I'm drowning

sewon16 · Nov 19, 2008

bsngrad2be, thanks so much for sharing your experiences. I am in the same position and have been trying to develop my own "cheat sheet" to organize each patient. I would love to see what you have made for yourself if you are willing to share. I have not posted many comments here, though, and am unsure about how to receive email. Would you be able to send something like that in an email?

A Simp, I would also love to see your sheet that you developed. I need a lot of help getting/staying organized and I am open to new suggestions.

Four patients also threw me for a loop. I need to be comfortable with five before I am done orientation. I have some more speeding up and organizing to do in the next few weeks.

It is helpful to read what everyone has written. Part of my problem is seeing myself as a competent nurse, someone who is "in charge" and "in control." It is a new hat for me to wear and it is taking some getting used to. :twocents: :typing

bsngrad2be · Nov 19, 2008

sewon16,

I hope my experiences help you and just so you know, posting here and having the support system available has really been helpful and put my mind at ease so take advantage of it.

I talked to my boss yesterday and she said I have 7 more days of orientation and then I'm on my own. :uhoh21: Yikes. The only thing that made me breathe a little easier is that she said they start us 'new-bee's' with three patients by ourselves or four with a care assistant. I had a great CA on Saturday and a crappy one on Sunday. I'm not sure where to go with this because a CA with an attitude (especially because she knows you are new and completely discounts your opinion as nonsense in front of others) can break you. SO....I have to ponder this one. I can't pick and chose because, of course, that would be favoritism and I don't want that reputation. Anyway, I'm very nervous but have decided to dig in and just do it. My boss told me I'm way to hard on myself and that they don't expect me to know it all by the end of orientation. I struggle with this because I am used to being the one in charge and I am used to being the one people go to when something goes wrong. In my former career, I was ran the show. In this one, not so much. It's real hard for me to adjust to this but I'm working on it. Plus, I like this career way better so I will get better because I'm not going back to an office and four walls.

As far as my 'brain', I don't have one on the computer-yet. I am using the one at work and tweak it as needed. They have very, very small columns with the standard information you give during report but on the back, I make columns for vitals, PCA information, nsg communication notes, significant events, and anything else I can think of. I do keep it to one sheet because I think carrying around to many pieces of paper is confusing but that's just me.

Report for me is a struggle so I had my preceptor help me out with this. I really am very lucky. I've read some posts about other preceptors and man....I got lucky. Anyway, she has me write this on the back of my sheet too so that when I give report, I am hitting all the systems and not LIKELY to forget anything. I make a column for each pt. and it really does help me stay on track. Here's what it is:

R: Respiratory

C: Cardiac

N: Neuro

GI: gut

GU: urinary issues

I: skin

MS: musculoskeletal

DEV: developmental issues

PSY: psychosocial/psychological issues (this is where the family dynamics come and in and boy do we get some interesting ones!)

So, while giving report, I go down the front of my brain, turn it over, and go over this list and make sure I haven't forgotten anything. I've only been able to employ this once but it made a world of difference in report. Although I did tell the night nurse that my kid was trach'ed when he'd actually only been intubated. Just one more thing to add to my list of stupid things I said or did. :lol2:

flyakite80 · Nov 20, 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.

Wow, this is scary - this is exactly what I do, every part of it! I also made my own report sheet and I change it as I go along when a situation comes up where there's a need to add to my paper. The check-off's help tremendously! I check off things like chart check, labs, tele strips, vital signs, the charting of focus assessments and shift assessments, etc. There is no way you can remember everything you do for every patient, so having a checklist really takes away the worry that you forgot to do something.

I am in my 3rd week of being on my own since getting off orientation. Many mornings I have gone home worrying about mistakes and oversights that I made. Every night it seems I'm running around like crazy while the other nurses are done way before me. But I'm learning that it's going to take time to get fully organized like they are.

We can do this, we just have to give ourselves time and try not to be so hard on ourselves! :nurse:

LogCabinMom · Nov 20, 2008

Ok, everyone - I'm a little lost -- I'm a new RN also, but I have no clue what you mean when you say "brain" - do you mean a list of all your pts and the previous rpt and what you did w/them on your shift?

Thanks --

flyakite80 · Nov 20, 2008

Yes, the "brain" is your report paper with all your patients' information on it. :nuke:

Whispera, MSN, RN · Nov 20, 2008

I remember feeling how you're feeling. Do you remember a nursing theorist named Patricia Benner? Her theory talks about levels of expertise. According to it, it takes some time before the "I'm drowning" feeling gets better, and it's natural to feel that way sometimes. Breathe deep, take care of yourself, and keep on keeping on. It will get better! :twocents:

A_Simp · Nov 22, 2008

bsngrad2be, thanks so much for sharing your experiences. I am in the same position and have been trying to develop my own "cheat sheet" to organize each patient. I would love to see what you have made for yourself if you are willing to share. I have not posted many comments here, though, and am unsure about how to receive email. Would you be able to send something like that in an email?
A Simp, I would also love to see your sheet that you developed. I need a lot of help getting/staying organized and I am open to new suggestions.
Four patients also threw me for a loop. I need to be comfortable with five before I am done orientation. I have some more speeding up and organizing to do in the next few weeks.
It is helpful to read what everyone has written. Part of my problem is seeing myself as a competent nurse, someone who is "in charge" and "in control." It is a new hat for me to wear and it is taking some getting used to. :typing

I PM'd you requesting your email so I can send you my report sheet. It is an excell spreadsheet and I can't up load it here. Maybe I can convert it over to word and try it. Stay tuned!

I'm attaching some other things you and others might find helpful. Hopefully, it works.

Lab Value Graph.doc

Daily checklist.doc

A_Simp · Nov 22, 2008

I did it! :yeah: Here is a copy of the report sheet that I use. It is my 5th version and on this one you can just circle things such as when meds are do, type of precautions, diet, etc. I use to just have empty space but I think just circling what you need will help out.

If you would like to have a file that you are able to change than just PM me your email address and I'll be more than happy to send it to you.:nuke:

Generic Report sheet v1.pdf