New Nurse Tips for Struggling Nurse

2018nurseandbeyond · Feb 21, 2019

i am in the same boat as you. 3 months is still hard. i am 6 months in and feel like a mess. hopefully it will come with time.

NurseTrishBSN, CNA, RN · Mar 15, 2019

Hi, have you been able to see some improvement? How are you doing now that a little time has passed?

TriciaJ, RN · Mar 16, 2019

This might seem rather stone-age, but is everyone using a work-sheet? When people complain of feeling disorganized I wonder if they're putting a worksheet to good use. (I once precepted a grad who kept her worksheet in her pocket and wrote notes to herself on her hand. Very bad idea. We covered worksheet 101 that day.)

If you can't get hold of preprinted ones, or they don't work for you, then design your own. What information do you need and how should it be arranged for you to stay on top of things? With a slot for each patient, it should include dx, postop day, med times, IVF and rate, any additional hardware like PEGs or Foleys, diet, activity, abnormal labs...anything you would need your eyeballs to land on in a hurry. Refer to it often; it'll give you a snapshot of what you need to be focusing on for the next half hour and for the next half of your shift. Update it frequently throughout your shift. It will help you stay on track and not feel as much like your brain is all over the place.

It will also serve as a cue card to help you give a complete and concise report. Of course, this advice might be hopelessly outdated, but I would not have survived corrections, med-surg or LTC without it.

For HIPAA purposes, keep your folded worksheet in your pocket during your shift and put it in the shredder box on your way out the door.

ss234, BSN, RN · Mar 18, 2019

I’m also 3 months in and still feel somewhat incompetent at times. But I have faith it will get better.

I totally agree with the worksheet though, they’re super handy. You can find some really good ones online.

Another thing I do is I take a piece of paper and create four columns going down about 1/3 or 1/2 the page. It goes: 7am-10am, 10am-1pm, 1pm-4pm, and 4pm-7pm. Under those columns I write what needs to be done and when. So before I start my shift I figure out when meds have to be given for each patient and put that into the respective column. I’ll also put things in that need to be done by a certain time. Like if I need to have an EKG/labs/etc on a patient before the medical team rounds at 11, then I make sure to include that in the column. As time passes you can cross off things that have been done. At the bottom of the page where it’s blank I make categories for routine things that might need to be done throughout the shift. For example, I’ll write “blood sugars/insulin: Rms 10 & 12”. I’ll do the same with PEGs, Foley’s, PICC lines, trachs, wound care, possible discharges, etc. Nursing never goes as planned, but as long as you update your to-do list and stay on top of it that should give you a leg up.

Sometimes if I’m receiving my entire patient slot from only one nurse, I’ll ask the nurse how they might prioritize care if they were me. That kind of gives me a place to start and helps me rationalize why I should see one patient before others. But definitely don’t be afraid to ask questions.

Hope it helps!

hopefulFNP2017 · Apr 1, 2019

Same...been at it for 6mths, second career. In my 30's. It's hard

What did you do prior to nursing?

I just think the environment is chaotic at times, too much happens simultaneously, and there's so MUCH to do and learn.

bostonnurse99 · Apr 2, 2019

Definitely not stone age! I've been starting to use nursing
report sheets to help me throughout the day which helps me keep me organized. I have used other nurse's sheets, but I started to design my own report sheet to help me out more.

On 3/16/2019 at 12:13 PM, TriciaJ said:
This might seem rather stone-age, but is everyone using a work-sheet? When people complain of feeling disorganized I wonder if they're putting a worksheet to good use. (I once precepted a grad who kept her worksheet in her pocket and wrote notes to herself on her hand. Very bad idea. We covered worksheet 101 that day.)
If you can't get hold of preprinted ones, or they don't work for you, then design your own. What information do you need and how should it be arranged for you to stay on top of things? With a slot for each patient, it should include dx, postop day, med times, IVF and rate, any additional hardware like PEGs or Foleys, diet, activity, abnormal labs...anything you would need your eyeballs to land on in a hurry. Refer to it often; it'll give you a snapshot of what you need to be focusing on for the next half hour and for the next half of your shift. Update it frequently throughout your shift. It will help you stay on track and not feel as much like your brain is all over the place.
It will also serve as a cue card to help you give a complete and concise report. Of course, this advice might be hopelessly outdated, but I would not have survived corrections, med-surg or LTC without it.
For HIPAA purposes, keep your folded worksheet in your pocket during your shift and put it in the shredder box on your way out the door.

bostonnurse99 · Apr 2, 2019

Thank you for your input! I will definitely try this 4 column technique. In addition, I do ask nurses for assistance and guidance. I will next time ask about how they will prioritize nursing care if they have a patient of mine.

On 3/18/2019 at 12:31 PM, ss234 said:
I’m also 3 months in and still feel somewhat incompetent at times. But I have faith it will get better.
I totally agree with the worksheet though, they’re super handy. You can find some really good ones online.
Another thing I do is I take a piece of paper and create four columns going down about 1/3 or 1/2 the page. It goes: 7am-10am, 10am-1pm, 1pm-4pm, and 4pm-7pm. Under those columns I write what needs to be done and when. So before I start my shift I figure out when meds have to be given for each patient and put that into the respective column. I’ll also put things in that need to be done by a certain time. Like if I need to have an EKG/labs/etc on a patient before the medical team rounds at 11, then I make sure to include that in the column. As time passes you can cross off things that have been done. At the bottom of the page where it’s blank I make categories for routine things that might need to be done throughout the shift. For example, I’ll write “blood sugars/insulin: Rms 10 & 12”. I’ll do the same with PEGs, Foley’s, PICC lines, trachs, wound care, possible discharges, etc. Nursing never goes as planned, but as long as you update your to-do list and stay on top of it that should give you a leg up.
Sometimes if I’m receiving my entire patient slot from only one nurse, I’ll ask the nurse how they might prioritize care if they were me. That kind of gives me a place to start and helps me rationalize why I should see one patient before others. But definitely don’t be afraid to ask questions.
Hope it helps!

bostonnurse99 · Apr 2, 2019

I'm also in my 30s as well. I did insurance and health administration in the past before I decided to become a nurse.

The floor can be chaotic at times, but you just have to try to organize yourself to be on top of things. As you see through the treads, everyone is talking about nursing report sheets (brain sheets) to keeps us organized. With me, I just have to see what sheet works best for me and customize to my liking. Also, ask for help! I used to be scared to ask for help thinking an experience nurse will judge me, however, they prefer that you ask for assistance! They want to make sure you're keeping the patient safe!

First year of nursing is never easy. I have yet met anyone who said they had a great first year. Nursing is a continuing learning process. I still look up information or YouTube videos on nursing materials. It is going to take us time to acquire our nursing skills; whether it be a year or more.

13 hours ago, hopefulFNP2017 said:
Same...been at it for 6mths, second career. In my 30's. It's hard
What did you do prior to nursing?
I just think the environment is chaotic at times, too much happens simultaneously, and there's so MUCH to do and learn.

_firely · Apr 24, 2019

I resisted the worksheets at first. Eventually I committed to one and simultaneously had to update a Kardex (shared worksheet). I stopped writing down meds and just circled times for meds. I learned to keep labs and vitals and abbreviated versions of test results as well as outstanding status updates (things the doc needs to know) on my worksheets because this is what docs ask about on rounds.

I learned to abbreviate things and note tasks, calls, etc in a chronological way with small notes of other small goals or notes. I ended up with maybe a page per patient. I think the key is to be on top of orders, tasks, meds while checking in with staff, pt, family. You must be prepared for the interruptions and answering questions often without a computer.

Every hour or two prioritize small amounts of charting and update your worksheets. Know where to look for things. You have to shut off conversation with patients, families, etc on busy days and master the backwards walk out of the room even when they are still talking. You aren’t there to make friends. Every day learn a new trick to save time. After a few years it is all practically automatic. The charting gets easier. There are many tricks to master. Watch the good experienced nurses and ask questions.

jdtong2013 · Apr 28, 2019

I'm a new nurse as well. When I gave reports, I tend to lose track when the receiving nurse interrups and asks questions. so I ask the receiving nurse not to interrupt and I will give time to ask question before i move on to next pt. Also I made my own report template with the most important info on it. my template is like this

top row: pt name, room number,age/sex, procaution, allergy（allergic to meds or not,no need ti write down alll allergy meds), IV(gauge/site/locked or running with what solution),code status.

next row：admission Dx, significant history

next row: your assessments cv,resp,GI/gu,skin,neuro,psych/endo etc.

next row: last vitals

next row:left side:imagings/tests, right side:abnormal labs(only significant abnormal labs) you can say there are some red flags if chemistry lab or hematology,but significant abnormal lab is: low K, high BUN,elevated white count etc.

next row: plan/notes: is the patient going to be discharged next day? if not, anything you need ti pass on to next shift? for examole,uncollected specimen, out for appointment, npo for testing, medication not given or nerd patient's own meds etc...anything you think that's relevant.

i used word process to draw a table. each item has enough space. i found my report is more organized when i use this template. also, it will need a bit more details if you admitted the pt first. so what is the background? pt had a fall at home and called the ambulance...or had diarrhea for five days and brought in by EMS? what meds or fluid was given at ED? i mentiin this only because im the one who admit the pt and it's within 24 hours so that the next shift would have a rough picture of what meds have been given. knowing this significantly decrease the risk of overdosing patient.

hope this would help.