As a current professor, bedside nurse and soon to be practicing nurse practitioner (oh yes! I got my dream job - cardiothoracic and critical care nurse practitioner in a hospital, freaking ICU! OMG, okay I'm calming down now), I've had many instances where I've felt out of my depth. It has nothing to be with intelligence, it has to do with adapting to a new role and getting settled in. I want to give nurses in transition some advice on how I make it work when my mind is telling me to run far and fast because I'm overwhelmed.
Fundamentals
Before you can jump to how things ARE done and what things NEED to be done, we must understand the fundamentals. For examples, some new nurses love critical care and loving titrating and managing vasopressors. But when asked about drug properties and expected medication outcomes, they have no idea. In order to get to the fun stuff, we must understand the fundamentals. The fundamentals are your foundations and will assist you when you're stuck or lost. I don't need to know everything about cardiothoracic surgery initially, that will come with time. But I do need to know the cardiovascular system, coronary blood flow, and possible surgical complications. Nursing schools rave about fundamentals being important because THEY ARE IMPORTANT. They aren't as sexy as clinicals or simulations, but they will be with you for your entire career. The cardiovascular system will never change. Knowing the basics will be my starting point. If you have a patient with COPD, you must understand the respiratory system to understand its abnormalities. You can't jump to disease if you have no idea what normal organ function should be. This background will assist you in constructing proper nursing diagnoses and care plans. When my patient has fluid overload (for example), I know the fundamentals and am able to articulate my findings in an appropriate manner. If I can't connect shortness of breath, crackles, and edema to fluid overload, my patient will continue to decompensate right in front of me.
Expectations
In order to meet expectations, you must know them first. Sit down and take the time to ask your preceptor what the weekly goals are and how much responsibility they would like you to take. Setting these upfront terms will leave no gaps or room for misunderstandings. Too often, nurses will say a new nurse is "lazy" when in reality, he or she is just afraid and doesn't want to get in the way. Don't let your emotions get the best of you. Take a deep breath and go talk to your preceptor. Talk to your preceptor about how he or she will be involved weekly and shift expectations. Try to agree on standards and fundamental approaches. The goal to be ACTIVE in your education and not simply REACTIVE. Explain what you think the ideal plan of action should be and then ask for his or her input. Collaborate on medical plans and be involved in the minute-to-minute activities. You are learning, you must be involved in every aspect of your patient's care. Don't assume your preceptor will "let" you know what's important. You will be on your own one day. Be ready and willing to do what is needed to be the primary point of contact. You should be talking to the charge nurse about concerns and you should be holding the phone and calling providers. It is up to you to show your preceptor that you comprehend the fundamentals and are trying to be the best nurse you can be.
Execution
Now that you have your fundamentals down, and are aware of the expectations, there is nothing left but to get going. This will be the hardest part, putting all the pieces together. This will take some time but learning to perform your job in the designated time frame is what makes or breaks nurses. Too often, we are staying late or getting to work an hour early. This is all due to the inability to manage our time properly. We all have those days where we must stay late, but if it becomes a pattern, there is a problem. Giving medications late is a problem, charting late entries over and over is a problem. You will start off like that, and that's okay. But as the weeks progress, you should acclimate and start to thrive knowing what is needed of you. Nothing feels better than knowing what you're doing and being able to execute it within the appropriate time frame. When I've done my job successfully, I drive home with a smile and my heart full. When I was a new nurse, it took me 35 minutes to pass my medications. Now, I knock it out in 10 minutes. Speediness comes with time, but don't focus on that initially. Focus on getting as close as you can to the time frames needed to do your job successfully. It might be overwhelming at first but know that comfort and ease will come with TIME. Give it time! This is a new job, and with anything new, it will take time. You're not a failure, you are learning, and again, that takes time.
Note: Learning is a process, which means you should be demonstrating growth at certain set points. If you are weeks in and there is no growth, that should be a red flag. A red flag that you need to talk to your educator about your current position and perhaps a growth plan needs to be initiated.
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