Don't let your pt use the call bell...

[kantuta]

5th week into my orientation at the Tele unit. I am taking care of 4 pt by my own (I know there are not as many as other nurses have to take care of) I am still under the supervision of my preceptor. She is there whenever I have a question. My facility is very big at customer service, and now they decide that as part of a good customer service we should anticipate the pts needs so they don't have the necessity to use their call bells. They said they will keep a track of what rooms and what nurse's pts use the call bell, in their perfect world if the call bell is not use then the pt was well serve. But how this can be possible. I want to anticipate my pts needs but it doesn't matter how well I explained then the plan for the day, or write on their boards when their next pain med is due, some of them still ring the bell to ask the same question over and over again. In top of that, to prevent falls is mandatory in my unit to set the bed alarm in position for all the pt at risk for falls, so as soon as my pt move to reach his glasses from the night stand, the alarm start beeping and guess what the call bell turns on. I want to do rounds every hour or even more often than that so, I can anticipate needs, but sometimes this is not possible, especially when pt in room A pull his NG tube, is depress, want someone to talk with and is also in pain, mean while at the same time doctor X want to talk to me in regards of pt J, and my charge nurse is telling me that a new admission will be under my care.

Everything happen so fast during the shift, when finally I find some time to chart I do so. I am the last one to leave because of charting. And even so, when I am driving home my brain think about the whole shift and then I always find that I did forget to chart something, this is killing me. I feel sooo overwhelmed I don't know what I am going to do when the load of my pt increase...I spend most of my days off thinking in what I did wrong..scared for what I forgot to chart...mad with myself for what I did not do well..I can't sleep, and because stress my shoulders hurt...My preceptor say that I am doing fine, I have pts thanking me for the care I had provided them...but I am not happy with my performance...

Sorry for the long post...Any advice??? Is this normal??? any comment will be helpful, please...

[SoldierNurse22, BSN, RN]

It is very normal to feel overwhelmed, especially when you're newly off orientation. I didn't really start to feel like a real nurse until I was well into a year of floor nursing.

However, you have some very unrealisitic expectations set upon you. You're absolutely right--try as you may, you will never be able to predict your patients' every need. If you could, we wouldn't need to communicate, much less use call bells. While the underpinnings of what they're trying to teach you--to round regularly and tend to your patients' needs on a schedule--is valid, the idea that one could eliminate call bell use by rounding adequately is erroneous simply based on the fact that you're caring for a living, breathing human being whose status can change within the confines of a second.

If you're having a hard time finding time to chart, keep a piece of paper handy for each patient and write down the time and what you did for them. I used to have the same problem and that worked really well. That way, when you go back to chart later, you have the time and a remind of what you need to record.

Keep your chin up! You sound like you really give a darn about what you're doing. Patients need nurses like that out there.

[SoldierNurse22, BSN, RN]

If you're a visual learner like I am, you may need to find a different way to organize your information. I created the below sheets on a whim to help me track each patient. Each patient had a different sheet. Usually, the info you're seeing was written on the back of the patient's MAR (printed off each morning). That gave me a vague idea of their meds (of course, always check the electronic MAR before administering meds) and it put my schedule and other info all in one place.

[nurseprnRN, BSN, RN]

If your preceptor says you're doing fine, is there some reason why you feel you shouldn't trust her more informed judgment? :)

Sounds pretty normal to me. It will get better. I wouldn't worry about the call light thing, either-- yours are not the only patients whose bed alarm goes off all day long or who are demented and call for the nurse all night. This too shall pass.

[Nurse SMS, MSN, RN]

I learned when I do my hourly rounding the call bell really does stay silent 90% of the time.

[kantuta]

Thank you guys for your feedback. Soldiernurse22 thank you soooooo much for your sheet. :)