New grad seeks assistance with organization - all suggestions gratefully received

Daytonite, BSN, RN · Feb 9, 2007

i used my "brains" to help me with a lot of my organization. when i did agency work i used to make a grid on the back of my brains of the times i had medications due, especially iv meds. also, from the "old days" 30 years ago, we used to have a clipboard that listed all our patients who had ivs and what was running. on the back of my "brains" i also made a list of patients and their ivs/iv orders. i often made notes of when next bags were due to be hung. on the front of my "brains" is where i took report (often in blue ink to distinguish it from the black ink i used for charting). i made notations in black ink of important things i wanted to make sure got charted and mentioned in report. the way i kept track of the final check of doctors orders and my charting was when i had checked a chart for doctors orders and they had been signed off (this was at the end of the shift) i made a forward slash mark in red ink over the patient's room number. when i had completed my charting for the shift i made a backward slash mark in red ink over the patient's room number. if i saw that all the room numbers had red "x"s over them, then i knew i had gotten those two things done. if there was something in particularly that needed to be charted, i circled it a couple of times in red ink so it stood out on my "brains". when it got charted or transmitted in report it got a big red "x" through it. by the end of my shift my "brain" looked like a big bunch of scribbling with red circles and "x"s. however, if you looked really closely at it, there was a lot of work that went into it and it kept me organized and on target. i'm attaching a copy of the report sheet i use. feel free to download and use it. [attach]5032[/attach]

part of delegation is also following up to make sure that the job you delegated has been done properly. so, no it is not bad form to check to see if an lpns orders are completed and meds passed. it would be bad form not to check, and guess who's gonna hang along with the lpn if something has been missed? you cover yourself by just thinking of tactful ways to follow up is all. (oh, mary, where are you with your med pass? do you need any help with it?) you are going to find that some people feel slighted that you even ask after them. you can't let that bother you. it, unfortunately, is part of your job. the nasty ones, unfortunately, are just being turds and using whatever little control they believe they have to make you feel bad. in reality, they should know that it is part of your job responsibility to check up on their work and should be telling you when they have completed their tasks. when it comes evaluation time and your nurse manager inquires of you about them, be sure to mention how these people have to be consistently supervised because they fail to report back as they complete tasks. some people are just determined to be mean and make others jobs more difficult for the simple reason that it is a game where they can cause you some upset. that is so dysfunctional. once you have more experience you develop a tougher skin against this kind of person and can give them back as good as they are giving you. you can't let them buffalo you into doing something you know could get you into trouble which is what will happen as you learned on your old unit.

feeling competent comes with time and experience as you gain a command over these skills.

MedSurgeNewbie · Feb 12, 2007

THANKS SO MUCH!!!!! That sheet is brilliant - I owe you one big time!!

Daytonite, BSN, RN · Feb 12, 2007

You are welcome. I used to save my old "brains" for years. I was afraid to throw them away because they had vital signs, blood sugars, doctor's orders I had taken over the phone and other little important notes on them. Pack rat mentality, I guess. Anyway, over the years, they evolved to something that worked for me. Initially, I used to use a yellow marker to highlight things, especially labwork and x-rays that needed to be done and follow-up on. I have a thing about color, too!

There was one other RN whose "brains" looked worse than mine at the end of her shift. It was a mass of scribbles. Even I couldn't understand it! She also used to write all over the palms of her hands and arms. (We worked on a stepdown unit). She would come into report looking like she had come out of a bad tattoo parlor! But, everyone loved following her. Everything was taken care of and had been attended to.

Good luck! It should be interesting to see how your organization evolves over the next year or two as well.

AprylLPN · Feb 20, 2007

I am also a new nurse on a Med/Surg floor. I have downloaded the sheet and I think it is going to be VERY useful. Thanks so much!!

MedSurgeNewbie · Feb 21, 2007

glad to see I am not the only newbie!!is it me or do you feel the nursing gods are out to get you somedays

MiaLyse, APRN · Feb 22, 2007

I have been finding it difficult to use worksheets to fit 5 patients info on them. So far, I am only able to come up with worksheets that fit 2 patients info on them at a time, so I end up using more. Hopefully, one day I'll be able to condense this. Here's an example of what I was going to try (attached)

Worksheet 1-B.doc

MedSurgeNewbie · Feb 22, 2007

thanks again! Things seem to be getting better - still have days where i feel like the worse nurse ever you could devote 24/7 and still never learn enough! med/surge is growning on me really you see so much I am loving the diversity and the nurses I work with are all very cool

Myxel67 · Feb 22, 2007

MSN--how do you divide your work load with the LPN? We used team nursing (they also called it patient focused care at the time) several years ago when I worked on a Pulmonary/HIV floor. I wasn't comfortable just splitting the pts up by room numbers the way the other RN's did. If we had 12 pts and I split the team, I would take the 5 most complicated pts and give the LPN 7 pts. I had already tried having the LPN pass meds on entire team, I did all IV push meds, the assessments, sign off orders, and we would share other duties such as dessing changes, turning patients, pain meds. I did vents and trach care because most of the LPNs weren't vent certified. But there was mass rebellion

When we were doing team nursing, one LPN in particular didn't like to work with me because she was used to the other RNs just splitting the team evenly by room numbers. She was the least experienced LPN on our floor and I was just not comfortable signing off on her assessments and allowing her to push IV drugs.

I wish I'd known about this BB at the time. I could have used the input.

We were 11 - 7:30 nightshift

MedSurgeNewbie · Feb 22, 2007

Most of the LPN's at my place prefer to split, with me doing the IV pushes and and meds on my half, many get offended if you want to do all the assessments - they are all very compentent and that is accepted pratice where I work, I typically try assess everyone to check assessments but with pulling orders its hard. Most want to straight split what complicates it more is they are eight hours to my twelve. What makes it hard for me is that most of them are quite experienced and I would have to honstly saw better nurses than me, so I feel like I really am being cheeky to set the assigment the way I would. I have found that I can work with two who are totally awsome and understand that i need to be in the more serious and have some room to review labs ect. I could really use input on how not to be a jerk in this area sometimes its hard to not feel like my license is on the line.

sabrn2006 · Feb 26, 2007

I've been doing this since June. I am still working on my organization as well, but it's evolving. I do aat least a quick head to toe assessment of the patients that my assigned LPN has. I don't like at it as second guessing them but more as another set of eyes. Sometimes I am in their rooms more than my own patients' rooms--depending on what's going on.

There is one LPN I really like working with. We help each other out a lot. If I am discharging one of her patients she will go pass some of my meds. We answer each other's call bells, etc. When she started to ask my opinion on certain things, I knew that I had gained her respect.

You do have to work with your team. And you are right that your license is on the line. It can be scary at times.

kimmymom · Feb 27, 2007

Just a quick note to let you know...YOU ARE NOT ALONE! I, too, am a new grad and work on a med/surg floor. I was a nurse tech on the floor since June, which is helpful, but I still struggle with prioritizing and trying to get everything done. Some days I feel like I know nothing....other days are just fine. I've learned to take one day at a time, and if I have a bad day, the next day is a totally new day. Keep me posted on how things are going. Good Luck! :nurse: