[RNAnna]

So, I'm orienting to M/S. I'm a new nurse, I love my pts, I'm in a supportive environment, everything should be just great. So how long does it take to get it? Just when I think that everything is going smoothly, a day comes along when I can't do anything right to save my soul. I keep asking myself, is it me, is it the cercumstance, is it the people on the shift, is it just the combination of clients that particular shift?

We have a doctor who likes to take all of her charts and write the orders on them all before she brings them back so the nurses can have access to them. So, there is one client waiting for discharge orders, one waiting for admission orders, and one just waiting for cardiac orders. The admission was at 0945 and I didn't get the orders until 1400. So then I have the nurse manager on my rear because I'm not noting and carrying out all of these orders all at once. My preceptor is telling me something completely different, and I'm stuck wondering what I should do. I'm a new nurse. I need to learn the skill called prioritization. It is not natural yet.

I'm really discouraged this evening and sometimes on these days I wonder what I'm doing with this thing called nursing. I have to really struggle to remind myself why it is that I started nursing in the first place. And it all comes back to one thing. The clients. I just want to be the best nurse that I can be for the clients. They deserve my best efforts. I'm just hoping that in the future my efforts can be better than the last couple of days.

Anna

[Daytonite]

Hey, Anna! I can remember back to when I first started (big sigh). It took about 6 months before I started feeling like I was a little on top of things. I went home feeling terrible many times. You are learning something that nursing school can't really give you much experience with--organizating the workload of your shift. It does get better. You are on a very busy shift, 3-11. Lots of admissions and new orders.

What I would probably do with this doctor is just go right to where she is charting and let her know (nicely) who you are and that you need to know if there are any stat orders or things that she wants done now while she is writing that you could get started on. Those would be verbal orders that you could go ahead and take action on. When you get skilled at this you'll have most of the stuff done by the time you get the chart so you'll just have to sign off the written order. And, if she forgets to write the order, you can write the verbal order. Does that help? It's kind of an organizational dance you have to do.

Since she's a regular I would definitely cultivate a relationship with her so eventually you'll feel more comfortable around her. You can't be intimidated by her because she's a doctor. Think of yourself as being her office nurse there in the hospital. She needs you and the other hospital nurses to carry out her orders. Once she gets used to seeing you coming around she should figure it out. But, let her know that you are waiting on her orders. It's also a good way to find out what's going on in the doctor's mind with regard to their plan of care for the patient because they don't always write that down in their progress notes.

In my heyday as a staff RN and team leader we made rounds with each doctor that showed up on our unit. We stuck with the doc while he examined and talked to the patient unless we were told to scram for some reason. We had a good idea of what the doc was going to order or we would discuss it with him as we went on to the next patient. That helped us in planning out all the different kind of care we were going to have to be giving for our shift.

I suspect that the reason the nurse manager is on you is because the shift that follows you is having to take off this doctor's orders, right? Stand up for yourself a bit and let the NM know that the doctor is hogging the charts and outside of clubbing her on the head to get them there is nothing else you can do if she won't give them up. Third shift won't be so upset if some of the orders have already been carried out and all they need to do is sign them off. Just make very clear communications about what you have gotten done before you leave.

Hey, a year from now you'll be a pro at this!

[Tweety]

It takes almost a year to get your groove on and be comfortable.

However, I still have days like that and I've been at it a while. It's still frustrating, but much easier and I've a knowledge base and experience behind me. That comes with times, so give yourself a break.

Good luck to you.

[Spidey's mom]

I agree with Tweety - a year.

Even then, stuff comes up . . ..

Our docs all come to the nurse's station to write orders and hand the charts immediately to the ward clerk, who lets us know about "now" orders. Occasionally a doc who doesn't usually have many inpatients will come by, write orders and put the chart back into the cart. That can be very frustrating . . but we have trained our ward clerk to check charts periodically. We are lucky in that we never have more than 12 patients on the floor - rural nursing.

steph

[pricklypear]

Definitely about a year for me. It took me that long to get comfortable with myself, and learn alot of dos and don'ts. One suggestion: I'm assuming that after the doc writes her orders, she's keeping to chart to do progress notes and stuff? How bout asking her if you can make a copy of the order sheet, then stick the original back in the chart. Just make sure you mention "I'll get started on these - just please let me know if you make any changes." Nothing worse (well some things) than getting started on a bunch of orders - only to find out half of them have been changed.

[RNAnna]

Thanks everyone for all of your encouragement. It has really helped. My next question is: How long does it take to learn the skill of prioritization. What i think is important and should come first seems to be different than others ideas. Is this a skill that should have been learned in school and was just missed at my school, or is this something that we grow into as we learn the job? To some it seems so natural. For me, I need to know why I am doing what I am doing and at this point, that takes more time that I would like it to. Is this unusual, or am I really lagging behind???

Anna

[pricklypear]

Actually, I was born with the ability to prioritize. Just kidding, of course!! Just give yourself some time... it'll all fall into place. You already know how to prioritize the important things, or you wouldn't be able to do your job well at all. All the little stuff will come as you learn what works best for you.

[Daytonite]

Originally Posted by RNAnna

Thanks everyone for all of your encouragement. It has really helped. My next question is: How long does it take to learn the skill of prioritization. What i think is important and should come first seems to be different than others ideas. Is this a skill that should have been learned in school and was just missed at my school, or is this something that we grow into as we learn the job? To some it seems so natural. For me, I need to know why I am doing what I am doing and at this point, that takes more time that I would like it to. Is this unusual, or am I really lagging behind???

Anna

I learned it from making mistakes. School of hard knocks. Very effective technique. We have to be able to be able to face our faults, learn from them and the fortitude to push on. That is the kind of experience that will turn you into the nurse you want to be.

Pricklypear's response made me laugh (I was born with the ability to prioritize)! Don't we wish we were born with that ability!