New grad, common mistakes

pauldarosaranch · Sep 11, 2011

As you are a nurse longer, you will get into your groove. You will automatically have things you chart. things you do automatically and don't really "think" about it much. forinstance. When I pull an IV I always look at the canula. I do this without thinking because I have been doing it for so long. so when I chart that the IV was removed I chart "IV removed c canula intact. no redness or drainage noted. bandaid placed."

carolmaccas66, BSN, RN · Sep 11, 2011

No, it's common to get behind - there's just too much charting.

I work ED now and we always put the times that an IV is started, but often don't get time to chart the time it finished. No-one ever remembers, and keeping FBCs up to date is a nightmare. I went and worked psych the other night in a private clinic, and stable patients there have VS/OBs done once a day at the very least. Some hadn't had VS done for 2 days, and some had cardiac/renal conditions. Hardly any UAs had been done, and no admitting weights were done either; weights were done if the doctor had specifically requested a weight every day. Some only had half the VS done. I couldn't believe how slack these people were!

In Oz we legally have 48 hours to add to our charting; after that time, it really doesn't matter.

Do u use a cheat sheet with patient names and times, to cross everything off as you go. Also ALWAYS start your charting/patient notes as early as possible, cos u never know what will come up later.

There are many threads on time management on here, just google them, and they should give you some good tips.

Also do a quick check of your charts etc b4 the end of your shift, or right after handover as I do. Also if u get home and think - I didn't chart such-and-such, then call the facility and they can write it in, ie: nurse Smith rang @ ___ time and reported a BSL done at ___ time. This is still legal - the other nurse doesn't sign it, just records that you have rung in and the time it was recorded.

I've been an RN for 3 years - I took out a lady's IV the other night and couldn't record it cos the doctor had walked off with her chart - I went home & forgot all about it. But that's not something urgent you would have to report, if you know what I mean.

Time management all takes time and practice, and sweetie, I've worked with RNs who have nursed for 18 & 20 years who STILL get behind! So it's not just you! Do things in a methodical manner and control your shift and your patients - or they will end up controlling you, I always say.

Let us know how you get on anyway, OK? I think you will be fine!

Girlygirl69 · Sep 11, 2011

You are fine, you will get better with time. I felt the same way. Just go

in with the intention to do your best and be mistake free. Mistakes will also happen. My stupid @as once discharged a patient with her foley still in place. After work I had to drive to her house and take it out, lmao. Now that was he dumbest thing I've ever done. So at least you know someone is worse than you. I also had a patient code at 6:58p, right at change of shift. Girl I didn't leave that hospital until a little past 11 pm

rngreenhorn · Sep 11, 2011

OK... let say the case goes to court.

Lawyer: "So, you are saying when you got home the IV was still in place"

Plaintiff: "No"

Lawyer: "Then go pound sand."

Worry about charting the big stuff and tell the administration the minutiae is annoying and not your priority unless they intend on staffing more people.

Jenni811, RN · Sep 11, 2011

thanks for replies! i always felt like there was something wrong with me. Administration is all over us for "missing something during charting" seriously, do they have someone actually sit and look through all this crap?? (i hope their lives are very depressing).

I cannot tell you the little tiny things i have missed then i have been called out on. "Why did you chart their cardiac was WDL when their heart rate was 110? Normal is 60-100. Did you page the doctor on this change in status?"....yes, i got a call on that once. AT HOME EVEN! :uhoh3:

SoundofMusic · Sep 11, 2011

I've been a nurse now for about 3-4 years, (some prt time) and I STILL feel this way. It's as if I get worse as time goes on, it seems, lol.

Throw in a demanding nit picky family and I'm toast.

If it's bad, I have no problem calling the shift on duty and asking them to fix things. They are usually too happy to do it ...I feel like a nincompoop, but oh well.

Today I am up early in the a.m. thinking about my prior shift and everything I didn't do charting wise. It's just too much.

MN-Nurse, ASN, RN · Sep 11, 2011

is this common? or am i the only one feeling like i am struggling with this??

Experienced nurses on my floor have the same issues. Some are better than others.

I can tell you that the most criticized former nurses on my floor are the ones that always had PERFECT charting. They had their head to toes done and flowsheets filled out by two hours into their shift.

However, they (reportedly) provided rotten patient care because they were too wrapped up in making sure all the blanks on the charting were filled in.

I make sure my VS are all in as soon as they are taken and I try hard to make sure that signout reports with valuable information are complete by the time the next shift arrives. The other flowsheet charting can wait and I pound all of that out when I can. (Of course I chart all meds when given. That never waits.)

dudette10, MSN, RN · Sep 11, 2011

I 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.

Jenni811, RN · Sep 12, 2011

Experienced nurses on my floor have the same issues. Some are better than others.
I can tell you that the most criticized former nurses on my floor are the ones that always had PERFECT charting. They had their head to toes done and flowsheets filled out by two hours into their shift.
However, they (reportedly) provided rotten patient care because they were too wrapped up in making sure all the blanks on the charting were filled in.
I make sure my VS are all in as soon as they are taken and I try hard to make sure that signout reports with valuable information are complete by the time the next shift arrives. The other flowsheet charting can wait and I pound all of that out when I can. (Of course I chart all meds when given. That never waits.)

Omg, you like hit it dead on. I always felt AWFUL because i wouldn't get my head to toe assessments done by 11:00am, sometimes even 12:00. I always get so hard on myself because it's not done by noon! And others get theirs done at like 9am, im like HOW THE HECK DO YOU DO THAT?!?

Jenni811, RN · Sep 12, 2011

I 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.

NurseSarah(: · Jan 10, 2013

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.