I am graduating in about 2 weeks as an RN. (If I pass stupid HESI). I am in my last rotation, on an oncology unit. Up until about a month ago, clinicals were more like glorfied tech/CNA positions. Now, I am taking patients on my own with an RN checking medications and guiding me some.
Today I took 3 patients, only one was high acuity. My professor said that she sees I'm having trouble managing my time (I'm too slow with morning medications, in particular) and organization (I missed a medication).
My questions are:
-What is your routine as an RN to ensure your morning meds are timely and accurate?
-When you go into the room to give meds, what other things do you do? Do you asses lung sounds, pulses, check for skin breakdown, etc. or is that something you do after the initial morning rush?
Ex: Today I went into a pts. room with severe MR, contractures, a PEG tube, who was incontinent of bowel and bladder, asphasic and who couldn't follow directions or respond. I gave my meds, checking them again (my teacher said too many times) and noticed he was position weird in the bed, his brief was soaked in urine, the Mepilex to his coccyx with a stage II was also soaked...etc. I wanted to (and did) fix all of those issues then, because it bothers me to leave someone in that shape and because we're taught to cluster care...but was that the time to cluster care?
Nov 28, '12
After I get report, I usually look through the chart and quickly read any important info. I look at the MAR and note any morning meds. Most meds are given at 0900. There are some due at 0730 or 0800, but those are usually few. I assess as much as I can before the 0900 time arrives. You have a window to pass the meds....0830-0930. That gives you a solid hour and a half to get thing lined up (minus the 0730 meds or insulin). As time goes on, you will be able to assess faster than before. Nursing school has you doing a full head to toe assessment, but in the real world, you aren't going to describe hair growth on the skin or check field of vision on pts with abdominal pain. Time management will be something that you master. There's nothing wrong with doing further assessments when you are back in the room.
Nov 29, '12
Thanks! My next clinical day is tomorrow...so I think I'll try to do that. The problem is sometimes it takes until like 7:45 or 8:00 to get report. But, we'll see what tomorrow brings and I'll try to implement some of your advice!
Nov 29, '12
Thanks! I really like a couple of these, I think I'll try to edit a little to fit 3 patients on one sheet until I'm better able to organization! Thanks so much!
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