New grads: fast burnout
I woke up this morning to this headline about how new nurses basically just up and quit in droves out of frustration and improper preparation for a crazy-difficult and terrifying job. The timing is interesting because just yesterday I was remarking to a room full of people that I now completely understand the healthcare staffing shortage. I understood it partially before (long hours, poo flinging, overwork and underpay…), but I didn’t see how nurses could contribute to the staffing problems by quitting or how they could throw away years of education and tens of thousands of dollars invested in that education. I see it now. Clearly. (Particularly after two shifts with a preceptor who tried her hardest to discourage me about being a nurse—in addition to browbeating me about my decision to remain childless and other bizarre topics. See below about electing against more orientation.)
I have had 6 weeks of orientation, which sounds like a lot, but it covers about 1% of possible situations that are really likely to arise in the critical care area where I work. I paid attention in school, I’m a quick study, and I’m one of the sharper knives in the drawer, but none of that stacks up at all to experience, which I do not have. I fly solo on my next shift. I had the option of several more precepted shifts, but I voted against it for compelling personal reasons. Two or three more shifts probably wouldn’t make much difference anyway. My hospital considers 6 weeks generous, and they can’t afford much more, and I think that’s standard or even long for orientation.
I have good time management and critical thinking skills, and they don’t substitute for experience either. I walk into patient rooms exuding confidence and competence because my patients need that, but inside I’m terrified and thinking, “It’s a good thing you don’t know I really have no idea what I’m doing.” I know the basics, and I can check off my tasks and administer medications and conduct/chart thorough and correct assessments. I know when I’m in over my head and when to go get someone NOW. But the small signs that someone is ABOUT to decompensate? Will slide past me until I’ve seen it happen, and that keeps me up at night.
Experienced nurses crow with delight at this attitude and say, “The scary nurses are the ones who think they know it all; you’ll be fine.” Small comfort. My hand cannot be held anymore, so now I have to rely on my training, common sense (oh God), and best practice as I know it. I hope it’s enough. I have many assets to bring to this profession and to my patients, and I hope I survive my first year without burning out so that I can keep those assets in this profession. A year of orientation would be great, but in These Troubled Times (DRINK) it’s not financially feasible. We new grads are going to have to suck it up and tough this out for now. Bah.
PS: I still love my job. It’s just freaking me out right now.
i’ve been a nurse for three years and in icu for two. i finally feel like i know what i’m doing 99% of the time. i’ve never killed anyone or made a mistake that harmed anyone. i’ve done a lot of good.
in the beginning, vigilance can partially substitute for experience. getting another’s perspective can help. looking everything up can help. ultimately, LISTEN to that little voice in the back of your head…it’ll save you over and over. speak up! even if you’re wrong (and sometimes you will be) your coworkers will respect you for being an advocate and for not being afraid to publicly learn new things. you really will do better than fine; you’ll do excellently.
thanks for all the iPhone tips, btw.
I feel your freaked out pain. My freak out has cost me an extra 6 weeks of being a student. Gonna have to let go of that hand sometime!
Oh.My.God.
They are letting you on your own in critical care with six weeks of orientation? I went live in 11 (12 was set at my first hospital) and I would have taken that extra week, but they ran out of people.
Common sense is a very important thing, so use it often. And always believe your intuition.
One of my nursing instructors always told us if something seems “funny” or a patient or family says something seems “funny”, take their word for it and investigate until you can rule out anything potentially sinister.
It’s not as bad as it sounds; I work in a critical care area, but it’s a brand new unit staffed currently with almost all telemetry nurses. Nearly everyone (not just me) awaits cross-training in the ICU. I think the plan is to (a) give me a full load to start with every night at first—so I don’t have to deal with new admissions—and (b) not give me, if possible, patients on drips and so on until I have my ACLS certification. We’ll see how that works out (I had patients on drips in telemetry). At least it’s not as if I’m being turned loose in an honest-to-God ICU; I don’t think I would accept that assignment, and I doubt the hospital would do that. I’m not sure my hospital even hires new grads into the ICU (and I’m the only new new grad in the CCU).
I’m gonna echo what somebody else said. Trust your gut. If something seems not to fit, go get a colleague and see what he/she thinks. You’re right, experience does account for more than all the book-learnin’ in the world, but it comes in small doses, builds upon itself amazingly fast – and it’ll be encouraging for you to see how quickly you get comfortable. And those big lessons, like make-sure-your-room-has-an-ambu-bag-every-shift (yes, I discovered that little gem as a patient with a dissecting aorta coded in front of me), well, you only have to learn those once, funny how they stick with you. Hang in there. It’ll get better.
I’m proud to “know” someone who is so honest and articulate about their fears. it never occurred to me what goes on in the head of the nurse on the other side of my pain and fear. You rock.
I’ll echo some sentiments above… Trust your instincts. I know you probably don’t feel like you have any, and no, they aren’t well-honed yet, but you DO have them.
If something doesn’t feel right, run it by a more experienced nurse and see what he/she says. I think you’ll be surprised at how much you are able to put together, even at this level of experience.
Or even if you aren’t able to put it together, you’ll still get the feeling that there is something TO BE put together. If that makes sense
And you know – sometimes there is just no freaking warning at all. None. And the sh*t hits the fan and leaves you spinning because the situation blindsides you. You are obviously smart. I think you’ll be fine
6 weeks IS the norm. On my Trauma ICU it was 6 weeks, unless the orientee or preceptor felt more was needed.
You’re never going to learn it all.. no matter how long your orientation may be.
“I know when I’m in over my head and when to go get someone NOW” ~ is probably the single most important piece of your puzzle right now.
Everything else will happen in time. I agree with Alex that it will take time It also took me just shy of 2 yrs to feel ‘comfortable’ and my ‘butterflies’ finally disappeared.
I have great faith in you. Especially the way you talk about what you know, and what you don’t know.
You’re already ahead of the game.
You go girl.
I have a question. When I was 17, my first time in ICU, my father had open heart surgery, and I saw him awake, but still intubated, and pale. It shook my world at such an early age. I literly almost passed out coming out of the ICU that day. I have started nusring school and the anxiety of going into or doing anything in the ICU for me is crippling. How can I reshape my old bad memory or how can I not let it affect me today, many, many years later.
thanks
Ms. Anxiety
I worry for a hospital that only has a six week orientation. I also worry that they don’t give you time to adjust to having more than one patient added at a time per day. Each of the three places I’ve worked were more considerate of that uneasiness. I also agree that it was not any of your preceptor’s business about your life. Yes there are social aspects, but judgmental behavior has no place with YOUR life.
Depending on the acuity, ICU really can be not so bad. I have rarely worked in one, and even then only in a small hospital. But usually most will only give you two patients, in my limited experience. Keep up the good work, and don’t surrender to self-doubt. I didn’t feel good about my career until my third year. But now, I feel great. You’ll get there, believe me.
How are you feeling one year later? Tomorrow is my first day on my own as a new grad psych nurse on an acute psych unit at a city/county general hospital. I feel exactly the way you did last year. I had two weeks of orientation. I feel like I’ve got the tasks down. Passing meds, the paperwork, assessments/vitals….but the other stuff….like if a manic patient gets violent, or a bipolar patient tries to manipulate the staff….that stuff is with experience. NCLEX says to “redirect patient”, but it’s so much easier said than done. I hope your first year went well, and I hope my first year passes by fast. I can’t wait to be in a place where I feel somewhat competent and comfortable. This transitioning phase from student to “real nurse” is a lot harder…emotionally…than I thought.
I feel more confident as time goes on and I get more exposure to patients, procedures, and conditions. However, I’m starting to think that the new-grad phase can go on for a really long time. In fairness, sometimes I’m also amazed at how much I’ve learned.