Seeing the big picture

  1. I'm ending my first month off orientation and what I am struggling with is moving from being task oriented to being able to see the big picture on my shift. My time management has already improved, which makes me hugely pleased; I know I have a long way to go, but at least now I remember to bring the blunt when I have to give heparin! At this point, I spend my entire shift going from job to job, and have a really hard time putting it all together, if that makes sense.

    I see lots of responses on time management taking at least 4-6 months to really click, but what about the rest of the job, the being able to look at all the jobs, the labs, the little tasks, and putting that into play? How did you get there?
  2. Visit pockunit profile page

    About pockunit, ADN, RN

    Joined: Nov '10; Posts: 634; Likes: 1,016
    Director of production, delivery, and education
    Specialty: 5 year(s) of experience in Emergency; med-surg; mat-child


  3. by   on eagles wings
    Just sticking around to see the responses you get. I am still on orientation and I am having the same issue! Kinda nice to know I am not the only one who feels this way.
  4. by   Altra
    Like any other new skill set ... at first you have to consciously think about step 1, step 2, etc. With time ... you'll get smoother and the steps will be more intuitive, freeing up your brain to think about the larger picture. You'll also make associations drawing from your growing-by-the-day experiences -- the last time I saw a patient with Symptom X, the underlying problem was Y, and Z test was ordered to confirm the diagnosis.

    Good luck to you.
  5. by   RNitis
    Quote from on eagles wings
    Just sticking around to see the responses you get. I am still on orientation and I am having the same issue! Kinda nice to know I am not the only one who feels this way.
    Same here, just off orientation. I at least feel like I can actually do it now! But today I really felt like I don't know what I'm doing (when in reality, we just don't have the experience, yet)..OP explained it perfectly, going from task to task. It's just going to take time.
  6. by   cougdogrn
    I think it is helpful to think with each patient:
    1. Why are they here?
    2. What is the goal today?
    3. How can I assist in reaching the goals to discharge etc.?

    Reading the H&Ps, progress notes and consultations are extremely helpful and I highly recommend it. Make it a habit for each patient. All of this will come with time. Hang in there.
  7. by   kayern
    Keeping your patients safe and completing tasks is about the best you can do right off orientation. You will start putting the bigger picture together as you gain experience and confidence in your practice. Little by little, it will click, I promise. Until then, continue to keep your patients safe, ask lots of questions, look to your Charge Nurse or Manager for advice and support. Good Luck
  8. by   pockunit
    Yeah, I go home every day and think, "Welp, no one died!" and feel pretty good about it. I have only passed one or two things on to the next shift, and those are usually 1430 admits that I just can't complete before report or giving pts paperwork that wasn't available when I did the admit. So far I haven't dropped the ball on anything big. I think. I'd probably have heard about it.
  9. by   dirtyhippiegirl
    It came in pieces for me. "What orders does your patient have that he doesn't need" actually came first, probably because we question everything on my unit. Next came the "what orders do your patient not have that he needs?" which requires a more intricate knowledge of your patient population.
  10. by   tewdles
    You will continue to practice your critical thinking skills and that will lead to greater proficiency, efficiency, and confidence.

    The general "rule of thumb" has always been that it takes you about 6 months of hard work and study off hours (if necessary) to feel "not potentially dangerous" in a new specialty and about a year to feel "reasonably competent".

    Ambitious and motivated nurses can become expert in their specialty in 5 years or so, IMO...again, that requires dedication and lots of experiences and opportunities to learn both on and off the clock.
  11. by   LindaBright
    Just like with any new job, there is a period of acclimating yourself to the tasks as well as being able to understand the whole picture. Think of it like muscle memory, that once you've done it enough, you'll just have the process down with very little thinking. Time is a huge factor, and you should have resources to go to when you're feeling overwhelmed and out of place.