Well, I'm about to graduate nursing school (Eeee! So excited!! And nervous!) I accepted a job on a cardiac step-down unit.
I would love some tips on staying organized throughout your shifts. What kinds of things do you do to plan care, check and administer your meds, and just basically meet all of your patients' needs?
I know I'm going to have to come up with my own routine, but I would LOVE some tips from experienced nurses that I can try to incorporate.
Always think patient safety first...if your meds are going to be a little late because you needed to spend extra time with a patient you are worried about, so be it! Learning strips isn't that difficult, and never be afraid to ask if you aren't sure about a rhythm. I've had 3-4 nurses debating on a strip interpretation when I thought I was stupid for not knowing what it was. If you are really that concerned, get a 12-lead. I was convinced that a patient was in a complete heart block once, I mean it REALLY looked like it. Grabbed an EKG and it was sinus rhythm...
This happened to me, too. And the 12-lead was completely normal. But you know what, it is better to do something vs. not doing something and risking patient safety in the end. What if that EKG did show some sort of block (I'm talking a Mobitz II/3rd degree or something) or ended up showing a new LBBB (hello, AMI!)? Trust your gut. Oftentimes if you feel like something is wrong, something probably is. Grab your charge nurse or another one of your peers and see what they think. Collaborate with docs. Sometimes your gut feeling may be wrong (as in the above examples) but that is okay, too.
One of the ways I organize myself is by using my "brain" sheet. I have tried numerous templates and while they are all good, I still just use a plain 'ole piece of paper. I make 4 columns (usually folded, "hot-dog style") and at the top are the patient's names/age. About 3/4 of the way down I draw a horizontal line straight across (so now I have boxes) and then usually split that in half by drawing another horizontal line (so now more boxes). In those boxes I put meds, treatments, labs, etc. For meds, I go through the MAR and write down the time (usually 2100, 2300, 0000 and 0600 but some patients have something due every hour) and what is due. So for example, I write "21 - Lopressor 50mg, Norvasc 5mg..." etc. As I do my meds and sign them off on the MAR, I also X out each time on my brain sheet. I don't know why, but I really like this and it works for me.
Color-coding as helps. I really like using these pens (the orange is fine-point). I primarily use the black and red inks (red for critical things, like critical lab values or things that need to be done right away...for example at shift change a doc wrote an order stating "urgent" to get a consent for a EGD, so I wrote that in red on my sheet). I typically use blue for histories and green for labs/treatments and such.
With prioritizing, remember your ABC's, or go by Maslow's Hierarchy; however, sometimes it won't matter who you start with.
ASK QUESTIONS! No question is a stupid question. It is better to ask a question vs. being sort-of right and making a potential error. You can never know everything in nursing; even the seasoned 20+ year nurses ask questions! I also suggest reading up on things, such as treatments or patho on your downtime. ALWAYS look up medications prior to giving them. On our computers we have Lexicomp which is nice, but I prefer Micromedex which I have on my iPod. It is more user friendly with side effects and monitoring (i.e. nursing interventions ) compared to Micromedex.
Review your EKG's. For practice, ECG Workout by Jane Huff is excellent. It is also informative. ECG's Made Incredibly Easy lacks on practice strips (it has some, but not nearly as much as ECG Workout) but is still very informative.
OP, curious to know how it's going? I'm a new grad too and started on a cardiac DOU at the beginning of the month and LOVE IT. Great staff, awesome charge nurse & preceptor. Makes all the difference.
Thank-you so much to everyone!! These are all so helpful! I graduate this Friday, and then start in January. I'm sure I'll be looking for more advice come Jan.
Thanks so much, again! Yall are a great resource :-)
turnforthenurse, MSN, NP
3,364 Posts
One of the ways I organize myself is by using my "brain" sheet. I have tried numerous templates and while they are all good, I still just use a plain 'ole piece of paper. I make 4 columns (usually folded, "hot-dog style") and at the top are the patient's names/age. About 3/4 of the way down I draw a horizontal line straight across (so now I have boxes) and then usually split that in half by drawing another horizontal line (so now more boxes). In those boxes I put meds, treatments, labs, etc. For meds, I go through the MAR and write down the time (usually 2100, 2300, 0000 and 0600 but some patients have something due every hour) and what is due. So for example, I write "21 - Lopressor 50mg, Norvasc 5mg..." etc. As I do my meds and sign them off on the MAR, I also X out each time on my brain sheet. I don't know why, but I really like this and it works for me.
Color-coding as helps. I really like using these pens (the orange is fine-point). I primarily use the black and red inks (red for critical things, like critical lab values or things that need to be done right away...for example at shift change a doc wrote an order stating "urgent" to get a consent for a EGD, so I wrote that in red on my sheet). I typically use blue for histories and green for labs/treatments and such.
With prioritizing, remember your ABC's, or go by Maslow's Hierarchy; however, sometimes it won't matter who you start with.
ASK QUESTIONS! No question is a stupid question. It is better to ask a question vs. being sort-of right and making a potential error. You can never know everything in nursing; even the seasoned 20+ year nurses ask questions! I also suggest reading up on things, such as treatments or patho on your downtime. ALWAYS look up medications prior to giving them. On our computers we have Lexicomp which is nice, but I prefer Micromedex which I have on my iPod. It is more user friendly with side effects and monitoring (i.e. nursing interventions
) compared to Micromedex.
Review your EKG's. For practice, ECG Workout by Jane Huff is excellent. It is also informative. ECG's Made Incredibly Easy lacks on practice strips (it has some, but not nearly as much as ECG Workout) but is still very informative.
Congratulations and best of luck!