How fast should I get this.

[KalipsoRed21, BSN, RN]

So I did travel nursing as a medical surgical nurse for a year. I didn't really have a problem with it and I enjoyed it but found opportunities limited due to my specialty so I got a permanent ER position for 3 years and now I'm trying to travel again.

I have a contract at a wonderful facility, but I feel as though I'm not meeting expectations. No one has said as such, but there are a couple of other traveler's there who seem to not be struggeling as much as I am to keep up with the pace.

I had a 2 day orientation and have had 3 days on my own. My orientation was not as productive as I would have liked because my preceptors would get bored and leave the area to help their coworkers and the thing I needed the most help with is charting. I needed someone to just sit there and watch me chart then check my charting. I know it is boring but I have never used the computer system that they use and since I was not able to keep my preceptor's attention I now struggle to get complete documentation down quickly enough. It is an issue because it makes me slow and puts me behind on their time guidelines.

Today I missed some orders for 3 hours on a patient. Not to say that I didn't see them but I thought they had been written then discontinued....turn out all orders have the word discontinue next to them as a hyperlink.

The computer system is Epic, which is a very nice system compaired to some of the others I've worked with. But with each new system....even good ones....is like going from using Windows and then suddenly be given a Mac and told that is what you have to work with now. Neither are bad, I don't really think on program is better than the other, but it does take me a week or two of working with it before I have all the ins and outs.

Also I'm just having a hard time going from the standards I was trained under to remembering all of their standards. They aren't far off. In the ER job I learned under any one under 30 with cardiac symptoms got an EKG within 10 min. Traveling facility has EKG for 25 to 40 with symptoms; over 40 they are automatically pulled back to a room for a full cardiac workup....everything is timed, how long you have to get them on the monitor, to place the IV, to getting blood sent, etc. Yes I do have a packet with their standards written in it....but am I suppose to be able to remember all of it in 5 days?

I feel like I have gone to a facility with standards much higher than what I learned under. I think that is wonderful and I want to be a good traveler for them, but I feel overwhelmed at the numerous differences. I also feel like I'm taking longer to be competent with the standards that then other travelers....granted the other travelers have done ER traveling before and have used Epic....but I'm feeling that my slowness is more than that.

Any advice on how to be much more accurate and fluid when transitioning from one place to another? How to keep up with differences in charting and standards? How long does it normally take a traveler to get completely familiarized with a new facility's standards and computer system?

Thank you

[NedRN]

Your charting should improve over several weeks, mine always does. It is easy to stress over computer charting and worry about the time you are losing on patient care, it will get better and then you may find you are not so far off clinically either.

Yes, standards of care vary, and the ones that stick are the first ones you learned (and are hard to change - ACLS is a good example). Keeping up-to-date with national standards should always be your goal, and soon you should be able to adapt quickly to hospitals by noting how far off the standard they are. Studying for and doing CEN when you have time will help fix those standards in your head. In the meantime, I often use a word processor to make a cheat sheet of important stuff organized how I find most helpful and carry it around as a quick reference and security blanket until I realize I haven't looked at it for weeks.

It is easier to "work down" than "work up" to better standards, but be thankful it happened early. And be very happy you have the judgment to be able to recognize what just happened. You will do well I think.

[wanderlust99]

I think you should cut yourself some slack. You are after all, learning a new computer system on top of learning how a new unit operates. Review the protocols on your day off and know that Epic will just take a bit more time to learn.

I generally tell people it takes me 3 weeks to feel comfortable. You are only in week 1 so of course you will feel slow. It's normal to doubt yourself at this stage but I think you will feel much better in just a few weeks.