First month on the floor... I need advice

[perfectly_4given]

I just passed my boards and am expierencing nursing on a Medical floor, where we practice team nursing. As a new RN im pretty scared. I feel in a way terrible that I am 23 years old and now have to delegate some things to these wonderful LPNS that have been nurses for 20plus years. in a way i feel its not my place :-/ .

Also I need some advice on organization. We have up to 10 patients at once...(in team nursing we dont pass any of the oral/subQ/IM injections) . so it can be a handful im trying to figure out how to gather ALL of my patients inforatmation through out the day. from writing doctors orders, assessments, lab values, exe. for each pt. can be messy!!!

One last piece advice, My preceptor can be pretty impatient. My nurse manager knows this. She told me before i even started with her to dont feel like "your being pushed away" How do you deal with taht when your just trying to learn and survive without feeling not only the pressure of the day but the pressure of the preceptor being impatient and trying to take over your work?

-Perfectly

[Wicked Wahine]

I'm a new grad working at a LTAC facility that uses team nursing. We usually have 10 pts per team, with an RN, an LPN and a CNA. We split up the group of patients based on accuity and IV pushes during the day shift. Sometimes, if it's an IVP heavy group, this means that the LPN will have 6 pts and I'll have 4, but I still am expected to do a minimum of 5 pt assessments every shift. I am struggling to keep up with all of the new orders and whatnot on the LPN's patients but every day I seem to get a little better at it.

It sounds like your facility does team nursing a bit differently. Maybe you can start the day with a blank piece of paper and make 5 boxes on each side for each patient. Write their names, room numbers, attending, admitting diagnosis and any big glaring comorbidities, like DM or renal failure or whatever. Write down the times for all of your scheduled IVP's and IVPB's (here RN's have to hang IVPBs for PICC lines, LPNs can only hang IVPBs on PIVs) and cross them off as you go through your day. Write down any labs that matter, like wacky K+ or H&H's. You can also leave space to write in new orders as you come across them, just make sure to check for new orders every time you walk past the charts, even if you are in a rush. I have finally come to realize that if I don't take the 1 minute to acknowledge new orders, they will all pile up to the point that I end up missing stuff. I also write a little side list on my paper of my unscheduled tasks, like "1. change PICC dressing on so and so. 2. insert foley for so and so. 3. change out IV lines on so and so" and then I just cross them off as I get them done. If it's a crazy day and I don't get all that stuff done, it leaves me with a good list to pass on to the night shift. Anyways, that's what seems to be working OK for me right now.

As for the preceptor, just do your best to be proactive about your learning experience. You will be on your own and the more you can experience now, the better prepared you will be. If this means you need to have a frank discussion with her about doing things yourself without her taking over, then you must do it. Acknowledge that you realize that it is probably very frustrating for her to see you do things so slowly but that you really need to have this time with her watching over you so you can learn how to get faster at your skills while doing them properly.

Good luck! I know it's overwhelming but you can do it. Just keep it up!

[RheatherN, ASN, RN, EMT-P]

I wanted to address the part you said about the delegating to LPN's that have been there 'forever'. That was very hard for me too! Heck, to tell ya the truth, it was hard for me to delegate to the CNA's. But its really comething that yhou need to learn to do.

i just wanted to say good luck! we do not do team nursing. although we used to have an LPN that we would super, but she is not longer there.

-H-RN