I just can't catch on - page 2

Hi everyone, First off let me tell you that I am on day 5 of orientation on a med-surg floor, so I know there are still a lot of things that I need to learn. But Sunday was just a miserable day... Read More

  1. by   marygirl
    Hi Brooke, med-surg is just that way--you can't beat yourself up after you leave. If you don't note the orders, hopefully the next RN will. It isn't like that patient is going to be in the hospital alone until the next time you come in. I have come up with a way to organize my patients that works for me and isn't too much for me to carry around. I could give you a detailed list of how I do it, but you will likely come up with your own plan anyway. No matter how well something goes on a regular basis, there is always going to be days that you wonder what the heck you're doing there. As you get more practice, things will get easier. Also, don't be afraid to ask for help. I tend to get behind on the paperwork so if the charge nurse asks if I need help, I know he/she can't do my charting, but they can start an IV for me or pre-op someone or get consents signed, etc. Don't forget to delegate what you can.
    It will get better, otherwise why would all of us nurses show up for work?
  2. by   jjjoy
    Thanks, Timothy. THAT's the kind of thing that would be useful to learn in nursing school or during an extended new nurse residency program. How many COMPLEX jobs with on-the-job training expect you to take on full job responsibilities within 4-8 weeks? Nursing is not only complex, but involves life and death issues (can't just 'fake it til you make it') and is immediate in its nature (you can't just save most of your questions until later). To make matters worse, the skills and tips needed to organize and deal with the "real world" are only randomly come by, either through the luck of some good preceptors or postings on a internet nursing board.

    I think new nurses should be allowed up to 6 months to get up to speed clinically. They could get lower pay, or even just token pay, until they are taking a full load independently. Everyone - students, new grads, nurse colleagues - would understand that one's basic nursing education wasn't complete until the new grads actually were working independently with a full load.
  3. by   Daytonite
    hi, brooke13-rn. . .you are going to have miserable days. that is a fact. it will take you 6 months to a year before you can sit back and say you are starting to really feel confident in your job. i'm sorry if that sounds shocking to you. however, we all went through this. missing tasks goes along with that. because you are still learning, but have no nursing instructor to guide you anymore, you now have to be your own nursing instructor. in a way, you have to do a nursing plan of your progress as a med/surg nurse. what i mean is each day that you complete you need to sit down at home and evaluate how you did and "re-write" your strategy for those things whose outcomes you weren't able to meet. but, before you are too hard on yourself, let me tell you that every single one of the things that you feel you failed to do were skills. it takes time and practice to master skills, even those as simple as checking charts for doctor's orders. there are a couple of pointers i can suggest to you based on what you wrote. first, of all utilize your report sheet, or "brains", or whatever you call it. besides writing orders, tests and all kinds of other information all over mine, i also used it for keeping track of charts that i had completed my charting on and made a final check for doctor's orders. the last thing i did before leaving my shift was make sure i had checked every one of my patient's charts for doctor's orders that had not been signed off. i started this process one hour before leaving and i used my own system of slashes and circles on my report sheet to tell me if i had checked a chart or not in case i got interrupted in the middle of this process. your patient will almost always know they are going to be discharged because the doctor told them, so make it a point to talk to your patients on a regular basis as you are walking by their rooms even if it is to stick your head in the door and say "hi, how is everything? who has been by to see today? what did they have to say?" that interview process that you had to learn as part of data collection in nursing school didn't stop once the patient was admitted. it took awhile for me to learn the value of talking to my patients frequently and getting their input often. although much of what they have to say may be subjective, you'll be surprised at the information you will learn from them about what is going on with their care and treatment. after all, they are the ones on the receiving end of it all. i learned this shortcut from many years of work. the last few times i was hospitalized i was very disappointed at how few times my rns actually came into my room to see me. i wondered if they really knew what was going on with me.

    time, patience and practice. you'll get there.
  4. by   EMAILRN
    Quote from Brooke13-RN
    Hi everyone,

    First off let me tell you that I am on day 5 of orientation on a med-surg floor, so I know there are still a lot of things that I need to learn. But Sunday was just a miserable day for me and I'm still thinking of things that I missed and needed to do.

    I took 3 pts with an LPN on my team. Plus I was doing any procedures that came up on the rest of the team for learning. I was doing pretty good I thought, getting everything done and keeping up on things. Then I hung a IV antibiotic and hooked my pt up to the wrong channel on the IV. I started up channel 3 to give the IV and hooked him up to channel 2. Nothing happened except the med ran onto the floor. Channel 2 wasn't turned on. Well I was supposed to call pharmacy to let them know I had an accidental wasting, but one of my pts had a emergency and I went to that and forgot to call pharmacy. I remembered today.

    So, then I was thinking about what else I probably forgot and this came to mind. It was 7:30 and one of the Docs came in. I was late leaving the floor just doing one last minute thing and he asked me a bunch of questions about how my pt was doing. So I was so happy with myself that I answered all his questions and knew what he was talking about. Then he said that he was going to go ahead and order a laxative for the pt. He was writting in the chart when my other pt started calling out for me. So then I went to take care of him and my preceptor told me to come on it was time to leave. So I just remembered that I didn't take the chart up to the desk to secretary to put the order in the computer.

    I was doing OK while my LPN was with me. She showed me more then my preceptor has shown me since I got on the floor. But then at 3 the census on the floor was low so they sent her home. I was on my own and I sure felt it.

    I'm just so frustrated that I can't keep up with things. I feel like the whole floor is moving in fast forward around me and I'm out of the loop. I keep missing when the Dr.s come on and new orders get written. I just don't feel like I'm catching on. I'm sorry if this post sounds like a huge whine, but I'm just so frustrated. I keep telling my preceptor and other nurses that I feel lost, but they only tell me that I'll catch on. I'm just so frustrated.

    I'm hoping that when I get to go to nights things will be better, I will have time to slow down a little. I feel like I'm on a dead run from the time I walk on to the floor until end of shift. I'm lucky if I get a 10 minute lunch break. I know that it's supposed to get better, but I don't know how to learn to make it better. How often in the day are you supposed to check orders from the docs? That's my biggest problem I think. I can get the assessments, procedures, meds done, but then I miss things. For example my preceptor asked me what time my pt was being discharged and I didn't even know that she was being discharged.

    Thanks for listening. I htink I just needed to vent my frustrations. I just feel lost. ~B
    Too funny you sound like me, I just took on 3 pt last week and it went ok, I too forgot to do minor things also, not like yours but still they all stick in our hearts.......remember priority thats all someone asking for water is not as important as getting the order picked up.....take your time and dont rush they expect you to make mistakes
  5. by   truern
    I feel your pain, Brooke....just last week I was told potassium was given on night shift and was due again at 0830. The patient was due to be discharged if potassium was >4.0 so we had to allow enough time for labs, etc. Can you guess where this is going?!? At ONE O'CLOCK I remembered that danged potassium!!

    Of course, in the meantime I'd also taken care of a copperhead bite patient (had to measure her foot, ankle, calf, thigh q 3 hours..coincidentally due at 0800), discharged another patient, admitted one more, had one on dialysis, and got one ready for surgery.

    Regardless, I felt knee high to a grasshopper and just as green when I realized I'd goofed.

    Things happen, sweetie...all you can do is learn from them and move past them.

    (((((Brooke)))))
  6. by   smiling nurse
    Unfortunately this was my day on monday this week, I am a new nurse grad in May passed nclex July, worked on a med/surg unit for 6 weeks(see post under 1st yr dmeyes) quit that hospital went to another hospital hired immediately day shift telemetry because I had worked there as an intern and my preceptorship, so they tend to think I know more than I do. I had full responsibility for the team of 6 patients, my preceptor god love her was watching out for me, because one of my patients I gave morphine to was also going through dt's and began hallucinating, delusional, combative, you name it and it went wrong. So in the midst of all this commotion I totally forgot about the other 5 patients, which of course all had orders, meds, charting, etc. So I quickly learned the value of teamwork, and utilized the help I had to keep an eye on the patient with the dt's so I could play catch up with the others and managed to get out only a 1/2 hour past shift. So the lesson learned is it takes teamwork and don't be afraid to ask for help when you have more going on than you can handle at one time. Hope this helps.
  7. by   RebeccaJeanRN
    All of these are good posts, really helpful- but especially Tim's 'thesis' on new nursing survival strategies- I agree- would make a very nice 'sticky' (any moderator listening?).
  8. by   marygirl
    I also passed the NCLEX in July and work on a telemetry floor. I just finished up working 6 12's in a row (picked up 2 OT shifts) and I realized during the six-day run that even if you have the same plan/energy/attitude and even the same patients, you can't have all good days. During this period, I had two patients who needed to go to the unit and I couldn't convince the docs that they needed to go. I guess the docs are more "unit-friendly" on nights because both of the patients went to the unit on the night shift after I had spent all day trying all kinds of interventions to keep them stable and paging doc after doc after doc on their behalf. This past Monday I had a really good day even though I had a team of 4 patients on my own and they were ALL confused and 3 went for procedures. It seems like a patient leaving the floor for a time is a good thing--you can spend more time with the rest of the team, right? wrong. First, each chart takes extra time in the morning to make sure the consents are signed, the IV's are patent, the right size and in the right location, the patient might be nervous and have more questions...inevitably, the doc forgot to fill out the order sheet that tells which meds to give and which to hold so the doc needs to be paged and a phone-chart review done. Labs will be late and they must be on the chart in order to determine if the patient is able to have the procedure. the transporter comes and spends half an hour of my time getting the patient ready to be transported. In between all of this, other call lights are ringing--people have pain, anxiety, spilled their water, the confused patient grabbed her jacket and is waiting for an elevator, the family member of the patient I have not met yet because she doesn't have a procedure/call light/urgent situation is on the phone wanting an update etc.
    Yesterday, I had the same team plus 2 with an aid (our policy is an RN with an NCA gets 5 patients but every team on our floor was one patient over yesterday). My day started off great and then my patient who went for a procedure ended up going to the unit instead of coming back to her room. My new patient was assigned within minutes of finding out--he had been in ER for 16 hours. Luckily for me my NCA was the best one I could hope for and there was an RN on work restrictions on the floor who spent 3 hours working up the care plan and getting the chart set up for my new patient and she was also able to pass meds for me while I worked up charts and orders and fielded phone calls. Oh yeah, also, our floor has 2 secretaries and one got pulled so the other one was just about at the end of her rope getting the orders caught up so if I paged a doc (only about 18 times) I had to stay by the desk and answer calls until my doc called or I would not get the call. I had already missed the call on a critical lab value that supposedly got called to the desk--a pt who had a 20 beat run of v-tach had a K+ of 2.7. I ordered the lab on behalf of his cardiologist after the v-tach--this doc had the man parked on our floor without ordering any labs in 3 days giving 80 mg of lasix each day. hmmm--wonder why his ventricles were getting irritated?
    Well, anyway, I had one pretty good day and one really good day out of six. Maybe that is the best I can hope for, especially when we run short-staffed.
  9. by   youngatheart
    Mary, You just described how my orientation and days are going, and next week I start on nights 7pm-7am throw that into the mix considering I have always been a day person (after 46 years) now I have to get used to working nights on top of everything else. Chin up, not one day at a time now 1 hour at a time.

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