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How Did You Find Your Niche?

I'm a new grad (May 09).

Our initial orientation was supposed to be 8 weeks, but I was thrown out on my own a little sooner than I would have liked. I started at my hospital June 1st doing orientation and by the fifteenth they had me on my unit with a peceptor. I did that for two days and by my third day I had two patients by myself. the next day three, next day four, five and so forth up to six which I am now at. (I think thats the limit) It was extremely stressful As soon as I felt comfortable with my time management and felt like I was finally getting my "niche" (as my co-workers called it) I would get brought back down to reality again when I had an extra patient.

I of course struggled the most out of any day so far the first day I had my own patients. I had not created any kind of system for myself...I was still searching for one. I found myself passing meds like an hour late and having patients who were supposed to have procedures done in the AM and I didn't have any of the paper work done for it. I also got a phone call that night from the cardiac unit telling me my patient had a pause in their rhythm strip. I was in the room with the patient when this was supposed to have happened and he was totally asymptomatic I checked his VS's and reassessed him and everything. I asked a new of my co-workers what had happened and what I should do about it. my shift was ending in less than 30 minutes. They recommended I just chart my findings and mention it to the oncomming shift when I give report so they will be aware of it. Well when I did this the nurse I gave report too flipped out and yelled at me and embarrassed me in front of the whole team. Telling me I was crazy and I should have "called the DR!!!"

She ripped my papers out of my hands and stormed off. Now if thats not a bad way to end your first day I would like to know what is! Here I was passing meds and having two patients by myself and its only my third day on the Unit! I'm still supposed to be precepting for another like 4 weeks here! On top of that My pt. with the critical lab (low K+) Is leaving for a CT scan and needs to have her IV K+ hung STAT...all the girls are yelling at me telling me hurry hurry hurry... I had never hung an IV bag of K+ at the time and was still trying to even figure out how their IV equipment even worked. After what seemed like an eternity I got someone to come walk through it with me and she was able to be sent on to CT. I was scared becasue I was in a hurry and I didn't want to go do somethign I didn't feel comfortable doing for the first time under that much pressure and stress. I have heard far too many horror stories about IV's getting put in the wrong port and people getting a bolus rather than a drip rate. I was a nervous wreck! Well that morning when I went home from my shift I felt like crying the whole way home. The nurses on my unit are very helpful and they come and help me whenever I need it. That particular night they were all just very busy. If I ever ask a question or ask for help and I notice that fabulour eye roll or I feel like I am getting on their nerves I just tell them thank your for helping me and I have to remind them that this is still new to me. I usually mention that I would rather ask for help and get something done correctly than to do it alone and mess up and have an even bigger mess than if I woudl ahve just asked for help. They usually agree with me, smile and are more than happy to help walk me through something I am not comfortable doing...thank god! lol....AFter that terrible shift I felt hopeless...like I was never going to be able to make it. I figured I needed to come up with a routine so that this sort of night will NEVER happen again! I went home and wrote down all the things that eiher I over looked, or got behind on, or just didn't understand well and I reviewed it. I created my own little "care plan" of what interventions I can do the next shift so that I can fix all these mishaps. This is what I came up with...

I created a little page with 6 blocks on it and I typed it up so it will be neat. I take a sharpie and put the pt.'s name and room number by each section and I made the copies on Yellow paper so it will stick out when I get a big load of papers and find myself fumbling through them. I have the time labeld on the left hand side... 2300, 0000, 0100, 0200..etc. with a line out from it I label the time everything needs to be done so I will have a quick go to guide when I get behind or confused. I also have a section saying what PRN's have been given and what time. What their O2 is set to...what IVF's are hanging and what rate..etc. I dread leaving stuff for the morning shift to do becasue they give your "the look" and make you feel like you didn't do your job. And being the new kid on the block I don' t like leaving feeling like someone else is picking up my slack. So I try to not let that happen as much as I can. My routine as of now is I clock in go get my report on my patients then I go assign each of them to me on the computer and look up everything that needs to be done on my shift for each patient. Labs, meds, xray, procedures, etc.

Once I fill that out I make my initial rounds do my assessments and pass any meds that I might have to give. I started asking them their pain scale while I'm doing my first rounds so I don't find myself running back and forth to the med room 10 times when they call out for pain meds, or nausea meds. After I get all that done I get to my charting with hopes of getting it all done by my 3AM Chart checks. This method works great for me unless I get critical labs adn have to call the MD or heaven forbids one of my patients gets bad and needs some extra TLC. It's those little surprises that can totally get me off track and feel stressed out. I talk to my co-workers and they all tell me my feelings are totally normal for a new nurse and that alot of them felt that way when they were new too. They always tell me it gets easier with time and once I get my "niche" I will be smooth sailing. I long for the day when I can actually go to the bathroom or sit down and have a lunch break and not feel like I am missing precious time.

How long will it be before I feel totally comfortable as a Nurse?

When does that "Reality Shock" finally wear off?

And does anyone have any tips for new nurses to help us find our "Niche"?

Any advice or tips would be greatly appreciated!!!

I work night shift so we have a little extra paperwork than the day shift does. The big stack of charts I have to go through one by one bogg me down so bad. I have a goal every night to get to them by 3AM if I can manage to sit down and start at 3 and not have interruptions I can get it done and go on and get ready to give my morning meds and make my next rounds. If not I get overwhelmed and feel like I'm not going to have time to get everything I need to get done.

Thank You!

Brittany


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12 Responses to “How Did You Find Your Niche?”

  1. Amy, RN Says:

    I work in the ED and started there straight out of nursing school, I remember thinking to myself “What did I get myself into” when I first started. I don’t quite have the same stuff that I had to get used to that you do, but I’ve been on my own now for about 4 months and I feel much better than when I was first on my own. When I was first on my own I felt like I needed help ALL the time because every patient is just a little different and there are so many procedures that get done in the department. Just keep asking for help even if you get the eyeroll because you’re very right about not wanting to rush through something you aren’t comfortable with yet.

    You have a great plan with writing things down. Just remember that you’re new and that you’re hospital gave you a crappy orientation and it sounds like you’re doing a good job – you aren’t being careless and you aren’t endangering you’re patients! In time you’ll get your routine down, one of the best nurses I know said she cried after almost every shift when she was a new nurse for like 6 months! But you’ll definitely get there, just keep going. And keep trying new strategies, you’ll find one that works for you.

  2. E.C. Says:

    Brittany-

    I just wanted to say thank you for posting that. I am a new grad and just started my orientation. My first day was “shadowing” and by 12:00 I was in the middle of my code experience. I was the one doing the compressions. Other new nurses had 6 patients and were receiving admits. It seems to be a very intimidating experience. I can’t sleep at night before going in and it’s only my first week.

    It’s comforting to know that other new nurses have similar experiences.

    So, thanks and good luck.

  3. nursingaround Says:

    Don’t worry, i couldn’t work in a ward ever again, too bloody disorganized. I used to stick to the fun areas, the ED, units, even a couple years working the psych ward.
    Just remember, don’t do anything you’re not comfortable or unsure of.
    Remember no one knows everything, and anyone who thinks they do you should stay away from.
    Another tip, part of being a good nurse is knowing when and who to go to when you need help. There woll always be someone who knows more.

  4. Rachel Says:

    That sounds like a really short orientation, and if it wasn’t enough, you should definately speak up!! I work in a Neuro ICU. Lots of orientation and they don’t let you off until you’re ready and your preceptor agrees. Very sick patients so lots of stress. I felt your pain about four years ago.

    I know it may sound crazy, but on your days off make sure they are days off, making all these plans and new organization sheets is great, but are you having any fun at home?!? Don’t stress about work at home or you’ll dread going back to work every time. Remind yourself what you’re doing right at work not always what you’re doing wrong.

    Ever watch Scrubs?? I know it’s about doctors but it has some great medical emotional advice and one of my favorites was JD learning how to run a code, stop and take a breath. Honestly when things are at their worst, stop and take a breath to clear your head. Great show to watch if you have some time and want to cry a time or two and laugh in between.

    Reality shock doesn’t really wear off. It becomes a lighter load to bear. Some nights will always be bad nights when you’re always in shock mode, but you realize you can think through it.

    And don’t let day shift give you a hasssle, different personalities work days and nights. Everyone needs to remember a hospital is a 24 hour operation, there is no reason to think you did something wrong if you had to leave something for day shift to help out with, how many times have they passed something off to you, especially those bad dressing changes or that one bath that takes five people to do? Take a breath and relax it’ll get taken care of. If you leave the hospital and you did everything you could to keep your patients alive or comforted those that were on their way out, then you did your job.

    Next shift make some cookies to share and enjoy one while you take a moment to breathe.

  5. Clare Says:

    Heres my orientation in a nutshell: A couple classroom days where I sat for endless hours hearing horror stories of how things can go wrong and how many ways you can get into trouble for not documenting “relationship based care” on the care plan in real time. Cut to orientation where the third day I am on my own with 3 patients I have never had with procedures that I am unfamiliar with because the unit is understaffed…….does anyone see a problem here!?! I am so glad I read your post I FEEL THE SAME WAY! I was a nurse aide in a Trauma ICU for 2 years before I started my job on a med/surg floor and was under the impression that the the transition would be smooth sailing. Boy was I wrong…cried on my way home from work this afternoon. I will definitly be using your tips for organization. Thank you seasoned nurses for your words of encouragement!

  6. ladythumbs Says:

    on week 7 of 8, feeling like crap, too. was an aide in a private care facility before hospital-based nursing, felt like i was really helping people. now i feel like i only sling meds and inflict pain with my still-in-development phlebotomy skills. preceptor seems to be on her last nerve with me, then tells me i don’t ask enough questions, how to you react to that? most of the staff is great, but the primadonnas are kind of tough to take. none of them have been at this particularly long, either, what the hell? SO questioning ye olde career choice right about now…

  7. Jason R. Thrift, RN, BSN Says:

    Brittany,

    You sound just like me after my orientation. I’ll never forget that first day. I think I had 6 patients on my own, maybe it was more but honestly by the end of that day I was so stressed it might as well have been 100! When I left, I went straight home and cried my eyes out begging God to help me just be a good nurse.

    I thought I wasn’t going to make it, that I wasn’t ever going to find my “niche”. My aunt, who was a nurse of 39 years at that time, told me it generally takes a year to truly feel comfortable in any aspect of nursing that you work. Whether it’s the ER, a Med/Surge unit, a Tele floor, doesn’t matter, always one year and if you move, even with experience, it may take one year to grow accustomed to a new department (although having experience helps by that time).

    I too felt I got the short end of the stick on my orientation. I can’t completely blame them because I had worked with my unit during my practicum for four weeks. But, that entire practicum I was with someone, never on my own completely. When I started my 2 week orientation I had on my unit (not kidding) I was practically alone the whole time. Maybe they had a little too much confidence in me? Needless to say, after my first day completely alone, I begged for more orientation time and got it. Two more weeks (for a grand total of 4), but that was still better and my mentor was with me the whole time the second time.

    She told me during that orientation, you can’t be afraid to speak up for yourself. If you don’t, people will walk all over you. I’ve dealt with the same issues between shifts that you have and during them. It’s amazing how some people even become nurses sometimes. You wonder what their motivation was in the first place? Unfortunately I’m sure you, as have I and many others, know some of their motivations.

    Nursing is a harsh climate right now, and people have to let their voice be heard if they ever hope to make a real change. Coming to forums like this is good, but the hospitals need to know too. The problem is, we all get complacent making money, having a life and becoming quite comfortable over time.

    Change can be a good thing, that is for sure. Keeps you on your toes. To be a nurse, you certainly want that.

    So, good luck to you Brittany! You keep hanging in there and working hard. Just don’t give up and learn from your mistakes. Trust me, that nurse that yelled at you made mistakes too when she started out. In fact, she made a mistake right then! Her antics taught you how not to treat your coworkers and especially how not to treat brand new nurses. You can always learn something, even if what you learned that day is the wrong thing to do.

  8. jjohnson Says:

    Ok, I definitely feel better after reading all these posts. I have been on my own on a general surgery/orthopedics floor for 3 days and each day seemed to get worse. The second day I had a patient with CBI running wide open all night so I felt like I was in there every 10 minutes emptying his foley and hanging new bags. Not to mention I still had to hand irrigate sometimes and had 5 other patients.

    My orientation kind of sucked too. I worked on this floor some last summer doing an internship so I feel like they thought I should already know some stuff so my orientation should be shorter. I also had what seemed like a different preceptor every day. By the end of my orientation, I felt like I was ready. What I didn’t realize until i was truly on my own, was how much my preceptor was helping me before. Now, any little issue that creeps up is totally mine to deal with.

    In general, I feel really good about my technical skills as a nurse, but it’s the paperwork and routines that I feel like I struggle with. I feel like there’s so much disorganization and things that you’re just supposed to “know” that I don’t know!

    Anyway, it’s just really nice to see that I’m not alone. I just keep telling myself that I’m new and I’m not going to be perfect right away, or ever for that matter. Also keep in mind that everyone else knows that you are new and they don’t expect you to come out knowing everything or not making mistakes.

  9. Eliza 30 Says:

    I,m an older nurse and I feel nervous every day in a new environment doing agency,I feel I need more time,I am always being rushed,get this one admitted,get this one discharged.I was so rushed I omitted something without knowing,until later.I was given a really hard time,even though I have never harmed anyone.I felt like quitting.It,s almost like a production factory the way we turn patients out or in.The more hurry,the more omissions due to time constraints.I keep telling myself to slow down and take care now,even when the charge is yelling at you.

  10. Brittany Says:

    Wow, I am so touched that so many of you replied to my post. It is also relieving to know that there are others out there who can relate to me and my feelings at the time. As you can see I have’t been on here in a while. It’s been a little over three months since I started on my Unit and I must say I am soooo much more comfortable. I love my unit and I love all my co-workers on it. I have to say it does take time…and you have to just remember to take ONE day at a TIME… Don’t get to bogged down and try to relax. In case there are any others reading thsi who are going through the same situation. I never did request to lower my patient load, and I never did request more orientation. I just befriended a few fellow nurses and they mentored me and helped me be more confident as a nurse. The mean people who are rude and roll their eyes? just stay away from them…they only bring you down. I figure if they are THAT unhappy with their work that they need to possibly come up with a new career choice. I as well as many of you new Grad nurses. are in this profession for a reason…and a good one. TO HELP people and to MAKE a difference in someones life. Thats the beauty of nursing we have the ability to make a difference every single day! An update on my current situation though, I actually got a phone call today from my boss and he offered me to move from part time to full time and to move from nights to evening. I am VERY excited about that. and Gladly told Him I woudl LOVE too. I will miss my good friends on nights, but I will be delighted to give THEM report every night and not those crazy wenches on day shift. Hmm that reminds me…they will be giving ME report? Hmm…I might have to have a little what goes around comes around! LOL Tell that nurse, WHAT?? you didn’t do that on YOUR shift? you should have called the MD!!! lol… thats a joke, I would stoop THAT low. LOL… Good luck all, and I hope Nursing turns out to be as rewarding as it has been for me. God Bless you All! -Brittany

  11. Jae Says:

    I am there right now. I trained as a paramedic but never worked as one, ended up in a bridge program. I was so used to the one on one, nothing prepared me for the light speed pace of a busy ER. Six spaces on a sheet of paper isn’t enough. At the end of the day I have fifteen pt barcodes on my sheet if I’m lucky, and I simply am not fast or accurate enough in my charting. I’m on week three of six weeks and in a panic about what happens when I am on my own.

  12. New nurse Says:

    I am in a similar situation as Brittany, week 3 on a busy medical ward, what the hell have I got myself into?already looking at other options but I really need the 12 months experience. Seems you just have to go through the motions…..crying, panic attacks, feeling depressed and struggling to get out of bed, is life to short for this or is life to short to give up to soon and regret what could have been? I don’t know but I pray every day I pray for acceptance and whatever will be will be.

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