I am a second career nurse—53 years old and a new grad.
I landed a job at a teaching hospital because I love to learn and felt it would be a good place for me. But I feel like I have bitten off more than I can chew.
Every day I make at least one mistake. I’ve already made two medication errors which resulted in my having to write incident reports. I am afraid they will not let me stay past the probation period if this keeps up.
This is so not like nursing school. It seems like 50 things are happening at once and you have to keep all of them straight in your head. I am having a hard time remembering everything I am supposed to do and have yet to get through charting on time.
While my preceptor makes it look so easy, I am terrified - feel like I made a terrible mistake and should go back to school, or find another career.
I have wanted to be a nurse for about the last five years and finally decided to take a chance. I never thought I would get accepted to nursing school but here I am: an RN.
Still I have no confidence and I'm always afraid I’m going to kill somebody because I don’t know enough.
Am I crazy, or do other new grads experience the same kind of feelings? What’s your advice?
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October 27th, 2008 at 11:05 pm
I’m about to graduate in Dec and I was told hospitals should provide some orientation, did this happen? Maybe you should look at a hospital that offers better orientation. Anyone else out there have info regarding this??
October 28th, 2008 at 7:50 am
Michelle,
We have all been there!! Even in a smaller, community hospital at first it seems like you will never get the hang of it, but you will. Nursing is a career that doesn’t all come from a text book…it takes time and experience. I’ve been a nurse for 2 1/2 years and I can tell you it took me around a year before I felt comfortable in my job. The key is to find a mentor and go to them any time you have a question. Don’t be afraid to ask for help. Also, do not rely on your brain to remember things…I write EVERYTHING down! Just take one day at a time, and learn from your mistakes. I promise it will get better…and if not, there are tons of different opportunities for RN’s that are slower paced than a big teaching hospital!
Hope this helps,
Stefanie Yelverton, RN BSN
October 28th, 2008 at 8:47 am
Crazy maybe but no different than any of us that have and are going through the same thing.
I have been off orientation for a little over a month. I had one med error during orientation and one med error after orientation. I was written up. My manager reassured me that its not the end of the world. Mistakes happen and we learn from our mistakes.
She said to slow down and follow the 5 rights every time you give a medication.
The RN orienting me said (not that this is the best advice) it is very hard to kill a patient.
The best advice I have received so far is to ask for help, if you don’t know don’t do it and ask for help. Simply state I want to do this but I’ve never done it before.
From everything I’ve read we will still feel like we have 50 things thrown at us at once and not know which way is up for at least 6mths to a 1yr some have even said 2yrs for them to really feel like they weren’t a fraud. I don’t feel like a fraud but I do feel like I don’t know what I am doing half the time but its there, school did give us the skills, something in our life gave us the wanting passion and compassion to become a new. the rest WILL come with time.
Your blog REALLY helped me, I was happy to see that there is someone else going through what I am feeling and experiencing at the same time. I am not happy we are experiencing this but I am glad to know I really am not alone.
Hang in there cause I am, WE WILL BE GREAT NURSES!
Beth Hancock RN
October 28th, 2008 at 11:29 am
Michelle, I am so sorry your orientation has been so difficult. The answers given so far have been right on! You did not say how long you have been working, but Joanne’s question about how long your Orientaiton was is a good one. Most new grads in med-surg units are given at least 12 weeks of structured Orientation with a Preceptor.
If you did not get this, or your foraml Orientation is over, try to find a Mentor on your unit–an experienced nurse you can go to with questions or to validate your assessments. This might be your Preceptor or someone else. If you are still in Orientation, are you getting both positive feedback and constructive criticism from your Preceptor? If he/she is not givng you enough, you must ask for it. Don’t be afraid to ask questions. For new grads who have not chosen their hospital yet, I always recommend they try to find a hospital with a New Grad RN Residency Program. (See my article from April, 2008 here on RealityRN.com, on this topic). Residency programs allow for discussion with other new grads on feelings they encounter. Every thing you have experienced, they are feeling too. Please do not give up on yourself, or the profession.
October 28th, 2008 at 3:14 pm
My first nursing job was also at a big teaching hospital (almost 20 years ago). I used to joke that this hospital had more beds than my hometown! It can be very overwhelming, the pace is very fast, but I assured you that one day you’ll look back and wonder what all the fuss was about. Give yourself a break, never do anything you aren’t comfortable with, and ask the experienced nurses around you for tips on how they manage their time. Some of the best time management tools I’ve discovered were already in use by coworkers. How they keep track of who needs meds when, procedures, etc. You shouldn’t be expected to function at an experienced nurse level just yet. I’m sure you’ll be great and it is such a fabulous experience. When talking to classmates I was astounded to hear that I was doing things they had never even seen because a larger teaching hospital can be more intense. Congrats to you for taking the chance!
October 29th, 2008 at 12:05 am
I started my new job at the one Nursing home that I wanted from the day that I interviewed. It was the one place I thought this will be where I start. It was a fancy nice place,, and since I never thought I would work in one as an LPN there are not many hospitals in my area that will take an LPN. The clinics were not paying so I went with it.
One of the nurses that I worked with was wonderful and a great teacher to a new nurse. She helped and did not degrade me in any way, then there were the couple of bad ones.
They make you fel tat you are a rookie and do not know what to do, or that there way is the slow way, you take too long. One actually told me that I would not make it off orientation and that she was sure that I would fail. Yep. that in itslf was a bad night. I actually came home and started to look for another job. The iteresting thing is that it tend to happen on the weekends when the normal supervisor is not there and I dont know who to go to when it happens other then suck it up. One night I almost walked out 1\2 way though the shift. She about made me cry due to her attitude towards me and the way that she treated me.
I had one treat me as her runner so she could tend to the residents! Ok I am not her CNA and I can help but what she sent me away from was something I need to learn. There policies and what to do if it happens when I am on my own. So if it happens again I guess I will have to be more asservite and tell her that I need to stay to learn and to have the CNA help her with the oter stuff!!!
So orientation has had its ups and downs, but the last couple of nights have gone well. So that is a plus. Remember that just cause we are new and don’t know everything about nursing, in the hospital or anywhere else, we do know what to do, and we ask more questions, but in the end I think we will be better nurses.
October 29th, 2008 at 7:08 am
Hang in there, Michelle. I started nursing as a second career when I was 43 and have been a nurse 5+ years now, but I still remember the difficulty of orientation. I was used to excelling in my previous job, things came very easy to me, and all of a sudden this wasn’t so easy. Nursing is hard work! During my orientation period I felt as if everything I learned in nursing school had suddenly been wiped from my brain. Everytime I took on an extra patient, it felt like things were falling apart and not under control. But gradually I developed a routine, and some nights I would go back to my medsurg school text and review a particular illness and find out if I missed anything I should have been looking for. I was in awe of the nurses I worked with who could rattle off the patient’s lab values from memory. But you know what, I can do that now too…it’s a matter of finding your place and settling into it, developing a routine but being flexible so that you can take care of emergency patient needs. You’ll get there, it doesn’t happen overnight. I had very supportive nurse coworkers and managers; we have a culture of helping each other and offering help. I’m not sure I’d be a nurse anywhere else, actually. But you do have to give yourself time, be patient with yourself; and you are right, this is nothing like nursing school. School gives you the basic knowledge, but you are still learning new information daily, and a lot of it, and it’s definitely in a different format and context. I felt a little more relaxed after I’d been a nurse for 6 months, then after a year was pretty good. After 2 years, I actually was starting to feel bored with certain diagnoses that you see over & over…CHF, COPD, chest pain….but then I realized, I was on my way to becoming a better nurse, because I knew what to expect with these diagnoses, I knew the expected medical treatment and the expected progression of the patient, so therefore I knew when things weren’t fitting the pattern and were abnormal, and could address those to prevent problems, and those are the things that an expert nurse really shines at. Give yourself a break, make sure you’re doing good self care, eating well, exercising, sleeping, not working overtime. There is no way to becoming a good nurse overnight, you just have to go through it day by day, hour by hour, but you can get there. Good luck and keep in touch!
October 29th, 2008 at 7:42 am
You’ve got it easy, my first head nurse admitted she disliked me a lot, plus I was the only male in the gynaecology ward. My head nurse blasted me for waiting to check IV meds with a 2nd person, it was a simple antibiotics, she literally said to me “Well, are you a RN or not? Begin acting like one and stop waiting for someone to hold your hand.” I was supposed to be working three months with IV’s before administering them without someone watching over me.
Anyway, as for stopping drug errors, in addition to the five rights, there is one more thing I did which helped a lot.
I got so used to pills, especially medical patients who sometimes had a dozen at a time, that I could tell which pills were which by looking at the colour and shape. What I did next was sit with each patient and as I gave them I told him or her what each one was eg “This is your metoprolol, it slows and strenthents the heart, and this is your Frusemide, and it gets rid of the excess fluid” etc. The advantage of doing it this way is that I have caught myself at the bedside from making an error, plus patients may say “Um, I don’t usually take that now” or “I take that at bedtime” or “I only take one of those, not two”.
Sometimes the admitting doctor has made the mistake eg evening meds prescribed as morning, dosage changes etc and this is a way to catch that out as well.
Often patients don’t know their meds well, especially the older generation that have multiple meds, they know general things like “My heart med or my blood med” etc. It may take a bit more time, but it works.
I can’t stress enough how this has saved me from messing up.
October 29th, 2008 at 12:52 pm
Michelle
I got my first RN job in 1977 (in a large city hospital ED on nights) and I remember feeling as you do. I almost died when I made a mistake. I finally became comfortable after a year.
But here is the thing. I have changed clinical focus 4-5 times in my career and I ALWAYS find that there is an adjustment period- it is the nature of our work. Hang in there, let yourself be a rooky, go to mentors who can help (a favored faculty member might be safe), and things will get better.
October 29th, 2008 at 3:38 pm
Michelle,
I am right there with you. I have been working on a cardiac floor for about two months and somedays I just feel like I know absolutely nothing. I am still in orientation until Dec, yet I know it will be a long road after I am off. I have a preceptor that is amazing and has worked as a nurse for 23 yrs and some days I feel as if I am more of a hassle than anything. My advice is to stick in there. Try not to get caught up on all the poor-spare-of-the-moment decisions you have made before, just learn from them and move on. Dont spend even a little time hanging onto them, because in that little bit of time you can be learning something more. Think of the strengths that you do have, because if you can make it through nursing school and the NCLEX you have strengths!!! Give it time, and if after giving it a fair amount of time, maybe reconsider the hospital you are working for.. but never reconsider nursing if it is your passion!!!
“If you don’t get nervous about your passion… then its not really your passion.”
October 29th, 2008 at 5:49 pm
I just graduated nursing school and May and started at a hospital that promised the best orientation program around….they were wrong. I had a terrible orientation having about 14 differant preceptors. It took me awhile but I finally figured out a way to keep myself on track no matter who my preceptor was that day. I started getting to work about 20 minutes early and before getting report going through my pt’s careplans and for each pt on a seperate piece of paper i wrote down each hour of my shift and under each hour wrote what med was due, what other tasks needed done, and what charting needed done. It really helped me out. I’ve been off orientation for about 3 weeks now and I’m starting to feel alright about my job and getting good reviews from my managers…..good luck with everything!
October 30th, 2008 at 10:38 pm
I completely understand what you’re going through. I am finishing my orientation within the next 2 weeks. It does feel like you don’t know what your doing. I too have made medication errors. I gave a patient a Lortab 4 hours after his last dose but as I was signing it off on the MAR I realized the dosage schedule was every 6 hours. I had to submit a variance for this. Thankfully there was no harm to the patient and I learned how important it is to triple check the MAR.
If you don’t understand something you need to do just ask. There is no stupid question. I would much rather ask a question to understand something than to risk making a mistake.
Talk to your preceptor about your feelings because every new grad has these same feelings. I always feel like I am asking questions that I should know, but it is different in the real world. In nursing school you were taught to diagnose the patient so you could care for them, but out here, the MD’s diagnose and we just care for them. All we need to do is recognize if a problem occurs. You may not know what the problem is but you recognize that something is wrong from their baseline. Use your resources – the RN’s with more experience – they usually have seen it before.
We all have to see things the first time so when we see them again we know what to do.
Hope this helps,
New grad Winder, GA
October 31st, 2008 at 1:04 am
Michelle:
Is there a nurse educator you can connect with?
I am the unit based nurse educator for the medical floors at a large hospital in Portland Or. I work with both preceptors and new grads. Often when a new grad is struggling, they will call me.
Sometimes it is just a matter of assisting the preceptor with a plan that will meet the new grads needs.
Other times, it is simply me working with the new grad on a one to one basis.
Either way, you need support and someone you trust to field your questions and help you see the bigger picture.
Find out who is responsible for staff development at your organization, specifically who works with preceptors. This person should be able to offer you some help.
Hang in there. It does get better..
Remember, that if your not sure, ASK,ASK,ASK….
If you would like to contact me, you can go to http://www.aacngpc.org click on contact us and ask them to forward your contact information to me. Mention that I am the coordinator for the Advanced Preceptor Conference.
Good luck to you!
November 1st, 2008 at 3:06 am
I’ve oriented ten weeks and now I am on my nineth day on my own. I have had 5 incident reports. I broke a bottle of insulin, had two paitents go AMA, had one fall and had a medicatin error. And every night there is one thing that went wrong. One night, an NPO patient got dinner. Another night, forgot to replce surgery’s bag of LR with NS. Tonight I didn’t catch the little note ” cover if bs is over 200″ on the insulin sticker. We almost always just do sliding scale coverage. This was an addendum. It is the addendums I have trouble catching. On the upside, I hung blood today and hung it perfectly. I really hope this streak of a mistake here and a mistake there ends because I don’t think making incident reports should become a clinical skill 8) How long does it usually take to get over this?
November 1st, 2008 at 9:30 am
I have the same problem. But instead of a hospital, I started out in a nursing home/rehab. I’m miserable, I spent every second on my feet running from person to person while the nurses i work with all have time to sit and do chart work. I’ve been told that its just becuase i dont have the experience and that it will come, but i still feel horrible and upset. I feel like if i had a typical hospital patient load, like i used to during internship, of 5 people, i could handle it. But here, I’m on an assignment of 10-20 people a day, all of whom need meds at 8, 12 and 1400 and all of whom go to the daily activities, which run all day and nurses are not allowed to interrupt for medications. Being a new grad sucks, I’m sure, wherever you are, but when a new grad is expected to be at the same level as a highly experienced nurse, its impossible.
November 3rd, 2008 at 11:50 am
WOW – I didnt expect to get such a wonderful representation of new grads. Your comments helped a lot. I am still slogging away. I have 4 patients now and even got out on time today! ( even though it was ONLY the night shift) Every day does get a little better. I am learning so much. I still make mistakes but thankfully nothing involving medications or requiring an incident report (today- anyway). I’m not sure a big teaching hospital is where I belong but I still know that I want to be a really great nurse.Hopefully that will start to express itself in my skills.
THank you all. This was a tremendous help.
January 11th, 2009 at 11:44 pm
Thanks for telling about your fears and struggles. I’m 56 and nursing is my second career. I’m on an ortho, neuro, urology floor. I had my orientation extented from 4 weeks to 6 weeks. I had had 10 or 11 preceptors & that has made it very difficult. Afew of them just gave me 4-5 pts. & told me to take care of them & ask if I had any questions. They checked my charting & I took all of the pts. Today was suppose to be my first day off orientation, but I was called off because of low census. I was determined to resign twice last week. I didn’t feel that I could ever get it all done. I feel so slow. Our pts. are asking for pain meds every hour & many vomit a lot & they need so much help turning or getting up. I need to do the regular charting, 24 hour chart review and care plans. They told me to be prepared for up to 8 pts. on a bad night. I’m barely keeping up with 4 or 5. I can’t eat or sleep. I have a big lump in my throat and in my stomach. I’ve almost had anxiety attacks. Just thinking about going to work starts my heart to racing & my muscles tightening up I’m not adjusting too well to the night shift 7p to 7:30 a. I’ve always been a morning person. After reading all of these I have some hope that there is a light at the end of the tunnel. Thanks.
January 17th, 2009 at 11:43 pm
Wow, what encouraging responses. I wasnt feeling so great as a new nurse but to know this is how it goes, I no longer feel like a fish out of water.
March 18th, 2009 at 1:04 am
I just finished my orientation and felt totally unready for like as an RN in the Emergency Room and I made my first med error last night. The MD and Charge Nurse were really nice about it and we just redrew labs and made sure that I didn’t put anything out of whack. Everything turned out to be ok and no harm done, I’m sure I’ll be written up at some point but I’ll definitely remember from now on to double even triple check medications from now on.
Just slow down a little bit when you’re giving medications. Some of the best advice my preceptor gave me is before you go in a patient room, think about everything you need to do. Do you need an IV, medication, an assessment? Get the medication before you go in so you start the IV and have the medication and do your assessment while you’re doing your IV or given you’re medication. Also finish what you start don’t stop in the middle to do something else because then you forget to come back or chart or something like that.
Also if you’re working on the floor really try to find some way of writing your “brains” so that you can see what needs to be done for all your patients for the day, what time are meds scheduled and what time are assessments due. Prioritize and work your way down your lists.
Don’t give up! You’ll make it and in a few years you’ll be the one making it look easy 🙂
April 27th, 2009 at 10:24 am
Reading all of this has been helpful to me. I have been a psych nurse 29 years. A month ago I started work at a nursing home. It has been horrible. I had no orientation what so ever and am the only nurse for 45 residents with 1 or 2 CNA’s. The residents have no quality care, even when the CNA’s aren’t out smoking or talking on their cell phones. I have 10 diabetics with blood sugars due at 1600 as well as the 46 getting scheduled 1600 meds. The same thing at 2000 med time. I can not get all the blood sugars and all the insulin and scheduled meds to everyone on time…it is humanly imposslble. Also the sare of feeding tubes which takes time. Some residents have difficulity swallowing meds and that takes time. Also, I do not have another nurse to witness the insulin I give.
After finally get meds completed I have to chart and transcribe physician orders and other paper work that I couldn’t complete in order to get meds out on time.
All of this puts my nursing license in jeporty… falls, residents pulling out feeding tubes, seeing them never being turned of fed properly. I could go on and on but you grt the picture.
I want to quit immediately but don’t want to be unprofessional by just walkind out. I plan to give my two week notice but I dread their reaction and fear retaliation.
Hopefully it will work out. If there are any praying people reading this, please pray for me!!!!
September 6th, 2009 at 11:50 am
Thank you,I was ready to quit after being given a hard time for not checking for a blood test before hanging a drip,it used to be automatic for that test to be done in my old hospital but they don,t automatically order it in this one,so I got the blame.I feel really stupid now but I was rushed too much and could not humanly complete everything and was not given time to recheck all orders.Thank you for your encouragement.
May 7th, 2011 at 2:47 pm
I have a question and i know this is not the thread to do it in, but hopefully someone will see this and give some insight. My mom is a wonderful nurse who was recently fired from her 10 year job at a major hospital. It was state inspection time and during the chaos and pressure she charted that she had dressed a patients wound but was pulled away and never did complete the dressing. Is this something she can lose her license for? I feel awful for my mom, she has the highest work ethic of anyone i know (she only called in sick 1 time in 10 years!!!). She has never been fired from anywhere in her life and now she is sitting on pins and needles waiting to find out if her license will be revoked for, what i assume would be misrepresenting charts. Again i know this thread is about new nurses but your responses are so amazing and i truely understand the workload and the pressure that all of you are under, i just wonder if one mistake could end it all…