Hello! I graduated in December '17 and began my new RN job in a very busy tele unit in January. Our unit is an ugly mixture of pre/post cardiac procedure, general cardiac care, and overflow med/surg patients. Our hospital has been using our unit as overflow for several months now and it makes for a very difficult load for even the most experienced nurses on our floor. As the new nurse on the floor, I am particularly overwhelmed with how to get everything done in a day. In school, prioritization focused on acute vs chronic, stable vs unstable, ABC's, and Maslows. On one of my first days of orientation, my preceptor asked me which pt I thought I would see first. I chose the most acute/urgent needing pt and was told that instead I should see the pt that I thought I would be able to address the fastest first, and choose the pt with the most time consuming tasks for last. This makes sense in order to get more done on time, but is the opposite of what we were taught.
I have been on my own for about a month now and just when I think I am getting the hang of things the night charge nurse will leave a list of things I left undone from the night before, and I just feel overwhelmed because I honestly didn't know that those things were required, so then I wonder what else I wasn't taught and that will come to bite me later.
So, my questions are: How do you keep track of all of the many things we need to do in a day and get to them when you have a full load of heavy patients. (For example, my patient load this weekend was a CHF pt requiring a hoyer to be moved with an NG on continous feeds who required all meds to be crushed and given per ng and was incontinent and on sunday we only had one tech all day, another pt with CHF exacerbation who had a long list of meds to give who I admitted an hour before shift change saturday night, another on TPN with C diff on contact precautions and a third who had a bedside thoracentesis sunday d/t recurring pleural effusion of autoimmune nature) and second, how do you manage the eat our young mentality of nursing as the newby and not get discouraged by it? Coming in and getting hit first thing in the morning with a list of things I didn't do the night before messes with my head for the rest of the day causing me to doubt myself. No one is rude or unprofessional, mind you. I just feel that telling me at the end of the day before I leave when you find these things is more psychologically manageable for me than having the next charge nurse told about it in the morning and having her tell me. Unfortunately, I am never off on time because I end up charting for at least an hour after I give report, so they could tell me when they find it. (Of course, one of the complaints this weekend was that I stayed 1.5 hrs after my shift.)
I just note that the nurse who completed your admission should have told you what the expectation was instead of saying nothing to you, then complaining about it to someone and letting you hear about that the next day.
Same goes for the nurse you were reporting off to and letting know you hadn't given 1800 meds. That nurse could easily have said, "I'm sorry, but you need to give those meds now before you go. That's how we do things here."
Unfortunately there are people in this profession who like to play "gotcha," esp with newbies. Won't tell you to your face, but will go behind your back. I get really, really irritated with those types of people!
As for what ends up on the list, it varies. While not on the list, I was told by the nurse who took my patients Saturday night that I was supposed to change the NG tubing every 24 hours on continuous feeds, as I had not done so. Can you suggest other things like that I should look up for future reference?
Probably any disposable item! IV tubing, IV sites, tube feeds, pressure ulcer dressings, chest tube dressings, drain site dressings, ostomy pouches, IV and/or central line dressings (if your IV team doesn't do these), trach ties...if the patient wasn't born with it, in my hospital there's probably a policy on it! Of course you can't spend your whole shift reading policies, but every time you get a new (to you) device, try to look it up. (Don't forget your common sense, though...the chest tube dressing that's falling off does need to be changed even if the last nurse just did it!)
It does sound like you have some normal new-grad adjustment challenges. I've been doing this only about 5 years and I will tell you 1) it does get easier but 2) some days I still feel like I can't get my feet under me. Stuff I'd be upset if someone else missed, in order of decending importance: major changes in patient condition > critical meds about to run empty or with expired orders > missed meds or treatments (and I will definitely chart that the reason for it being late is 'not given by previous RN'...not trying to make trouble for anyone, but now *I'm* the one charting a late med!) > pt lying in stool/urine or with an obviously blown IV > expired stuff in room > no supplies in room (for the patient who needs frequent pericare or whatever).
It *is* a lot to keep track of and some days are easier than others! I try not to let the things that slowed me down become a thing that slows the next nurse down as well. Now you know about the admissions...personally I think the nurse after you *should* have completed it in case meds needed to be ordered or the like, but at least you know what the deal is now. Staying late to chart is a hard habit to break (and I still do it!) but keep working on it!
maxthecat
243 Posts
Agree with what others have said.
I just note that the nurse who completed your admission should have told you what the expectation was instead of saying nothing to you, then complaining about it to someone and letting you hear about that the next day.
Same goes for the nurse you were reporting off to and letting know you hadn't given 1800 meds. That nurse could easily have said, "I'm sorry, but you need to give those meds now before you go. That's how we do things here."
Unfortunately there are people in this profession who like to play "gotcha," esp with newbies. Won't tell you to your face, but will go behind your back. I get really, really irritated with those types of people!