New Grad Nurse on Medical Floor

[NoDakRN]

I'm a new grad nurse, just about to finish up with my (oh so short) five week orientation to the medical floor. I'm beyond nervous about starting on my own and no longer having my preceptor there with me for any help I might need or questions I might have. I'm sure all new nurses feel/felt this way...but what did you do to handle and prepare yourself?!?

I'm working both days and nights, for days we usually have anywhere from 4-6 patients and nights usually 6-9. So far it just seems so overwhelming! (Last night 38pt's btwn 4 nurses) When you are assigned 8 or 9 patients and then plus might have admits as well! How the heck can you get everything done (assessments, vitals, meds, charting, phone calls, preop instructions, etc!) and still be keeping your pt's safe as well as keeping yourself sane! Don't get me wrong, I know that nursing is what I love and what I want to do, but it's just hard to get the hang of time management ...especially when the more experienced nurses are sitting around and taking the time to eat a meal, while I'm running my *** off trying to get some what caught up!

Anyone have any pointers as far as time management?!?! Any tricks of the trade would be nice! :wink2:

Thank you so much, I really appreciate any advice!!

[dorselm]

I have been where you are and truth be told, I'm still there but it's getting a little better. I work nights on a 28 bed unit and I get no less than 8 pts every night. I have 6months experience now but I still feel like I'm running around like a mad woman sometimes. You just have to get a routine going and stick with it. There will be days and nights when the routine cannot be followed completely but you need something to help you manage your time. You may start by getting your assigment and seeing who your aides are. Then listen to report or getting verbal report from prior nurse. After you have that information, check the meds and make sure all were given up to the time when you come on shift. Look at labs (any imbalances? Where they corrected? Was the doc notified? Look at the vitals any instabilities that were not there previously i.e. bp high, does the patient have a trend of this? if no does the doc know about this? Make sure all orders are signed off. Do not let the prior nurse leave until all of this is checked. Usually I come in about 1/2 hr early so that I have time to look at all of this. Once you have the information you need, go see the nurse with your concerns so that you are not left running around trying find answers to these issues. Next see your aide and let them know who needs vitals and blood sugars and if the the pt needs daily weights, i &o's and any urine samples or poop samples (c diff, guiac, occult etc) Once you have that done, start to see your pt's starting with the most unstable and going to the most stable. If you have meds due at that time, bring them and assess and then pass meds so you are multi-tasking. Try to assess a few, chart a few so that you are not so backed up in your work. This may not work all of the time because you may step on the floor when all hell is breaking loose but this is a guide that will work when the floor is not so chaotic. And once the floor calms down you may be able to go back to this routine.

Hope this helps!

Also, you may need a nurse brain sheet to help you organize your pt's info so that you don't miss anything and you can give a good report. I am attaching what I use, hope this helps! Under meds, write the time they are due.

Revised Nursing Brain Sheet.doc

[orangepink, NP]

During my 3 month orientation, I was trained by 2 different experienced RNs and so, I kinda of combined the stuff / time management tips I've observed from them. I started by visualizing what an ideal shift would be like. An ideal shift means that nothing unexpected happens. So here's mine:

1.) Get report. (read post above for helpful tips on getting & giving good report).

2.) Do rounds. This includes introducing myself to the patient. For example, "hello my name is orangepink. i am your day / night shift nurse." Then I verify what I got from report. For example, I ask "How's your day / night so far? I heard you got your dialysis done today." By asking open-ended questions, I learn a lot from my patients. Like, my patient apparently experienced mild chest pain during her dialysis. She tried to tell the dialysis tech but nobody listened so now that she got back from dialysis during our change of shift, she suddenly had a HR of 35. Also, during rounds, while the patient is talking and telling me about her day, I check the IV site to see if it's patent. I look for the telemetry box because some patients accidentally yanks off their box and throws it away or stuff it in some place and guess who gets fined for losing it?!?!

3.) Do chart check.

4.) Give 1st round of meds. This is when I assess them prior to handing out the meds of course.

5.) Lunch break.

6.) Do 1st half of my charting.

7.) Give meds again.

8.) chart check again.

9.) Finish 2nd half of my charting.

10.) Give meds for the last time.

11.) do final chart check.

12.) Give report to next shift.

Now, I don't know if my routine is perfect but so far, in the last 4 months since I started working as a nurse, it has worked for me. I do chart check a lot because some doctors just breeze in and out then lo and behold, they just wrote an order to upgrade a patient from med surg to icu.

I also write down a list for the CNA like the frequency of VS checks, fluid restrictions, etc and I hand it over to the CNA at the start of our shift. That makes their work easier too. Helps them deal with their own time management issues. Like, if a patient has VS q4hrs check, I delegate that to the CNA. Or if a patient is on strict I/Os, I take responsibility for logging in the IV fluid intake while I delegate the oral intake to the CNA.

[lovelypr]

Thanks for the new grad advise. I'm still nervous but excited with this new position about to start feb 15th.