I'm drowning

blaaveispiken · Nov 11, 2008

Hello,

I feel for you -- it can be very stressful.

You may already be doing this, but I have another sheet of paper I use (typed form) besides my "brain". On this paper I have the hours of the shift at the top of the form, on the left side I have spaces for my patient's name and room numbers. As soon as I get on the floor I check the MARs on each patient and put in the times meds are due on this form. In addition, on the far right on each row I have typed in on the form all the routine tasks that need to be done for all patients, e.g., assessment charting, I&O's, Care Plan, MARS (end of shift I check the MARS to make sure all is initialed), etc. As I accomplish those things I cross them off. Also on the back of this form I divide it into quarters and list my patients names. On this side, I list additional things that need to be done for the patient, i.e. start a new IV, dressing change, etc.

Hope this helps. It has saved me so many times, I can't count.

Good luck to you!

BEDPAN76 · Nov 11, 2008

Don't hesitate to ASK FOR HELP!!!! For some reason, other nurses will see you running around but won't offer to help. If you see yourself getting in a mess, TELL your preceptor and/or charge nurse right then. Even if you have to humble yourself, and apologize, just say it. They were new, too, once. Try to hang in there. If they won't pich in and help, put in for a transfer. Keep us posted. I feel for you! :flwrhrts:

jschut, BSN, RN · Nov 11, 2008

Get all your information you need at your fingertips. Use a flow sheet for your patients.

Now, you have that done... take a breath.... now take another....

You are NOT drowning... you are learning. Give yourself time.

Blessings~

bsngrad2be · Nov 12, 2008

Thanks for your posts. I have been thinking about what Julielpn said, and you are right, I'm not drowning, I'm new. I need to give myself a break and a little credit for the things I do right. I can't think of any at the moment (oh wait, I remembered clear before cloudy the other day so that's good--basic, but good). I do have a 'brain' that my unit provides me but I find there isn't enough room for me to write down all the pertinent stuff and on my unit that's pretty much everything. I need to tweek it a little. I just feel like the minute I make one mistake, it flusters me and then the whole day just snowballs into one big, well, snow storm.

I actually emailed my NM yesterday and expressed some concerns about my performance over the weekend. She is great and called me almost as soon as I hit send. She told me not to worry that I was doing great and that they don't expect me to know everything. She also said that they would not rush me off orientation if I wasn't comfortable (it's only been 6 weeks so I have 4 more to go) and that we would revisit that when the time came. So, in the mean time, until I work again, I'm just casually reviewing the basics so I don't have to waste time looking them up. I'm also reviewing some of the posts from people about organizing their 'brains'. It's a start right. :yeah:

HouTx, BSN, MSN, EdD · Nov 13, 2008

bsngrad,

You are so absolutely NORMAL! Every new grad I have ever worked with has exactly the same issue. As a new grad, you tend to give everything the same level of priority - so everything has to be done NOW. And there just isn't any way to manage everything at once. You are not disorganized or dumb or anything -- you just need to make an effort to learn to prioritize better.

Start by actually dividing everything up into 3 categories

NOW - must do within 30 minutes - otherwise there can be serious consequences (patient safety, rule violation, etc) - call Dr with stat lab results, give scheduled meds, give pre-op or pain meds, etc.

Soon - must do within 2 or 3 hours (bathe patient, q shift dressing change, OOB, etc)

Should Do by end of shift: patent teaching for tomorrow's discharge, tidy up room,

Okay - then work focus on your NOWs... when you are caught up with them, attack the "Soon" stuff - and so on. Whenever you get anotehr NOW - stop and take care of it. Eventually, you won't have to actually write anyting down, it will stick in your head automatically.

Relax and trust the process. It will get easier with experience. Learn to prioritize and learn how to 'let go'. There will always be something you have to leave for the next shift - that's why we have 24X7 staff.

joseash · Nov 13, 2008

Sorry I don't have much advice for getting you organized but I think you will work that out on your own anyway, part of the learning curve. I just wanted to provide some encouragement and say I've been in your shoes. I can remember in the beginning having days like yours. During orientation, I was eased into the patient load game starting with one, then two, heck, I even handled three patients just fine. But then they tacked on #4 one day and it was like all hell broke loose. I was running myself ragged trying to figure out how to keep who needs what straight. My preceptor was awesome and encouraging and well, I could rave on about her forever but she was a real blessing. The point being, I did learn to manage four patients before orientation was up. Then I moved to night shift and suddenly I was handling 7 and 8 patients and doing it well! (1:6 is a much better ratio and what we aim for but the reality of it is, there are times when we end up with more as the night wears on.)

I have my own little system of checklists and organization on paper but I am also much better now at keeping things in my head than I was in the beginning. I used to be so in awe of my preceptor because just off the top of her head, she know that Patient A was NPO for a test and Patient B had labs drawn an hour ago that we needed results on and Patient C needs a B/P check before we go give that Lopressor, etc. She just had all that in her head, meanwhile I was struggling just to remember who my patients even were without looking at the papers. In time, it just all comes together. It really does. Just keep on trying and learning and doing and things will be okay!

bsngrad2be · Nov 14, 2008

rbezemek, I really like your 3 categories of organizing. I am going to try that on Saturday. I'm already dreading the weekend. I'm trying to stay positive, but jeesh! it's hard when all you do is mess up! I think this category thing may just work for me. I just need something I can hold onto and when I start feeling that knot in my stomach I can stop and ask, is it a "NOW", is it a "SOON", or is it a "SHOULD DO BY END OF SHIFT". I really like that. Thanks so much!

A_Simp · Nov 14, 2008

I could have written this post! I am a new grad and have been off orientation for about 1 month (Yea!) but towards end of my orientation, I had a day of total meltdown. Unfortunately, 1/2 through my shift my preceptor went home sick and the RN picking me up did and said absolutely nothing to me, when I told her I was in over my head and drowning. Errrrr!

As upset as I was over the situation and lack of support, it also gave me some perspective. I realized we all go though the same struggles - sort of a rite of passage and I can only do the best I can do with the time I have.

Since my meltdown, I've been doing much better and not trying to live up to my "perfect" standard/expectation.

Now, if I could just work on dealing with the poor, RN attitudes of the night shift....

A_Simp · Nov 14, 2008

I also wanted to add... what I found helpful in keeping myself on tract during my shift, is I made up my own report sheet that I use for each pt.

Before I begin, I copy the info from the cardex, print/post tele strips and check the MARs for times meds are due. I circle the times on my sheet and fill out the box under plans for things I need to do U/A, dsg change, etc.

I would also suggest writting up some sort of check list of all the action items you do during your shift... notes, I&O, chart checks, etc. so you can check them off as you go.

PM me if you would like a copy of my report sheet. I actually modeled it off the one my facility uses in the ICU. You can customize it for your needs and I'm currently on my 4th version.

bsngrad2be · Nov 17, 2008

A_Simp, thanks for your post. I have a brain I'm working on too but if you want to post yours here, that would be great. I think the more information we have the better off we are.

I worked this weekend and it was much, much better. I had 4 patients and my preceptor pretty much stood back and let me do my thing which scared me at first but ended up being a blessing. I used the "now, soon, at end of shift" philosophy that rbezemek posted about and it really worked well too. Another thing I did, and I suppose it's not 'best practice' but it worked, was I didn't rush around trying to document as soon as my initial assessments were over. There was nothing significant so I felt it was okay to do this. When I did my noon assessments, I documented them both at the same time. This helped too. I think I will stick to that unless something happens. If something significant does happen, I have a spot on my brain to jot down notes so I remember to document it. Things went realtively smoothly but I did have to stop myself every so often and take a breath so I didn't get freaked out because a med was 10 min late (it was actually missing from the med drawer so this was out of my control) or because I wasn't able to finish all my documentation before noon.

Like I said, things went great. BUT, on Sunday just before shift change, I got a new order for a BMP that couldn't wait for the next shift!! AAHH!! :yawn: Since I've only done this once, it takes me a WHOLE LOT LONGER to do it than just a few minutes!! My preceptor was great though, she stepped in just enough to ensure that we were got it done in time to document and give report. :bowingpurPhew!

I love it that I can come here for support and I hope that my experience helps someone else out there. Stay tuned, there's bound to be more!

lpnflorida · Nov 17, 2008

A_Simp, thanks for your post. I have a brain I'm working on too but if you want to post yours here, that would be great. I think the more information we have the better off we are.
I worked this weekend and it was much, much better. I had 4 patients and my preceptor pretty much stood back and let me do my thing which scared me at first but ended up being a blessing. I used the "now, soon, at end of shift" philosophy that rbezemek posted about and it really worked well too. Another thing I did, and I suppose it's not 'best practice' but it worked, was I didn't rush around trying to document as soon as my initial assessments were over. There was nothing significant so I felt it was okay to do this. When I did my noon assessments, I documented them both at the same time. This helped too. I think I will stick to that unless something happens. If something significant does happen, I have a spot on my brain to jot down notes so I remember to document it. Things went realtively smoothly but I did have to stop myself every so often and take a breath so I didn't get freaked out because a med was 10 min late (it was actually missing from the med drawer so this was out of my control) or because I wasn't able to finish all my documentation before noon.
Like I said, things went great. BUT, on Sunday just before shift change, I got a new order for a BMP that couldn't wait for the next shift!! AAHH!! Since I've only done this once, it takes me a WHOLE LOT LONGER to do it than just a few minutes!! My preceptor was great though, she stepped in just enough to ensure that we were got it done in time to document and give report. :bowingpurPhew!
I love it that I can come here for support and I hope that my experience helps someone else out there. Stay tuned, there's bound to be more!

I enjoyed reading about your dilemma as you saw it. My reading suggestions given, and now reading your post of how you processed the feedback you received and integrated into :yeah:your plan of care for working with your patients. Good job.