Feeling so overwhelmed

Piki · Oct 9, 2007

Don't be so tough on yourself. I'm on orientation (just a few weeks left, we get 12 weeks) and although I'm getting more "with it" and organized, I still have a ways to go. Everyone tells me that's normal -- it will take at least a year on the job to feel grounded. Those first few weeks on the floor I felt exactly the same as you are feeling - like a first semester bumbling nursing student! Hang in there, it will get better. :welcome:

RN1989 · Oct 11, 2007

You are going to get complaints about your report until the day you die. Since you're a newbie - you just happen to be an easy target. After you get experience, you'll hear complaints about yourself through the grapevine but most don't have the nerve to say it to your face. So take any constructive criticism about report and ignore the rest. Frankly, if you tell me what is normal with the patient, I feel like you are wasting my time. What is normal is not pertinent to my care. I want to know what is wrong so I have an idea of my plan of care. And if you don't know the exact time you gave meds - I know how to read! :)

You should be using some kind of form to take report and write things down on during the shift - commonly referred to as your "brains". Many nurses find that making their own form up helps them to get accustomed to remembering what they need to do in the room. Then you just make a bunch of copies to use each shift. I no longer have to use a form, but if there is something in report that I know I need to look for, I write it and leave a blank line that lets me know that I need to fill in the blank. Example: pt has accuchecks AC/HS. I am working a 12 so I have 3 sugars to check on and cover. So on my sheet I write

07_____11_____17_____

This reminds me to check the results. I write down the sugar in the blank space - that way I know what it was and can remember to give it in report, also then I go to the MAR to do the insulin. But the filled in blank also clues me in that I DID look at the sugar and do something about it.

When I was new, I also used different colored pens (4 color pens) to write down med time. blue for po, green for iv, red for stat/one time/timed dose. If there was a po and iv med scheduled at the same time, I wrote 09 in green because the iv med takes more work than a po, so I know that I will have to take extra time, and then just take the po med with me when I go. Same for red pen - stat/one time/timed dose is more important so the other meds can come along for the ride if they are at the same time.

You should make it a point to check edema and DP pulses on everyone. Then - you won't forget to check because it will be part of your routine assessment. You can tell a LOT by pulling back the covers and checking for a pulse. Many people think it is weird that they have a pulse in their foot. So they will be more than happy to have it done. After you've done the heart, lungs, abd - pull back the covers and say "I need to check the circulation in your legs" While you're feeling for a pulse, you can also be feeling temperature (cold is bad), color (blue/ruddy is bad) sensation (none is bad) edema (+ is bad). You can also check mobility because patients generally start kicking covers off and move feet where you can reach them - if they don't do this, then you ask them to wiggle toes, pick their legs up off bed while you put weight on their ankles by holding them down to the bed lightly. This is also a good time to check Homan's on at risk patients (post partum, post-op, hx of dvt, decreased mobility). If you make this part of your exam on EVERY patient, you will have done a pretty thorough exam and gotten a lot of info in literally a minute or two. And it is applicable to pretty much all settings. Don't forget that your neuro assessment is also included in talking to pt (ao x3 or not), how they move in bed, sensations, pt goes "whoo, I'm dizzy when I sit up". You can basically assess everything at the same time. You just have to stop and think about it.

Ask the patient's family to leave during your assessment. Usually the only one that says that they want to stay is the spouse or the primary caregiver of an elderly person. Say "I need to complete my assessment on Mrs. Doe right now. So if you could step out for just a few minutes since I need to examine her thoroughly. You can get a cup of coffee if you like. I'll be through in a few minutes and then you can come back in." If they are dumb and don't get the hint, tell them "I need to look at certain areas and we need some privacy." If they really don't get it - Then I tell them (if they are elderly, bedbound, minimally ambulatory etc) "I need to check your backside to make sure that you aren't getting bedsores and I prefer to do it without everyone seeing you". That usually gets everyone moving pretty quick. If someone wants to stay, I only let the spouse/caregiver stay and only if the patient is agreeable to it also. Don't be afraid to ask them to be quiet. Explain that you need to be able to concentrate on your exam so that you don't miss anything and you need it quiet. Most people will get up and go because they feel dumb sitting their watching you, not saying anything. You will usually find them huddled around the door on your way out of the room.

If you remember nothing else - YOU ARE THE NURSE! It doesn't matter that you feel dumb and you don't think you learned anything in school. Have you heard the phrase "Fake it till you make it"? You need to act like the nurse. Doesn't matter if you feel flustered - hide it. A stethoscope in the ears while you "listen" to lung sounds can help you focus and regain composure. These patients know less than you do. So act confident - even if you don't feel that way. If you need to - say "I'm going to listen to your heart now". Then "I'm going to listen to your lungs now. Take big deep breaths until I tell you to stop". Telling the pt what you are doing/going to do helps you remember what you need to do. It also helps them know to be quiet so you can listen. And if they don't know you from Adam - then they won't know that this is your trick to keep yourself focused and not forget things. Stop letting it overwhelm you. Think of yourself as the patient. Assess yourself, decide on the outcome you desire, then make a plan on of action to achieve the outcome. Use the same nursing process for these issues as you use to plan what to do for your patients.

SuesquatchRN, BSN, RN · Oct 11, 2007

RN1989,

I just pasted that into Notepad and printed it out. I've been feeling overwhelmed, too, and plan to read it before report tomorrow morning.

Thanks again.

AstonishiaInlimbo · Oct 11, 2007

I will seriously make that as my mantra when I start too..." I am the nurse...fake it till I make it..."

hehehe!