New Grad Issues

You're caught between a rock and a hard place. The speed will come with time and experience, but in the meantime you have to find a method that works. Since you are still technically being precepted, you need to sit down with your preceptor and say, "I need help. Here is my assignment for today, please help me prioritize and try to find a way to get everything done without falling too far behind."

I think part of is accepting that for some time you're NOT going to be getting everything done and you ARE going to hear about from others. There are certain tricks and styles that others can teach you on organizing your time, but the bottom line is that you're new and you WON'T be totally up to speed for some time. It takes experience and experience takes time. Until then, try to sort out what feedback you get is crucial and immediately relevant, what can be thrown in the "later" box, and what you can just let slide right on by you. Of course, your colleagues and managers want you to be up to speed asap, but they have to deal with reality, too. Do your best. Practice safely. And whatever comes, you can proud of your efforts.

I can totally relate to that! And I was actually hoping more people had replied to this entry so I could get advice too. I am also on a busy telemetry floor (post heart and lung transplant pts as well) and it's hard to get everything done. I usually stay 2 hrs after my shift to finish charting. My manager has actually sat me down and told me I've been staying too long and that I need to get done with my work sooner otherwise they can't let me pass my internship period. I also thought it's better to be slow and safe but apparently management thinks i'm "too slow" and they don't want to be paying for so much overtime. =(

My first hospital job was in a busy tele floor. Prior to that i had worked in LTC and this did help me alot with time management. I worked down in south Texas and boy that was tough. Talk about 7-8 patients on a tele floor!!!!!!. You had some going to procedures. You get admits like crazy. 96% spanish speaking only. So you have to get a translator to finish the admission.

When i was precepting, i noticed the CN who also has 6 pts on top of that was really organized. So i asked her how she does it. I precepted with her for a few weeks and it was great.

Heres what my schedule went like on a good day.Come in at 7 get report. Get done by 730-745. Start my rounds, During rounds i'll also do my focussed assessment. If they take potassium, lasix and drugs which needs labs to be checked ill check them. Then i get my VS. Pull meds from pyxis. If trays not on the floor yet, check for consents and required labs for those going to procedures. Do the floor checklist-surgery. Pass meds. If i knew the pts already, i usually give meds to those who take less time taking them or with less pills unless i had to give it quick. I do crushers last. I usually try to finish the med pass before 930-945 if all goes well.

Then i do a opening note with the focus assement checks.If i cant finish the opening notes for everybody, i atleast do for those going off the floor. 10-1030 go for breakfast.

After breakfast, quick rounds,check any new orders, check labs, chart some, go through the MAR.This the time i also do my discharges.I f i have meds which will be due later in the day, i usually note them with the times somewhere, and check them off as i give them.Time for accus and VS. Cover whoever needs coverage. Look at the VS.

On a bad day, come in get report, while making rounds they calling from ER for an admission. Boy i hate when this happens. All i do finish round, get meds if the pt comes i set them up in the room, do a quick asses. pass meds then come finish up with the admit.

wow have to go now.

Dear new grad:

They gave me 6 weeks of orientation.

98% of those shifts, I got out atleast an hour late. I felt horrible because my preceptor had to stay over and watch my work/charting. But I was blessed with a fantastic preceptor - the one who pushed and prodded me forward while reassuring my fears and doubts.

6 weeks AFTER orientation, I was STILL getting out at least an hour post shift.

12 weeks AFTER orientation, I noticed I was still getting out an hour after shifts - but it was only about 50% of the time.

As of today, 70% of my shifts, I get out on time. And if I'm late, I'm usually not late beyond 45 minutes.

And you know what? My charge nurse made a comment the other day about how I was not "staying over late any more to do catch up work!"

I'm improving!

There are many dynamics to floor nursing - just simply "6 patients to one nurse" is not enough.

For example: Your six patients could consist of post-op hysterectomies who have been afebrile through day 3 and are ready for discharge [in which case, they have no IV stuff, are tolerating PO, voiding without difficulty and have had more than a couple bowel movements].

Or: Your six patients could consist of one fresh post-op, one fresh direct admit to the floor, one ICU transfer on tele with two medicated drips, one patient in restraints, one post op with fever and one post op day two who suddenly develops a bowel obstruction and uncontrolled nausea/vomiting.

What you have to face each day will determine how your shift goes. You won't notice it "right away". The "hump" you pass won't be noticeable ... but it is ever present... and with dedication and perseverance, you will pass it!

cheers,