i dont know where to go forward

Specialties Med-Surg

Published

I don't know what to do anymore guys. I recently graduated with my bachelors. I was working and going to school at the same time. It is nice that I could finally just focus on work now.

I worked for a rehab/snf right after I got my associates degree. I knew the assistant director of nursing there. It was hard there at first, but I got the routine down at about 6 months.

I recently got a job at a big time hospital in my city. My preceptor is nice. THe medication administration isn't as bad. I have 20 less patients to deal with. I'm barely at the 1 month mark of my orientation. (I'm night shift so now I will have to go with another preceptor which works night shift. The work isn't as exhausting as my old workplace, however I'm mentally exhausted. There is so much charting. We had paper at my old workplace, and everything is computer over here. It is nice in a way, but also difficult to learn. I got a chance to work with computer charting during clinicals while I was in school, but that was only for about 5 times a semester.

-I'm just afraid I might do something wrong and hurt the patients. I currently work in a med-surg acute care floor. I got most of the medication administration part down, but not the charting. Today i was so busy, that I barely had time to use the restroom once. I was just running around like crazy. I didn't have a chance to look at the computer, and miss 3 critical vital signs! I'm new to the hospital setting so I wanted to make sure everything was done correctly (thus I don't have the time to sit down). My patient temperature was 101, 102, and 104. I finally saw it and gave the PRN Acetaminophen for PRN fever. Now I just feel bad that what if I could kill my patient or that I might get into big trouble for not giving it when it was that high the first time. I got out 2 hours late today just to finish up charting. The whole time I'm thinking if I'm going to get in trouble for missing the first 2 vital signs to give the PRN Acetaminophen.

-It was raining today after work as I walked to my car. I was just crying. I'm the only one that works right now that makes money to take care of my mom. I'm afraid that I might do something wrong at work.

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Specializes in Family Nurse Practitioner.

I hate charting too. I have learned to chart as I go with the COW. At my other job with computers that are meant to stay in the room, I chart on patients when I finish my Med passes and backtime my documentation to around the time I gave meds. This works better on night shift (more down time). Your routine will come with time. Getting used to the computer takes time too. You've only been there one month. Give yourself some time.

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During my orientation, I missed a critical systolic BP of 200+. I gave the blood pressure meds without even looking at the BP. If that patient's BP was already low, I could have bottomed them out.

I felt terrible, and since that day, I've never missed a BP.

Point is, we were all new once, we all made those mistakes. All that matters now is that we learn from them, and when we do, we become stronger, safer, better nurses.

You got this.

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Give yourself some time. Take your time. Hang in there.

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Do you use a brain sheet? Even though it may seem silly, I would write down a spot for VS check at the time VS are taken and leave a empty box to check off. At first I would always forget to check VS as they were being done and I have missed a few critical ones as well as rechecks. Your time management, prioritization and organization will get better with time. If you feel like you are so busy your head is spinning and you dont know what you are doing, take 5 minutes to reorganize your thoughts, write down what needs to be done, breathe, and relax.

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Specializes in General Surgery, NICU.

withorwithoutyou,

I have had problems with critical vital signs being charted and due to busyness, I wasn't aware of them for hours! One way I try to address this is to identify who my nursing assistants are at the beginning of the shift and kindly remind them to please make me aware of vital signs that are out of norm; usually it works and they come to me and let me know. It is very frustrating when critical vital signs are documented and I don't realize them till 2 or 3 hrs later when I have a chance to log onto a computer.

And don't be so hard on yourself, it will take some time to get acclimated. I remember crying to my car at the end of hard shifts during the first six months or so, and beating myself up for mistakes or things I overlooked. The key is to try to think of ways to change your practice to avoid preventable errors or lapses in care. :)

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Specializes in Med nurse in med-surg., float, HH, and PDN.

Brain sheets were always a life saver for me. I couldn't work off the assignment sheets provided, so I created my own and made blank copies of it. We all 'see' and understand things in different ways, and you may find that your brain-sheet evolves as you learn, but it will help you with your priorities for sure.

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Thank you so much for the kind advice guys. For that moment I thought I was the only one that would be so stupid to not log on to the computer to check the vital signs. You are right 11RN, one downside of not taking own vital signs is that the CNA don't tell me the critical vital signs out of the norm. I think she couldn't get a hold of me because I was just everywhere. I will definitely take your advice to get to know the CNAs and ask them to inform me any values out of the norm. Thank you again guys :)

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Specializes in Certified Med/Surg tele, and other stuff.

Never assume the cna to tell you any vital signs. I find the cna after report and tell them parameters that require stat notification. Give them numbers or what your policy states. Mark your brain sheet with a reminder to check vitals/labs. If you are busy at that time, delegate what you can to the CNA, and look at the computer.

Don't kick yourself too hard. We have all missed critical labs, vitals etc..You aren't the only one!

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Specializes in medsurg, progressive care.

Just curious- where was your preceptor through all of this? When I was an orientee, my patients were all also still my preceptor's responsibility, so at the end of the day if I missed something so did she technically. If my patient had an elevated temp and I missed it, chances are my preceptor would have caught it. Of course my PCTs are AMAZING and 99% of the time hunt me down for abnormal vitals, but still. This is where she should be teaching you "hey, your patient had 20:00 vitals; did you see them?" to get you into the habit of checking vitals.

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My preceptor was the one that actually caught it rinskin. She is a great preceptor. I had to get a different preceptor for night time because they have a new nurse and my previous preceptor has to start with him. My new preceptor is very good as well. Yeah after that incident, I have pay much more close attention to the vital sign

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Specializes in School Nursing, Telemetry.

It will get better. It's disconcerting when you are first learning the routine and learning how to use computer charting that is often not user friendly can be tough. When I started my first job, I felt like throwing up every night when I'd go in. About 6 months in, I noticed I wasn't feeling panicked every time I went in. Gradually, it goes away. As far as your missed vital signs, are these automatic vital signs? Is a CNA taking them? If they are taking them, they should be reporting those numbers to you! I know it is our responsibility as nurses to make sure that we check up on this data throughout the night, but those numbers are way out of the norm! I can't imagine any of my CNAs not telling me about a high fever like that. Don't beat yourself up. It is over, the patient is alive, and you took care of the situation.

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