My performance sucks.

[nutella]

I started my job some weeks ago, it is a med/surg tele floor. Before that I had never worked on reg. floors, ICU & IMC only, well some shifts on regular floors - but really only a few.

I am always in time trouble, have a hard time to pass out all the meds in time, there are times when I need to delay them b/c I just can do only so much.

There were also some struggles with doctors .

Baseline is I feel that after 6 weeks of inconsistent orientation ( several preceptors, inappropriate assignments = too many patients to manage in the beginning or more 'heavy duty cases' then manageable) I am just a mess. I was supposed to go off orientation today but now I will have two more days with somebody to figure out why I just can't get things done in time there.

When I do my first quick round in the morning , there is almost always a situation which requires immediate attention and that it how I get behind in meds right from the start. I just can't ignore compromised oxygenation, blood pressures out of control etc. and just start passing out meds when this is the case . Perhaps I am not the best person when it comes to time management but I try to prioritize best.

I delegate when possible but I was also told that I need to be able to manage 4 patients daytime, 6 - 7 nigh shift. I do admit that I have a problem to pass out meds in time and sometimes I forget one and give it later and I feel like a total failure b/c of this. My assessments are ok, my nursing care is ok, overall communication with doctors is ok but this is the one thing that really sucks.

In addition there is confusion with unlicensed helpers - who is doing what and when and how and I still haven't figured out after 6 weeks.

Often I spend so much time looking for stuff, ordering stuff, running after unlicensed helpers ( also doing their job if there are not enough or they are busy) picking up pieces from the previous shift, trying to figure out which doctor is on service and so on and on.

Perhaps it is b/c I am not used to chaos on regular floors, it is much more organized in units,.

I never feel that I can really give the patients the care I would like to provide.

I could go on and on but will stop now .

Can anybody here relate ? I feel like a total failure.

thanks

[not now, RN]

A lot of it is "How much can I do in one trip to the room?" I work nights on med/surg and although I don't get to chat much with my patients it's my personal mission to get out of there on time every day. 90% of the time I do. A huge part of this could be the fact that I was an LVN in LTC for two years before I was an RN. I spent that time doing everything for 50+ residents on my own for eight hours five days a week. I can hustle when I have to, it's how I function at work.

For example: I wanted to be in the room to give my new guy a bath so I could look at his skin and because the family didn't think we were attentive enough. I brought in everything I needed, gave the meds, gave the bath, applied special lotion (ordered as a treatment), got the waffle mattress/boots on and cleaned the room. After that all I had to do was hang one bag of fluids and check on him hourly.

I also clean the room as my patient is taking their handful of meds one.by.one. I explain them when I open the package and let them at it if they can do it themselves.

Finally, I constantly tell myself "Everything gets done eventually..." when I get flustered. I make sure everyone is safe and if someone get their baby aspirin at 2230 instead of 2000 I know the world isn't gonna end.

[nutella, MSN, RN]

Thank you so much - all of you! I really appreciate every single post!

I had some kind of little chat with the manager. When I do the planning in the morning I often ask the preceptor if she thinks it is ok how I am doing it - and if there are suggestions how to do better I usually do ( unless it is some kind of strange advice which compromises patient safety).

I did ask for somebody to check off meds and just have a quick peek to make sure I do not forget anything important b/c I know with a lot of assignments I am more prone to forget things. But this is what the mentor is concerned about - I think it is not a signs of weak skills to be aware of the fact that I can forget to give meds .

You are right - it is all about prioritizing. I guess I will have to suck it up and just see that I can get out all the meds in somewhat timely manner, I will have two days now with only 2 or 3 patients and really experienced nurses to figure out what is going wrong. Most nurses on that floor are not that experienced, a lot 2 y of experience and they do prioritize differently than I do with all the years of icu nursing - I just can't ignore situations which are not safe or could lead to some kind of emergency.

I would never recommend to get precepted by nurses with only 2 or less years of experience.

The whole thing makes me really sad.

[YellowFinchFan]

You are not a failure. You are a beginner in this environment. It is very different than the units and priorities are a little different here. The level of care is different. How about spending a day with a willing experienced nurse who will show you how she manages her time. Shadow her for a full day and take copious notes.

Generally the pace is very fast. You use a different skill set. Time management is one of the biggest priorities.

Organize your self and develop some personal systems so that you are not doing all that running around and spending a lot of time looking for things.

Plan well ahead so that you did your equipment and supply search well ahead of the time when you will actually need them and then go on to do your other duties. You will find a med serg floor is very task oriented. Sounds bad but for the sake of efficiency this is the way it needs to be.

I have found that a day following someone who is willing to share organizational tips and time management skills with taking notes extreemly helpful.

Good Advice!

nutella:

I precept new RNs and I remember well how badly I was treated on orientation too (by some not all) and as others stated when you don't know how to do something - instead of being shown where it is how to order it etc - you get a 'I'll do it myself'. Thats not right.

The one thing I do try to pass on to new RNs is the time mgt tricks I picked up from SO many RNs I've worked with and admired. You can learn from others around you - once you get established or even now while you're on orientation.

It's impossible to do everything scheduled in the time they allow - that's when prioritizing is imporant. If you can get to work earlier (?) or before you start your shift review your orders and be familiar with the tasks that are important.

Also - try to find a 'friend' on your shift - certain RNs truely helped me get through my first year and I will forver be grateful to them. I had unusual horrible situations with some of my patients in my first year that even seasoned Rns had never seen and I got through it with their assistance and it helped me to grow as a nurse who learned priortizing big time. I still get frustrated - we all do - there is not enought time - but I do the best I can and I try to teach new RNs to do the same.

Lastly - can you consider going to ICU? The ICU nurses do have difficult patients but less patients. Not sure if that's an option for you.

Good Luck - hang in there!

[CaLLaCoDe, BSN, RN]

I just can't ignore situations which are not safe or could lead to some kind of emergency.

I would never recommend to get precepted by nurses with only 2 or less years of experience.

The whole thing makes me really sad.

Boy can I relate to your situation! But have you ever noticed that most every assignment involves usually only one squeeky wheel? One patient going down the tubes? One, where you have to drop everything initially, get them transfered to the unit, call a doc, or just plain bite your nails for but not show it!?

Well, I just find that odd! Know this, the less frantic you appear on your shift, the less your patients will feel panicked, feel that their nurse is not in control of herself, feel that everything is falling apart. Act calm at all cost.

I've found just by standing by a squeeky wheel's bed for a few minutes, holding their hand, breathing calmly, restating their feelings, just listening to their worry is enough to bring the blood pressure down and stop the madness period.

Oh well, I'm no expert. Hang in there! Don't beat yourself up if you have to pass your a.m. meds at 1130 or 1200! Be kind to other nurses on the floor and help them in your spare time...you're not alone! Things will get better!

Wild things happened on my orientation:

1. Patient acting really agitated and confused. Patient not diabetic. My preceptor suggested to check his blood sugar. And it was way low. Got an order for D50 and he became "normal." If we'd given him Haldol who knows what would have happened?

2. Gave a patient 2 mg of Dilauded for pain. Patient became nonresponsive, grey, diaphoretic, respiratory rate of 8! With the help of other nurses prompting my patient, asking her where she was, who she was and the giving of Narcan; we got her out of this downward trend!

3. Patient had a heart rate go up to 200 and was not controlled with Verapramil...sent the pt down to ICU.

Off of orientation I noticed that my shifts were easier. I thought that the shift leader was purposely assigning me easy patients! However, others told me that things became crazy off of orientation. So, there is always an exception to the rule.

[YellowFinchFan]

This is how my days are at my med/surg floor every single day....a chaos....but I have learnt how to organize myself....some days when I feel like a failure I just go to the break room and take time out...I cry:(

I usualy have 5 patients, if I am teaming I have up to 7.

I know many nurses that float from ICU get overwhelmed when they come to our floor. Most of the time our charge nurses try to give them eaiser assignment.

I hope things will get better soon....:)

How true! It actually made me feel better my first year to see so many seasoned RNS and even pulled RNs from ICU struggling to keep up with the work - so new RNs need to know they are not expected to be super human - and learn that things will get done - when to ask for help! - and priorizing .

We really try to help each other out (team work) when someone is "drowning" on our unit too.

[YellowFinchFan]

A lot of it is "How much can I do in one trip to the room?" I work nights on med/surg and although I don't get to chat much with my patients it's my personal mission to get out of there on time every day. 90% of the time I do. A huge part of this could be the fact that I was an LVN in LTC for two years before I was an RN. I spent that time doing everything for 50+ residents on my own for eight hours five days a week. I can hustle when I have to, it's how I function at work.

For example: I wanted to be in the room to give my new guy a bath so I could look at his skin and because the family didn't think we were attentive enough. I brought in everything I needed, gave the meds, gave the bath, applied special lotion (ordered as a treatment), got the waffle mattress/boots on and cleaned the room. After that all I had to do was hang one bag of fluids and check on him hourly.

I also clean the room as my patient is taking their handful of meds one.by.one. I explain them when I open the package and let them at it if they can do it themselves.

Finally, I constantly tell myself "Everything gets done eventually..." when I get flustered. I make sure everyone is safe and if someone get their baby aspirin at 2230 instead of 2000 I know the world isn't gonna end.

You sound like a great nurse! Time mgt is huge! I would probably be taking notes from you too....

I do definitely make my own schedule and either leave someone who has drsg changes, lots of meds, peg tube, complete bath etc for a one trip either at the beginning of the shift or whenever I can do it all at once...you describe a great system! :)

[Bugaloo]

First of all. I am sure that you don't suck!

Nursing is like any thing else. It takes time to find your groove. Med-Surg nursing is usually crazy anyway, but there is no better way to get your feet wet!

Some helpful hints:

1. Pay close attention to the report you receive from the outgoing nurse. If they mention problems through their shift, note that. With that being said, there have been many times that the patient was fine through their shift, but starts falling apart the minute I come on.

2. The minute that you get out of report, go and check on each and every one of your patients. At least do a very quick head to toe assessment, listen to heart and lung sounds and ask how they feel or if they are in pain. After you have seen everyone, then go look at their med sheets for any "NOW" orders and to get a sense of how long your med pass will be. Sometimes, I will then either go back in and do a longer, more thorough, assessment on each patient or do that as I pass their meds. By looking at everyone quickly as soon as you get out of report, you can sometimes catch things before they get out of hand.

3. Remember that nursing involves 24 hour care. If, for some reason, there is something that you must leave at the end of the shift for the next shift to do, apologize and briefly explain why it did not get done. Most nurses are forgiving, as long as it does not happen all the time.

4. Some patients get scared if they feel like they have not seen the nurse in a while. I make a habit of at least sticking my head in the door every now and then, asking them how they are doing and telling them that I will check on them in a little bit. Since I work nights, I make a point of letting them know that even if they are asleep, I will be checking on them often through the night.

Hope this helps!