encouragement please

[sistasoul]

Hi all,

I graduated in May 2008. From there I went to a LTC facility to work because the hospitals were not hiring full time new grads at the time. I worked for 5 months at this facility and decided to bite the bullet and take a job in a hospital even though it was only a 32 hr position every two weeks- hence no insurance. I really needed to practice my skills so I took the hospital position figuring something would open up full time eventually. I started this position in March on an ortho-medsurge floor. I only received 4 weeks of orientation on the floor. The director that hired me knew this was my first job in an acute care position and I was a recent grad. I was suppose to only get 3 weeks preceptoring but my charge nurse got me another week. I was told I could not get the 3 months that a new grad normally gets because I did not go through the new grad orientation. The new grad orientation fills up quickly and only accepts 12 people and these people typically come from the school that is associated with the hospital. I decided to take the position figuring there was definitely no guarantee I would get into their new grad orientation in the Fall. Hospital positions are not plentiful in my area.

My main problem with this is that I am now being told I am to slow. I have only been on my own for 6 weeks. I feel like I am constantly running, I never get a lunch, and can not chart until the end of my shift. I feel like I am just barely able to get the meds out and do the assessments and do not have the time to be able to really know what is going on with my patients. The other day I had a patient with an H + H of 7.6 and 26.2. I did not even have a chance this day to check his labs and I was there a 12 hr shift. The Doc called at 8PM and ordered 2 units of blood to be administered and his heparin to be discontinued. Granted the labs were drawn that morning and the 7 AM to 7PM doc did not pick up on this. As the nurse i feel like I should have had time to look at these labs and inform the Doc. I felt so bad about this that I went into an empty room and cried. I feel that my patients are being neglected and I feel so badly about it. I just don't know how I can keep up this pace and feel like I am not doing enough for the patients. Is this normal in nursing? It is never the patients that take up your time but rather it is the constant interuptions from PT, OT, pharmacy, pastoral care, family members, radiology, ultrasound and Drs that take up all of my time. Please tell me it gets better.

[colorado nurse]

ok well i have never worked in the hospital setting. but it does take some us longer to get our routines down. have you tried talking to someone who has worked the floor a bit longer and asking them how they keep on top of everything? granted things are a lot different from your clinicals and the "real world" but how did you prepare your day when you were at clinicals? one thing i always tried to keep in mind from report was what appt do you have, who is the most critical (as far as your assessments), what labs have been drawn or need to be drawn and prioritze that way. also depending on diagnoses start your assessments with prioirity and try to get them done asap. i also used to make myself a cheat sheet with room numbers,dx,meds if they had more med times throughout the day and then leave yourself some space to write little notes for when you go to chart. chart whenever you get a chance even if that's the only chance you are going to have to sit.

nursing i have found is a lot of time management and lots of running around.the more you can prepare yourself the less running you will do. get to know your doc's and when they make rounds so that you know what you need to be up to speed on before they get there.

Hope this helps and hang in there.....i think we all get frustrated at the beginning of our nursing careers. best of luck to you.

[netglow, ASN, RN]

I can't offer any advice, just some :icon_hug:

[blondeoverboard]

time management is a big part of the crush you're feeling. what stood out to me was your comment that docs, and ancillary are eating up your time. the docs i can understand but pastoral care, PT/OT/speech/rad, etc should be able to function of their own accord. when i start a shift the first thing i do after getting report is pull up my patient's labs and flag everything that is abnormal. is it new? has it been this way for some time? if the sodium is 120 today and it was 118 yesterday i won't call but if it's 120 today and was 135 yesterday you can bet your butt i'm on the phone. if you have multiple patients with the same doc, review all of their charts and make one call. the doc will appreciate not getting 50 calls and you'll have "extra" time. are you making use of your resources? your unit clerk, nursing assistant and charge nurse are there to help you out. one of the first things i did when i stepped on my first unit (neuro icu) was identify the power players and strike up a relationship. it never hurts to have a more experienced nurse to turn to for advice and some tricks and tips. also, visit with the education department in your facitily. ask for a refresher in those areas where you feel weak. that's why they're there. how are your assessments going? do you feel comfortable in your observations or are you second guessing what you're seeing and hearing? carry a note pad and, as you do your assessment, make notes. dont leave your charting until the end of the day. a little bit here and there throughout the day is much more accurate than trying to remember everything that happened 12 hours later. follow a head to toe assessment pattern and apply it to each and every patient. it's easy to become overwhelmed and frustrated (i did my share of crying too) but when you know where to go for the information and help you need... the job gets easier. the fact that you're asking for help is a good strong sign that you care about the quality of care you're providing and have a desire to improve. you'll get there.

[mommiof2kids]

It's been 11 years but I remember feeling exactly the same way you do now. It will get better, I promise:hgu: So, first off, what are you using to organize your day? Do you have a jot sheet? If you don't start using one right away. This will help you organize your patients, and your day. When I started out as a new grad I used one that broke my day down by hours. Whenever I had a med, or VS, assessments, labs etc.. I wrote it down in the appropriate time slot. This way you have a visual of everything that is going on in your day and can plan ahead when to chart, eat lunch etc.. Next, start with your "sickest" patient first. Go do your assessment. Make little notes to yourself on your jot sheet. Write you VS down, I&O etc.. Take care of that patient and any interventions that are needed right away. Then go see your next patient. Once you have seen all of your patients you need to chart your assessments. This should all be accomplished by 0830. By this time you should be ready to start on your meds. If you get in report that someone's lab values are out of wack then do your assessment, when you're charting check their labs. Then call the doctor. Always assess your patient before you call the doctor b/c they'll want to know current VS, assessment etc.. Try to chart a little bit throughout the day rather than saving it until the end of your shift. Not only is that overwhelming but it's really difficult to remember all of the details. Remember, there is nothing wrong with asking for help or telling your charge nurse that you're overwhelmed. That is what they are there for, to either help you trouble shoot and come up with a game plan or find someone to delegate a few things to. Keep your chin up. Keep plugging away and you'll get it!

[It'sMe, RN, BBA, MBA]

What you describe is the common everyday experience on my surgical unit. Most of the nurses end up crying by the end of the shift. I end up dehydrated and having cramps all night. Three 12s in a row absolutely kill me. Exhaustion is my constant companion. We don't eat or drink and that keeps us from going to the bathroom. The mood goes from happy and friendly to angry and isolated by noon. The worst thing you can hear is "your getting a postop in room 48." Not enough time to get anything done. Floor nursing has become a list of tasks to get done and get it charted. You need to get on top of your charting at all costs. I doubt you are to slow but you are probably not doing the things that "they" want you to do. The nurse that is considered the best on our dayshift is rude to patients, rude to her peers except the ones she wants to suck up to such as the charge nurses and the nurse manager and can amazingly enter a room, do a complete assessment and be out in under 2 minutes. Of course her patients often don't know "who" their nurse is or if they actually saw one. Yet she is the NM's favorite nurse. Things have changed in nursing. I doubt they teach in nursing school how to make it in the new world of floor nursing.

Hang in there, it will get better.

[nathangenesis]

These comments gave me an idea of what to expect in the area. I'll start my hospital experience this week. Thanks, fellow nurses.