[Michigan RN]

I recently started my orientation on a large SICU. I will be off orientation next month. The only thing that my preceptors say is that I need to learn to organize and prioritize. I worked a progressive care unit prior to this job and had four patients on that unit and my prioritization or organization was fine. Also, I have a question about drawing labs while administering blood products. I had a patient today that is one day post/op liver transplant. Labs were due to be drawn at noon but the residents ordered a 12 pack of platelets and I was infusing that during the time(because they ordered it at 11am) I should have been drawing my labs. Should I have drawn my labs while infusing the platelets or wait until after the infusion was complete? At my previous job, I always waited one hour after to draw labs on any patient that received some sort of blood products regardless of what time the labs were due. My preceptor made it seem like I should have drawn the labs first but wouldn't the residents want to know what the platelet level was after the infusion? Back to organization, does anyone have any suggestions on how to stay organized during my shift?

[ukstudent]

I think what your preceptor was trying to say about organization in this particular instance is for you to understand the why of what you are doing.

Why was the lab draw ordered for noon? You didn't say what lab it was. Why were platelets ordered for this pt?
Organization could have been shown by asking at the time of the blood product order if the MD wanted the lab draw delayed or not. Or later, at the time you should have been doing the lab you could have called the MD and found out what was needed.

It is very hard to be organized if you don't know what you are meant to be doing. The rules of your last floor do not always apply in an ICU setting. ie on a medical floor PRBC's are normally transfused over 3 1/2 hours, on the SICU I work the average time of infusion is 10-15 minutes.

Organization comes with time and even though you are an experienced nurse, this is a different type of organization. Give yourself time.

[Michigan RN]

I know exactly why the infusion was being ordered. I feel from your post you are implying I don't know what I am doing.

The patient's platelet level dropped from 75 to 27. He is s/p liver transplant and bled quite a bit during the surgery and received lots of blood products in recovery. You check labs frequently on these patients to assess their coag levels, liver enzymes, CBC,etc. They have a high risk of bleeding.

The platelets were ordered at 11am. At that time I was with another patient who was being taken to the OR. When I got back I saw the order and called for the platelets right away. I got the platelets at 1140, checked them with another nurse and set up the infusion set and began infusing them wide open.

My preceptor had set our lunch at noon because we knew we would be getting our patient back from OR after we came back from lunch. She actually knew beforehand that I had not drawn the labs.

I didn't feel I did anything wrong by leaving the labs until after the platelets were done infusing. The doctor was well aware before ordering the platelets that labs were going to be drawn around noon time. When I drew the labs after the transfusion, not one of the residents had a problem what I had done. They actually wanted to see if the platelet level had come up and the PT/INR go down because that was elevated also.

I gave Vitamin K IVPB after the platelets because pharmacy still had not sent it by the time I went to lunch.

Sometimes I think my organization and prioritization are okay, sometimes not.

[ukstudent]

I'm sorry. However, I only had the information that you provided in your OP. I got confused because you wrote about the lab draw and platelets in conjunction with your question in organization.

Do you have any examples of when your preceptor thinks you need to be more organized or when you yourself feel like you need to be more organized. I, and probably others that would like to help you, need more information than a blanket statement about needing help getting organized in a SICU.

I will say that on the prioritization question, maybe your preceptor just wants to hear your thoughts throughout the day. Try making a point of saying allowed every couple of hours, "this is what I see as being the priority problem at this time, do you agree?" or " I am going to suction this pt now before doing vital signs on this other pt due to respiratory distress." Maybe just verbalizing that you are doing an ongoing look at your organization and adjusting it with changes in the priority needs of that time would help.

[Michigan RN]

Sorry, didn't mean to confuse you with the stuff about lab draws. One day I had a patient where I was giving FFP every 1 hour and a half and I felt like I was staying organized, granted he was my only patient but he was a busy patient, very sick and I needed that experience. I felt like I stayed organized then, made sure I had enough blood infusion sets primed with normal saline before the next infusion was done because our hospital policy states we can only give two units of FFP with every infusion set. I stayed on top of what I needed to be doing, charting vitals, documenting the CVVH on the CVVH form. Gave the guy two units of PRBCs and 6 pack of platelets and drew labs after. Yes, I felt overwhelmed but everything was done at the end of the day and I didn't fall behind and miss things. My preceptor rarely helped me that day and still wrote in my evaluation that I need to stay organized. So maybe she's just saying that cuz there is nothing else to say or I'm missing something.

[ukstudent]

That seems organized to me. Can you sit down with your preceptor and ask him/her just what they mean about organization. Can they give specific examples of when they think you need to be more organized. If it's just a general complaint because you do things differently than them, I would forget about it. Good luck. You seem to be turning into a great ICU nurse from what you have posted.

[Michigan RN]

All I can say is, is that my head is spinning. My orientation will be over at the end of next month. I will take your advice and talk with my preceptor. thanks

[NanSeeH]

Kati2005

It's great that you are concerned and speaking with your preceptor is a good idea. Ask for specific examples and advice.

Preceptors do regularly give "organize and prioritize" as areas for improvement. And, it may be because there is nothing else to say.

Still, our ability to "organize and prioritize" does improve with experience. It is a continous process and does not end with orientation.

A year from now you will be blown away by all that you are able to accomplish on a shift.

Good Luck!

[Michigan RN]

Today went much better. I had one patient and I was up for first admit but I didn't get a new patient until about 530pm. I felt my organization was much better but then again I just had the one patient. When I got my second patient it was a bit hectic for about an hour having to practically beat in the resident's head that the patient needed a central line for IV access since her arms were very large and edematous. I actually felt guilting for leaving a lot of stuff for the night shift nurse to do but I couldn't help it although I know she was a bit annoyed. Thanks for the advice. One more month and I'm off the orientation.