Disgusted

[sistasoul]

I need to vent.

I have been a nurse for 9 months on an ortho/ stroke floor. I continually get out late. I can never find time to sit down and chart as I am always doing some task or another. The charting usually does not get done until shift end.

I have been told by a nurse of 30 years that I spin my wheels and that some things can wait till later. I asked her what things could wait for later she replied, " I have seen you looking up a disease that could have waited till you got home". I was looking up pulmonary embolism. I had never had a patient with that before and I was nervous about it. I remembered from school that it could be life threatening and I wanted to look up the signs and symptoms of a PE so I would know what to look for. I told her I didn't feel like that was something that could wait till I got home. I also do not spin my wheels as I am constantly doing A, B, C, D, .... As soon as I would go to sit down a patient would need something or I would get report that Patient A's vitals were off and off I would go and then that would most like ly lead to calling the Dr., writing the order and then follow through with said orders and then follow up with patient. Oh, and I am also one of those nurse who looks up the meds I am giving if I do not know what they are for.

I don't know how any nurse can be sitting down at 1700 and charting. I am still asseing and giving any meds that are needed at that time. I wish that someone could follow me around for a shift and then they could tell me I was spinning my wheels and suggest ways I could maybe do things better. I do what needs to be done and then I move on to the next task.

I know I have a lot to learn but I am just disgusted that this nurse told me I could wait till I got home to look up the diseases that I felt I did not know enough about. I also told her I did not like to stick people with IV's because I know it hurts them. She told me that she never even thinks about that when she puts an IV in. Maybe I am too sensitive but that statement made me mad.

I feel like I am a good nurse and I feel I am a safe nurse.

[diane227, LPN, RN]

You are having the same frustrations as a lot of new nurses, having to put what you learned into work at the bedside. To make that connection because you cannot remember every item that you learned in nursing school. You have to look some stuff up. I have been a nurse for 33 years and I have to look stuff up EVERY DAY while I am doing my work. You might be a little slow right now as most nurses are because they usually don't have the best organization skills and they don't know how to delegate to others like the CNA's. If you don't mind my asking, what shift are you working, how many patients do you have assigned to you at a time, what kind of unit do you work on, do you have CNA's, does your charge nurse help you?

[sistasoul]

You are having the same frustrations as a lot of new nurses, having to put what you learned into work at the bedside. To make that connection because you cannot remember every item that you learned in nursing school. You have to look some stuff up. I have been a nurse for 33 years and I have to look stuff up EVERY DAY while I am doing my work. You might be a little slow right now as most nurses are because they usually don't have the best organization skills and they don't know how to delegate to others like the CNA's. If you don't mind my asking, what shift are you working, how many patients do you have assigned to you at a time, what kind of unit do you work on, do you have CNA's, does your charge nurse help you?

I work from 3-11 on an ortho/stroke floor. We also get a lot PNA's, COPd, stomach pain, etc. A lot of our patients are confused. I do have LNA's who are fantastic. I do have trouble delegating. My charge nurses are really good. They have to take 4 patients but they are ususally "light" patients so I hat to bother them unless I absolutely have to.I usually have 4 patients and then an admit. The admits are so time consuming.

When I started at this hospital I received 3 weeks of floor orientation with the charge nurse of the day who had other stuff going on besides orienting me. I worked in LTC for 5 months before this basically passing meds. That was my only previous experience as an RN. I was so happy to get a job in the hospital that I took this position knowing I would only get 3 weeks of orientation. Jobs for new grads are not so plentiful over here in the northeast. maybe the initial training was not enough for me to develop a good organizational system. I was told I was not consideredd a new grad because I worked in LTC for 5 months and that I would not receive the 3 months of orientation that the new grad residents received. I did not want top wait for another new grad residency to roll around as there was no guarantee I would get one of the 12 slots alotted for new resident grads.

[cookienay]

May I gently offer some input? "Spinning your wheels" is a common phenomenon of new grads. You seem to grasp that you do have limited knowledge, which is better than thinking you know things you don't. However, your knowledge is not as limited as you may think. Using your example of pulmonary embolism. As an RN I would expect you to know what a PE is. Beyond that all you would really need to know to look for would be alterations in respiratory or circulatory status- which is included in your ABCs. I know in nursing school you got your patient info and then you had the luxury of looking everything up before clinicals, but those days are gone. I would always tell my students- Nursing school teaches you to practice safely. Experience is what makes you proficient. don't be discouraged. You will get it. Also sounds to me like you are getting the shaft with your orientation.

Good Luck!!

[Jules A, MSN]

I can remember when you were frustrated looking for a job so congratulations! I agree with cookienay although our recent grads with some experience start with 3 weeks orientation also. Try not to be disgusted, if she didn't think you were worth it she wouldn't have offered suggestions. It takes time but do be open to suggestions because often others see what we can't. Hang in there.

[cherrybreeze, ADN, RN]

I have to say that I agree with the RN that told you that, things like the PE can be looked up when you get home. Here's why:

You assess your patients. You know their vitals. You listen to their lungs, ask about their pain, etc etc. If *something* is wrong/changed in their assessment, you will see that (you mentioned "wanting to know what to look for,"...a status change will present itself, you'll know something is going on). You don't need to know, right then, WHAT it is. All you need to do is see the change and act accordingly. Is their sat low? Apply O2. Call the doc. You get the idea. Yes, a PE is life threatening, but if they are going to throw a clot, you aren't going to stop it by knowing everything about it. The things you already DO know, and put in to practice, are enough for right now. You make sure they have their SCD's/TED's/plexipulse on, administer lovenox/heparin as ordered, ambulate as frequently as able. Those are what are most important. You call the doc, give them your assessment data, and it's the doc's job to determine if it could be a PE and order whatever needs to be done. In time, you'll get a sense for what's going on when you see changes (ie, respiratory changes...is it a PE, fluid overload, anxiety, atelectasis, pneumonia, etc?). You don't need to research those things mid-shift. They come with experience.

I hope this makes sense. Perhaps that nurse's approach didn't come across well (I don't know what her tone or wording was, exactly), but I think I know what she was getting at. It WILL get easier, and you will find your groove, I promise.

[SuesquatchRN, BSN, RN]

You're a good nurse, and congratulations on landing a hospital job!

Take her criticism as it was meant, kindly.

:)

[NurseCard, ADN]

Also, regarding what she said about inserting IV's.... I'm being honest here, if I sit there and think about how much the IV stick is hurting the patient, I can't do it. So, I have to focus on my technique, the vein, getting that flashback, and that's it. Now, that doesn't mean that you dig and fish and wiggle that thing around under their skin for fifteen minutes until you get that flashback!! =) But, yeah I used to be the same way, I just couldn't insert IV's because I knew how much they hurt. Now, instead of thinking about how much it is hurting, I focus solely on the job that I am doing.

That's probably what the nurse meant. She focuses on what she is doing instead of thinking about the pain she's causing. =)

[dudette10, MSN, RN]

The responses by cookienay and cherrybreeze were so helpful to me as a student, who is trying to get through school and anticipating what it's going to be like when I'm done. It highlights the difference between novice nursing and expert nursing, and the differences in the thought processes of each. There is also a HUGE confidence level difference between the two, which shows in their answers. They are comfortable with not knowing everything about every condition; however, they do know what they must look for and how to act accordingly.

To the OP...it will come in time, I'm sure. But, I'm right there with you in wondering how long it will take for me to get there!

[Scrubby]

I think it's great that your the type or nurse who likes to know exactly what's going on and the disease process. It shows that you care about your patients and that you want to improve your knowledge. But I have to agree with those who said that rather than looking up a disease your better off assessing for any changes in that patients condition.

You say that you have trouble delegating tasks. This is something you might want to improve upon. There is nothing wrong with not being able to do everything.

Try not to be too disgusted with this person. Maybe their approach was a little harsh but they were most likely trying to point you in the right direction. It always pays to listen to nurses with years of experience-even if you disagree with them.

[RNKPCE]

You might not get someone to follow you around but you good volunteer to follow someone else around that it known for being a good nurse and organized.

As a new grad I had great role models. This was day shift and this one nurse would walk in and starting getting stuff out for a semi assisted bed bath she would wash the patients back and listen to their lungs at the same time, then listen to their heart and stomach this went on with the whole bath, checking skin etc finally she would let the patient's feet soak and while putting them in the basin assess for pedal edema and peripheral pulses. Next patient might have to go to the bathroom, again she would help the patient sit up listen to their lungs while upright walk to the bathroom and after tolieting ambulate that patient in the hall since getting oob is the hardest part. Not everyday went that smooth but you get my drift.

Novices would do each task separately experienced nurses can combine tasks and save time while still giving the best of care.

[mappers]

I agree with Cherrybreeze that looking up s/s of a PE isn't something you need to do at work, unless you have some down time. You are going to see a change in status and react according to the change you see. The underlying cause isn't important at that time. Get vitals, apply O2, do stat labs, call a Rapid Response, follow your floor's protocols....you react to the s/s and let the docs worry about the underlying causes. That's not your role. Your role at that time is to gather data, follow protocols, and apply appropriate nursing interventions. Don't get me wrong, reading up on a PE so you know what it is, can educate pt's etc is great, but may not be the most productive use of your time on busy day.

It sounds like you may need some help with learning to prioritize. I have a sheet I use that is set up with times across the top and patients' names down the side. I write in all my meds and treatments when they're due on this sheet. This way I get a snapshot of my day and can see when I'll be busy and when I may have some time to get to lower priority items, and even when I might be able to chart and take a lunch! (LOL) The sheet is constantly being revised as things change, but it still helps me stay on task. It also helps me see when I can cluster care for a certain patient. Did a patient just call out for pain meds? Well let me see, they have an ABX due within the next hour, I'll take that back there too.

Also, chart whenever you have 5 minutes. If you can just get one patient charted on or partially charted on in the next 10 minutes, that's one less patient you have to chart on later. I've had crazy days where I can't chart on anyone. Some days I have 45 minutes and can get all my charting done. Some days I chart here and there and am often surprised at how much I have done by the end of the day.

I'm still new and learning lots, but my days of staying til 9:00 charting are becoming fewer and farther between.

PS, NurseCard. Did you go to UofL? Me too! Go Cards! (even though they lost today.)