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Advice/Help for a new grad nurse

calexis20 calexis20 (New) New

Hello all! Just venting/need some advice! So i graduated 06/16. passed boards 7/29 and have been working as a shift lead at an ALF sonce august. I scored a LTC/Rehab PRN job sometime in september. They offered 40 days of training which i graciously took. I am still on orientation, today i came in and they were short a charge desk nurse and asked if i would jump on a cart so another nurse could take the desk. I said yes. Now, i feel like I did okay. 1st med pass and treatments were done by 1130 ish. now i have about 22 patients, but they are pretty needy. Narcs around the clock. one with IV abt, another with GI bleed, ETOH abuse etc etc. anyway my question is i feel like i was kind of all over the place. how do you organize getting your vitals signs, mini assesments, meds accuchecks etc etc in a way where you dont constantly have to go back? and the charting has me nervous! I feel like my charting sucked today especially because i dont know these patients! I feel like im freaking out a little here!

Wow...stick with that place if you get the 40 days. That is very generous! There are many threads on this subject in this section..browse thru them to get a little more.

I would make a time line to plan the shift.

7a- 730 Report/ get cart ready

730-8 check for appointments/ therapy schedule..do a quick round to check residents/ treatments

8am -1030/ 11 am Med pass and treatments

11 am..charting

11:30 start noon meds and accu checks

12 help with lunch

1pm meds

charting/ follow up calls etc until the end of the shift.

In the morning..residents might be going for therapy or dr appts..try and get them first.

I am a recent graduate as well and I have been working on a med cart with 15 sub acute patients in a SNF/LTC facility. It sounds like you are days shift, the best way I was able to organize my day was first coming in and checking the therapy schedule so I knew which pts I had to catch before therapy stole them for the next hour or so :) The 11-7 was usually busiest at this time and never ready for report so it worked perfectly, by the time I had an idea of who i needed to catch first, she was ready to give me report. Afterwards I immediately rounded to do accuchecks and vitals, prepare any IVs and then preceded with my medpass in order of peoples therapy times, plus the random pt here and there that was practically independent and ready for d/c that walked up to my cart. Taking me to about 1000, next I typically do my physical assessments and treatments up until 1130. Accucheck time again, granted this changes a lot and sometimes I have none, sometimes I have 10 and they are all sliding scales! 1200 - Lunch trays are on the floor and insulin is administered, so between I and the other nurse on the unit one takes lunch and the other takes that time to do Med A Charting and progress notes, then we switch. 1300 - Next round of medications, which is typically much lighter, finish any charting I have left. Note: *Making time for the occasional admission comes with experience, the more you do, the better you get*

Also, a lot of nurses don't utilize the CNA's to their full potential, our full skin checks & braden assessments are scheduled the same day as shower days, I have a good relationship with "my" CNA's and they know to call me in to check the skin or if it would be more convenient to do a sacral dressing for the person that is a hoyer lift now, during AM care, rather than later. You sound just like me the first time they put me on a cart, a nurse had to leave because of an emergency and they asked me if i was comfortable enough to run the cart alone, I also happen to work with very supportive people, but everything went fine! You're first few days alone are going to feel crazy, you're going to think you forgot something, or did something wrong. Just take a second and breathe and remember you got it! Generally employers know you need some time to get into your routine. You'll get there! Hope this helps!

Yes that helps ton! Thank you both! I did keep my report sheet from this specific hall so that I can write notes for next time. I definitely am a list person so I am going to try writing out my timeline like coffee rtc said. And I will definitely be going in early to look at the schedule because looking for ppl takes so much time! and i also had my first fall, its like they can smell a fresh nurse on the floor! lol


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