Hi, everyone with 16 days to graduation I am getting a little worried. My preceptor shared some concerns with my instructor that my organizational skills are not exactly where she thinks they should be and my instructor told me. The thing about it is my preceptor saw it from week 1 and I have been with her for 3 weeks now but she decided to wait until week 3 to let it all out. I don't know if maybe she was waiting to see if I made major improvement or what. That may be possible. I do agree that they are not horrible, horrible but they are not where they should be either. Can someone offer me suggestions on how you organize your shift right when you come in and right after report.
My problem is giving the meds to all my patients on time. The patient only has one MAR printed out and it is on their chart. So in the morning you have all kinds of doctors, residents and medical students looking at the patient charts. So I can't give meds on time without the chart. Is it appropriate to go up to a doctor and tell them so and so have meds that needs to be given. May I borrow the chart right quick so I can take the Mar out of the chart so I can see what they have? Is that appropriate to say that to a doctor? Any and ALL tips on organizational skills overall will greatly be appreciated. For some reason my organizational skills have slipped this semester because the last 2 semesters before this one they were better.
May 2, '03
Yes, that's definitely appropriate to ask for a patient's MAR- you're just doing your job. I do it all the time- just say "I need to borrow so-and-so's MAR so I can give him/her their meds."
What I do to keep track of meds is write down what time each patient has meds right away at the beginning of the shift. Saves a lot of hassle.
Organizational skills come with time. Eventually you learn what you need on your worksheet and what you can just remember. Everyone develops their own sysytem eventually.
May 2, '03
It's not your organizational skills. It's being in the uncomfortable position of being a student and not feeling like you have the authority, so to speak, to sidle up to a doc and snitch the med sheets
. That's ok. Doctors are not deities and you are on the same team with them and the other health care providers. Asking for the MAR is the same as asking someone politely at the dinner table to pass the potatoes. The chances of someone biting your head off are remote
Congrats on your pending graduation!
May 2, '03
Is it just me, or is it kinda odd to have a MAR sheet in the patients chart ... ?? I've only had one round of clinical, but we had three med carts, each containing a three ring binder w/ all the MAR sheets for each patient in it.
It just seems like it would be easier to have all the MAR sheets in the same spot ...
May 2, '03
First of all, I want to compliment you on your wonder attitude toward the feedback you recieved and your ability to see the situation from your preceptor's point of view. You're probably right about her wanting to give you a little time to see if you improved before saying anything about it.
I think Rachel H and Nurse Ratched had some good advice. I found the role of the staff nurse to be VERY different from that of a student years ago. I never felt comfortable in the student role. As a staff nurse, I felt more responsible for the patient and took more ownership of the situation. By putting the patient's well-being first and taking full ownership of that, I quickly became more comfortable with being assertive and getting what I needed when I needed it.
Organization skills, smoothness, efficiency, etc. ... these are all common issues for new graduates. So, don't worry too much about it. Just do as you are doing: identify it as a learning need and keep moving forward. Have you accepted a post-graduation job yet? Will you be getting a good orientation? It will be important for you to identify this learning need as a high priority in your orientation and share your desire to focus on that with whoever is coordinating your orientation.
As for practical organization tips ... I could never work without a "cheat sheet" that listed all the tasks that needed to be done and the times they were due. Some nurses refer to those sheets as their "brains." Without them, it's as if our brains aren't functioning fully. As I did each task, I crossed them off the list. That's just how I learned nursing. So, I was always checking that sheet, making sure that I was "on task" and not falling too far behind. Also, by having it all written on one sheet, I could see what tasks could be combined, when I could gather supplies for 2 or 3 tasks at once to save trips to the supply closet, and other such strategies to be more efficient.
What tips can your preceptor supply? How does he/she stay on schedule?
Last edit by llg on May 2, '03
May 2, '03
At your level of experience you should not be expected to have time organization down pat. It should be a goal at this stage.As for the MAR, we quit that method years ago. Now each pt. has own folder in med room. it is always accessible. Docs can read previous orders to see what pt is taking or go to med room and look at MAR or ask nurse, etc. Works SO MUCH better. P.S. Will you have this same preceptor after graduation? Hope not.
May 4, '03
MARs are usually kept in a separate binder so that we did not have to snitch them out of the charts
However....perfection comes with experience, which comes with time. You are off to a good start by accepting the constructive critisism and looking for ways to improve. Keep up the good work....you will make it and we are here for you.
Yes, do say, Excuse me, I need to get the MAR to give Your pt's meds.....No, they will not chew you up and spit you out. No, it is not inappropriate for you to ask this of a doc as you are just doing your job and trying to provide his or her patient wit h the care that they need and deserve.
May 4, '03
I remember when I was shadowing a friend RN on her busy medsurge unit that they all had a binder on their medcarts as well.
They all had a COPY of the MAR in their binder (this would then be shredded at the end of their shift)... they used this copy to mark through the meds they had given, and to highlight or write the times ..ie., 0600, 1000, 1400, 1800 next to the ordered med in big bold marker.. then they'd cross through it as it was given. This copy was their own to use and write on as they needed.. this was thier "cheatsheet". It worked very nicely for them.
May 4, '03
I had a problem in nursing school with organization, and after working for some time have found certain things that work for me especially well. I make up sheets with each pt's room number n them and a time grid. instead of simply circling a time when the pt has meds i differentiate them. Red for IV's, Green for BS type meds or insulin, black for po, and so forth. I also have some small boxes to the side, one where i mark the fluid the pt should be on, a box beside it where i mark where the site is after I check it, and on for a few quick comments. After you work for a while you will carve out your own "stardard practice" example. for me this is coming in doing the assignment, getting report on pts, getting report from the other charge nurse, checking my mars, looking over every pt on the floor, and using that time to check iv site, and if i have just come from the nurses station give that particular pt there immediately due meds. you can also make it so you see those with meds due first first and assess and give the meds in sequence. A lot more comes with being in charge all the time and that doesnt always work out perfectly, you need to be flexible, but most of all you need to see what safe practices work for you
May 5, '03
Great advice has already been given here. I also use the "cheat sheet" or "brains" way to organize. At my hospital we receive a sheet at the beginning of the shift for each of our patients. It lists info about each pt such as name, MD name, tests due that day, etc. It does not have the meds on it, so as I checked the MAR, I would write down the times I needed to give meds on that cheat sheet, as well as things I heard in verbal report that I wanted to remember to do for that pt. Then I had a ready-at-hand check-off sheet to use during the day & I could cross the items off as they got done. It also was used at the end of the day to give my report to the on-coming nurse for the pt. I wrote down brief notes about the assessment and the VS on it as well. It also worked to use whenever a doctor came up to me and wanted to know what so-and-so's labs were or what was todays BP, etc. Then at the end of the day, after report, it got shredded. The only times I kept them was if I was working again the next day, because I would likely have the same pt and it helped to remember what the previous day had been like.
As for asking the MD for the MAR, yes....the docs will not mind. Just slip the MAR out & give the chart back to the doc. I know as a student, it is hard to know your place, so to speak. And it is hard at first to have "nerve" to talk to the doctors. Just remember: They put their pants on one leg at a time, too!!! Hee Hee
Hope this helps.
May 5, '03
Oh, and if your hospital doesn't have the printed report sheets, just create your own. Use one sheet per pt. Lots of aides as well as nurse I know use a sheet they made up with empty blocks or spaces to fill in appropriate info.
NAME ROOM # MD LABS VS TESTS
And so on..........
Must Read Topics