Charting and learning

[Trampledunderfoot]

I am very discouraged and seeking advice again. Sorry that appears to be the only time I contribute....

I am in my first job out of nursing school, and have been there for a few months now. One of the main reasons I chose this job was because they said orientation could last however long I needed it too. I am very smart, and a quick learner, but I also want to do things right, cover my butt, and not make mistakes. Good orientation felt like a must for a new nurse to me.

However, this place is EXTREMELY short handed (as I know a lot of places are...) and due to the need for me to cover a position by myself, my orientation lasted only a couple weeks. The orientation I received was not very good. The nurses I was with saw me as a way to get out early, I think. They had me do all the work I knew how to do and could handle myself with no guidence, such as taking vital signs and retreiving supplies. I expected to graduate to more difficult things, I thought eventually I would be doing the charting and the actual patient care while being observed by a nurse to make sure I was doing things well. This never happened. So basically, I went from doing CNA tasks, to winging it by myself, and learning through trial and error how to be a nurse who is not in the perfect NCLEX fantasy world.

This scares me.

I have confronted the DON about this issue, but she is new herself, and she has given me advise before, and then other nurses who work the floor have told me that her advise is bad and she doesn't know what she is doing. I have told the DON that I need more training, and she listens and says she will make that happen, but then we are so short, there is no one to train me. The other nurses are very helpful when I ask most of the time, but lots of time we are so short and they are so busy, that there is no one for me to ask for help. I also don't want to come across as a bother, or like I am stupid. I hate asking for help.

When I come to the DON with a specific question, usually she tells me she will show me how to do it tomorrow, but then someone calls in, she does a double, and does not show up tomorrow. I am supposed to be charting daily assessments that I don't know how to chart, and she has known this for weeks and cannot show me how to do it.

I feel like I am missing out on simple things that experienced nurses may not know a new nurse struggles with. Things like when to call the doctor, when to simply get a verbal order, how to read a urine dipstick properly, how to effectively chart without getting yourself into a heap of trouble.

I feel like I come across as really stupid, and I'm not. I did really good in school, one of the top in my class. I just feel like it was all crammed in my head so quickly, that a lot of it is gone now. I try to go back over my text books, but a lot of it does not seem applicable to real life. Also, I have trouble knowing what I don't know until I am in the middle of a situation at work and realize I didn't know it.

I don't feel like I'm making much sense.

I am looking for some advice, and maybe resources for self learning on some things like charting and nursing tasks that people assume you know. Are there any good websites or books? I feel particularly stupid about the urine dipstick thing, but I was not taught anything about it in school, found the jar of dipsticks in the drawer, and there were no instructions. I had never done one in my life, never seen one, and had no one to ask.

I'm rather afraid that if I go to work somewhere else, they will expect me to have experience that I don't have, because I have been on my own winging it and not doing a good job when I didn't know it. Does that make any sense?

I feel like I am stuck in a deep hole, and when I think I am digging myself out, I am truly digging myself deeper, and can't tell it because I have too much dirt in my eyes. I am having a blast at this job, and am very optimistic. That makes me worry that it is worse than I think it is. I could be going along fine, thinking I'm doing a great job...and then find myself in court.

I am very bummed out, and this pity party is lowering my self esteem. A cartoon would be nice, Davey ?.

I appreciate any advice. Thank you all so much ?!

[beekee]

Before you resign, speak up and ask for more training on charting and anything else you have questions on. You need to learn to speak up for yourself, so you might as get practice in a place you don’t care about, right?

[Katillac, RN]

1 hour ago, JKL33 said:

- When people say things that sound TGTBT (like "Your orientation can last as long as you need it to!") realize those things are lies, and you are presently having a conversation with a liar 

What she said X1,000.

[Workitinurfava, BSN, RN]

What a shame. Honestly you need someone to verify your techniques and let you know what you think you know through confirmation, otherwise how do you know if you are doing things right. Nurses should get similar training like medical doctors. I have always wished that there would be someone more experienced leading new nurses in the right direction regardless if we are short staffed or not. You have asked for help so many times already. You are basically going to have to beg at this point or walk away. Like you said if you go somewhere else it will be assumed you know enough and your training opportunities will dwindle naturally unless you luck out and find someone understanding and willing to train you late in the game. Make the most of the situation right now and keep your eyes open for teaching hospitals.

[Workitinurfava, BSN, RN]

On 3/11/2019 at 1:16 PM, Katillac said:

I think the problem is nobody actually showed her any charting, they just had her doing legwork for them. Policies and procedures don't typically cover the charting flow. Cheat sheets are awesome when you have the instructions and steps to put on them but it seems like she doesn't and has limited access to resources.

There's a difference between orienting to a new facility's systems and orienting to practicing as a nurse, and two weeks of doing CNA tasks are NOT enough to make you a safe nurse.

I'd start looking for something else as of yesterday.

ETA For the meantime, you need to work on not wanting to ask for help. You need help in order to practice safely. Think of it this way; I know you wouldn't put in a non-sterile Foley just because you didn't want to go all the way to supply to get a new one. In the same way you need to get past your discomfort about asking for help, because it's about your patient's safety and your license.

I agree. 2 weeks is not enough when preceptor are strictly doing their jobs and keeping you in a CNA role. The first week is generally classroom stuff. If she works 12s, the second week could be only 3 shifts.

[Trampledunderfoot, LPN]

Yes, I had a week of classroom stuff, and then one eight and three twelves of doing basically CNA work and popping out meds. I was a med tech for three years before I was a nurse, and kept telling them that I got this, I don't need to pop meds, but management was sure this was the hardest aspect of the job.

Since it is a prison, and that is a very new situation for me, I was happy to take vitals at first, because I thought being close to inmates could take some getting used to. It wasn't bad at all, though, and I was ready to move on fairly quickly. However, that did not happen until I worked shifts alone. The first day, I remember struggling to get the computer to work at all, dialing extensions for every supervisor I could think of, and no one would pick up. I eventually basically figured it out, and asked questions when I was done.

I am going to try to stick it out, and see if they can help better this time around. I am going to be better about being persistent when I need help, too, instead of giving up and trying to wing it.

[TriciaJ, RN]

I'm glad you're enjoying your job and sorry they threw a new grad into the deep end without an orientation.

Make yourself an orientation check list. Start listing all the things you aren't sure of, when and whom you asked for help. Mark down every time the DON promises to extend your orientation or provide training. Hopefully you will gradually feel comfortable with more things. If you get in trouble meanwhile for something you didn't know how to do, you have a paper trail of trying to get help.

Another suggestion since you are a new grad working corrections: get a copy of the book Games Criminals Play and How You Can Benefit From Knowing Them. It'll help you be more savvy and astute with all the behaviours you're going to encounter.

Good luck.

[Trampledunderfoot, LPN]

Thanks, TriciaJ. I wouldn't have thought of creating a paper trail. I'll have to look for that book, I'm a big reader.

[SeasonedOne, RN]

OK....Take a breathe............. welcome to nursing!

In my first nursing job I wanted so much to impress my bosses and do a great job. I couldn't seem to remember anything. I finally realized I was going to write down what I saw without the medical jargon and figured if that wasn't good enough, they could fire me. I was there 5 years. Over time it got easier and I remembered more.

You need to start by believing in yourself. Yes, you have a lot to learn, but you also know some things to start you on your way. As a CNA you assessed patients all the time. Orientation status, ABCs - Airway, Breathing and Circulation...skin.... start at the head and work your way to the toes. If you do that every time, you will get into a routine. Breath sounds, heart -rhythm/rate, bowel sounds, peeing-color, last BM, LE edema. There is a reason all documentation flows in a similar manner. It is practice and habit. You just need more practice and you will get better as you add more of the details. Try to take 5 minutes to read over chart notes of other staffers each day. Follow their lead and learn the process. Build on what you know. Add more skills and refine them.

If there is something that needs done, jump at the opportunity. Observe. Offer to work with someone, not always run for something. Look for someone that is open to having a partner. It is wonderful to have a mentor if possible, but sometimes if you have a skill learned in class, you just have to go for it. These days, for any kind of procedure that fits your skill level, use youtube.com as a refresher. Schools post tutorials for almost everything. We all have missed an IV start or two and had to ask for help.

Work settings aren't always ideal. Being safe and giving good care should be your focus. If the site isn't well staffed, then you have to ask yourself why? Given today's nursing challenges, short staffing is more the norm then the exception. Will leaving bring same circumstances in a different place?

You might find with a bit of perseverance, this challenge might be a springboard to many more opportunities to learn more.

Positive thoughts!

[Apples&Oranges]

If you were my little sister or my best friend, I would tell you to start applying for hospital jobs. It may not be what you want to do long term, but at least you will get an orientation, experience and something to put on a resume. Hand out in the hospital for a year. If you stick with corrections as a new grad, particularly with no real training, you will pigeonhole yourself, and it will be difficult to find work in an acute care (or many other) settings if you choose to do so in the future.

Better to open doors than to close them...just my 2 cents.

[TriciaJ, RN]

6 hours ago, Apples&Oranges said:

If you were my little sister or my best friend, I would tell you to start applying for hospital jobs. It may not be what you want to do long term, but at least you will get an orientation, experience and something to put on a resume. Hand out in the hospital for a year. If you stick with corrections as a new grad, particularly with no real training, you will pigeonhole yourself, and it will be difficult to find work in an acute care (or many other) settings if you choose to do so in the future.

Better to open doors than to close them...just my 2 cents.

I hear similar sentiments from a lot of younger nurses on here, wondering if accepting a certain job will limit their opportunities in the future. My own career trajectory was: psych to corrections to med/surg to agency to ambulatory. I moved on when it was time to move on and didn't lack for opportunities.

I firmly believe in doing what you want to do when you want to do it. Being resilient and adaptive will be the biggest determinant of where your career goes.

[Lovejday1]

I’m going through the same thing Six lousy days of orientation I’m expected “to know it already “ I have spend more money to further my education just to get out of this situation I also have a question Can nurses from long term care ever have jobs in a hospital???

[TriciaJ, RN]

On 3/14/2019 at 8:35 AM, Lovejday1 said:

I’m going through the same thing Six lousy days of orientation I’m expected “to know it already “ I have spend more money to further my education just to get out of this situation I also have a question Can nurses from long term care ever have jobs in a hospital???

Yes.