I am a new graduate Dec 2009, 51 yr old RN. I am working on a tele floor and to be perfectly honest feel like I don't know crap. My preceptor is awesome and a great teacher but with 6 and 7 patients I feel like I am doing but not understanding why I am doing. I am looking at lab results and don't understand how it is affecting this particular patien,giving meds and again not knowing why. I understand I am giving HTN meds yes but how is it affecting this patient. I feel like all I have time for is charting and passing meds. When will I have a chance to actually figure out what I am doing and why?
Doreen
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March 28th, 2010 at 3:24 pm
Hi Doreen,
I assuming your school didn’t require you to do patient research or critical thinking on your patients so that is why you don’t know now. My suggestion to you would be to pick a few of your patients and take their pertinent information home with you including medications, dianosis, lab results and spend some time doing research on them. Pretty soon you will start to see the bigger picture with out having to spend the time at home.
March 30th, 2010 at 11:13 am
I TOO WRKED A RENAL TELEMETRY UNIT RIGHT OUT OF SCHOOL FOR 8YRS. WOW WHAT A START. YOU’LL BE ABLE TO WRK EVERY WHERE ONCE ACCLIMATED. “LEARN SOMETHING NEW EVERYDAY”, WAS MY MOTTO AND ACTUALLY IS EVEN NOW. I WOULD ALWAYS READ H&P, TALK TO PT RE: HOW THEIR HEALTH PROGRESSED TO THIS POINT.IT HELPED TO PUT THE PUZZLE TOGETHER. YOU’LL BEGIN TO SEE TRENDS AND BUILD YOUR KNOWLEDGE BASE, FROM EXPERIENCE. GOOD LUCK!
March 30th, 2010 at 11:47 am
no the program was great and critical thinking always but in the “real” world it is harder. I love being a nurse and will be all I can be but your idea is a good one, and I have actually already done that and will continue to do that. thanks for your input.
April 1st, 2010 at 1:49 am
All nurses (especially new ones) should spend time studying on your time off. Look at labs, look up meds, think about particular patients and their issues when you get home. Never stop studying. Nursing school is only the beginning – you do it to pass the boards but the real learning begins on the job. Teach yourself, find mentors at work that may be able to explain things to you in ways that you understand and always remain curious. Get books in your area of nursing and within a few months, things will start making more sense. Good luck!
April 1st, 2010 at 12:49 pm
you are brave
April 3rd, 2010 at 12:20 pm
I feel for you. I am a relatively new RN grad also – May 08 and still don’t feel like I know much.I took a specialty job right out of school- cardiac rehab/non invasive cardiac tests- TEE’s, stress test monitoring. Since I was an LPN before, (non- clinical though)my new job expects that I know more than I do so it is hard. I study all the time and that helps. One thing I would advise and wish I had done- get a mentor right away and never stop asking questions. This is the best time to keep asking. It is harder when you have been there a while as people expect you to know it by now. good luck to you!
April 7th, 2010 at 4:50 pm
My aunt once told me that all new nurses should start out on a Med-Surg floor. She was a nurse for 39 years at the hospital I work at, and her final position was as a Patient Care Coordinator (aka Head Nurse of the hospital). So when someone with that much experience tells you something like that…you listen!
Now, she wasn’t telling me this suggesting Med-Surg was somehow easier than Tele or ICU, by no means. All levels of nursing are hard. Some just require more skills and frankly some of those skills in question new grads just do not have.
It’s not the program you were in, or even the level of critical thinking that determines this. It is simply the fact you’re inexperienced and working Tele is no picnic, even for experienced nurses sometimes. So I do agree with some of the suggestions people have made thus far, but you’ve also got to give it some time.
The best advise I could give is, asks questions! If you’re unsure about something your preceptor wants you to do or give, ask them about it. Believe me, people questioned me all the time when I preceptored them. If they didn’t, I didn’t think much of them as a nurse. I encouraged it, because how else are you going to learn? My only concern as a preceptor dealt with whether or not I was giving my students or orientees the best experience I could, because I never wanted to short change them.
But from your post, the biggest thing that stands out to me is you just need to ask more questions of the people over you. There’s nothing wrong with it and I bet they’ll appreciate it. In fact they’ll help you learn ways to do everything above and not go crazy in the process. Because although nursing does require lifetime learning, you can’t spend a lifetime ONLY learning. Somewhere in there you have to live.
April 7th, 2010 at 10:34 pm
Doreen –
Hi. I became a new RN at age 39 after spending my previous life in other professions. I’m glad I did it and I think you will be too.
Listen – do NOT for ONE MINUTE listen to anyone who questions whether you went to a school that taught “critical thinking.” That is patently absurd and is not what is causing you concern.
I have found that these 22 year olds who are fresh out of nursing school are very smart but are too young to be scared. Those of us who are older and have worked in other fields know that the consequences to doing something wrong can be horrible – and irreversible. That knowledge, stemming from experience, causes us to be very cautious, sometimes making us feel paralyzed.
Believe me, if you weren’t “thinking critically,” you wouldn’t be bothered by this issue and you definitely wouldn’t have taken the time to write about it here.
First: give yourself some time. A LOT of time. Realize that there are at least 100 different drugs that are commonly given to cardiac patients (I know – I went straight from nursing school to a cardiac unit). It takes patience – don’t put undue pressure on yourself. Know that you are going to be learning what will seem to you like “simple stuff” years into this profession.
Second: Start learning the drugs, one class at a time. I started with the beta blockers: read up on them in detail. (And yes, I had learned about them in school but when you are in school, you are responsible for learning a huge volume for the test. Now you can specialize in a smaller set of drugs and learn about them in depth – and that’s a good thing.) I wrote the key points down on a notebook I carry with me in my pocket.
Third: When you are giving a beta blocker to your patient, tell them what the drug is doing for them. It is great pt. education and it reinforces what you are learning. When you have that one class under your belt, move on to the next group: ACEI, ARBS, whatever.
Fourth: If you have to look up a drug every single time you do it, so be it. Eventually it will stick.
Fifth: Don’t let other nurses fool you. When I started, I thought all of the nurses I worked with knew everything. Now – I can’t even begin to tell you how many times I’ve caught nurses being wrong about something. And it’s always the ones who are the least patient with nurses who are new or tend to ask a lot of questions.
I have found that I tend to like the older nurses better. Not always but frequently, the older nurses (at least the ones I work with) are the ones who continue to study and read. They are not afraid to say, “I don’t know.”
Don’t be ashamed of not knowing. The purpose of nursing school is not to turn out fully competent nurses – it is to turn out new nurses who will learn their new profession and practice it in a SAFE manner.
Good luck!
April 10th, 2010 at 9:58 pm
You will be learning from now on, every day. You have to continue to study and learn. If you didn’t learn about the meds and labs in school you’ll have to go home and study, then it just takes time. You’ll get there. Use every resource you can, including other nurses.
April 11th, 2010 at 12:43 pm
thanks for all the great advice.
April 11th, 2010 at 8:15 pm
I have been a nurse for 37 years and have never quit learning. And by the time you learn things and start to feel comfortable there are new things to learn again. Always ask if there is something you are unsure of-nobody knows everything. And remember-first do no harm. Sounds like you are on your way to being a great nurse.
April 11th, 2010 at 9:45 pm
I agree with whoever said to ASK QUESTIONS!! Hearing someone explain it in their own words tended to stick better for me than trying to read it in medical books and reference materials. Then after someone explains something to me, I always turn around and explain it to someone else…putting it in MY own words really drives it home.
And not all young nurses have a feeling of invincibility or are bad resources! I’m 22 years old and I’ve been an RN for 3 years….I work full time in a hospital and part time in a doctors office and am also in grad school full time working on my CRNP…and I’m still scared shitless! I’d say 90% of the nurses on my floor have less than 10 years experience, and probably 80% of us are under the age of 40. Age and years of experience don’t matter….its people who are dedicated to their jobs, people who realize you’ll never know it all and you’ll never stop learning, and it’s people who embrace every opportunity this profession lays in front of them ….THOSE are the nurses to emulate and rely on…and definitely ask them questions!
June 1st, 2010 at 11:49 am
Thanks again for all the feedback, guess its good that I come home and study daily, any new drug, test or procedure is written down and looked up when I get home. I love being a nurse and am proud to be in the field.