Does nursing ever get easier?

[Red_Diamond]

Hi all. I'm a new nurse about to start my 5th week on a ENT/Urology floor. I'm about half way through orientation at this point. I hadn't had any previous experience with nursing except in clinicals during school, and I was a CNA at a long term care facility before. I'm finding the job incredibly overwhelming and difficult. I feel like one of my biggest downfalls (besides learning the flow of the unit, the different surgeries and procedures...) is keeping up with my patients. I try to write as much down as I can before I start my shift, but I feel like I forget to do so much. Just simple things like remembering to chart I's and O's, forgetting to chart that I removed an IV, or that I have to take a blood glucose right before bed. I'm feeling a little unorganized, but I also think my new preceptor has been acknowledging orders and not telling me, because for example, yesterday she had told me to stop the IV on a patient and saline lock him, but I hadn't read anything about his fluids stopping. Sorry about the long post, but does anyone have any suggestions for me starting out as a new nurse? I'm thinking about asking to extend my orientation. I feel like there's so much that I don't know. I guess I'm looking for some hope that people started out as flustered as I am right now and somehow managed to become a great nurse. I was never at the top of my class in school, I was just an average student. I'm starting to doubt if I can do this! Thanks for your input.

[Wuzzie]

Do you use a "brain sheet"?

[cleback]

You need a good brain sheet. I write down the tasks that need to be done and physically cross them off when I complete them. I feel like the process of writing it down helps my memory and crossing them off is satisfying.

[mi_dreamin, BSN]

First of all, take a deep breath and CALM DOWN. Everyone started out new, overwhelmed and confused. Speaking fresh out of orientation I can say that I think it was more stressful for me to have a preceptor for the reason you mentioned, I never knew what they were doing or not doing.

My best advice is to get a good brain sheet, come in 30 minutes early to write down the basics/review orders/get ready for the day. Then tell your preceptor that you would like to do everything and ask them not to do anything (with your patients) without telling you or you asking them.

I found that the more I did independently the more confident I felt. Write things down that you need to chart and cross them off as you do them.

Also, it will get better. You won't be new forever. It is hard but you can do hard things!

[anewsns]

I found it helpful to write the flow of an ideal day at home. What should happen in each two hour time block. Writing that down helped me slowly incorporate that system into the day. The other is to try to stay present with each patient rather than thinking of all the other stuff you have to do. If there's no emergency in the other room then try to focus on what's in front of you. (I know that's hard with all the bells dinging and phones ringing and people talking to you.) I try to do everything in patient rooms (if they're not annoying me lol) like look at their labs, look at their order list, think about their problems. I think it makes it much easier to remember later. Also, I like to be really methodical about my charting. One patient at a time and one (EPIC ) section at a time. I can't chart on them all at once in order of time so I get mixed up. But now that I can focus I can chart faster. Also, I would recommend trying to end your preceptor stuff on time, as long as you're a safe nurse and can somewhat stay above water. Having a preceptor can cramp your mental style and flow.

[NuGuyNurse2b]

When I was a new nurse I was also overwhelmed with tasks at hand and prioritization. Different strokes for different folks but I've tried brain sheets, they're too regimented for me. I ended up writing by exception (meaning if lungs are clear, I left it blank) to save time and the brain sheets were mostly not filled in. Now I just have a piece of paper that I sectioned and write notes on.

[JKL33]

I think this is worth a review with your preceptor. It's really problematic, while you're trying to learn, to have someone going around doing things behind the scenes on patients for whom you are responsible. Either you need to only be responsible for part of the assignment and do everything for those patients, or you need to be responsible for the whole assignment and sort of switch places so that you are keeping up with what needs to be done and sort of assigning things to your preceptor (easy task-y things that you already know how to do). I have used this many, many times with orientees when they are working on pulling the details together - - I have them manage the assignment and assign me to saline lock someone's IV (super-easy task that they already know how to do) once they have noticed that it needs to be done. I stay on top of what's going on and alert them (after a time) about things overlooked or that I become aware of.

How long is your orientation?

I would start the discussion by saying that you're worried about getting the rest of the way up to speed and feel that you're missing a lot of details - or that you'd like to practice managing things with his/her help while your still on orientation. Ask whether your preceptor thinks one of these alternate arrangements could work. What definitely doesn't work is to have someone going around acknowledging orders and taking care of crucial items while someone else is trying to get a handle on details.

Don't complain, just be pleasant and proactive.

You can do it.

PS - I hope you are less than half-way through your orientation at this point. Which if that's the case then you may be getting ahead of yourself with some of your concerns.

[Wuzzie]

When I was a new nurse I was also overwhelmed with tasks at hand and prioritization. Different strokes for different folks but I've tried brain sheets, they're too regimented for me. I ended up writing by exception (meaning if lungs are clear, I left it blank) to save time and the brain sheets were mostly not filled in. Now I just have a piece of paper that I sectioned and write notes on.

I think your idea of a "brain sheet" is a bit different than most. I never documented assessments on my sheets (we actually called them peripheral brains). My PB's were divided into time blocks and I noted what tasks needed done in each block specific for the time it needed done. Always done in pencil because sometimes the order of tasks need rearranged due to patient needs. It also helped if I needed to temporarily hand off a patient (like during a post op open heart admission) to a co-worker so they could see what needed done. I had a PB for each patient but I worked PICU so never had more than 3 patients. Our current EMR has a "task list" which many find helpful.

[Daisy4RN]

I would speak to your preceptor and let him/her know how you feel and what arrangement would help you in your second half of orientation. Agree with others that it might be easier for you to start doing everything yourself and asking for help prn. It can be more confusing/time consuming when someone else is doing things for you, plus you will not be able to get your groove going (this arrangement worked good for me as a new nurse and as a preceptor). If you are only half way through your orientation it sounds like you are doing fine. I would work on the brain sheet and find what works for you. I used to put very important/timed tasks in red with a little box after it so I would not forget, then after task done make a check mark in the box, then I know through out the day what is done/not done at a glance (that was paper but computer might work also). You will find what works best for you and get your groove in time. You will be fine!!

[ocean.baby]

I had what I call a cheat sheet, the same thing as a brain sheet I am sure. It had what time meds, treatments, tests, etc. were due. It had the most important diagnosis, what they were in the hospital for - not the entire list of dx for that patient. If there was something important like making sure a continuous bladder irrigation did not run dry then it was written in red. I do feel lucky in that I come from the dark ages where we had med carts and paper charting. You could do everything right outside of the patient's doors, no running back and forth to the pyxis or the computer.

I do believe though that cheat sheets are a God send. I have one for every job that I have ever worked, and it has saved me on more than one occasion. It helped me to organize my day. Just be careful to not get too bogged down with information on it. You don't have to put I&O for everyone, just a general note at the bottom that will remind you to do it on all patients that have one ordered before you leave. I continually update mine, taking off what I no longer need and adding anything new that need to.

I honestly felt I was drowning as a new nurse. I only worked PRN as that was all that was available in our small town, so every day I worked it was with new patients. Once I got on full time I realized how nice it was to have the same patients for more than one day (lol mostly). It was November following my May graduation that things started to come together. It seemed to just happen overnight though I know that is not true. Look around at some of the nurses you work with, at some of the students that graduated with you. Honestly, some of them aren't that great - you know in your heart you will give better care than some of them, maybe just because you are conscientious and will ask questions if you don't know something. Hang in there, your November will come!

[mi_dreamin, BSN]

When I was a new nurse I was also overwhelmed with tasks at hand and prioritization. Different strokes for different folks but I've tried brain sheets, they're too regimented for me. I ended up writing by exception (meaning if lungs are clear, I left it blank) to save time and the brain sheets were mostly not filled in. Now I just have a piece of paper that I sectioned and write notes on.

That is basically what my brain sheet is. I have one for all my patients that day. I actually really like the system I came up with for this, it is great for helping me remember what needs done.

[RNrhythm, BSN, RN]

I promise you, it gets easier. So much of what we do is repetition. Be consistent and things will get easier. When you get/give report, make it a narrative so the facts makes sense together. You will be amazed at how your memory capacity increases with constant use. The important thing is to stay calm. Memories literally do not form when you are stressed.