I just started about a month ago on day shift on a consistently busy med/surg floor. I am so overwhelmed that I can't hardly breathe! They messed up my orientation a bit b/c I was scheduled for a different med/surg floor and then decided before orientation started that I'd rather be on the floor I'm currently on. So I was on the other floor for 2 weeks with one preceptor, then they switched me up and put me on my current floor for the next 2 weeks with a different preceptor. I think that might've jumbled me up a bit. But this was supposed to be my last week of orientation and I asked to have it extended one week because I'm having so much trouble with everything.
First off, I usually have like 2-3 patients out of 7 going down for procedures/tests first thing in the morning. So just when I'm getting out of report the transporters are there to take them when I haven't even gotten to LOOK at them nevermind give insulin if they are blood sugars, or call down to ask if they can have their morning meds. Much less can I chart an assessment which I think is incredibly important to have done before a pt goes off the floor. That can come back on ME if something bad were to happen. So there's that.
I can't seem to find the time to get all meds passed within their time frame (for 0900 meds we have from 0830 til 0930 to get them passed otherwise it's considered a med error) for SEVEN people all receiving 0900 meds. Especially if I have elderly patients that either need them thru a tube, or crushed in applesauce. Most of the time if I have to go the applesauce route it takes forever to get them all down due to a lot of complaining of the taste and refusal to take them!
Charting is another biggie. How am I supposed to do meds/assessment charting on each patient in about 1-2 hours on 7 people!? It's just too much to get done. Not to mention I am always interrupted by a call of "so and so needs pain medication" or "so and so's family would like to speak with you now" or a call from a family or doctor.
GAH I'm just so frustrated. It'll only get better when I have to do major things such as giving blood/dressing changes (complicated ones...I usually only get simple ones thank goodness), blahblah you know the list...it goes on forever!
I can keep pretty organized on paper, but when it comes to actually doing it, I go crazy. I haven't really been taking my full lunch breaks because I can't get everything done before my shift is over. So then my report ends up a little jumbled because my mind is in 5000 different directions! My current preceptor is fabulous and he really tries to help me. But I feel like an idiot when he's having to cover my med passes so they don't become med errors.
Specializes in Infection Preventionist/ Occ Health.
Seven patients and four weeks orientation as a new grad! If it were me I would start looking for a new job pronto!
I suggest that you speak to your manager about this. Let her know that you feel that your workload is unsafe, and try to brainstorm with her about possible solutions. I suggest that you actually map out your morning with her. She might have some suggestions for you, or more likely she will see that it is just not possible to complete assessments and med passes on 7 patients in the time frame allowed.
When I first got out of school I had another tech's work dumped on me all the time (I often had to run 7 instruments with hundreds of tests and do a manual assay, report results and archive specimens in less than 6 hours). I had only been given about 5 days of orientation, two of which consisted of my preceptor reading a novel while I did all of the work.
I finally got up the nerve to speak to my manager, telling her in no uncertain terms that I was not willing to do another person's work in addition to my own every time we were short a tech. She spread out the work more evenly among the staff after that, and I learned that I need to assert myself in situations such as these.
I hope that you are able to work something out with your manager. Please do not be too hard on yourself, because I think that any new grad (or seasoned nurse) would struggle with an assignment like yours. Good luck.
Experienced nurses, please chime in here... do you REALLY get all that done that PinkAurora describes? Are you able to assess those patients before they go down for tests? If so, is it more of a once-over-glance where you can tell from experience whether or not you're comfortable with them leaving the floor or is something a newbie can truly emulate without the experience (and thus be able to be timely)? Do you manage to check if patients going off floor can get their AM meds and pass them and take care of any insulin needs without holding the transfer too long? Or do you just accept that the other departments will be annoyed but they will just have to wait? How often do you get ALL of your meds passed and charted within the one hour time frame allotted (and not start passing them earlier than the allotted time either)? How often do actually chart on EVERY patient every two hours?
Bargainhunter advises "pick out someone who you see getting it all done and copy them." When I was working, it didn't look like anyone was getting it all done. They were all running around, not available to help much and often snappy because any interruption would throw them off the rest of the shift. During preceptorship/orientation, they generally only let you shadow one day and it's fine and right to jump in right away, but as a newbie, you barely know half of what you are watching on your day of shadowing. After that, you never get the chance to see how (or if) others manage to "get it all done."
When I'd ask about how or why someone did something a certain way, the answer was almost always snappy and/or defensive - making one wonder how a newbie supposed to get it down when experienced nurse are just barely scrapping by or what shortcuts they weren't willing to admit they took to "get it all done." Is this kind of cynicism and hopelessness unfounded?
Did you really want an answer to your questions, or was this just a sideways rant against experienced nurses?
For the OP: 4 weeks is definitely not enough time for a new nurse to feel comfortable. Your orientation sounds inadequate, at best. Those are some pretty unrealistic expectations that are being placed on you.
Go to your education coord. or your NM and let her know how you're feeling. The fact that you switched from one floor to another set back your orientation, through no fault of your own.
I agree with PRN and the others before me. You have hardly had enough orientation to learn anything, let alone how to get along on a med-surg floor on your own. I am continually dismayed and angered by the lack of proper orientation of new nurses. Sadly, many just dont' know the disservice they are being done, until the poop hits the fan. And then they do like you are, berate and put themselves down, thinking they are incompetent! Grrrrrr... How unfortunate. YOU are not the problem. This hospital IS.
You need more orientation and learning time before being set on your own. 4 weeks is nothing. Demand more time or consider this is probably not the job for you. What they are asking of you is ridiculously unsafe.
That seems like a lot of patients for day shift, and definitely not enough orientation. It comes down to this: It just takes time! Time to learn everything, get your time management skills improved, a routine established, etc, etc. I would try to get more orientation if possible, and if you do get that extra orientation, focus as much as you can on prioritizing your patients. Personally, with your days, I would quickly check my patients who I knew were going for tests (look at their vitals, assess their orientation, review blood sugars) first, and if you don't feel they should leave the floor, or you need an extra minute (or 5) to assess them first, just say so. Its better to be safe than sorry, and if the other unit gets upset, just explain calmly, "I just started my day, I need to make sure this patient is stable to go to you." No one wants to get a patient they will have to code, right? Then after that, I always started my day (night) on tele by checking my orders/med kardex and then seeing my patients in order from sickest to healthiest. Or if they are all about the same, see whoever's awake first, who need's meds first, something like that. Maybe coming in 5 or 10 minutes before report to review your charts first might help you feel more organized and ready to hit the floor running. Sorry I went a little long with this post, I hope some of it was helpful.
You should not have to be calling anyone to ask if very early cases can get their meds. Nights should have taken care of this.
Ask your manager the questions you posed here. I'd like to know the answers. I'll bet you that no one is actually staying within that 1 hour window for meds - not consistently.
Would the world stop turning if you didn't talk to family members every time they called or if you called them back when you had more time? I used to work in a situation where we had no secretary, no aides, and we did have as many as 6 callers wanting to know how each patient was. I just told the family that they needed to work out a system whereby one of the calls and talks with the nurse then the one who has spoken right to the nurse calls down the list of other relatives/interested parties. And they were to call no more often than q4h. I told them the truth - every time I had to answer the phone, it took me away from their loved one so would they please help me to help him. They were delighted to be helping and adhered to the plan I described.
I'd also bet that charting isn't being done, assessments are fudged, and treatments are skipped. That's how some nurses work - their work is always done because they don't do it. Or they do it but do it late but then chart it at the right time. If a med is daily, giving it late might not matter but you should clear this with the boss, as someone is bound to report you for giving a daily med at noon - no matter how reasonable it to do that.
Specializes in Critical Care, Cardiothoracics, VADs.
You've got great advice, but I can't help but say "it's not you"!! Every nurse that ever graduated has felt the same, usually daily. It takes 1-2 years to feel even barely like a "real nurse".
A few tips:
- Is night shift handing over with a written report? If so, highlight things which need attention immediately. If not, write your own during handover. I had a sheet divided into separate patients, with diagnosis, each hour written in, and then space at the bottom for notes. During report, if the night staff said someone was due for a 10am test etc, I filled in the sheet accordingly. If there were particular issues, I'd write notes. Night shift should be getting patients ready who are scheduled for early tests. If they tell you about a test, specifically ask what is done, so you know what you need to run and get done immediately.
- Experienced nurses start mentally prioritizing the patients during report. Every time you hear certain things (so and so has poorly controlled BP, needs frequent blood sugar etc), make a note. You know that patient will need earlier/more frequent checks.
- After report, anyone I mentally assigned during report to "low priority" will get me sticking my head in, saying hello, checking IV and taking vital signs. This should take no longer than 5-10 minutes per pt. Then let them know you're busy but will check in at ___ o'clock. That way, they are more likely not to bother you than if they don't know when you'll come back.
- Start thorough assessments of sickest patients in descending order. There usually won't be more than 2 or 3 in this category (in my experience, although it depends on your unit).
- Get to your meds.
It's very overwhelming, and NOONE gets EVERYTHING done. Part of the job is knowing what can and cannot slide. This comes with experience, and you learn not to sweat the stuff you just can't physically do.
Thanks so much, you guys are THE BEST! I figured four weeks (well really just 2 on my unit!) wasn't really enough, but others have just gotten out and are on their own so I feel like an idiot that they are doing okay and I'm not. They do struggle though because I have talked to them about the issues I've been having.
As far as going down first thing in the AM for tests and whatnot...the only thing that night shift does for that kind of thing is making sure the consent papers are filled out. They don't deal with the meds or anything. I guess I'll get it eventually, I just hate pissing people off and I know the units will be angry if I throw off their schedule by making patients late! I definitely say hello and check important things before they go down, but it's good to know I don't have to do a full assessment on them. As far as all of my other issues...I guess I will just have to learn as I go. I'm usually pretty good at picking things up quickly, but this is HUGE. I don't think this is going to come as quickly as everything else. That's okay though.
hang in there, nursing is at best, a difficult job to do.(more accuratley, nursing can be like a roller coaster ride without a seat belt) most nurses go through this. in the "old days", we were placed on the floor so that we could gain organizational skills. and it worked, although, it was tough. we only had a couple weeks orientation and during that time we were usually used as staff anyway. (called it , learning by fire). you'll find these same stressors as you change jobs in nursing . i've done critical care / er, now for 30 odd years. i remember feeling those same feelings when i started there too.(only it was very cut throat) what helped me was: when i got off work, i thought back and reviewed the day, i thought about what went right and what went wrong. thought about what i could do differentley the next time (to improve) or, if i should continue to do something the same way.when things went well, i thought about way to tweek it to make it even better. i even thought about emergency situations , and reviewd in my head what my actions would be. when i was new on a unit i didn't find it very helpful to watch other nurses because i was usually so busy just trying to keep my head above water. on my way to work, i turned the radio on to relaxing music and started my action plan for the day, what are my priorites etc.. even after many years of nursing i continue to look at other nurses documentation for ideas. every once in a while i see a nurse do something that makes perfect sence. (i think, gee. ..why didn't i think of that about 25 years ago) other nurses can be wounderful resourses. seek the nurses that teach rather than tear apart. :studyowl: but be prepared for constructive critisism as well. but most of all hang in there!
So then my report ends up a little jumbled because my mind is in 5000 different directions! My current preceptor is fabulous and he really tries to help me. But I feel like an idiot when he's having to cover my med passes so they don't become med errors. 
Help.
(i think, gee. ..why didn't i think of that about 25 years ago) other nurses can be wounderful resourses. seek the nurses that teach rather than tear apart. :studyowl: but be prepared for constructive critisism as well. 
ICRN2008, BSN, RN
897 Posts
Seven patients and four weeks orientation as a new grad! If it were me I would start looking for a new job pronto!
I suggest that you speak to your manager about this. Let her know that you feel that your workload is unsafe, and try to brainstorm with her about possible solutions. I suggest that you actually map out your morning with her. She might have some suggestions for you, or more likely she will see that it is just not possible to complete assessments and med passes on 7 patients in the time frame allowed.
When I first got out of school I had another tech's work dumped on me all the time (I often had to run 7 instruments with hundreds of tests and do a manual assay, report results and archive specimens in less than 6 hours). I had only been given about 5 days of orientation, two of which consisted of my preceptor reading a novel while I did all of the work.
I finally got up the nerve to speak to my manager, telling her in no uncertain terms that I was not willing to do another person's work in addition to my own every time we were short a tech. She spread out the work more evenly among the staff after that, and I learned that I need to assert myself in situations such as these.
I hope that you are able to work something out with your manager. Please do not be too hard on yourself, because I think that any new grad (or seasoned nurse) would struggle with an assignment like yours. Good luck.