New Nurse-Bad Bad Day

[mjmiller525]

Please help!

I'm on a PCU floor (ICU stepdown) and I'm still in orientation, but I only have 3 weeks left. I was with a different preceptor yesterday. She was completely hands-off. She did offer a little help but she mainly wanted me to do things on my own. It was a disaster. We get 3 patients...Shift report started okay, and then it all went down hill. I got stuck in my 1st patient's room for 45 minutes and I couldn't recover after that. I had orders coming in right and left, family kept calling me, lab was calling, an IV went bad, I needed to draw blood, LOTS of pain management. I worked an 8 hour shift and I didn't get my assessments charted until 2pm (and I really didn't even put in good assessments because I rushed through it). I got everything done and was only 20 minutes late, but I only turned my 1 patient twice (in 8hours), my other patient's urostomy bag was leaking and I never got in to change it (I passed that off to the next shift), and he complained of constipation and was asking for an enema. I only gave him miralax. I couldn't keep up and I felt like I was barely floating above water. Gave terrible patient care because I was so focused on getting the tasks done. I want to be a good nurse and I'm really hoping to get my flow... Any advice???

[Tait, MSN, RN]

Sounds like your preceptor dropped the ball. Next time demand help and delegate things you can't manage to her. It is her job to help you learn time management for your floor, and make sure all the patients are safe, considering it is her team as well.

It will get better, I promise.

Best of luck,

Tait

[moonischasingme1]

I think that your preceptor should have freakin' helped you when she saw you struggling, especially if a patient isn't being turned, etc.

Did you ask her for help at all? I know it can be hard sometimes when you don't know someone very well or how they might react, but definitely ask her for help and tell her what you're struggling with...

[mjmiller525]

Yes, I did ask her for help. She passed 9:00 meds for one of the patients and gave a bath for one of the others. She did ask me if I needed help, but there wasn't much else she could do. Most of what needed done was charting and she didn't do any of the assessments. She did kind of disappear a few times... I just didn't realize how much paperwork there is to do. My usual preceptor helps a lot more and keeps the flow going. I think my major problem is that I'm usually doing things my preceptors way, instead of my own. So then when I actually had the opportunity to do it my way, I sunk because I don't have "a way" yet...

[moonischasingme1]

Sometimes you're just going to have days like that and as time goes on you will know how to time manage better! I've been a nurse for a year and have had many days that sound like that, even just yesterday! You just gotta figure out a flow, like you said. It will come together!!:)

[macbelleRN]

I have worked on a Progressive Unit or step down unit as well. Let me tell you even with experience it is easy to drown or feel like your constantly treading water. While I agree with the others that your preceptor should have helped you these things do happen when you are on your own. Sounds like your floor may need a complete teamwork seminar! On these floors everyone needs to work together. I know on our unit at times someone accidentally got a better load or they were charge nurse and everything was under control. These people would go up and down the hallway turning and checking patients. Another thing that is difficult as a new nurse is delegation. There are things that can be delegated to your NA's. Don't make a habit of constantly asking them to do something for you and only you but it is their job to assist us! Another recommendation that helped me when family members would call 5 minutes after I got report I would politely ask them to call back later after I've had a chance to assess their loved one and check on their needs or get a number and call them back when you feel like you are able to catch your breath.

Best of luck to you!! You will get this! This type of floor was one of the hardest places I've ever worked!

:redpinkhe

[ChristyRN2009]

I work on a stepdown unit, and there are a few days like this. It happens less and less with more experience. You will eventually learn what is priority and what is not priority. Giving a bath is not (and should probably be delegated anyway to a NA) but the other things are. Your preceptor could've started and IV and when you couldn't find her, ask a charge nurse to help with that. Its a hard task to learn but you need to learn when to delegate and when to ask for help from a manager. I also struggled with this when I was a new RN because in school we're pretty much taught NOT to delegate in clinicals since they want us to get all the experience we can. But in the real world it is 100% necessary to do so. And when you can't delegate to an assistant, tell your charge you are in the weeds and need assistance. It's everyone's job on the unit to care for the patients.

[mjmiller525]

Thank you all so much! You are all very encouraging. I love my floor and the people I work with. I know I will get the hang of it.. I'm sure all new nurses go through a similar experience. I'm looking forward to a very rewarding career!!