New grad, common mistakes - page 2
So, i just came up on my 1 year as an RN. I feel like i am doing ok, and right where i should be. However; i feel like i'm ALWAYS falling behind on my charting and forgetting something. Usually i get... Read More
0Sep 11, '11 by Jenni811Quote from dudette10I have my report sheet on the right and a blank sheet of paper on the left so that they are facing each other on one spread.
Because I'm a new nurse, and I desperately want to get the "big picture" from the start (although I can't do it perfectly without support), I take a few moments after report and think about the patient's admitting dx, co-morbidities, and meds so I know what to watch for during my shift. I make a list of to-dos at the top (treatments, lab checks, specimen collections, potential discharge/transfer, etc.). Through my shift, I may add to the list.
I also have two sheets that are placed in a prominent place in my binder: shift VS and insulin and med admin times for each patient. That way, I'm not running through the separate MARs every one or two hours to see if I have to pass a med. It also helps me carve out time for charting and when I can take my break.
I carry my binder with me, except into isolation rooms. After I have done my assessment and gone through my list of to-dos, I jot down a few important notes about the assessment and the time of completion for my to-do list. I usually write as I'm walking away from the room toward the nurses station to save time. I also jot down times of when docs were notified: new consults, change in patient status, etc.
Pertaining to the example you gave in your OP, if a patient is discharged, I also jot down the time of completed discharge and stuff like, "IV, Foley, dressing, wheelchair, DD (meaning left with daughter)."
I'm still one of those nurses that charts actual times of activities, rather than throwing everything in a single charting entry. Assessment is done first, so that's the longest charting. Everything else is charted under different times if completed at different times, and it's much shorter. I try to chart assessment and other tasks completed after the first med pass, and then I do final charting right before report to the next shift for tasks, notifications, etc., completed the second half of the shift. I usually have two charting sessions for each patient that consist of anywhere from two to five separate entries, depending on the patient's needs.
I started this routine only after I realized I was forgetting to chart things, and I too would have to go back into the chart to correct it.
As I get more experience, I'm hoping all this stuff will be in my head. Right now, it's info overload, and I feel more comfortable jotting down stuff so I don't forget. Also, if I get an admit or something goes wrong/bad with a patient or family member, I don't forget the stuff for my other, more stable (and less time-consuming) patients. At the end of my shift as I'm walking to the time clock, I rip out all the sheets and throw them in the secure paper disposal bin.
I haven't yet found my method to be time-consuming and a waste; on the contrary, I feel that my charting is more thorough and accurate, but I certainly don't have much downtime during my shift, except for my break.
ETA: I also do one other thing that makes charting go faster. I have the facility's definition of WNL in a prominent place in my binder. I see a lot of double-charting of WNL, so I decided to chart only abnormals (unless it's neuro checks or something like that ordered q whatever). I had one younger, more stable patient with no comorbidities the other day, and her previous charting was very long with a lot of normals charted individually. I took a careful look at the WNL definitions and realized that I could just chart WNL within facility policy for many of her body systems.
Wow, that is really organized! i like the jotting things down, but i don't know that i would want to carry a binder. Everything is computer charting at my hospital. our WDL is always shown on the side, so its available anytime i need it.
I write down medication times at the beginning of my shift.
1Jan 10, '13 by NurseSarah(:Okay, i know this is going to seem long and drawn out. I was an aide (SRNA) for YEARS, while I was getting my basics for nursing school. I thought, all these nurses do is complain complain complain, then i became a Unit Secretary/Ward Clerk while I was in my first year of nursing school and still thought wow all they do is complain. Now i'm a nurse, and it's like whoa! lol. The responsibility is so much greater and the work load is a lot longer, I rarely had to stay over as an aide or as a ward clerk, now it's common and if i make a mistake the buck stops with me. as an aide i never got into trouble and as a ward clerk maybe one order was missed under my watch and can ready any sort of Doctor scribble. as a nurse HOLY COW! i've made more mistakes in 6 months, then my whole career as anything else! lol.
1. Thorough Assessment: Strangely enough some people (including myself) had such a hard time applying my book knowledge to what's going on in the real world. Listen to those lungs, uncover your people, get in their business. if they're immobile look at their butt! i don't care if they were just assessed an hour ago! see for yourself. Check those IV sites, if you have 5 patients, 4 are heplocked flush them frequently. With that assessment in toe, try to put why they're on medicine EX "Lasix 20 mg IVP q12 hrs" for a COPD exacerbation, you could see if it's helping by lung sounds.
2. Make rounds with the doctor: if your md's like to make evening rounds, or comes in often you'd greatly benefit from rounding with them, they rarely ask you questions, you just serve as a vehicle from doctor to patient it really cuts down on miscommunication EX "Well Sally, i'm gonna consult you to doctor goodbody for a port a cath placement" the nurse knows with out orders being written that the patient is going to be having a consult and to make sure the Consulting MD is aware. and if you can't get to it, make yourself a note!
3. READ THE ORDER: sometimes doctors are like little snakes that will weave in the facility and out with out you knowing he or she is there. i know the ward clerk wants to see the orders so they can put them in like if its something simple like a diet, make yourself a little note, but i know doctors who are so bad for ordering crazy labs, and the nurse really needs to make sure that's what the doctor wants, and when it comes to medicine, double triple check the order, it's so easy to think they mean one thing and not the other.
4. Knowing when to CALL & CALLING The right one!: okay so this takes some common sense, please do not call and attending physician at 4 am for cough syrup, that is the worse thing a new nurse does is they think oh my i should call the doctor i should call the doctor this was my big down fall with being new, i had a call on a telemetry of a pt who was ST at 150. i checked him he denied chest pain and was a symptomatic, but i called the md anyway, little did i know he was on BetaPace. boy was embarrassed when my RBVTO was "I believe he's on betapace scheduled, lets try that first" Always know who's on call. but i'm promising you unless it's such a severe cough they can't stand it the Robitussin should be able to wait until morning and there is a such thing as standing orders, please use them and become familiar with them most of them include ROBITUSSIN for cough.
5. Get to know your pt: further than an assessment talk to them find out what's going on, ask questions. it never hurts
6. USE YOUR CHARGE NURSE: alot of people think that's old school, but they can help you. they know a little about every patient and are experienced and if they don't know they'll find an answer.
7. Communicate with each other: nurses need to work together, i've never been so prideful i couldn't ask a question. ask someone and if they don't wanna help, then tell the supervisor they don't want to, 9 x's out of 10 they will. cause they remember being in your shoes. and pt safety is always our first goal, i don't know any nurse who'd risk pt safety over not helping. they're in the wrong profession if they do.
8. Listen Listen Listen: when an older nurse tells you something, listen. especially if you don't know like "do you have to NPO for this test" or "i've never assisted with a bed side procedure will you help me" but if you feel like they're telling you wrong like "65 Units of Levemir is the same as 65 units of Humulin R" ask someone else.
9. Learn from your mistakes: contrary to popular belief everyone makes them, don't be so hard on yourself when you do make them. so you'll know you won't lose your license or anything for a mistake
10. Report vs Assessment: yea listen to report but make your own call. and be responsible for your own opinion nurse a "i don't kn ow how you're going to tolerate that patient in 504 she's terrible" then when you meet her she really likes you or vice versa, and don't think for a minute report is a replacement for an assessment, someone is wheezing at 8am they may not be after lasix and bronchodilator. at 7p they may be clear and they 22g in the RFA maybe a 20g in the LAC!
there's my top ten mistakes new people make, i know anyone could make them, but it's what i had trouble with but anyone could make them.