Quote from marienm, RN, CCRN
I hear you that getting a list of stuff you forgot first thing is demoralizing. Charitably, I'll assume that your charge nurse is trying to help you, either by letting you know so you can fix your charting, or at least letting you know so you don't become the nurse no one wants to pick up from!
What kinds of things are on that list? Is it 'unit maintenance' stuff like stocking your rooms with linen and a pile of periwipes? Every unit has tasks that certain shifts seem to be expected to do, and they're probably not on a checklist anywhere. They're also not critical, but you can bet other people will be annoyed if you routinely don't do them. Develop a pattern whereby you include this in your workflow.
Or is it stuff like missing medications or other treatments? Figure out why you are missing them...do you not know where to find the orders? Not sure which orders are still current? Medication wasn't delivered and you forgot to follow up? Just didn't have time? (In which case you should ask for help rather than skip things.)
Or is it patient-care stuff that you are supposed to know (but isn't going to be in an order)? Like, at my facility we change tube feed setups every 24 hours and IV tubing every 72. These are based on policies. When I don't know how often to change something, I look it up. If you need to change your tube feed, make a habit of looking at the date & time...do you need a new set-up or just a new feeding bag?
FWIW, I agree with your initial instinct to see your sickest patient first. However, by 'see' I mean look at them for a quick minute to make sure they are okay...don't necessarily do their whole bath and meds and whatever else. Do get a baseline of their ABCs and obviously attend to any immediate need.
I agree that the list is just to help me. I don't know why it gets to me, except that it is first thing in the morning and the job is so intense that I already have to psych myself out to carry the necessary confidence for my patients sake. It is water under the bridge, but I didn't realize just how overwhelming this position would be for me as a new RN, and it may not have been the best choice for me. Experienced nurses who work on this floor say that they are tired of feeling like a failure for always being behind and feeling like they are drowning. It is a tough floor.
As for what ends up on the list, it varies. While not on the list, I was told by the nurse who took my patients Saturday night that I was supposed to change the NG tubing every 24 hours on continuous feeds, as I had not done so. Can you suggest other things like that I should look up for future reference?
This Sunday the list involved the fact that the admission was not completed Saturday night, that my 1800 meds were not given on two of my patients, and that I was there 1.5 hrs after shift ends.
When I worked in a different unit at the same hospital as an LPN, admissions were passed on to the next nurse to complete. Apparently, on this floor you are responsible to complete your own admission, unless they arrive within 15 minutes of shift change. So, the expectation was that I stay to complete it, but I did not know that. I told the next nurse what I had completed and what was left like I would have on the other unit. I ended up completing the admission the next day, and we have 24 hours to complete them, so it all worked out with this patient.
I did not give my 1800 meds because that is when the admission arrived. My charge nurse told me to ask another nurse to help me in the future, something I wasn't sure of with everyone so busy themselves. Sometimes we have a SWOT nurse who can help so I will try to find one next time.