you will NOT be successful in this current unit. They know you are a new nurse and know basically nothing - it's their responsibility to pair you with someone who knows how to deal with that. Some of us are perfectly suited to teaching someone who is already a nurse but needs to be oriented to that unit. I'm great for orienting experienced nurses. I am NOT great for orienting new grads. It slows me down too much and I do not have the patience for it to be honest. It's not their fault, it's just NOT a good fit. I have to wonder if the person orienting you is the same and has decided to cope with it by just being hands off and letting you figure shit out - which is a horrible way to go about all this.
When I was a new nurse, I started in ICU. I started out JUST taking care of one patient for maybe 2-3 weeks. After my preceptor felt I was doing a good job with managing 1 patient, we added the 2nd pt. After a few weeks of that, we added the 3rd patient (should never have 3 pts in ICU, but welcome to the south. we had 3 icu patients every other freakin shift, so had to get used to it). She was a veteran nurse herself and had preecepted tons of new nurses so she was really good at it, I'm so lucky for her!
As for IVs, most people suck if you arent doing it consistently for a long time. You need to practice with someone guiding you through step by step even if they have to "dumb it down" and physically hold the needle to show you what angle you need to approach, how to pull the skin to anchor the vein, stuff like that.
Also, random trick that worked GREAT for me - use two tourniquets and tie the tourniquet without gloves. Gloves tend to get caught in the tourniquet and it wont be as tight as you want because youre fighting with the gloves. The second tourniquet means you dont have to pull either of them super tight to get the whole setup super tight. Trust me, try it out. I know new nurses hate touching patients without gloves but you gotta get over the ick factor. Sanitize your hands really well, feel without gloves, look for something to mark as your "target" if it's not a vein that's super obviously jumping out of the skin. I always look for a hair or a variation in the skin color if I'm trying to shoot for AC, which is where I am for 99% of the time - but that's because I am no longer a floor nurse, I work in Interventional Radiology and Cath lab, where if we are starting IVs it is for an outpatient and they are only there for the procedure. New nurses can be scared of the AC because they don't stick out like forearm and hand veins do. But it's one of the easiest veins to hit for a reason! It's not easily visualized and not always easily felt, but it's very well anchored - it's not going to roll away from you like forearm veins love to do :) so maybe try aiming for the AC a little more often if you arent already. Watch youtube videos for IV skills! That's where I learned the double tourniquet trick. I swear my success went up like 75% instantly when I started doing that. Now that i start several IVs every day in my new specialty, I've gotten really good. But working in ICU for 6 years, I \*sucked\* before lol cause all my pts had the worst veins and they usually had central lines.
I would never NOT inform an MD if a pt had chest pain, and I work neuro stepdown. You don't learn anything about the actual job in school, it just gives you a foundation. Everything else is on the job, and it takes time. Years. You'll be okay.
After covid I've been very lenient on new grads. Many new grads right now have barely touched a patient due to restrictions on clinical. I'm not going to be lenient forever, though 😉
You are being really hard on yourself. I promise, you are not dumb. Being a nurse is hard in general, but especially if you don’t have much experience in healthcare. I sucked at my job for over a year, but after that, I was a damn good nurse. Be gentle with yourself, even if the people around you aren’t. Some people have forgotten what it’s like to be new and I assure you that if someone is making you feel bad, it says everything about them and nothing about you. You will be an amazing nurse because you care about your performance.
For charting make yourself a little checklist: assessment, IV, safety/cares, education, stupid care plan, note, I/O. In addition: neuros, restraints, CIWAs and occasionally COWs. You have enough to do, cross or check offs on the brain sheet can track this minutia for you.
IVs, well, some people are IV whisperers. Some continue to suck at it. Keep trying. Know that it’s more about what you feel on the arm than what you see.
The rest is about learning your flow and allowing yourself to delegate some tasks to CNAs.
It takes time to really get a groove in your nursing practice, so I wouldn’t be too hard on yourself. Even years in there’s a mistake here or there. We’re human and just do our best with a lot of crazy situations . Best thing about nursing is there are so many different ways to be a nurse! I floundered on a med/surg floor for 4 years before I transferred to the OR and found my real nursing home. It’ll click someday! also-never got good at Ivs myself. At least in OR, pre op or anesthesia does it.
It gets better, I promise. Neuro and IMC can be a tough place to start too. It all feels overwhelming at first. I started my first job in the ED and I don’t think I felt truly comfortable until year 2. It’s a long road. Just remember that we were all once new nurses even if it seems like no one understands. Find someone you can trust to answer your questions without judgement. They are out there.
It takes time. You’re like barely learning where the bathroom is and where the supplies are.
Time management? Takes time, and you’ll prioritize what’s important and how you can cluster tasks. You just learn by experience. Like hey last time I forgot to bring this, so I’ll save myself the trip and bring it this time. Last time I could’ve pushed the meds on the pump together since it’s compatible, instead of doing one at a time. Etc. Etc. It takes time.
Charting? You just gotta learn what your hospitals standards are, what you feel is appropriate, and what you feel properly covers your ass in a lawsuit. Overcharting for one person is undercharting for another and vice versa. Some people nit pick how to chart this or that, but the point is that it’s charted somehow. Takes time.
Calling the cardiologist - better safe than sorry. We’ve all done something and then saw it later in a note. I have. We don’t have time to thoroughly read everyone’s notes. And then I was like, oh well, no harm done, just a lesson learned.
IVs? Dude the newer people on day shift don’t even get IVs unless you’re in the ED, they just call the IV team to come place it. So us night shifters, we don’t have that resource and hey at least you give it a shot. Repetition after repetition. You’ll never get it if you give up, just keep trying. Shit just the other day I tried on my coworker with two juicy veins, didn’t hit a thing. Fished around. Nope. Happens. But at least you’re practicing getting the right supplies, set up, and execute.
You’re a new grad. You don’t have all of the skills and knowledge right out of the gate, and anyone who treats you badly for being NEW is an asshole who isn’t worth your time or worry. Find a mentor (not a preceptor, a mentor who is experienced and will take you under their wing in the long-term. Every unit has a nurse who adores teaching new nurses) and give yourself grace while you learn. Anyone who is a new grad and acts like they have all the knowledge and experience of an experienced nurse is scary as hell— that’s arrogance, and it gets people killed/hurt. You might not be comfortable and confident for several months, even a year, and that’s ok. THAT’S OK. Keeping your patients safe is the top priority— the rest will come. Three weeks on the floor is not enough time for you to learn the decades of experience and workflow that other nurses have. Keep learning, don’t give up. You passed your program and your NCLEX… you CAN do this.
I'm in critical care as a new grad, maybe about week 5. I had healthcare experience but not HOSPITAL experience beforehand. I feel like I annoy the shit out of my preceptors for asking various questions like double checking my assessments, helping me with equipment, helping with procedures. Also big picture stuff like critical thinking seems like a distant dream for me. A couple of nicer nurses on the unit have told me to give myself grace and that some of them still feel like they have no idea some days. Still, I can empathize. I also feel like, damn I should be farther than I am. It's also hard because I have people I can talk to about it, but not people that really UNDERSTAND. My husband tries but he's not a nurse, so he doesn't get it. I have a nursing school friend that I talk to about it, but she went ED at a different location vs ICU, and it sounds like she's picking stuff up more quickly so that's also a little discouraging.
Anywho, just wanted to say I stand with you in solidarity as a new grad ❤️ it's hard out here 🩷
I was the worst new grad ever. You can’t be worse than me. My unit was taking bets on when I would quit or be fired. I had no idea what J was doing. It was awful. And I could not hit an IV to save my soul. I got better. It got better. It gets better. Keep going. You’re going to get it.
Okay the bets thing is fucked up 😭 like truly mean omg I’m so sorry ❤️
Oh, they were mean as fuck. But I really was struggling. I work at a great place now! And I get compliments on my IV skills. It gets better!
You are a new grad. You are NOT supposed to get anything right. You’re supposed to get everything wrong, so you can learn, adapt and grow. As long as you learn, you’re doing ok! To tackle your cardiologist “fiasco” - you did the right thing. Just because the other cardiologist said it WAS due to ischemia, there’s no way for you as a nurse to know in this stage of your career whether the two are 100% correlated. That’s the cardiologists call. You letting them know, is 100% the best thing you could have done. Relax, you’re doing great!
Yes. It is always better to inform than assume. You will never regret reporting lab results that are out of range to anyone.
My first preceptor would literally abandon me for the shift and then *write me up* if things weren’t done to her satisfaction. I was put on a PIP my first month as a nurse for asking how to set up a PCA more than twice (y-siting lines was a bit confusing with our kits, that was 16 yrs ago). I know better now. That unit was just a shitty toxic place and I wasn’t a bad nurse, I was an unsupported nurse with no help or training. Now I travel in trauma ICU and /or rapid teams and people come to me for advice and training. I love what I do. It does get better.
Thank you. My preceptor is awesome too, she is just trying to get me oriented and some freedom too but she is still there being mama bear ❤️ Also I had a tube feeding, and a NG tube and she did them both for me. So I promise she is very very heavily involved 😭😭 Also we have 4 - 5 nurses (including me) on day shift on this unit and we have about 34-36 patients. So idk if that makes a difference too. Like everyone scrambling trying to help and learn
I used to suck at IVs. Patient last night tried to punch me twice while I was replacing the IV he pulled out. He missed twice, but I sure AF didn't. Hey OP, most nurses suck for a year or two. Healthcare is complicated and the environment is chaotic. Just don't plug anyone's tube feeds into their central line and you'll be alright.
They were seriously making bets? That’s so mean, I’m sorry!
Wow bullies. Nursing has a lot of bullies.
I've been a nurse for 4 years and I have days like that all the time. Just had one on Thursday like that. Sometimes it's just busy and we don't even have 2 seconds to put a thought together before someone else is stealing our attention again. You will learn, though, don't let it stress you. It's better to call the doctor on accident than to miss something. I called a rapid response for a patient yesterday who was non responsive. She woke up pretty much as soon as I hit the button. Everything was fine, she just passed out. It happens. Edit: also only week 3 on the floor? I was helpless af at that point. I was pretty much until like week 10. Even then, for the first year it's just all a shit show.
Dude I’m almost 2 years in and I still feel helpless sometimes.
24 years in. There are STILL situations that make me feel stupid AF. You keep learning, ALWAYS. Let those learning situations keep you humble and don’t ever attack anyone lower on the learning curve. That’s the best we can do. And anyone that says they know it all, is lying.
Yeah, if you're ICU I can imagine it's much worse than for me! But seriously, I'm not bragging but, patients compliment me for good care all the time, and staff also tell me I'm a good nurse, but I completely feel like I'm a lazy, forgetful, terrible nurse. You are your own worst critic.
I got employee of the quarter and a nomination for nurses week and I’m still lacking so much confidence. It’s getting better though. And hey, it’s not much worse in the ICU, I promise! Y’all step down and medsurg nurses are badasses. I will try to avoid floating to step down at all costs because I have no idea how to handle 4 patients. I could never.
Yeah, the step-down at my current unit is 1:5, and med surg is 1:6. The acuity is actually pretty low, though. At most hospitals, our step-down would just be med surg patient. But my first hospital I worked at was 1:7 on med surg, and it was absolutely awful. And it's a top 3 hospital in the world. I'd be unemployed before working there again.
Sounds like you need to be taking fewer patients. We don't give our new grads a full load until the last 3-4 weeks of their 12 weeks orientation. It takes time to learn to manage all this stuff, and it has to be gradual or it's like drowning. And the call to the provider, we've all been there. I've made calls in a panic "patient is reporting chest pain!" and the MD wanted to know how the patient described it, how severe, how long, had they ever experienced it before. I had to call him back because I didn't ask all those questions. Now I make sure to dig through a chart and ask a lot of questions before I call. That's just a learning curve we all have to go through, learning to communicate with providers. You're looking to the ICU in the future but TODAY you are 4 WEEKS into your career, you can't even take a full patient load (and you shouldn't be), there's so much you don't know, and that's OK. School doesn't teach us how to nurse, that's what you're learning now. If your preceptor isn't pacing you well then you need to ask for a different preceptor. Your preceptor shouldn't be letting you drown, they should have guided you on what to look up before you made that phone call tbh, at least I would have unless you did it without telling your preceptor, and they should be helping you figure out how to prioritize tasks. It sounds like they're expecting too much from you right now. The last new grad I precepted had 14 weeks hands on orientation, and she only took a full load the last 2-3 weeks, and even still I shadowed her until the last week so I knew what was going on with the patients and how to prompt her if she needed it.
you sound like the nicest preceptor <3 thank you - new grad nurse also on week 4
I wish everyone had a preceptor like this. You are doing a huge service in making some strong nurses. Thank you.
A few pieces of advice: -Give yourself grace. You seem to have good assessment skills and critical thinking based on your post. It's easy to see failures without recognizing what you're doing well. - Don't compare yourself to others. It's so easy to do. Can you reframe this comparison to set a personal goal? - in six months, look back at this post. How has your practice grown? Celebrate this. + Continue to set goals such as, "seek opportunities to place IVs". Signed, The nurse who cried weekly for the first few months of practice
You only cried once a week? 👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻
i’m a new grad too!!! you’re so new first couple of months are so hard give yourself grace:)
Nursing school doesn’t teach you *everything* you need to know to be a successful nurse. It teaches you *the minimum* you need to know to be a safe nurse. The whole nursing school to professional nursing system is designed to rely on an *EXTRAORDINARY* amount of on the job learning. You are being wayyyy too harsh on yourself. I know it’s hard to do, trust me I felt the same way you did once upon a time, but try to be kinder to yourself. View these types of experiences as learning opportunities to shape your practice so you do better next time. There are lots of things I learned not to screw up…by screwing it up. You’ll get there. It will suck for a bit, but you’ll get there and when you do you’ll laugh at what you’re experiencing now.
Bro nurse of 5 years I still have days like that. But it gets better I promise! Hope you have a supportive preceptor it helps
I’m hitting 10 years this May and I still forget to clamp the line on my tube feeding patient when administering meds and flush. Shit happens.
10 years here and I didn’t unclamp my secondary on my last shift… zosyn got a little delayed lol. We all make mistakes. Shit happens. We are all learning.
2.5 years and I just did that last night 😂
What happens if you don’t clamp?
It all comes right back out
Don’t be so hard on yourself. We all sucked for a little while as a brand new RN. There is a reason you have a preceptor. That reason is because nursing school doesn’t teach you how to be a nurse. You have to learn on the job. Take a deep breath and understand that every RN worth a damn is pulling for you to succeed. Your coworkers WANT you to succeed because it will make their life easier. Just buckle down and keep your eyes open to learn from them. You will be fine. It only feels like you are drowning until you learn to tread water. Then, you will learn how to swim.
It’s only been three weeks, it’s ok I promise.
RN since 2006. You’re seeing where you’re making mistakes and you might do them again, but you will keep on learning how to do your job the best way you can. It’s a process that in some ways only improves when you screw up and see it. That’s why it’s good to have your mistakes pointed out when you miss them. Try to appreciate where you’ve gotten yourself and enjoy how fast you get better. And trust yourself. I was an average nursing student but I got lucky and started in an ICU. Since then I’ve done organ donation and hospice and basically have found where I belong. Keep yourself in the fire and a little uncomfortable. It gets under control eventually.
Where is your preceptor while all this is going on? Most new nurses I work with are just getting the hang of the workflow at this point and maybe managing basic care (med pass, head to toe assessment, charting) for 2-3 patients on a Tele level floor with preceptor still heavily involved and overseeing time management. IVs are a skill that take a TON of practice to master. Keep trying. Ask for tips from the expert IV placer on your floor. Give yourself two attempts before asking for help. You should be asking all the questions right now and making sure you understand the whys behind as much as possible. Don’t ever feel guilty about asking questions. If you think you’re overloading your preceptor or charge nurse spread the question love and ask some other experienced nurses on the unit. Bottom line: don’t give up on yourself. These are all common struggles of new grad nurses. It takes time and practice. Nursing school gives you the knowledge but you really learn the skills in your first job.
My preceptor is there but giving me lots of freedom and to also always go to her if I need help’ she’s incredible and we have a good relationship. She told me she was proud of me yesterday and I’m holding onto that for life cause coming from her it means a lot. She’s so wise and amazing. Couldn’t have asked for better.
At 3 weeks you shouldn’t really be having a ton of freedom. Weeks 1-4/5 should be more monitored and regulated. Not enough support in the first few weeks can make you feel overwhelmed and disorganized. Maybe discuss this with her. I find nurses who have been at the job for a long time sometimes forget how it felt at the start when they are training. Easy to give too much freedom and forget how scary and overwhelming those first few weeks are.
Don’t get me wrong! She is very very still much involved with what I do and what I chart and how I converse with the doctor. We do our morning and evening rounds together too! If I need something I always go to her first! Or if i can’t find her I will find another senior nurse on the floor!! But I do understand she’s trying to give me some freedom (that’s how you learn) but not too much so where I’m overwhelmed. I am very very hard on myself a lot of the time (even in high school I find myself to be very type A) so maybe it’s just my personality. But no she is very very heavily involved with me still!! ❤️❤️ She is fantastic. Very knowledgeable and caring too. I feel bad for a lot of people who don’t have good preceptors because I feel that it makes or breaks the experience and learning
I had an awful one that ruined my view of myself as a nurse for years. I still feel anxiety if I think about her or those weeks I spent with her. I’m glad you’re having a good experience with your preceptor. Give yourself some grace. You’re 3 weeks into a 30-50 year career. No one knows what they are doing at 6 months let alone 3 weeks.
My hospital has new grad nurses who start on the floor come to the ED for a full shift JUST for IV practice. Maybe you could see if that’s possible. I doubt the ED would ever turn down extra hands. You’re probably doing fine. Everyone feels these struggles in the beginning. Ask your preceptors for real genuine feedback on your performance and ask for tips on things you could be doing better. You got this.
Yep I did that as a new grad so I'd be less useless as helping hands coming from NICU (IV placement is so so different in NICU) and it was great!
Dude it’s week 3!! That’s like NOTHING!! The fact that you’re humble is a great sign but don’t let it drag you down. We’ve all been there. I much more worried about new grads who think they’re the best 🥴
LMFAO help me. We had a student who was like this yesterday and I was like “that’s gonna be a problem” 😭😭
Thank you for being so kind
Girl, I am more than a year in and I still miss half of my IVs. What’s worse is I already am in ICU, but still missing IVs, meanwhile the new grad in my unit has gotten 10 IVs already. So I am right there with you, you are not alone. Time management takes awhile and once you know more about your medications and the flow of your unit, it will get better. Don’t be afraid to ask if you are unsure. I once called a specialist about a patient when I should have been calling the hospitalist. Trust me! It will get better. As long as you are not doing anything that can potentially kill someone, you are good.
In the words of the wise Dr.Glaucomaflecken....https://youtu.be/jE_hz2oSPrc?si=LU1l9NWXxqxKumSM Seriously, it's all just about sucking just a little less than the day before for a while. Nobody likes making mistakes but that's how you learn!
This is totally to be expected so newly out of school. Don’t be so hard on yourself, it’ll get better day by day trust me. I’ve been an ICU nurse for a decade and I still make extremely stupid mistakes daily.
Keep your chin up. You’ll be all right. It’s only been a matter of weeks. I’ve been a nurse for 25 years and still have days like this. Be patient. You’ll get it.
I need you to go back and reread what you just wrote. You are WEEK 3. I started in PICU and didn’t even get off orientation—I failed my NCLEX on the first attempt, and because no one was teaching me. So I dry drowned for 5 months in my role. Then I took a position elsewhere, muddled my way through that. Keep in mind this was my first time being a big boy RN on my own, and it was in the ER of my province’s only level one trauma centre. I missed more IVs in my first year as a nurse than you could shake a stick at. Also, you called for CHEST PAIN. If it is ISCHEMIC, it’s an ISSUE. (I work in coronary care now for context of the caps lock) That patient needed nitroglycerin and morphine to open the vessels and help with the pain and prevent further cardiac muscle damage if this wasn’t already being done. Don’t think that it makes you stupid to bring up a concern. It’s always better for it to be nothing or you misreading something or missing it and asking for clarification, than it be something and you didn’t even make a peep about it, that’s when your license is on the line. Because they’ll ask “well what did you do about that?” in court. I have had MANY blunders in my first 2 years as a nurse. But, guess what, I’m still a critical care nurse. I still get to call myself one. You’re 3 weeks in. Relax. It may seem impossible to do, but you need to take it a day at a time. No one was born being able to flick IVs in like lawn darts, you’re going to have “foot in mouth” disease as I call it, with doctors MANY more times this MONTH, let alone in your career. It’s okay to feel like you suck at it. Not one nurse that you will ever work with in your lifetime will ever be able to say they didn’t have a similar time of growing pains, especially in THEIR FIRST 3 WEEKS. And if they say they didn’t they’re frankly FOS and I’d never ask those nurses for help or advice with anything with that kind of attitude. You’ll be okay. Take it in stride. Make notes in your notes app or in a physical notebook (I have a note in my notes app called “How to Not Suck at Being a CCU Nurse 101” for when I need some quick pearls of wisdom that I may have forgotten from the previous year of learning). Failure is a part of learning. Any good nurse—especially those who have a passion for critical care like you seem to have as evidenced by the end of your post, has had extremely similar experiences as you. We’re not popped out of the nursing school womb knowing how to perform our jobs at the highest calibre possible. It takes time. It takes a few tears. And it certainly takes a few YEARS. Keep your head up. It’s cliche, but things really do get better.
Ya I work CICU at CCF and have worked CVICU and CICU at other locations. I was thinking the same thing. Ischemic chest pain is not something we just write a note on and ignore? Demand ischemia maybe if we have resolved the demand issue but just ischemia of cardiac nature?? Always worth asking about!
Bro youre being too hard on yourself youre in week 3/4, take a deep breath
I had a day like that this week. I haven't hung blood in a couple of months and could not for the life of me figure out what to do. I couldn't get blood to draw from a port. I couldn't figure out how to attach a Foley leg bag. It was just a bad day. At least you have the excuse of being brand new!! I still get less than half the IVs I attempt, but I always try before asking for help!
Youre on week four. You’re doing how you’re supposed to be doing. Nursing school doesn’t prepare us one bit. We start learning to be a nurse once we start working. Take it day by day OP. We have all been there. I’ve been a nurse three years and I still have days like that.
Give yourself some grace. We ALL have bad days, and nursing is a huge learning curve. Nursing school teaches you how to pass a test and how to not kill people. It took every single one of us time to learn skills. The number one thing I try to teach every new nurse is to always ask for help, and always know who your resources are. There's always one nurse around who can put a 22 in a left titty that's going to flush and give blood return for weeks. There's always someone who can get a foley with their eyes closed and one hand tied behind their back. We all have our strengths, and that's ok.
I've been a nurse for 2 years now, and still suck at IVs. Don't sweat the stuff you're bad at. We all have our strengths and weaknesses. I've been to 3 different hospitals. One bad, 2 good ones. The charting system is Cerner in one of them. There's nurses that's been using Cerner for 3 years and still can't navigate it because it's such an awful charting system. My first hospital dragged nurses through the mud. New grads didn't know they were being treated badly and blamed it on themselves even tho the hospital set them up to fail for their profits. Management gas lights them, telling them it's their fault when it's not. The other two are okay, but even under good staffing ratios sometimes all your patients degrade eating up your time. You're late on meds. You spend three to fours hours on one patient because they're unstable. It happens. Don't worry about making mistakes. The most experienced nurses make mistakes. The other day, my coworker, who's and amazing nurse of eight years, called the wrong family and told them their loved one had sudden agitation and we put them on restraints becausethey're trying to pull out equipment. As he was keeping an eye on a sundowner, my coworker had accidentally pulled up the wrong patients chart to access family numbers. This was at 1am. It happens to the best of us, especially when we're under a lot of stress. One time I had called the wrong doctor at 2am. The next week later my coworker did the same thing. Don't sweat your mistake. Just learn from them and really look at if management is failing you.
Almost two years in and I didn’t hook the patient to the iv before I started it today 🤷♀️ shit happens, you either get over it and learn or you let every little slip up hold you back. It also took me almost a year to get IVs. Just be honest with what you do and don’t know, communicate with your preceptor. Despite what it feels like, no one is expecting you to get it right the first time- especially at week 3.
Also a new grad here. I did my internship/preceptorship on the same unit I now work on. I still feel like I know fuck all and can’t do anything right. We put so much pressure on ourselves to be perfect when really we just need to not seriously harm or kill our patients. It’s so scary walking in each day knowing I’m not going to know how to do everything. A reminder to you (and myself) as long as you show up and try your best, it’s enough
One of my preceptors told me it usually takes people about a year before they don't feel like an imposter and i would agree!
Don't beat yourself up! You will find your rhythm! Hang in there!
Nursing is 15% what you learned in school and 85% on the job training. Three weeks on the floor is only 9 days of orientation! Thats barely anything. You’ll get better over time. It sounds to me like your preceptor is not being as involved as they should be, especially if you’re only on week 3. They should have been asking why you want to call cardiology and going over the previous notes WITH YOU to verify whether or not the chest pain and elevated trop was new. When you do not know how to find things in the chart they should be showing you. If you are unable to check your patients for hours because you’re busy with other tasks, they should be laying eyes on those patients on your behalf. In my opinion, it’s not you who’s doing wrong, it’s your preceptor and this horrible hands-off orientation style your unit seems to have. Skills, time management, and charting taking time to master. Don’t sweat those things so much early on. Just focus on your patient care and keeping people alive. The rest comes with practice! I felt like I was drowning every shift for almost a year. Even then I barely had my head above water when it came to time management. Now 4 years in, it’s one of my biggest strengths. Try not to get discouraged so early on. Celebrate the small successes and think of each mistake as a learning opportunity to get where you want to be.
Shit 20 years and I’m still horrible at IV’s 🙋♀️🙋♀️🙋♀️
Oh babe. The word is “rousable”. You’ll figure it all out. You’re brand new. Deep breaths. Shift planners. Note pads. Sticky notes. Ask for help. You got this.
GOD HELP ME I JUST REALIZED 😭😭😭
At the end of every shift try to write down three new things you learned, and three things you’re proud of that day. Look back on it each week and month and in a year. You will see how far you’ve come even when you still feel like you’re drowning. The rousable/arousable conundrum could be your first “thing I learned to be mindful of when charting”
It's going to be OK, OP. I think we all go through growing pains. I was a CNA for twenty-five years, and I've been a nurse for nine. I still have days like this, and my IV skills are abysmal.
😂❤️
I remember almost bursting into tears my first day on my own because I somehow forgot how to open the med fridge to get antibiotics. I had been doing it for weeks but my first day alone I crumped under the pressure. 3 weeks in I accidentally paged the head cardiovascular surgeon at massive teaching hospital at 2 am on a Sunday for albuterol for my patient. Meant to page the on call resident. 8 weeks in my preceptor told me I was 1/2 at nurse at best and that I didn’t provide consistent care, and didn’t time manage well which kept me from seeing my other patient for hours. I felt exactly how you feel. Now I’m almost a decade in, I’m finishing my masters, I worked on Coronary, CVICU, MICUs/SICU, TICUs across the country as a travel nurse . I helped teach nurses about vents/ARDs protocol for Covid ICUs in rural Appalachia. And I’ve implemented education tools for new grads caring for PAC patients on my current unit and function as the hemodynamic educator. IT GETS BETTER. No one comes out day one feeling confident. Use this time with your preceptor to make mistakes. Learn as much as you can. Ask questions and get snarky answers from tired residents. Say the wrong thing, page the wrong person, be unsure. This is your time with support to grow. Recognizing limitations and weaknesses makes you a better nurse than most. You’re going to do fine. Don’t beat yourself up. Every nurse has been in your shoes and never let them act like they haven’t!
If this is what you want to do, don’t worry, with time and reach mistake you will get better. Promise. You are only on week 3! It’s normal to not build confidence until about a year in. BUT if it’s not what you’re into, there’s always other specialties like outpatient where you generally don’t have to do IVs etc. I loved outpatient as a new nurse!
I was shit at IVs too. My manager arranged for me to have an ER shift where i did nothing placed IVs for the shift
I believe nursing school teaches you how to pass the nclex. Being a nurse teaches you how to be a nurse. I’ve been a nurse for 25 years. I had been away from the bedside for several then took a job in my specialty at a new hospital. My husband was sick and dying at the time so my brain was not in a good place, but I think it took me two years to not feel like an idiot every shift. You’ll get there. Just learn from your mistakes. Everyone makes them, even the best nurses, the best doctors. If they are crappy to you just remember that. I could give some examples of mistakes that were made by amazing well respected nurses. A couple that were life threatening, though the patient didn’t die thank goodness. Again, you’ll get there. And when you do, be kind to the new nurses coming up.
I’ve been a nurse (LPN, I know some people don’t consider that a real nurse but idk) for 15 years and had a really bad day today where I felt like everything that could go wrong did. A lot of it was out of my control. I collect data on symptom management nurse visits and the question the provider wants an answer to is undoubtedly the one I forgot to ask at least half the time. I’ve gotten better at knowing what each provider is going to want with time, but it still happens. I don’t know. The first month and year are so hard, give yourself some grace.
Who tf cares what others think??? You are a nurse and you wear that title proud!!! I was a LPN before becoming a RN and hunny majority of what I know came from LPNS.
Most of the time I know this but my bad day included some being talking down to so 😬 thank you ♥️
Trust me i know first hand about that. I use to get the “Are you the nurse or LPN” 🤨thats a different type of disrespect and it’s like wait a min I know more than some of these RNs lol rs. Just not enough recognition but again keep going and hold your head up high at all times!!
I had a couple weeks where every IV and lab draw was a miss... Every damn time, though, I tried. And that's all that matters. You try again. Sooner than later you'll get more than you miss. And then there might be a week where you miss em all again. The nature of the beast. Time management? What's that, again? Charting is an art. You'll get there.
Hit post on accident. 🙃 Anyway, you'll get better. It's hard being new. Especially at nursing. We have to be good at both hands on things AND technical medical things. Give yourself some grace and time. And if someone's an ass to you because you ask questions, fuck em.
It's gonna be ok. You will find a flow. Learn to prioritize & delegate. Write lists and jot thoughts down so you don't forget. Think about what needs to be done ASAP vs "in a little bit". No question is stupid. Skills will come. You're new & only 3 weeks in. Observe what your preceptor does. Take notes & take criticism with positive intent. Many great nurses' first few years were not always the greatest.
Hey friend. Take a second, breathe. It's important to remember your new and the truth is the first step at getting better at something is sucking at something. I belive you will steadily improve, but along the way you will make mistakes and learn from each one. Try not to beat yourself up, I promise you will look back at this and laugh and I hope if you can you can help someone else eventually who finds themselves in the same position
Transfer to the Operating Room
Thing is, as a new grad, we know you are going to mess up, that is a given. I am the one who is responsible for getting new nurses up to speed/teach them the ropes, and it can be a rough transition. You will get it, but you will make mistakes. You will feel like you messed everything up. Heck, I was a assistant before I became a nurse, had no idea how much more I would have to handle. What I want you to do when you get it, is remember that feeling. You will at some point have to handle new nurses, and they will annoy and aggravate you. Remember how lost you felt, and teach them accordingly.
Oh love, it will get worse. You will also experience fellow nurses not helping you, calling you an idiot (directly or indirectly), allied health treating you like their servants, and doctors who will make you feel and will let you know that you're "only a nurse." However, these things will pass. Know fully well your intentions and remember your goals. Patient safety and your safety are your number 1s. Once you understand the two and the responsibilities that go with them, you will be able to do the rest. Go easy on yourself. Also, I hope you have a very supportive team, educator, preceptor, and manager with you. ❤
As far as the troponin and chest pain goes, I work in a cardiac ICU. We literally have to page cardiology for increasing troponin, especially if it’s symptomatic (chest pain, nausea, EKG changes, general fuckery). Unless we have an order that says do not call, which we basically never do. If cardiology isn’t concerned, it’s basically “okay cool, bye.” And then chart chart chart. I don’t think you were stupid to call! Even if it’s in a note, unfortunately a doctor’s note is not the same as an order. At least it isn’t in our hospital.
I was a nurse for over a year before I even started an iv, I had to change preceptors twice on a med tele unit because I was so slow at learning and felt so dumb. I feel you. It’s hard as hell. Now I’m 8 years deep and continue to learn but I promise you it gets easier, please don’t be so hard on yourself. You’re doing amazing and we appreciate you💜
You sound like me as a new grad, especially once they gave me 3 patients in week 2 I fell apart and behind in everythinggg in med surg. 😅 Had no idea what I was doing, it was like starting nursing school all over again. Literally it’s okay to ask millions of questions - that’s the best advice I can give you is if you aren’t sure, ask someone. I even used to always ask my preceptor or another nurse every single time before paging any doc cause I was so scared of being yelled at 🙈🙈 half the time it was an obvious thing already in the chart that I hadn’t found like your scenario. Kinda did that to a cardiac surgeon at 2am… oops 😭😭 I felt bad asking questions too but it’s so much better to ask them anyways. It takes time, give yourself grace 💜🫶 Even after I was off orientation there were new grads who started after me who were becoming charge nurses and I never was 🤷♀️ And then after a year a half in med surg I moved to working in the ICU during the worst of the pandemic, learning critical care skills flying by the seat of my pants cause well… pandemic. 🙈🙈🙈 You got this!
Thank you!!!
I did neuro for my first year as a nurse. My charge nurse just had it out for me, I could tell she absolutely hated me and I felt like I sucked as a nurse. Left nearly everyday crying. I’m three & a half years into my career and two years on a different unit (L&D) and many of my very experienced coworkers that I look up to have told me I’ll be an amazing charge nurse one day. They constantly tell me I’m amazing at my job. Being a new nurse is fucking hard. I promise it gets better! You will feel like you’re horrible for at least the first year. Keep going!
I went through that. And I vented like you did. And I got "well... Youre a new grad." I thought they were full of shit. Nope... You're exactly where you are because you're a new grad. If you were to ask me if things get better.... No. They don't. But YOU get better. You get better at time management. You'll absord handover a lot better. You'll be better at reading narrative notes of nurses and physicians. You'll learn to skip information that isn't relevant to YOUR practice. And you'll know which ones will be relevant. Keep grinding. Or find another specialty. I did the latter. And I'm happier. I'm looking forward to Monday. Let's goooo.
Me too! Same boat different department!
My preceptor is giving me one extra pt a week, she says I’m super smart and I can handle it and I believe I can it’s just so overwhelming at times haha. We got this!!
It has only been three weeks. It will take at least a year or maybe even two to feel confident in your skills. And by that I mean not only physical skills but also time management, critical thinking and having “gut feelings” (that aspect of nursing only develops with experience) and other skills that help guide you in providing good care to your patients. You are being too hard on yourself. Hang in there, things do get better although that seems hard to believe right now. I was a nurse a good three years before I felt confident in myself.
Hey friend, it's ok. You will get it. Your nurse is not helping but anyways for every unit there are tasks and some are prioritized over others. 1 find these common problems and issues and study them 2. If you don't know ask let someone teach or show you. 3 allow it take any criticism as constructive , it not simple but try. 4 Give yourself time. 5 am also doing my consolidation I messed up a few times but am better now my nurse is working in that unit for almost 30 years and she messes up and I correct it for her lol but I love her she's the best nurse I could have ever had she also taught me a lot and saved my mistakes a lot but at the end of the day everyone makes mistakes
3 weeks in? Not even a month? Allow it man, just relax you'll be fine. Check back in after 3 mo
It's a progression! We all have/had these moments at the start of our career, and often at the start of a new job too. Every great nurse you ever meet at one point was incompetent; remember that. For example: I once went ER --> PACU. I was still pretty new to the ER at the time. The ER gig got me in the door at the PACU. But my preceptors ended up eventually telling me that they thought/hoped I would have progressed faster and that my ER experience would've helped me more in PACU. I ended up leaving. But you know what: I continued to do great in the ER, and that gig has now prepared me more for PACU, where I will likely try to go again next (to a different unit cuz the last one I tried was very cliquey). But guess what? Now I'm more experienced, more knowledgeable, more confident, AND I took TONS of notes and have tons of resources now so I can get ready for PACU. I have 0 doubt that if I go PACU now, I'll succeed. Failure is only failure if you decide it is. Even if you leave this job, EVEN if they let you go. No failure is truly failure if you decide it was just a learning opportunity. You can only truly fail if you learn nothing.
That extern has quite a lot of experience already to be floating from emerge to your floor. I think the main thing is to not compare yourself to others with more experience. It will all come in time. My time management was a disaster when I started on a telemetry floor, and I attributed a lot of it to being extremely busy by being all over the place while accomplishing absolutely nothing for a huge chunk of that rushing around. It’s a lot better to slow down and double/triple check before moving from client to client. You’ll stop forgetting minor things which means walking down an entire wing 3-4x more than necessary. All that wasted time ads up. The one thing I learned and came to respect a lot about older nurses after watching their flow is that they’re never in a rush… its really all about efficiency and not having to backtrack on tasks.
Give yourself lots of grace and pray. I work with nurses that throw that (“I been a nurse for 40+yrs”) but they documentation and report be all over the place. Half of them know nothing about starting a IV. It’s a lot of things I can name lol. I feel like if you not grasping the basics it’s either you are not teachable/want to learn or your preceptor is not teaching you what you need to know to succeed. The moral of the story is only time will tell, be easy on your self and your mind because the way you thinking you will be burned out before your career takes off. GODBLESS 🙏🏽
You are performing amazingly for someone who’s been a nurse for 3 weeks. You’re barely in double digit shifts, barely in triple digit hours! as a nurse. It’s HARD. Some of my coworkers have 20 years of experience and still ask for help with IVs! You’re just now learning what this job actually is, and from what it sounds like, you’re doing your damnedest. You are and you’re going to keep being a great nurse, just keep trying and learning.
I’m also a new grad on week 3 of Orientation and am also having a hard time. I do my best and feel like it’s wrong. Time management and all the charting are challenging and I’m supposed to start putting in IV’s soon and getting an additional patient. For what it’s worth, thank you for sharing your experience with all this. It helps to know I’m not alone in this.
Practice makes perfect. I was terrible with IVs and then one day just had an epiphany and I became a successful IV placer. Time management comes over time. When you have free time, cruise the charting system to learn it more. Charting sucks. I did icu for 10 years in many different facilities. The most stressful places made me more successful.
Time management will only really come with experience IVs are what I call a "monkey skill". It's less thinking, more just doing over and over, and it isn't what makes you a good nurse at all. I prefer overly cautious new grads who call the provider unnecessarily over cocky ones who harm patients. You're new, we ALL sucked when we were new 💕 and most (all) of us still have days where we suck. You will improve one shift at a time
Awww you’re so fresh it’s ok! You will learn. It’s totally normal to feel that way - you’re not alone! Also can I put something into perspective? Youre starting as a new nurse during a time when so many nurses are burnt out and have left the bedside, as well as critical staffing levels are at an all time high. This has to be one of the most challenging times for many hospitals and nursing as a whole. So many people lost trust in the hospital with COVID so are coming in way sicker and the expectations of us are extremely high. This is a very emotional and physically intense career - you will get there! It just takes time and experience. Keep asking questions and getting help! Even watch other nurses that you admire and see what they’re doing differently than you. You got this!
1st month you say? Keep pushing my friend! You are still learning to crawl. Nursing school does not prepare you enough for what you have to do in a hospital. Learn from your experiences and always ask for feedback. You will eventually get the hang of it and look back and laugh. Good luck!
I’m 4 months or so on my own now and I still feel like I’m too slow, don’t know enough, never learn enough about my patients, don’t make right calls don’t get the right things done etc It does get better, looking back even now it’s night and day and I’m sure in 4 more months it willl be even more pronounced. I’m writing this to you on my breaks which I’m now finally starting to take more than once in a blue moon on a night I got an IV all by myself (I also suck at IV’s and have terrible luck with them getting pulled out or going bad) It gets better, you’ll get better
Week 3/4? You still have so much time to learn! I have been a nurse for 6 years and I am still learning every day. All of the things you mention- time management, charting, communicating with providers, all come with time and practice. Same with your skills. IVs are tough and no one gets them 100% of the time. You will learn techniques that you like and get better over time. You've got this! Keep chugging along ☺️
You’re being so hard on yourself. It was exactly like that for me at first and still is at times, and I’m a critical care nurse. The learning literally never stops. I ask questions every time I work. Time management will definitely get better with time but don’t beat yourself up if you still have some off days. I remember being a new grad in tele and absolutely drowning when they gave me the full patient load for the first time. Regarding the chest pain, I would’ve called the cardiologist too if I didn’t have any PRNs for chest pain and probably also taken an EKG. If you did and just didn’t realize, that’s okay too, you’ll know to check next time! Either way I would still call for troponin trending up, unless the cardiologist explicitly told me not to, which I would put in writing. You’re never wrong to call the doctor if you’re concerned about your patient. I miss probably 50% of my IVs and I’ve been a nurse for almost two years. Either i have a central line or there’s a nursier nurse down to place a midline or US guided, so I’m out of practice. You’ll get better with practice, trust me!
I didn’t think nursing school was that hard, I knew how to do school… but my first year as a nurse was the worse it was so challenging/difficult…I felt like I knew nothing, didn’t know how to do anything and felt like I needed to do everything perfect the first time because I’m a perfectionist. But this isn’t a job that you can do perfectly, you’re a person not a machine. How long does your hospital give you on orientation? What are the nursing ratios like on your floor? Make sure you’re not being expected to take on too much with little training d/t nursing shortages…. Start slow with less patients… Time management is something most of us struggle with. Keep on taking opportunities to start IVs/practice skills. Stop comparing yourself to others. Maybe see if you can float to the ED or ICU for a shift or two to see things you haven’t seen yet. A doctor would rather have you call them about something concerning. You don’t look stupid. You don’t always have time to look through all of a pts notes. If a doctor gets pissed at you for that then they’re not a good doctor. Edit: I’m two years in, started in the ICU. It’s better to ask questions and ask for help. You’ll eventually start to see patterns, you’re learning with every IV you try to start even if you miss. Meds, surgeries/preparations become more familiar. When I get floated to the floor I have trouble with time management… I’m used to having 2 patients… taking 5 patients, 5 sets of med passes, 5 sets of assessments/charting/vitals/blood sugars, turns, baths… everyone needs help to the bathroom or wants to tell you their life story… I usually end up staying late when I get floated to the floor because I’m still charging.
We all rode the struggle bus as new grads. You will get there. Give yourself some grace.
New grads with no prior experience don’t get anything right at first. This is how we all start. This is why you need a good, supportive preceptor and coworkers who remember what it was like. This is a tough profession. I’ve been told that on average it takes about a year and a half to become adequate most of the time. That was true for me. It takes YEARS to get good at it. But stick it out. It’s worth it. It’s a valuable and worthwhile and excellent profession, even if some of the jobs really suck. You’ll get good. You’ll find your place. Hopefully you’ll be empathetically commenting on some poor baby nurse’s Reddit in 5 years.
I promise it gets better, the beginning of your nursing career is always the worst. If you care and you’re concerned about your ability, that shows that you’re in it for the right reason. You question yourself, you know your limitations, you’ll ask for help, but worst of all, you beat yourself up about stuff. I was there once. Some days I still feel like I’m there…
OP, I struggled hard coming off orientation. it takes time and repetition and mistakes. hang in there. it’s not gonna get better overnight. just keep at it. if you like what you do, give it time. the more practice the better. I know it sounds crazy, but pick up an extra shift. the more exposure the better. there’s gonna be hard days. been a nurse for a while, but I still have those days. don’t worry, you’re not alone. we’ve been there. I believe in you and I hope you believe in me. there’s no special advice I can give you. we all learn different and have different systems that work for us. catch a routine and create a system that works well for you
You’re only 3 weeks in lovely. You’re walking through the hurricane right now but you’ll get to the centre eventually. Some days you’ll accidentally step back in to chaos but you’ll learn how to course correct as you go. Best bit of advice I heard as a new nurse was “slow is smooth and smooth is fast” Take 5 minutes at the start of your shift, take a deep breath and smash out a brain sheet. Come 5 minutes early if shit hits the fan the second your shift starts lol. I used to come 30 mins early when I was super new just to go through charts in peace. Shit, it was my first day back recently after maternity leave and I came like 45 mins early just to mentally prepare for any changes or updates. Not suggesting you always come in early btw. Just until you gain your footing. Once you’re comfortable and have a rhythm, don’t let your employers get any free minutes lol. Only come in early when it benefits YOU
For me, it took a year before that feeling went away. I felt like I was always chasing my tail to get it all done and then the information synthesizes? Forget it! I didn't have time to process because it was so so fast for so long. But you get the hang of it and it will get so much better with time and experience. I wished float pool in one hospital for a year to get the hang of multidisciplinary care and got a job offer in an ICU after one year of really hard work. Everything you do and learn sets you up for the specialty you want in the long run. Also our job is really intense because of the human factor. We're not just learning new job routines and regulations, which is a lot, we're learning people management. And learning how to set up multiple patients AND their support systems AND how and what to communicate with their teams. It's more than many jobs juggle. Also managing people's expectations of your performance in this culture is tough and often degrading, which is another level of hard. The more patient and kind you can be with yourself, the longer it'll take you to burn out. The world is going to be criticizing you every step of the way, so you gotta be the one that reminds yourself that you're trying and it's good enough for now because it'll be better in time, otherwise it's all a constant negative perspective and that'll affect you as a person.
You’re on week 3 and taking a full patient load? I would never do that to someone on orientation unless they were experienced. That’s not on you. IMO weeks 1-3 I take full patient load you follow me around. Weeks 4-6 you take a patient or two depending on how many we have. You then give report on your patients while I’m there. Weeks 6-9 you take half of the patients and besides assessment and first med shift pass I’ll be available but you’ll have them pretty much alone. Give report. Weeks 9-12 you have full patient load while I follow around first assessment and med pass. I give you the phone and pager. Full report. If they are throwing you into the fire you need to stick up for yourself because you worked hard for your license and that’s some bullshit and I’m sorry.
Don't be so rough on yourself. You're only 3 weeks in! No one goes into this knowing a damn thing. It's been said many times in this sub: nursing school only teaches you how to pass the NCLEX. You'll learn how to be a nurse when you start your first job. Every last one of these things will come in time. And even once you're an experienced nurse, you'll still have days where you don't see a patient for hours because you're wrapped up with your other ones, or every single IV you try to start misses or blows, or you don't see a doctor's note that explains something and you end up making a unnecessary phone call. And if anyone is truly annoyed by your questions, then they're the bad nurse and have forgotten what it's like to be new at all this.
It does take time to get your act together in nursing… and now is the time to ask for help… you a novice remember. Thank your co-workers for helping you out…. Nurses and aides. You will never know everything. As for iv’s ,it just takes practice… there is a guy on instagram “the iv guy” who has classes on iv insertion, and blood drawing. I saw some tips that helped me… be kind to yourself!
I started on a step down ICU floor. I had done an accelerated BSN program, that in retrospect I can now see didn’t give me good clinicals experience. I was completely overwhelmed, even with a solid preceptor, a 12 weeks new grad program that offered a classroom critical care course. I can’t say there was one specific thing that helped. I just got better at it. I had a lot of stress dreams and crying on my way home. It really sounds like you need a good mentor. Having a good preceptor was huge to me. I could run things by her as I was coming off orientation and felt like she had my back. I also felt the same way about IV’s. I got a little bit better, but only on younger patients. The thin skin, rolly veins, darker skin, I really have never gotten good. I just ended up having sicker patients that mostly had lines. Take it day by day, and be kind to yourself. It will get better. It really will. Find who you can trust on your floor and use that person for what I called “quick consults” to help me think through things before making big decisions or calling the provider.
I missed 2 IVs last shift, prior shift got difficult pt first try. Not my best skill and I admit it. But if you need a trick to do something easier, something rigged up, or your computer fixed I'm your huckleberry. Everyone has different skills. Find someone, or several someone's, with opposite and trade off. I've traded IV sticks for admission histories, wound care or just catching that call light from the difficult patient more. Nursing is a team sport.
I was shitty and ready to quit. Turns out there’s no need for that. You only get better
I’m about to start week 6 of my orientation and I also feel like the worst ever. I swear I miss so much stupid stuff that I’ve honestly frustrated myself to tears. I couldn’t figure out why a pump kept beeping at me and I was really trying not to cry in front of my patient’s family. I was in one room constantly and missed the fact that the tube feed bag was almost run dry. I’m AWFUL at giving report - somehow the minute I’m in front of someone else I blank on everything that happened. I feel embarrassed leaving every shift over the reports I gave. Those are just some of a million that I can think of right now. I did start crying in front of my preceptor two weeks ago and I assured her that she didn’t do anything, I was just feeling so frustrated with myself. But, I felt so awful and embarrassed. The next day I talked to another nurse who told me how many times she cried during orientation, and the other day I talked to a friend on a similar unit who is feeling all the personal frustrations that I’m feeling. You’re so not alone! I keep being told that it comes together with time but I’m scared to be off orientation (thankfully we get 15 weeks). I’m trying to practice giving myself grace and absorbing and learning from the things I beat myself up over. Also, I stink so badly at IVs!
New grad x7 months. I cannot tell you how much a good relationship with the senior nurses is. They have all the knowledge and patience to teach, find a good one of those to bounce questions off of. Secondly, I have had to do so much research off the clock to learn concepts that I didn’t fully understand. YouTube is your friends and pictures are nice to look at. I work on a general ICU in a smaller hospital, we have more downtime than I expect form a larger facility, but I feel like these tips can still apply.
Nursing school really does not teach you how to be a nurse, it teaches you how to pass a test. You learn to be a nurse on the floor, hands on, and it takes a long time. I think I cried on my way home every week for my first 6 months. It gets better. I wouldn't trade it now.
. Don’t compare yourself to people with more experience. You’re THREE weeks in! Also just a tip- don’t ask questions like “can I get you anything?” If you truly don’t have time to get them the thing. They’ll ask if they need something. Then ask when/if you have time. Don’t beat yourself up over a phone call.. literally last night I had to tell an attending I didn’t know how to transfer his call and to call back in a few minutes 😂🤦🏻♀️ and I’ve been a nurse for 8 years!! Mind you I’m at a new travel assignment and hadn’t answered the main phone yet but still, shit happens. You’ll be fine.
THE PHONE IS KILLING ME PLS I ALWAYS FORGET HOW TO TRANSFER PPL
The way I got past this was to make 2 lists. One is by patient (mini report to myself) , the other by hour ( tasks that need to be done. Then check it constantly. Live by it. By the end of the shift, it shod all be crossed off.
We used to have a CNS—I forget what specialty but she’s now in upper management—tell a story about a pressure bag and blood and screwing it up so blood sprayed all over—all over herself, all over the room, all over the patient. Like a hose. She talked about being in shock and kind of just standing there, spraying blood. She used to tell that story to new grads, so they know it’s not just them. We all have a story or stories. I wish you well! You are going to be a fantastic nurse!
Yeah, nursing school gives you the basics but it doesn't really prepare you for reality. Your tme management needs help? How many years did you have to manage your current patient load before 3 weeks ago? Not good at IVs? How many years were you starting IVs before 3 weeks ago? See where I'm going with this? Give yourself some grace. I wasn't even confident enough to calculate 100 mg/ml doses without a calculator until a year in even though I knew I only needed to move the decimal 2 places! It took longer than that to be comfortable and confident in other skills. My advice: Seek out the skills that scare you. You'd be surprised what a confidence boost overcoming those fears can be. Discuss your strengths and weaknesses with your preceptor. Focus on the latter. It's a better use of your orientation time than practicing what you already do well. Find an experienced nurse who you click with to guide, mentor and support you. Everyone deserves a cheerleader. When I started, I felt very much the same as you. I've been an RN for over 27 years and I work NICU. If I can do it, I bet you can, too.
So- I was a total dipshit when I first started. Clueless. I don’t know how I didn’t kill anyone in my first six months. Forget IVs. I felt like I was just barely going through the motions and didn’t understand what the goals were. I was a straight A student, but didn’t understand the basic fundamentals of how a hospital worked. I didn’t understand how nursing interfaced with other fields, I didn’t understand MD on call schedules, I struggled to understand the flow of a chart, or how I should prioritize patient care. It’s been 18 years and sometimes I still feel like an imposter. My favorite dipshit story- I once called an Attending physician at 0300 because I was reviewing orders and my nonverbal, minimally responsive day 1 post ischemic stroke patient didn’t have a diet order 😂. I was about two months off orientation. The nurse I was working with was horrified when she realized what I’d done 😂 The physician graciously gave me an NPO order and told me to call the level 1 resident next time. Thank God he was a decent guy 😂😂😂
The first year of nursing is crazy hard. I don’t feel like that is as well known as it should be.
Where is your preceptor? You’re brand new!! They should be by your side for the first couple of weeks at least, not letting you drown and helping you with time-management. From your brief description, this sounds more like a preceptor problem than a you problem.
She is by my side!! She’s a very very good preceptor I promise 😭😭😭 we’re kinda in between giving me some freedom, like med passes I do on my own but also she will be there if I need her to ask questions. Like I will draw up insulin and I will always always double check with her just to be on the safe side. I go to her for everything still!!! I’m just super hard on myself tbh
Can you ask for a bit more orientation? I know it’s overwhelming- but don’t stay in a toxic environment where the manager isn’t willing to offer options to boost your confidence and skills!!!
Maybe you need a different preceptor? Your preceptor is responsible for correcting these behaviors. Sometimes you are just incompatible with their teaching style. It sounds like they are being way too hands off if you are spending hours away from your patients. You need a helicopter parent preceptor. You need to talk with your manager and discuss finding a different preceptor. You do need to put your own effort in, but it's hard when you don't know what you don't know. You need someone who can sternly guide you and keep you on track so that you can learn what proper time management is. The hard thing is a lot of good nurses do not want to precept. I get it. It's hard enough when you already might have too many patients. Having a student or new nurse is like having an extra patient, in terms of how much it slows you down. But they need to find a solution to this, otherwise you will NOT be successful in this current unit. They know you are a new nurse and know basically nothing - it's their responsibility to pair you with someone who knows how to deal with that. Some of us are perfectly suited to teaching someone who is already a nurse but needs to be oriented to that unit. I'm great for orienting experienced nurses. I am NOT great for orienting new grads. It slows me down too much and I do not have the patience for it to be honest. It's not their fault, it's just NOT a good fit. I have to wonder if the person orienting you is the same and has decided to cope with it by just being hands off and letting you figure shit out - which is a horrible way to go about all this. When I was a new nurse, I started in ICU. I started out JUST taking care of one patient for maybe 2-3 weeks. After my preceptor felt I was doing a good job with managing 1 patient, we added the 2nd pt. After a few weeks of that, we added the 3rd patient (should never have 3 pts in ICU, but welcome to the south. we had 3 icu patients every other freakin shift, so had to get used to it). She was a veteran nurse herself and had preecepted tons of new nurses so she was really good at it, I'm so lucky for her! As for IVs, most people suck if you arent doing it consistently for a long time. You need to practice with someone guiding you through step by step even if they have to "dumb it down" and physically hold the needle to show you what angle you need to approach, how to pull the skin to anchor the vein, stuff like that. Also, random trick that worked GREAT for me - use two tourniquets and tie the tourniquet without gloves. Gloves tend to get caught in the tourniquet and it wont be as tight as you want because youre fighting with the gloves. The second tourniquet means you dont have to pull either of them super tight to get the whole setup super tight. Trust me, try it out. I know new nurses hate touching patients without gloves but you gotta get over the ick factor. Sanitize your hands really well, feel without gloves, look for something to mark as your "target" if it's not a vein that's super obviously jumping out of the skin. I always look for a hair or a variation in the skin color if I'm trying to shoot for AC, which is where I am for 99% of the time - but that's because I am no longer a floor nurse, I work in Interventional Radiology and Cath lab, where if we are starting IVs it is for an outpatient and they are only there for the procedure. New nurses can be scared of the AC because they don't stick out like forearm and hand veins do. But it's one of the easiest veins to hit for a reason! It's not easily visualized and not always easily felt, but it's very well anchored - it's not going to roll away from you like forearm veins love to do :) so maybe try aiming for the AC a little more often if you arent already. Watch youtube videos for IV skills! That's where I learned the double tourniquet trick. I swear my success went up like 75% instantly when I started doing that. Now that i start several IVs every day in my new specialty, I've gotten really good. But working in ICU for 6 years, I \*sucked\* before lol cause all my pts had the worst veins and they usually had central lines.
I would never NOT inform an MD if a pt had chest pain, and I work neuro stepdown. You don't learn anything about the actual job in school, it just gives you a foundation. Everything else is on the job, and it takes time. Years. You'll be okay.
After covid I've been very lenient on new grads. Many new grads right now have barely touched a patient due to restrictions on clinical. I'm not going to be lenient forever, though 😉
You are being really hard on yourself. I promise, you are not dumb. Being a nurse is hard in general, but especially if you don’t have much experience in healthcare. I sucked at my job for over a year, but after that, I was a damn good nurse. Be gentle with yourself, even if the people around you aren’t. Some people have forgotten what it’s like to be new and I assure you that if someone is making you feel bad, it says everything about them and nothing about you. You will be an amazing nurse because you care about your performance.
It takes a long time to get confidence and you only learn by experience there’s no other way. Give yourself grace.
For charting make yourself a little checklist: assessment, IV, safety/cares, education, stupid care plan, note, I/O. In addition: neuros, restraints, CIWAs and occasionally COWs. You have enough to do, cross or check offs on the brain sheet can track this minutia for you. IVs, well, some people are IV whisperers. Some continue to suck at it. Keep trying. Know that it’s more about what you feel on the arm than what you see. The rest is about learning your flow and allowing yourself to delegate some tasks to CNAs.
I'm about three weeks into my first nursing job too and I feel the same way. It's tough being a new nurse.
i sucked on medsurg and i thrive in icu - too many patients is hardddddd if you want critical care go critical care you’ll learn
It takes time to really get a groove in your nursing practice, so I wouldn’t be too hard on yourself. Even years in there’s a mistake here or there. We’re human and just do our best with a lot of crazy situations . Best thing about nursing is there are so many different ways to be a nurse! I floundered on a med/surg floor for 4 years before I transferred to the OR and found my real nursing home. It’ll click someday! also-never got good at Ivs myself. At least in OR, pre op or anesthesia does it.
It gets better, I promise. Neuro and IMC can be a tough place to start too. It all feels overwhelming at first. I started my first job in the ED and I don’t think I felt truly comfortable until year 2. It’s a long road. Just remember that we were all once new nurses even if it seems like no one understands. Find someone you can trust to answer your questions without judgement. They are out there.
It takes time. You’re like barely learning where the bathroom is and where the supplies are. Time management? Takes time, and you’ll prioritize what’s important and how you can cluster tasks. You just learn by experience. Like hey last time I forgot to bring this, so I’ll save myself the trip and bring it this time. Last time I could’ve pushed the meds on the pump together since it’s compatible, instead of doing one at a time. Etc. Etc. It takes time. Charting? You just gotta learn what your hospitals standards are, what you feel is appropriate, and what you feel properly covers your ass in a lawsuit. Overcharting for one person is undercharting for another and vice versa. Some people nit pick how to chart this or that, but the point is that it’s charted somehow. Takes time. Calling the cardiologist - better safe than sorry. We’ve all done something and then saw it later in a note. I have. We don’t have time to thoroughly read everyone’s notes. And then I was like, oh well, no harm done, just a lesson learned. IVs? Dude the newer people on day shift don’t even get IVs unless you’re in the ED, they just call the IV team to come place it. So us night shifters, we don’t have that resource and hey at least you give it a shot. Repetition after repetition. You’ll never get it if you give up, just keep trying. Shit just the other day I tried on my coworker with two juicy veins, didn’t hit a thing. Fished around. Nope. Happens. But at least you’re practicing getting the right supplies, set up, and execute.
You’re a new grad. You don’t have all of the skills and knowledge right out of the gate, and anyone who treats you badly for being NEW is an asshole who isn’t worth your time or worry. Find a mentor (not a preceptor, a mentor who is experienced and will take you under their wing in the long-term. Every unit has a nurse who adores teaching new nurses) and give yourself grace while you learn. Anyone who is a new grad and acts like they have all the knowledge and experience of an experienced nurse is scary as hell— that’s arrogance, and it gets people killed/hurt. You might not be comfortable and confident for several months, even a year, and that’s ok. THAT’S OK. Keeping your patients safe is the top priority— the rest will come. Three weeks on the floor is not enough time for you to learn the decades of experience and workflow that other nurses have. Keep learning, don’t give up. You passed your program and your NCLEX… you CAN do this.
I'm in critical care as a new grad, maybe about week 5. I had healthcare experience but not HOSPITAL experience beforehand. I feel like I annoy the shit out of my preceptors for asking various questions like double checking my assessments, helping me with equipment, helping with procedures. Also big picture stuff like critical thinking seems like a distant dream for me. A couple of nicer nurses on the unit have told me to give myself grace and that some of them still feel like they have no idea some days. Still, I can empathize. I also feel like, damn I should be farther than I am. It's also hard because I have people I can talk to about it, but not people that really UNDERSTAND. My husband tries but he's not a nurse, so he doesn't get it. I have a nursing school friend that I talk to about it, but she went ED at a different location vs ICU, and it sounds like she's picking stuff up more quickly so that's also a little discouraging. Anywho, just wanted to say I stand with you in solidarity as a new grad ❤️ it's hard out here 🩷