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First nursing job - help

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Mariec3 Mariec3 (New) New

Has 1 years experience.

Hey guys,

I'm a new RN, just passed my NCLEX and started my first job on a cardiosciences unit. I had my final practicum on CCU and loved it so thought the cardio ward would be a great place to start. I was so excited when I got the job I wanted!

I started jan 10. The first orientation went ok.. I learned some speciality procedures like pulling temporary pacing wires, managing chest tubes etc and felt pretty confident with those skills. My first couple days taking a patient load along with a nurse went ok but I felt rocky and like I wasn't ready. I mostly had trouble with putting patient stories together and REPORTING OFF. At the end of the day I could not seem to put a face to the name when reporting off. I think I have worked myself up with reporting off and it drives me nuts every time I have to do it. (Also not used to having 8-10 patients)

I had 3 orientation days and 2 nights. I had my first 3 nights shifts alone this week and they won't ok (besides asking tons of questions and feeling so SLOW) I thought except for REPORTING OFF!! I am trying so hard by adding to my report sheets and my 3rd night I took extra time to check charts and make sure I had stories straight and everything uptdated. We were short by 2 nurses so it was a busy night but I did my best and felt ok. Then when it came time to report I realized I did not have everything straight!!! I stumbled through report and the nurse was asking me so many questions, some I knew and some I didn't. I apologized for the rocky report and one of them said no no it's ok and the other was just silent... so I feel really bad and like I just can't do it. If I can't do it on nights when I have the time to go through charts, how will I do it when I'm on days and it's busier!!! I find the report sheets confusing and not in order, and although I've tried to familiarize myself I stumble through report. I know I need to tell it like a story in a time logical way but I always am everywhere.. and feel like I don't make any sense...

Suggestions would be great... feeling really discouraged and like maybe such a busy setting isn't for me.

LessValuableNinja

Specializes in Cardiac (adult), CC, Peds, MH/Substance. Has 8 years experience.

Just to clarify before advising: You had a total of 5 shifts of orientation as a new grad?

Mariec3

Has 1 years experience.

Actually 6 total of taking a team with another RN. Before that I had an 8hour day with just information about the unit and an 8 hr day to review specialty skills (pulling wires, pulling small bore pleural tube, managing chest tubes)

my last two day orientation shifts were super busy too so don't feel confident with my day shifts. I did learn a lot and they told me if all I feel uncomfortable with is reporting and time management just know I'm not alone... but extr shifts would be denied

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

You definitely did NOT get an adequate orientation.

Are you organizing your report by system? Having a format for reporting off makes it much easier to remember the pertinent info. You're working in an acute area but not critical or intermediate care so there's a lot you can leave out without worrying you're not giving the next shift enough information. Start at the top and work your way down. For example: "Room 213, bed 2. Mr John Smith, patient of Dr Jones, for discharge today. Interventional cath on Tuesday with pulmonary stent placement. Alert and oriented x3. No complaints of pain. Pink, warm and well-perfused. BP 120-130/70s. Cath site dressings are off, a small hematoma present at the right femoral arterial insertion site. Anticoagulation is clopidogrel 75 mg PO daily. Access is a left upper arm PICC, only infusion being milrinone at 0.25 mcg/kg/min. which was discontinued at 0400 as ordered. Lungs are clear, O2 sats >96% in room air. Rate and rhythm normal. Diet as tolerated, appetite fair. Urine output slightly decreased, 0.4 mL/kg/hr average, so furosemide 40 mg PO ordered q8H. Fluid balance +200. Wife will be here early for med teaching. Otherwise he's ready to go."

Mariec3

Has 1 years experience.

Thanks, that actually helps a lot.

We have to add to a "nurse handover sheet" online, print it off and then it pass it on to the next nurse and we report off using that... So sometimes it's overwhelming with all the info on there. It's very poorly organized and at this point this is what I use as my report system.

I am definitely getting overwhelmed with all the details of history and need to just focus more on the basics and the care NOW. We don't take our assessment sheets or add it onto that sheet so I was having to remember it off of my head... I will write notes on my assessments on my report off sheet so I can put it all together and not rely on memory (especially when I'm nervous!)

Edited by Mariec3

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

All of us carry some sort of peripheral brain to help keep us organized and to keep track of important data. Some people find it very helpful to make notes on their sheets in a different colour so whatever essential data is easily seen and communicated. I work in a high-acuity ICU, so I typically only have one patient. You'd think it should be easier to stay on top of things, right? Let me tell you, it's not! I use a worksheet that I record all my scheduled meds on, all necessary lab draws, treatments, line changes, alarm parameters and so on. I jot down things on it all the time, partly to remind myself to chart that PRN med or consult visit or critical lab result, but also partly to remind myself to pass the information on to the next shift. I commend you on seeking some suggestions about how to manage the issue, rather than throwing your hands in the air and declaring you just. can't. do. it. Or worse, calling yourself all kinds of nasty names because you're not there yet... when you really shouldn't be! Build on what you do well, recognize the things you're still shaky on and ask for help when you need it. We've all been there, but unfortunately not all of us remember that.

I recently just started my graduate year on a high acuity ward. Handing over to the next shift can be tricky, but at the hospital I'm working at we use a handover system called ISBAR. Doctors, nurses and allied health use this and it works really well. its worth trying and gives you a systematic approach to handing over.

Introduction - introducing yourself, and the patient

Situation - why they are in hospital, what is their current issue

Background - past history, what has happened previously on your shift and others

Assessment - this includes your observations (vital signs), what they have insitu such as drain tubes, cannulas, catheters, etc. results of any procedures or blood work.

Recomendation - what is the plan for this patient and what the next shift needs to get done. Usually get a good idea of the plan after doctors rounding.

this was drilled into me while I was studying and it has been really helpful in ensuring a structured handover!

I also feel a bit discouraged some days but we just have to push through! Hope this helps!

I use the system going from the big picture/most important info to the least important/small details:

1) pt's name, room number, admitting dx, related hx - Mr. Jones in room 11-1 admitted with CHF exacerbation, hx of PCI in 2012

2) what we're doing for the pt, and what's the plan - basically we're diuresing him with lasix 40mg IV q8h, with good urine output, planned for an echo in the morning

3) pertinent info/important findings - he is still having SOB, on 4L O2, crackles on the lung bases, and +2 edema on lower extremities. His BNP is elevated at 1234 and troponin leak at 0.08, rechecking every 8 hrs. Last CXR showed bilateral pulmonary edema.

4) other normal findings/less important details - otherwise he's A&Ox4, NSR on the monitor, vitals stable, he can ambulate with a walker with 1 person assist, skin is intact, IV 20g on the left AC saline locked.

Usually it takes me 5 minutes to give report on a patient. I find this way working for me, at least the oncoming nurse have a big picture of the patient even if I left out some small details. It's completely normal to feel not confident at first, but you'll find your way of giving report.