Not loving my career choice today

I know exactly how you feel. You should read some of my posts. I feel like I want to quit everyday, but then I think, I cant, for a few reasons...1) I'm not a quitter (this is the first time in my life I have acatually considered it though), 2) I'm under a contract, 3) I need the experience if I want to do anything else, 4) I need the money, 5) and the most obvious, I'm blessed to have gotten this job in today's economy. Being a new grad sucks...I know the hospital is not for me. I went into this field to help people, not run around like some crazy person filled with a whole shift of tasks. Its definitely rough out there, but I try to listen to everyone who tells me that it will get easier with time.

First of all, I want to tell you I am sorry that you are feeling this way. I am offering a few practical solutions, and I don't want you to think I am being critical.

Five weeks isn't a very long orientation. It sounds like they pushed you out on your own really quick.

Maybe you need a better way to keep your list, since the list you make at the beginning of your shift isn't working for you. How many patients are in your assignment.

How do you go about your day. Sometimes you just have to tell someone else to hold on a minute and finish what you are doing so that you don't have to come back.

Do you all use SBAR when communicating with docs?

Don't work med surg but a suggestion from a new grad that is a year and a half out. Try to get everything done on one patient before moving to the next. Give meds, check VS, check IV site/fluids, reposition, take care of any STAT or critical needs and then move on. Everything else can wait. You don't need to fluff the pillow, get fresh ice water, etc. None of that will harm the patient. As a new grad I was so caught up on the little stuff. Then I realized I need to assess, medicate, and chart. Sure I would like to spend all day with the patients talking to them and making them comfortable but charting is a fact of the job. I need to protect that license and I have to make a living somehow so I do what absolutely needs to be done first and then take care of the minor stuff later.

Nursing is nothing but a whole lotta TRIAGE. You have received some good advice here. I would suggest you do some study/practice in triage and prioritization.

We have computers in every patient room too and what has helped me the most is to chart my assessment first thing. Pull them up on the computer at the bedside and just get it done, it really only takes a few minutes and you don't have to second guess things at the end of the shift. The only things I have left to chart are care plans (ugh) and progress notes. I don't take a lot of notes since we do bedside report and I'd forget to look at them anyhow. Oh and when I call a doc I pull up the pt on the computer so I can find the answers fairly quickly. Good luck it does get easier and it just takes some time to find what works best for you.

Here's what works out perfectly for me, to help me to remember my "to-do" list. If there is something that needs to be done at a certain time, such as drawing labs, MRI or neuro checks, or if a doc wants to be called at 3 or whatever, I take all of that and add it to my medication times. For example, on the bottom of my patient's facesheet, I'd write my med timelines, i.e.

7-8-9-12-15-17

Then I'd add in my neuro checks, phone call, MRI with reminder to take off tele, and lab.

7-8-8(n)-9-10(MRI, tele off)-12-12(n)-15-15(doc)-16(n)-17-18(lab)

I leave some space so that if another thing popped up during the day I could add it in. When I get done with that time's thing to do, I'd X if off. If I can not do it for whatever reason, like the patient is in surgery, I wouldn't X it off until I could see it as officially done.

If there was something special that needed to be done before I left, or random things that are of extremely low priority, I'd write it at the end, like

7-8-8(n)-9-10(MRI, tele off)-12-12(n)-15-15(doc)-16(n)-17-18(lab) - 19(special/list)

I have got to say, that since I started doing this, I haven't missed a single time-sensitive task yet. I always glance at my pt's timelines before moving onto new things so it is a constant reminder to keep me on track. I really suggest you try this if you are already relying on the medication timeline as it has been a tremendous help to me.

I'm the type of person that can't sit down and chart when I feel like there's something else that needs to be done soon - with so many interruptions in the day, it just fits me better to have the charting be near the bottom of my list. If I chart throughout the day I waste more time because I constantly check to see if I remembered to chart something or not. Instead I have my blank sheet of paper to write notes, and my facesheets. On my facesheets, I write if there is anything out of the ordinary on my assessment (as I'll need to remember it anyway for report). I'll put down the tele box number, the amount of O2, that they are a L BKA, that they have a glass eye. Our computer charting assessment area is cumbersome and takes a good amount of clicks to do. But to each his own, however, as there are a lot of people who swear by charting as you go. But this is what works for me, as if something comes up mid day, I want the time and space to be able to feel like I can get it taken care of, not thinking about the zosyn I could have hung an hour ago while I was charting that is now overdue, or that I still need to check potentially stat orders and talk to the tech. However, I always chart my meds as I'm in the room as this serves as another check for me for accuracy so I feel it is of high importance. I also get real time data this way so I know exactly when the IV bag will run out and will need replacing, or when the next pain med is available.

So, here's what I do. Report/labs, get vitals from techs and give them report, give meds along with doing assessment, check & take off orders and let techs know what is going on, and take care of inevitable morning issues like bad IVs, calls to the doc, and discharging an antsy patient. Do lunch insulins/meds, make sure my patients are comfortable, then take lunch myself if I'm able to around 1:30. Then I glance at my timelines to see if anything is coming due, make sure my patients are comfortable, and then can concentrate on charting without a million interruptions. I can at times get a good chunk of my charting done here before I have an admit, and then the it gets busy again with more meds and things to do. Charting is one of my strong points as I'm very fast on the computer and thorough. I don't feel like I miss much on charting because the important stuff I wrote down on my facesheet which I reference as I write the assessment.

I have another paper for miscellaneous notes. On the right hand side is my area for doctor calls. Here's what I do

1 - Something is wrong with the patient (i.e. meds need clarifying, pt not breathing well, blood pressure too high, family upset and is demanding things, lab is wacky)

2 - I make sure I have a current set of vital signs and that I've assessed the patient (listened to lungs, gotten more detail about their chest pain, etc). I see if I can do anything to help first, such as recheck the bp manually (has saved me many a phone call), or make sure that a foley isn't kinked if a patient's urinary output is low, and look at the appearance of the urine in the bag.

3 - I assess the importance of the problem. Is it something that needs to be addressed asap? (severe chest pain) Is it something that should be addressed but can wait a few hours? (patient forgot that they take flonase at home and wants to have it today, but is feeling fine and is nonchalant about it)

4 - I write down the important information in my doctor area on my sheet of paper. I try to put myself in the doc's shoes and ask myself what the doc would want to know. Do not call the doc until you have sat for a minute and organized your thoughts of what you will say, and your supporting evidence. It will really help. For example, if I am calling about a low blood sugar, I should have the last couple blood sugars readily available so that the doc can see trends and then be better able to decide on med changes. If my patient is sounding coarse I can let the doc know the O2 sat, the liters of oxygen, and the results of the last chest xray and when that was done. I can let them know that he has already had a breathing treatment, and recommend lasix. I write down things so I don't forget when the doc calls me while I'm focused on something else while in another patient's room. I write down the time I called the doc and what patient it was about so when they call I can get right into it, and I can see when another page is warranted, and, so I can chart it. I put one line through it when I'm done so that it can still be read, and I'm sure to include all the doc calls when I sit down to do my charting.

Hope this helps somewhat, 6 weeks isn't very long and its a steep learning curve. Things do get better in the sense that you will know the answer to a lot of your questions in the future instead of needing to take the time to think about it and find someone to ask, such as where to go on the computer to order a new IV pump. Are any of these questions something you can research at home, like 'what is this med for'? However, the work load will always remain high (because when it isn't, they send people home). Some of the stress will ease, such as the stress that comes from "I'm going to do my 4th IV!", but honestly a lot will remain because it is inherent in working with acutely sick people. The question is, once that ancillary stress eases, will the pros outweigh the cons? It is hard to say but if nothing else, you are not alone. So many have echoed your thoughts. Please continue to ask questions rather than potentially do something that will inadvertently hurt a patient. Please also utilize your charge nurse for help. They are life savers. Best of luck to you.