Frustrated ...Thinking what am I doing.

[Cruz.Cookie]

I had a meeting with my preceptor about a nurse who complained that I wasn't taking initiative. However, I did everything asked of her yet she rated me all below average. The preceptor didn't tell me how she felt until I left at the end of the day !! So imagine my surprise when she started telling me how she didn't understand how I got this far and I'm not ready ..she ran me around like a PCT. she wanted me to be the "nurse" . Well, I got written up that I need to prove that I deserve to be in the program. I understand to take criticism and grow from it. However , I feel like I always get the short end as a student compared to the RN. In all my semesters of nursing school I've only had one complaint about "not being motivated enough " and more ratings of being a great student ...Well my question is how do I become the solo nurse without the nurse telling me what to do ?? I have never done this before and would like some advice . I was thinking I can probably look at the work list , write down /administer the meds, write down how many times to take the vitals on each patient on paper...I'm really trying to be better. What can I do to show that I am indeed ready I just need to prove it ?

[Cruz.Cookie, BSN, RN]

Part of being a nurse is effective time management. I'm in my last semester of nursing school. We're now responsible for total patient care on a minimum of 2 patients at a time, plus we have to help out with other patients if we have down-time. Each day, I do the following:

1. Get report from the night shift

2. Go see my patients to do a quick once over/vitals

3. Look in the MAR and plan out my med passes/review labs/history, etc.

4. Determine my patient goals for the day

5. Fill out my hourly grid so I know exactly what I need to do each hour

6. Go forth about my day

By using grid, it keeps me organized. I always stay ahead of schedule when I can see, at a glance, what I need to do (hourly rounding, shift assessment, med passes, re-assessment, vitals, etc.). I make notes on it, make changes to it as things arise, but it keeps me from forgetting anything important. When I stay ahead of schedule, it frees up my time to help out the other nurses/techs on the floor.

As I make my plan for the day, I think to myself "my patient has X going on. I anticipate we might need to do X, Y and/or Z. I'll need to make sure I do 1, 2, 3 during my shift". Does that make sense? Put your critical thinking skills to use and be pro-active. When you get to a point where you aren't sure what you need to do, going to your instructor and saying "this is what I think I need to do, I want to run this by you to make sure" and then reviewing your plan of care will go a long way to show her you're "getting it". For example: my patient is 2 days post-ileostomy. I anticipate I'll need to do the following today: manage pain, ambulate, incentive spirometry, continue ostomy education, etc. I then fill out my grid with all the things that need to get accomplished between med passes.

I really feel like you get out of clinicals what you put in to it. Take charge of yourself & your learning experience and you'll find that you have a much better time and your clinical instructor will see the effort. Good luck :)

Thank you do much sopranokris with the step by step detail ...that was exactly what I was thinking! Except you made it clearer. If this doesn't show the instructor my full capabilities as a fourth semester nurse then I don't know what will. At least I can leave there knowing that I did this to my full potential ..with no way around it. Thank you!!