Need advice , especially from those who used to be techs.

live4today, RN · May 9, 2002

Anagray, it sounds as if you are already doing the very best you can so stop beating yourself up. It's good that you have the staff behind you and that they are supportive of you which shows that they think a great deal of you as a person and as a professional tech assist. As much as you would like to be more organized, sometimes the type of unit a tech works on makes it more challenging to stay on a time schedule, but as long as your patients needs are being met, and no one has crashed due to anything you did, pat yourself on the back and call it a great shift accomplished when you clock out at the end of your shift! Hats off to you, and God bless you for all you give to your patients and staff of peers. (((HUGS)))

CountrifiedRN · May 9, 2002

Hi Anagray

It sounds like you've got your hands full at work! A two day orientation doesn't sound like a whole lot of time to get the hang of things on a busy unit. Any chance you can ask your employer for another day or two with a preceptor so you can see how to organize your shift?

When I worked as a CNA, the first thing I did at the start of my shift was get report from the CNA before me, or if he/she was busy I would skim the pts chart to see who was independent and who needed assistance. I often came about 15 minutes early to be able to do that. But it helped a great deal to know how to allot my time accordingly. (If the charts were not available, I would ask the charge nurse, or unit secretary if they had an idea of the pts activity level. All in all, I would at least have an idea of the majority of my patients status)

Then I would set about getting the vital signs. I just used a piece of paper and wrote the all pts room numbers, T,P,R,B/P, & O2 sats. I made the VS my first priority, unless something important came up. As I went from room to room to take the VS, I introduced myself, and let the pts know that I would return shortly to help them with what ever they needed. I also made notes on my paper if a pt asked for something so I wouldn't forget about it. Once the VS were complete, I would go make a copy for the RN so that she had it at the beginning of shift. Then later, when there was time, I would chart them.

BTW, just wondering about you having to do rectal temps. Can you do them by another route, or is it due to the units policy? I'm also wondering why there are pts who are soiled when you come on shift. Is there another tech that is there when you come on? Where I worked, the pts who were incontinent were supposed to be cleaned before the next shift came on. If it had been a busy shift, then the CNA getting ready to leave would at least help you do the ones the he/she didn't do before leaving.

Anyway, hope this helped a little. Your unit might have different policies, so don't know if what I used to do on my unit is even feasible on yours.

You'll get the hang of things soon, it takes a while to learn how to manage tasks at a new job. Just keep asking questions, and it will all start to fall into place. Good luck, and keep your chin up!

Anagray, BSN · May 9, 2002

Hello Renee and Rn2b! Thank you for your support and kind words!

Rn2b, I usually come to work about 20 minutes before my shift and talk to other techs, see who is still in the rooms and who is a newcomer. ( i should probably used that time to find a critikon, shouldn't i?)

I work on a cardiac floor. Most people there are for monitoring, pacers and caths. On one side we have people who come in just as outpatients, then we have rooms which are occupied for 24-48 hours and on the side I worked on for the last week, it is usually for patients who have major problems and are being read either to go to heart surgery and transfer to ICU or to go to other floors, but not as a cariac patient, so the rotation of patients on the floor is usually very quick.

The reason why I need to take rectals on some people is because they are usually incoherent and their mouths are open all the time. Most of these people are elderly, and the nurses advise me to take rectals, which as u know are much more reliable than underarm.

Why they are soiled, i'm not soo sure. It could be they haven't been changed in a while, but some of them are also intubated and are on supositories, so they just go constantly. what makes it hard is that 2 of those patiens are quite large and on top of that they need to be turned every 2 hours, because they have stage 4 decubiti.

I do have a notepad where i write down everything from vitals to I&O and bllod sugar, even if i do chart it. In case if there is a mistake or a problem, i can alway go back to my pad and confirm everything.

I'm glad u think it's a good idea. Some people think using printouts from the machines is better.

Thanks again for re-assurance. I will as my super if they can have me orient for another day.

Be well!

MPHkatie · May 10, 2002

I was a tech for 4-5 years as I went through nursing school- spent 6 months on an ortho/Gi floor (someone crazy though up that combo for sure) and then I was an ER tech- which is my total recommendation. I recommend it to everyone who is a tech though, and it probably isn't for everyone.

But when on the floor I usually had about 15 patients. I did vitals q four hours. WHile doing vitals I rolled along a cart with ice to refill peoples pitchers, I also put juices and sodas on the bottom, with some other high demand items (toothpaste/soap, washclothes) So I could just hand them to pt or family as I was already in the room. that saved me a ton of time. I would also sometimes ask the RN's to get the vitals when assessingt he pt, except temps, then I would head down the hall, turn pts and do temps- which are a lot quicker than everything else. Trouble is, you gotta work with good RN's. Mine were pretty good. I would also sometimes ask the patients RN to assist me with a consistently solied pt- if they are constantly urinating, usually the RN would get a foley cath order, because even if you clean a pt immediately, the constant urination is so bad for the skin, If youcna carry the fingerstick machine with you wike you do vitals, do that.

What I foudn with my little cart was that the less I had to go back for stuff the more time I saved and the patients loved having me say, "I've got that soda right here...." Or slippers or whatever they wanted. you will develop all sorts of interesting ways to get it all done over time. Give yourself 4-6 weeks to start to really know the routiene of the place and then things may start to seem easier.

whipping girl in 07, RN · May 12, 2002

I work in ICU and we do axillary temps on pts that for one reason or another can't have orals. Haven't had a problem.

Even if the pt's tongue is lolling out, as long as you get the probe in there deep under the tongue (forgive me, I can't remember what that space is called!), you should get an accurate temp.

We RARELY (OK, never!) do rectal temps. If your hospital does not have a policy that says you HAVE to do rectal temps, don't do them if you can do axillary (unless the doc orders them for some reason). There should be a policy and procedures manual on your floor. Take a few minutes and look at it sometime just to see. Sometimes we tend to do things a certain way because that's how they've always been done, not because we have to or even because it's the best way.

And give yourself some time to get used to everything. You'll eventually work out your own routine (which will more than likely be different than anyone else's) and you'll do just fine. In the meantime, do your best and learn from the mistakes you make.

And don't let the prior shift dump on you by leaving you a dirty patient! Try to round with the tech you are following so that they can tell you about each person as you walk and check on them. If you find one that's dirty, insist that they stay and help you. Just don't be surprised when you sometimes have to stay and help. It happens. I rarely get off work exactly on time. I consider myself getting off "on time" if I leave within 30 minutes of quitting time.