Is this normal?

[AlisonBSN]

I'm a new RN and I'm in my 6th week of orientation on a MedSurg floor. I'm orienting on days, then I'll be going to nights next week for a few more weeks, then I'm on my own. It's been kinda hard for me. I've been staying over til like 9pm every day, and I get there at 6 or 6:10 every morning to get my stuff together, look up labs, and eat so that I can get out of report ASAP to be first at the pyxis, etc.

I know I'm new, so it's expected that I'll be behind, but THAT far behind?..so that I don't get to eat lunch and I'm charting Assessments at night? I try to do all the little time management things that people tell me, but I don't know.

And if somebody's going for an EGD or something else that's out of the normal "assess and pass meds" routine, and I have to do a pre-procedure checklist, or something of that nature, then I don't know where I should fit that in. I don't want to save it for after meds and assessments because...what if they come earlier than they say they will? ...Like they do sometimes. And I don't want to do the checklist before passing meds because I find myself already passing meds super late because there's never just one patient going for one procedure.

I also have a hard time remembering which patient is going to what procedure and when. Or like if I have two transfers, one to Rehab and one to Transitional Care, it involves faxing different things to different places and etc.

Another thing that slows me down is when the meds I need are not in the pyxis, so I have to make a list of the ones I don't have, while pulling the ones that I need, then calling the pharmacy and hoping that they'll send the meds without me having to call them again.

I guess I'm wondering if every place is like this. Is this what I'll get used to one day? I feel like I would do better with sicker patients, but less of them...and possibly even have them sedated...lol. So that I could learn the right way to do things and be more involved with patient care, and be safe. It just seems like I'm not learning anything but time management. Seems kinda backwards.

By the way, I'm taking 5 patients now. I took 6 once, but that was on a Sunday so it was a little slower...but I was still behind. And I gave Lovenox in the arm. I thought you could give it wherever there was fat, like insulin. I want to learn the right ways to do things and not run around crazy. Is that just not going to happen in nursing? Do I just need to suck it up and try to try harder?

[ShayRN]

Yep, sounds normal to me, lol. Don't get frustrated, it takes a good year to feel comfortable. Don't burn yourself out in the mean time, remember to take care of the nurse too;)

Oh, and Lovenox, always in the abdomen. It absorbs best there.

[TonyaKayRN]

You need to get a "routine" and obviously how to priortize. I used to work tele and took care of up to 6 patients AND did primary care!! I would get to work in the am and look up any labs, tests they are going for that day. Now is when I would pull the checklists that need to be done and put them on my clipboard (along with my very organized report sheet) I would then get report from the night shift. Then I would go to the med book and write down the times that my meds were due (9a,12n,etc) Sometimes we had off times like 1300! Then I start my VS and my assessments on each of my patients and chart them as I go! Do not wait to chart those or you will be caught in the end! Now the time is probably about 830am. My VS, assessments, labs are done! Now I go to the pyxis and pull out ALL my patients at once and put them all in an emesis basin, grab my MARS and down the hall I go. On my report sheet, I will cross out the med times that are complete. If I an missing one med for one pt. I will not cross it out, so that will remind me to go back later and look for it. Now it is 10am and I am calling doctor's with the AM lab results, checking charts for new orders and a break! At 11am, I am doing my noon assessments and documenting them as I go. That is how the day goes!!! You need to find a "routine" that works for you

[Anjann, RN]

Geez. I want to laugh and cry at the same time, only because this is EXACTLY what alot of us new grads in here on a Med-surg floor talk about all the time and are going through right now, and I can tell you that I am about ready to pull my hair out. Every morning I pray that my car will blow up just so I don't have to go to work! I look like walking death in the morning and the dark circles under my eyes are so purple that I look like I have been perpetually punched.

I got about two weeks of hands on time, and got thrown under the bus. Just last night after my first experience with a patient who crashed on me and had to be rushed back to the OR, the only compliment I received was that I rolled the stretcher down the hall backwards and that makes patients dizzy so do it right next time! Please! How dizzy would he have been in the ground??

I also am at work until 9/9:30 every night and can't seem to get in a groove if I have anything more complicated to do than assessments and meds.

The thing that sucks on our floor is that our techs won't do any work and we have to do ALL of the AM care or we get fussed at. So I end up spending more time emptying bed pans and changing sheets than doing any assessing of patients or watching out for crashing labs.

It's so frustrating I am ready to quit.

It's helpful to know that other people feel the same, at least I know it's not me, but it still doesn't make the problem any more acceptable. I love taking care of people and making them feel better as a nurse, not as a hotel concierge and waitress. :angryfire

[jmgrn65, RN]

i am wondering that if you are still on orientation where and what is your perceptor doing. They should be with guiding you and assisting you. I would never have a student or orientee be that far behind. Now that being said.

Yes it is normal for you to be behind. You are learning and that takes longer. Like the op said you need to find a routine that works for you.

I always get report, check mar and then go see my patients and do ax, then it is time to pass meds and then i chart my ax. Then what ever needs to be done, drsg changes, getting ready for procedures etc. But always make sure that I look at all my patients first thing if I can't ax for what ever reason at least a quick eyeball and hello.

good luck

[AlisonBSN]

Someone asked what my preceptor was doing... She knew I was behind, and knew I still hadn't had lunch at 2pm when the cafeteria closes. She said she would like to help me but she can't do that because I need to learn how to catch myself up when I get behind. I understand the rationale, but I was super behind...like unsafe behind. Giving insulin for high blood sugars waaay after I was told what the blood sugars were. It felt like hours would pass in a matter of minutes, and before I knew it, I was 30 minutes late hanging Vancomycin, then I realized that I needed a vanco valley first, so that pushed it back even further.

Sometimes she'll be talking to someone at the nurses station, and I'll have to say her name a few times before she comes to answer my question about charting...or a med that's different or whatever. I feel like I should be the priority, but that's how another orientee on my unit felt about another preceptor. She said it's like you have to wait until they finish telling their story or joke before answering your question...which wastes a good 30 seconds to a minute...which adds up when I ask 100 questions a day. Sometimes I just "wing it," which is scary and wastes time when I have to redo whatever I just did.

Someone else said that you wait until 10am to call docs for lab results? I always call first thing in the AM...I just thought you'd get yelled at if you didn't. I guess it depends on how critical the value is. I always call when the potassium is off, even one number out of range. That would help out if I didn't have to stop and call the doc, then fax crap to the pharmacy first thing in the morning for messed up labs.

Another thing I just thought of is that my preceptor lets me make my own decisions about things...but I think it's too early for that. I guess she's trying to make me think independently, but I haven't developed a foundation to think independently...so then I do something wrong, and I waste time having to go back and fix it. It seems like if I kept less patients all day, that I could spend time learning more about their condition and how to chart the not-so-common things. I know nurses like to have the same patients again, but it would be a better learning experience for me if I had three different patients each day to see a variety of medications, conditions, and things to chart.

Like I said in the original post, it's like I'm just trying to learn time management at this point. I'm really not 100% sure that time management is my problem...I just get hung up on the stuff that I don't know...then I have to come out of the room, find my preceptor, say her name 5 times, click my heels 3 times, spin around, then say her name one more time, and all that is just exhausting!