First RN job!! Need some tips please!

Nola009 · Apr 6, 2014

Look for styles/ideas of your coworkers. You gotta find out what works for you, and in time you will!

swansonplace · Apr 7, 2014

I am new also. A brain sheet helped me a lot. I am still working on it also. My preceptor tries to have me look up my labs, and orders first thing. Then I do assessments. If it is getting late, I bring my meds in, do my assessments, and give my meds. I do this for each patient. I try and log my vitals right when I am in the room. Also, if I have to take glucose or temps I do it all at once.

These simple things save me lots of time. Before I go in the room, try and bring everything you need so you don't have to go in and out of the room.

Also, when I walk on the floor, I look at each patient I may have: checking vitals, patient, fluids, etc. It's just a quick peek.

I jot down exceptions on my brain sheet for assessments, and the time I took the assessment so I can chart later.

Also on my brain sheet, I have a section that is a todo list. I jot down things that are on my todo list for the patient, things pending, or things of note. I cross out when they are completed. I have this for each patient.

I am still in orientation, but the brain sheet helps. Allnurses has a lot of brainsheets so just search for it, and get the ones you like.

I am new in orientation, and having lots of trouble with organization. So feel free to swap ideas with me.

annasmum · Apr 7, 2014

Where do you find the brain sheets?

swansonplace · Apr 7, 2014

On allnurses type in brain sheet under search. Share any time saving tips you have.

matthewandrew, NP · Apr 7, 2014

I don't use brain sheets, I just make sure I have the following written down:

Room

Name

Age/sex

Provider

Consults

Allergies

Dx

Hx

Mental Status

IV/fluids

Accucheck

02

Ambulation

Skin

Last BM

Voiding

VTE

Rhythm (if tele)

Plan

I just write those down in red pen and when I get report, I make sure I get to ask those questions to start my shift.

Best of luck!

Matthew, RN

Ativan · Apr 7, 2014

Basically, you need to learn to edit and cut stuff out to get to just what's important. Then when you're caught up after lunch (theoretically), you can dig deeper into the notes, chart your care plans, spend more time chatting with the patient, etc.

I don't use brain sheets, because I find it takes a ton of time to fill them out, and you can often look things up later if you need them. If you use computer charting, see if there is a way you can print out a condensed report (like whatever the residents use to keep track of all their patients). I know there is one in Epic called a patient rounding report. Then just write down or circle/highlight things that are especially important to find quickly (like code status for me). Use the computer as your brain- don't write down every single med you need to give at what time, just check the computer occasionally. You don't need to have every piece of information (last BM, last night's blood sugars) at your fingertips, you can tell the MD or patient that you don't know off the top of your head, but you'll look it up.

Learn how to do focused assessments. Maybe this is controversial, but if the patient is in for cellulitis on the leg and eating and pooping normally, I don't spend time listening to bowel sounds, I just eyeball and gently feel their belly as I scan them head-to-toe. Also, if your hospital uses charting by exception, don't over chart! A lot of nurses chart WNL and then chart all the normals under it. It's a hard habit to break once you get into a routine.

Communicate with your patients about your timeline and schedule. Say, "I'm going to do your vitals quickly right now and then I'll be back after your breakfast to give meds." That way they don't call you to ask for their meds, etc. Learn to make an exit gracefully: "I'm just making rounds to check in with all my patients and I'll be back in a bit to talk to you more."

Ask and watch other nurses to see what kinds of nursing judgments are acceptable. In some hospitals, they are very strict about the timeline to give meds, in others (like mine), nurses routinely reschedule some meds and things like dressing changes to work better for their schedule, and no one cares (be careful which meds and dressing changes you do this with, though, this takes time to learn. IV antibiotics should generally be given on time). Along the same lines, if I have meds due at 1300, 1400, and 1500, I will give all of them at 1400 together (unless there is a specific reason why they need to be at certain times. I will often run that by the patient verbally to make sure that's OK with them: "I'll be back around 2 p.m. to give you these meds, does that sound OK?" Better to find out then instead of after the patient feels like you gave them their medication late).

And of course, learn to delegate tasks to your CNA or ask for help from your charge nurse, other co-workers, or float/lunch relief nurse if you have one.

allnurses Guide · Apr 7, 2014

Brain sheet, brain sheet, brain sheet. Saved my life as a new grad and frankly still saves me at times now that I am in my third year.

A brain sheet is anything you use or create to keep yourself organized. It doesn't have to be one of the ones you find here. I make my own and it is very simple. I usually have four patients. I fold a piece of paper from the printer into fourths landscape direction. Each section is one of my patients and I put the room number at the top, then number in military time all the way from 0700 to 1900. I go through the EMAR and write in where blood sugars and medications are due for each of my four patients at the times they are due. At the very bottom I make little check boxes for things I know need to happen in my shift, such as if the patient is due for an echo, going for a procedure, dressing change, blood draw, discharging, etc. All of this takes less than five minutes.

As I go through my day I cross off the time zones/scheduled events as they happen. This sheet helps me in two ways. One, it keeps me and my thought process organized. When I don't have my brain sheet done, my brain itself is always searching to come up with the next thing I am supposed to do. Having it right in front of me helps my stress level and sense of control immensely. It also can be added to throughout the day so that I don't forget new orders that come up. It also satisfies me to be crossing things off. Two, it helps me identify gaps in my day where I will likely have time to chart. This keeps me from stressing out too much as I get pulled from room to room during the busy times.

Find what works for you, but you definitely need a brain sheet if your overall feeling about your shift tends to be "overwhelmed!". You will start to feel much more competent and confident. Good luck!

swansonplace · Apr 8, 2014

Could you give me a rundown of what your morning looks like. For example, 1. get report 2. assess patient complete head to toe - focused assessment 3. look at chart 4. give meds

swansonplace · Apr 8, 2014

I don't use brain sheets, I just make sure I have the following written down:
Room
Name
Age/sex
Provider
Consults
Allergies
Dx
Hx
Mental Status
IV/fluids
Accucheck
02
Ambulation
Skin
Last BM
Voiding
VTE
Rhythm (if tele)
Plan
I just write those down in red pen and when I get report, I make sure I get to ask those questions to start my shift.
Best of luck!
Matthew, RN

Could you give me a rundown of what your morning looks like. For example, 1. get report 2. assess patient complete head to toe - focused assessment 3. look at chart 4. give meds

swansonplace · Apr 8, 2014

Brain sheet, brain sheet, brain sheet. Saved my life as a new grad and frankly still saves me at times now that I am in my third year.
A brain sheet is anything you use or create to keep yourself organized. It doesn't have to be one of the ones you find here. I make my own and it is very simple. I usually have four patients. I fold a piece of paper from the printer into fourths landscape direction. Each section is one of my patients and I put the room number at the top, then number in military time all the way from 0700 to 1900. I go through the EMAR and write in where blood sugars and medications are due for each of my four patients at the times they are due. At the very bottom I make little check boxes for things I know need to happen in my shift, such as if the patient is due for an echo, going for a procedure, dressing change, blood draw, discharging, etc. All of this takes less than five minutes.
As I go through my day I cross off the time zones/scheduled events as they happen. This sheet helps me in two ways. One, it keeps me and my thought process organized. When I don't have my brain sheet done, my brain itself is always searching to come up with the next thing I am supposed to do. Having it right in front of me helps my stress level and sense of control immensely. It also can be added to throughout the day so that I don't forget new orders that come up. It also satisfies me to be crossing things off. Two, it helps me identify gaps in my day where I will likely have time to chart. This keeps me from stressing out too much as I get pulled from room to room during the busy times.
Find what works for you, but you definitely need a brain sheet if your overall feeling about your shift tends to be "overwhelmed!". You will start to feel much more competent and confident. Good luck!

Could you give me a rundown of what your morning looks like. For example, 1. get report 2. assess patient complete head to toe - focused assessment 3. look at chart 4. give meds

allnurses Guide · Apr 8, 2014

1. Get report on all patients. Look up labs, make notes on abnormalities, check orders with off going shift

2. Bedside handoff. Ensure patient is breathing and comfortable, introduce myself if they are awake, fill out whiteboard, see who needs pain meds, quick glance to see if I need any fluids so I can pull them with morning meds. Make sure pump has been cleared and foley emptied.

3. Pull meds for the morning, line pockets with general necessities (alcohol swabs, blunt tips, flushes, syringes etc) and specific necessities.

4. Back to each patients room, pass meds, head to toe assessment (focused if i had them the day before) light chat with the patient about plan of care for the day. Take vitals if short a tech or tech is slow or delayed (prior to giving meds of course), check blood sugars, ensure each has breakfast ordered. Check diapers.

5. Chart. I have the goal of being done charting by 10:30. Usually I can hit that goal. Attend morning huddle, give report to charge and social work/case management. Communicate with techs about who needs bathing.

6. Round on patients, turn, change them, greet family, answer questions, discuss plan of care, maybe a dressing change? By 1130 pull midday meds. Check orders. Noon, pass meds, check blood sugars, chart reassessments, ensure everyone gets a meal ordered. Go to lunch by 1330 at the latest. Bathroom break in there somewhere. Etcetcetc