Hi all! I have just started a new job in a TICU at a Level 1 trauma hospital. I am still in orientation but I feel like it's going to be a constant battle to get all the "tasks" done on my shift (labs, meds, assessments) on really critical patients. For example, my last shift the patient had several meds, q2h lab draws, and q2h neuro assessments and then their respiratory status crumped (alredy vented). I think in all the confusion I forgot to chart the last neuro assessment even though I did perform it and I'm freaking out.
With experience does it get better? Do you ever get every little thing done and go home with a clear conscience?
Feb 1, '14
Some days are just like that! I focus on getting my physical tasks done. I figure I can always do my charting after I give report, if all else fails. I have been at work past 0900 charting before.
Make yourself a cheat sheet with what needs to be charted. It really helps during the busy shifts where you don't have time to look through all of your charting to make sure you charted everything. I have a sheet I attach to the report sheets we have that has blanks for all the assessments, the q2 charting like turns and IVs, and PRN medication initial charting and follow up. If I have something like q2 neuro I will write each hour I have to put it in out to the side. Check each off when you've finished it - that way you don't miss any charting. I have found it unbelievably helpful.
Feb 1, '14
My advice would be to never get lax with your time. Stay on top of your tasks and charting even when your patient is seemingly stable. I find those patients are the ones who decide to decompensate 1 hour before shift change and then you're scrambling to finish up charting/tasks.
Feb 1, '14
I dont work in a trauma icu, however i work in a cardiac icu and i will tell you; keeping up with your documentation, i&o,vitals,assessments, labs, etc, is very important. There was a day where i had 2 seemingly walkie talkie patients who, within 2 hours of each other, they both had v fib arrests despite having good labs and everything. Luckily my documentation was on par and i didnt need to be present for the second patient coding while i was stabilizing the first one. I am still very new to my unit as well and it still a constant struggle sometimes to keep up. It is getting better though. The biggest thing for me is making sure my critical alarms are set up, i have suction ready to go, my ambu bag is ready and i have a patent, easily accessible line in case of a code.
Feb 1, '14
Thanks all! My current brain has boxes for UOP, temp, and BG; I might have to add some for neuro checks. My preceptor said I need practice getting everything done efficiently which I should get by the end of my orientation.
Feb 2, '14
I agree with all of the above.. Right after I get report and before I walk in my patients rooms I will label each hour with an R for restraint documentation reminder, n for neuro, etc.. My hospital makes us chart q1h vitals (our monitors don't send them straight to our charting, apparently it's too much money), so I jot down notes by every hour, specifically if a dr was there, any major change in assessment, etc. Some days I could get away with not doing that and I'd be able to recall it all, but others are hectic and it helps a ton!
Feb 9, '14
Honestly--I don't think the neuro check that you didn't chart will be on a priority list if your pt isn't BREATHING! We all have to prioritize our work. But the best laid plans will go to s**t when your pt circles the drain. No one should fault you for saving your pt from dying!
Feb 11, '14
Our facility also has a policy allowing us to chart on a patient within 24 hours, so we can come back the next night to add anything we may have forgotten. Not sure if that is an option for you. As a new nurse in a MICU, I can sympathize, and it does get better! Like others said, the trick is to get as much done in the first half of the shift as possible, including charting. You can always "relax" later, if time allows. Many nurses, even seasoned ICU nurses, socialize & play in their phone early in the shift, and end up freaking out/playing catch-up the rest of the shift when something unexpected happens.
Feb 15, '14
I try to chart everything right when it happens, but that's not always possible. AFTER I give report at the end of my shift, I take a couple minutes to make sure everything is charted appropriately. It only takes a couple minutes and it has saved me a lot of stress.
Feb 22, '14
I think I am still adjusting from my previous PACU experience; there it seemed so easy to get all your charting done and everything wrapped up nicely. Unfortunately, the expectation is you will chart everything within an hour of it happening or you have to annotate "late entry" on everything you chart late. And it is unthinkable that you would enter anything 12-24 hours later (to admin anyway; there have been a few times I come to work the next day and realize I could have added something). One day at a time I guess! Thanks for the support
Feb 22, '14
I think all this live charting is for the birds....especially in critical care. ((HUGS))
Feb 24, '14
Another voice here recommending staying on top of your tasks and charting throughout your shift. I am relatively new to critical care and I notice that many of my seasoned colleagues are the types who are always scrambling at the end of the shift. And if they happen to get an admission or some unplanned event happens, the scrambling is even worse. I often get dirty looks at the end of the shift when I go around asking if anyone needs help because I have tied up my few loose ends. I'm not the type to stay late to chat and chart. I like to get the job done safely and efficiently and get the hell home.
Anyway, to sum up, get as much done as you can when you can. Use your down time to get ahead if it is at all possible. Leave yourself time for the crap to hit the fan, so that when it does, you won't be worrying about what you didn't get done while you're trying to manage a stressful, unexpected situation.