no critical thinking here

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I am a new nurse on a small tele floor. I love the people I work with and the small setting makes learning a lot easier. However, I do end up with 4/5 pt. a night. I work the 3-11 which gets very busy with admits/discharges. Well, right now I feel like I do my initial assessment as quick as possible, give out meds and do paperwork. I dont' feel like I have time to talk to my pt's research what's going on with them, and think about their diagnosis and try to really assess their conditions to help with whatever the best care I could give would be.... It's frustrating because I am sure I am not managing them as well as I could if I didn't have as many pt's and really had time to do a better assessment. I think my paperwork is rushed and not as accurate or thorough as it should be, I feel like I am just running around without really "nursing". Admissions take at least an hour and I end up with 2 most nights. That leaves other pt's with little contact from me other than giving meds. I feel like a babysitter who gives out medications and just passes them off to the next shift. I know I could give better care with less pt's. But let's face it that isn't going to happen. I also know with this pace I will make a mistake or miss a symptom or sign I should have caught with a pt. Critical thinking is so emphasized in nursing school but I know I don't have the time to even properly assess my pt's never mind really think about what's going on with them! I feel I can't give the best care without really knowing my pt's that is impossible with 5 pt's and no time to really assess them. Maybe it's time for school nursing! No rush there! Except for flu season..... Anyone with any thoughts.:bowingpur

Specializes in NIH Stroke certified.

I work on a floor with usually 28 pts on tele 12+ new stroke patients, a few post-Bariatric Sx patients and 1 or 2 vents on 7p-7a. It was a nightmare at first, but I got tele certified, saw a bariatric Sx and took a competency test (no CEs) from our institution, and will be taking a ventilator class soon. At first I felt like a chicken with his head cut off but I quickly learned to group as many things together as possible, do the most important things first and make a sheet for a quick head-to-toe assessment. I've almost memorized that sheet and with everything else I usually get done close to on-time. By the way we usually have 6 pts or 5 + an admission. The acuity of most of the patients is similar to that of a rural or local hospital. Unfortunately, admissions ruin any plans that you tried to set to accomplish tasks and nursing is 75% paperwork. I get the quality and quantity of information I need from a pt to do the paperwork, but I wish I could spend more time with the pts. Good luck to all.

-Paul

Specializes in ER.

at my first job right out of school, before i had even done my boards, i was on a monitored med-surg floor w/10 different services. and when i first started, i was SO TIRED and scared and confused, etc etc.

at some point i had this epiphany and realized that my pts don't need head to toe assessments every day (which ate up a lot of time if you have 6 pts) and i finally, after about 3 months, got to the point where i felt like i had a routine down.

i don't think that the kind of therapeutic communication they talk about in school is always realistic on the floor. and on the days when you have a pt that *really* needs that extra minute, you will give it to them. i have sat in pt's rooms charting because they were scared to be alone or held their hand while i charted. (i guess lucky for me i type one handed)

i hate call lights interrupting me, so i always went by my pts rooms at the start of shift to introduce myself, check their equipment and ask if they needed anything. then i got right on my med pass, and did my assessment while passing the meds. THEN i charted and that is also when i googled stuff i wanted to know. i tried to get everything that *had* to be done completed as soon as i could so that a crisis was entirely screwing me over.

you'll find the time to get what you need, but really developing a relationship with your pts is much too time consuming for a floor, IMO.

but i absolutely understand where you are coming from. it sucks when your primary way of knowing if they are diabetic or not is seeing insulin on their MAR.

Specializes in NIH Stroke certified.

Let me correct myself. I meant to say the acuities of these patients are similar to the ICU or CRITICAL CARE of a local hospital.

Specializes in Did the job hop, now in MS. Not Bad!!!!!.
Thanks, I was referring to L&D, in our area L&D gets only 1 pt. 2 at most and are trained for the postpartum floor. Also even on postpartum we are only given 2 pt's because technically you have 4 or more if you include the newborns.

L&D here is pretty good. But again hard to break into. Thanks

Gosh Chris,

if I only had 2 couplets on PP I might not have suffered a nervous breakdown and had to quit. My whole life is crumbling down around me now and I am scared to death of what I'm losing because I had so much riding on this.

Sounds like you have a pretty awesome work environment that understands proper (even idealistic) nurse:pt ratios. Give it some time and take every opportunity to learn. And give yourself a break. I truly wanted OB and I'll never have it again becasue of what has happened to me. My most recent exposure to hospital nursing has forever scared me away. No one should have to live in daily fear and physical illness over a JOB!!

Good luck to you!

Chloe

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