New RN - Just Barely Keeping Up

[jessbRN]

I have seen many articles posted about new nurses being overwhelmed with their medsurg jobs and I'm sorry for posting another, but I just need to vent.

I have previously worked as an LPN at a LTC facility for a year and a half before I went back to school and obtained my RN. I liked it at the LTC facility in that I loved my patients, but I did not really care for my day seeming like it just consisted of med passes and charting.

I have been working at my new job on a general medical floor since February. I have already come off of orientation and have worked on my own for about 3 shifts. My entire orientation I felt went well - I had SEVERAL preceptors (not my fault, but a poor choice by my manager for not putting me with one consistent person). Everyone has been great so far - they've been kind and helpful and occasionally check up on me to see how I'm doing, when they get a minute out of their busy day.

The first two days off of orientation went fairly well. I tried staying on top of being on time with my medications, and I do my assessment on my patient while I'm giving them their medications. But, I never can seem to chart my assessments until way later in the day - even after I've given report at the end of my shift and have to stay later, which doesn't bother me, but I would like to chart as close to real time as possible, but I just haven't seemed to have been able to do that.

I worked on Friday (my 3rd day off of orientation) and that day was just terrible. Again, I tried to make sure my medications were on time, but I didn't chart on one single patient until after I gave report to the night shift nurse. Hand off report took forever this day because 2 of my patients decided to have some issues going on with them that they didn't have all day - so had to call docs on those patients and put orders in the computer and carry out those orders. I didn't leave work until 10:45pm that night. And I got to work at 6am that morning (don't clock in until 6:45) so I can do quick research on my patients and have an idea of what I'm getting into for the day. I didn't mention that I didn't even take a lunch break this day, because I was just so darn busy.

I know that the first year, and especially the first few months of nursing, is like boot camp and I know it's going to take a while to get my routine. But the day that I had just got me discouraged after the good days I had previously on orientation and the first couple off of orientation. I feel like something always needs my attention, and when I get a minute to start charting assessments, something else comes up, like someone gets sick and needs tending to, or someones blood sugar drops, or I get phone calls, or the doctor is rounding. All of the things that happen, I feel like need my immediate attention and I take care of those things so that more stuff doesn't get piled up and get more behind. And then I feel like at the end of the shift, I have tried to keep my own head above water so much, that I haven't had much time to get everything sorted out for the next shift so I can tell them what the patient is going to have going on that night or the next day that they can prepare for.

I love being a nurse. I really do. I love people and I love helping. I am just overwhelmed and my most recent shift situation has gotten me discouraged. And I work 4 twelve hour days in a row this coming up week and I am already not looking forward to it because I am terrified it is going to be like the last shift.

Just some words of encouragement would be nice. I love that this website allows for people to vent and to share experiences and advice. Thanks in advance for anyone who comments here!!

[Shanty3710]

I have seen many articles posted about new nurses being overwhelmed with their medsurg jobs and I'm sorry for posting another, but I just need to vent.

I have previously worked as an LPN at a LTC facility for a year and a half before I went back to school and obtained my RN. I liked it at the LTC facility in that I loved my patients, but I did not really care for my day seeming like it just consisted of med passes and charting.

I have been working at my new job on a general medical floor since February. I have already come off of orientation and have worked on my own for about 3 shifts. My entire orientation I felt went well - I had SEVERAL preceptors (not my fault, but a poor choice by my manager for not putting me with one consistent person). Everyone has been great so far - they've been kind and helpful and occasionally check up on me to see how I'm doing, when they get a minute out of their busy day.

The first two days off of orientation went fairly well. I tried staying on top of being on time with my medications, and I do my assessment on my patient while I'm giving them their medications. But, I never can seem to chart my assessments until way later in the day - even after I've given report at the end of my shift and have to stay later, which doesn't bother me, but I would like to chart as close to real time as possible, but I just haven't seemed to have been able to do that.

I worked on Friday (my 3rd day off of orientation) and that day was just terrible. Again, I tried to make sure my medications were on time, but I didn't chart on one single patient until after I gave report to the night shift nurse. Hand off report took forever this day because 2 of my patients decided to have some issues going on with them that they didn't have all day - so had to call docs on those patients and put orders in the computer and carry out those orders. I didn't leave work until 10:45pm that night. And I got to work at 6am that morning (don't clock in until 6:45) so I can do quick research on my patients and have an idea of what I'm getting into for the day. I didn't mention that I didn't even take a lunch break this day, because I was just so darn busy.

I know that the first year, and especially the first few months of nursing, is like boot camp and I know it's going to take a while to get my routine. But the day that I had just got me discouraged after the good days I had previously on orientation and the first couple off of orientation. I feel like something always needs my attention, and when I get a minute to start charting assessments, something else comes up, like someone gets sick and needs tending to, or someones blood sugar drops, or I get phone calls, or the doctor is rounding. All of the things that happen, I feel like need my immediate attention and I take care of those things so that more stuff doesn't get piled up and get more behind. And then I feel like at the end of the shift, I have tried to keep my own head above water so much, that I haven't had much time to get everything sorted out for the next shift so I can tell them what the patient is going to have going on that night or the next day that they can prepare for.

I love being a nurse. I really do. I love people and I love helping. I am just overwhelmed and my most recent shift situation has gotten me discouraged. And I work 4 twelve hour days in a row this coming up week and I am already not looking forward to it because I am terrified it is going to be like the last shift.

Just some words of encouragement would be nice. I love that this website allows for people to vent and to share experiences and advice. Thanks in advance for anyone who comments here!!

I hope that someone that's been in your situation will be able to impart some tips and tricks and words of encouragement to you. I hear your heart on this, and I hope so very much so that you get the peace and rhythm that you need! Blessings on you, and those that you serve!

[RNsophia]

It gets better. Soon you'll be more confident and things will become second nature. Until then (based on the info you shared on your post), I have some advice. First, after you get report (whether at the bedside or at the station), quickly round on all your patients. This especially includes toileting, bed alarms, and pain. Once you get that out of the way and when you do start your assessments, you can take the extra time to chart in real time in the room with the patients right after you do their head to toe. You don't have to chart everything in the room, but if you quickly chart your head to toe, that gives you more time to pass your meds and then chart the extra risk assessments, etc out at the nurses' station. Also, don't be afraid to delegate so that you can do your charting. And finally if something happens during change of shift and you have to call the doctor to put the orders in, that's all you need to do. Don't feel guilty or feel like you need to stay to carry out the orders because nursing is a 24/7 job. Just call the doc, put the orders in, and tell the nurse taking over what the orders were. You don't have to do things this way, but over the years, this is what has helped my preceptees. You got this!

[tsm007]

I'm still kind of new myself, but what I've been doing is charting my vitals and any abnormals while in the room. I don't go through and chart all the normals that takes too long, but anything that is abnormal I get charted right away. This way I at least have it time stamped for the time I was actually in there and this way if anyone looks they can at least see the stuff that is not normal and the vitals. I do not do my IV assessments always in real time or my ADLs/bradens etc in real time, but at least try to get the head to toes in real time. When I first started working I would try and chart everything on one person at a time. Now instead I skip the ADLs and care plans and only focus on getting everyone's head to toes and then go back and fill in those other charting needs as I have time. I also have a little checklist on paper so I can cross out things once I have them charted so I don't keep looking in the chart to try and figure out what I have left to chart and where I left off. I was wasting a lot of time opening and closing the chart trying to figure out where I left off. Anyway, those are my best tips.

[kaeRNBSN]

It sounds to me like you're still learning and that's perfectly fine, dear. Nothing will be perfect but long as you keep your patients safe, you're already doing the right thing.The thing about medsurg is you just never know how your day is going to go. You can't just "plan accordingly" because things don't always go as expected! I agree with previous posters. Having that little handy dandy checklist is so very helpful. Chart the assessments and the medicines in real time, chart any changes/notifications in real time. Also as things happen with the patient try to jot down those changes on your report for the following shift so you won't feel as if you're missing anything. Once you do it enough, it'll get repetitive and become second nature to you. Even if you feel in a bind and are tied up, ask a coworker or the charge nurse for help!