I am a new nurse working on a busy telemetry floor on the south side of Chicago. I have a couple of issues to put forth that have been bothering me for a while now. Sorry about the length, and I did try to cut it down, but I don't think I can adequately describe my situation otherwise.
I would consider myself a thorough person when I do anything in life. I really try to do things the right way and do a good job, and I take pride at still doing them this way behind the scenes. So, when it comes to my nursing assessments, being a new grad, I try to do them as I was taught, which is, obviously, assessing everything from head-to-toe. So, as I do them, I try to actually think about what I am hearing with the heart and lung sounds, to take about 15 seconds for each quadrant when I listen to bowel sounds (I mean, who seriously has 5 minutes per quadrant like they say in the books??), check skin, pulses, edema, actually assess their orientation status, etc. I also take their vital signs. This, on average, with normal verbal interaction with the patient, takes probably 7-10 minutes. On nights, we have 5 patients, so on average for my initial assessments and vitals, I would say it takes anywhere from 40 to 55 minutes (give or take) to assess all five patients.
Let me also mention that I am more of a slow-paced guy, meaning in general I don't like to have to rush through things. I prefer to take my time, slow down, process what is in front of me, and not do things as if I have to meet some sort of deadline all the time. I'm also much more people-oriented than task-oriented. And with this in mind, I try to be consciously aware of time so I can pace myself and not get too caught up with one task.
But, even with this mentality, I still find that most other nurses around me (newer and experienced both) seem to get things done significantly faster than I do. This makes me wonder what I am doing wrong. Am I still going too slow? Am I being too detailed? Are they cutting corners? I am not in any way intending to be accusatory here, but I honestly don't know how others can do thorough assessments on their patients and still be that fast, you know? I know with experience that it becomes easier to recognize certain things and to know what to pay attention to with greater detail, but, isn't there still a minimal standard of thoroughness that everyone is required to meet? Again, I don't want to inappropriately imply that others are cutting corners because God knows maybe it's just me, but for the life of me I just can't understand it, given that objectively, with the time noted above, I think I am being efficient. But I am afraid that if I move any faster, I will start missing important details that I would otherwise notice. And, honestly, doing it any other way, I think, would require me to take short-cuts, which I can't in good conscience do and honestly have no idea how to do (I mean, are there safe short-cuts?). Side note: I realize that the detail nurses are taught to go into in nursing school with assessments is completely unrealistic in the real world, so just for clarity, I do understand that a healthy compromise is necessary (i.e., listening to the lungs in 2-3 places for each one, not 6, etc.).
Lastly, to give a little insight into the OCD part, when I do my reassessments (we do 3 assessments total on our floor), I take vital signs and listen to the heart and lungs, and only chart on what I actually did, which in these cases, is the heart and lungs and other things like skin/edema and things you visualize without realizing it when you go into the room. Although, sometimes I question whether or not I should chart on these things, too, because I never actually consciously look at them (i.e., is the patient's edema still severe, or has it decreased to moderate or mild now? You know what I mean?). This was just suggested to me by one of my preceptors because, I presume, it looked like I wasn't charting on enough things for my reassessments. Anyway, all we ever hear is, "Don't chart on things you don't assess," and instructors and managers alike are VERY strict about this (for good reason), and yet, when I actually try to apply it, it seems like I am charting too little (as suggested to me by some of my preceptors). So, I recognize what seems to be like a gray area, and I chart a little more (such as the skin/edema example above), to which I have had other nurses ask me, "Did you REALLY look at that edema?" (or fill in the blank). It just feels like I am damned if I do and damned if I don't. Even though I am on my own now, this has been an issue I recognized in school that has still not settled for me, mainly because of the inconsistency in feedback I have received. Which makes me wonder why other (particularly new) nurses don't have this same struggle, which makes me ask myself, "Am I crazy, or is this OCD-like?" By the way, I do have Pure-O OCD, but I recognize it and have been able to control it well. At any rate, though, this issue seems like one that would be more common to every nurse, given that nursing standards claim to be so black and white when it comes to charting.
Anyway, I would really appreciate thoughtful answers/encouragement. I've racked my brain a ton over this and can't seem to figure it out, which is why I am questioning and doubting myself and thinking that maybe it really is just me, in which case I would love advice about how I can be better and improve because that is ultimately what I want.
Thanks so much for your time, everyone.
Jul 13, '17
When you're new, you're slow. As you get experienced, you can go faster. Don't beat yourself up. Five assessments in less than an hour is great! It's easy to just look at the edema while you're listening to bowel tones, etc. You'll get it.
Jul 13, '17
Thanks, Ruby. I appreciate the support!
Jul 14, '17
Hi, Ethan -
I suspect that what you are is an excellent nurse in-the-making. I'm serious. Not only are you trying to do the best for your patients, but you have significant insight into your own operations.
Am I still going too slow? Am I being too detailed? Are they cutting corners?
You are not going too slow, though you are likely to pick up speed as you advance beyond novice level. The good news is that, with a conscientious person such as yourself, you are likely to naturally develop ways to pick up speed while at the same time making few compromises in quality. You are likely not being too detailed, especially at this stage of your career. It takes time at the bedside to learn what normal lung sounds sound like so that you recognize abnormal quickly when you hear it. It takes time to listen to normal heart sounds so that you easily recognize an arrhythmia or murmur when you come across it.
Are others cutting corners? Maybe, maybe not. There are always those who aren't thorough, both slow people and fast people. Some of your co-workers likely have honed skills and can get through a little faster than you right now, but that's of no concern to you.
Anyway, kudos to you, keep up the good work.