Nurse-without-a-clue

perfectbluebuildings, BSN, RN · Feb 2, 2006

Hey!!! what happened??? I had a whole post, it came up twice so I edited this one, to say duplicate post. Now the real post is gone. I'm just wondering what might have happened? thanks

EDIT: any moderators out there, could tell me what might have happened? I want to not do it again :) thank you!!!

suzanne4, RN · Feb 4, 2006

I just took a look at your posts, you can check them out by clicking on your name. At the time when you were deleting the one, a moderator was doing the same for it being a duplicate. We will do that when we come across it.

suzanne4, RN · Feb 4, 2006

nurse-without-a-clue this is the post that was mentioned above, i was able to retrieve it............suzanne

hey you all,

i have had a bad few days at work and want your advice. i'd thought things were getting better and i was knowing more what i was doing, but that's slipping away.

first off, i have trouble giving report. i feel like i know what's going with my patients just fine to care for them, up till time for report when i'm staring at that care plan, going through it, and realizing that if i didn't know something about a certain patient some things on the plan wouldn't make sense. i seem to go on and on, especially when i feel bad that i didn't do something or missed something.

i feel like i am the nurse without a clue- someone asks me about labs, or about something that always seems i have no clue. i have noticed people who've gotten report from me often before, leave me for last to get report from, so that they won't be stuck there forever while they still have other patients to get report on.

i guess what i am looking for, are some ways to stay really organized during the shift and to keep up with things during the shift even when you don't quite have the time to- and also, how to be more concise in giving report and stop rambling when i'm nervous. i don't know if you can help me, but any and all suggestions are very appreciated!!! it's gotten to the point that i just dread giving report because i know there will be something i forgot during the shift that i don't realize till then, and will get the "look" and "that's okay!" from the oncoming nurse that means it's really not okay. i offer to do something about it often, like make a phone call or whatever, and they say "no don't worry about it."

and the when to know about calling the doctor- my charge nurse was upset that i didn't call about a pt on a 50% venti-mask, and i guess it is a matter of policy, that i didn't know about. the doctor too, was very very nice about it but could tell that he wished he would have known the situation earlier in the night.

and a mom who was supposed to be feeding her li'l one every 3-5 hours, and i thought she had been and get to checking the i&o's while writing my pt notes and find that he's had hardly anything after 11. i had gotten in report that she'd been woken up through the day to feed him, but she stayed up so late and it seemed that she had fed him several times that i'd seen, but maybe he hadn't eaten much those times. and early in the shift, i got orders to leave his iv out because he'd been eating so well. so at that point, i went in and he's very hungry, i feed him 4 ounces and wake mom up to try and give him more. he still seems hydrated: fontanel flat and not sunken, good turgor, moist mucous membranes.

i am just frustrated and feel like there are things i'm not picking up on, that i should be. i've been a nurse since june now. but i feel like i don't have any nursing common sense at all yet. where does that come from and how can i get some? :)

any insight you may have would be wonderful. i am feeling more overwhelmed every day. it's not the staffing; i have great staffing and wonderful people to work with. it's just me. but i am ready to call off this whole nursing thing; don't think i was meant for it, but i am trying to get advice first on how to get better before i just give up. i don't want to give up. thank you.

__________________

-rachel, rn!!!! thank you lord...

truern · Feb 4, 2006

Rachel, I'm in my last semester and it seems I *just* got giving report. I find it helps to keep my "brain" with me on which I've written all the info I got in first report in one color, then add new stuff in a different color. I check off things as I've done them, and mark things I need to check on. Then when my shift is over, I give report from that sheet. It has all the usual: name, room #, age/sex, DOA, dx, reason for admission, past med hx, attending and consulting MDs, diet order, VS, I&O, activity order, orientation, dx tests, procedures, PT/OT, telemetry rhythm, IV info, any discharge plans, CK and troponins, K+ protocol, pertinent labs, accuchecks, wounds/dsgs, and times to give meds.

I could send you a copy if you'd like?

SNLiz · Feb 4, 2006

I would like a copy of that sheet if you dont mind...

grinnurse, RN · Feb 4, 2006

Rachel-

I've been a nurse for the same amount of time and I still have trouble giving all the information that I feel the next nurse might need to continue to care for the patient at times. The good thing is that they (the oncoming nurses) will ask me information if there is something that I missed and if I know I tell them and if I don't i can usually access the information quickly. I have also begun writing the report that is given to me by the last nurse in green and mine in black and that has seemed to help me.

I am glad to hear that you are not totally giving up but looking for ways to improve. Good luck.

Indy, LPN, LVN · Feb 4, 2006

Ok my brain's a mishmash of what I do and may not have anything to do with peds. That said, I'm gonna give you a rough outline of what's on it, but it won't look anything like it does in my notebook, 'cause this is not a word processor. The only reason I get away with using patient sticker is 'cause the paper goes in shred bin when I am done with it.

Top: patient sticker room no.

date

Dr.

Dx

Lungs: Edema:

Cough: Abdomen:

Pulses: Diet: (I also scribble in here snacks)

INT:

IVfluid:

Tele: O2:

8vs:

12vs:

4vs:

Wt:

Meds: Labs: I O

Procedures:

Imagine a vertical line between the items in the last few lines of that doololly and there ya go. Like I said, this may not be helpful for you at all but others might find it to be a good thing. How does this figure in report? If I'm tired I just read everything off the sheet. Having VS together allows me to read a range of things like "bp ranging from X to Y, afebrile" and having telemetry readings and 02 grouped allows the person to say the same type things... "O2 sats range from this to that on room air or 2liters or whatnot, tele ranged in the 80's A fib on monitor" and it just sounds like you know what you are talking about. You may be 3 seconds from falling over but sometimes the way you give the info sounds so nice.

Rayrae, it sounds like you give report in person. I truly feel for ya; we tape and I can not stand getting verbals when I get them. The one thing that people do both on tape and verbals is try to read the MARs to me. Grrrrrrr. Unless it's an IV fluid, which yes, we wanna know what the drips going at, or a big important change in meds, I don't write info down if people start reading the MAR's. Since I'm on nightshift I use the "procedures" section for procedures that will be done on dayshift.

"So and so is a - year old pt. of dr. - who is here for whatever ya callit, and he's been - read assessment data and ranges on vital signs-. INT in right hand dated - with some fluid going at x ml/hr. He's on a fluid restriction, gets X labs in the morning (tho by the time I tape they are drawing the labs) and will be going for X procedure today. He gained 3 pounds and has a foley draining green chunky stuff. (just having fun here)"

I turn page and look for notes of anything out of the ordinary that I jotted down like what time I gave prn narcotics, and spit that out, if they had pain, fell down, pulled out an IV, etc. Voila. End of report. Really I couldn't give report before I had a brain, and I couldn't give report now without reading off my brain. Hope that helps.

perfectbluebuildings, BSN, RN · Feb 5, 2006

Thanks you all... good ideas with the "brains". Usually what I use is our printed-off care plan and just go through it, but that sometimes gets scrambled b/c people ask questions or something later in the care plan must be explained first to make sense of the rest, etc. I think I should use different color pens and write on it t/o the shift anything on the care plan that changes, as I update it into the computer. I also use a flow sheet, with the patients' names and room #'s at the top and the hours of the shift down the side, write in all my meds at the start and any treatments etc. that need done and write my assessments q2h of each patient as I go, that I refer to in report that is my "brain" all night. I have gotten a LOT of good ideas from you all of what to add and how to organize though- THANK you!!!

I think some of it will come better when I figure out how to organize my shift better and how to get done those little so-important things that I tend to forget, like armboard changes or a permit to be signed for a procedure two days from then, or teaching that needs to be done before D/C that I usually don't do at night, but should know/find out if it's BEEN done. That's another thing I could use your-all's help on if you have any ideas. I know some shifts you just can't be completely knowledgeable, but what to strive for?

I don't like verbal report either, we used to do taped when I did externship at a different facility, and it was a lot easier and if you screwed up or forgot something you could go back and add it. BUT verbal is here to stay at my place and I am getting more used to it.

Anyway, thanks again you all. You've really helped. Keep the suggestions coming PLEASE!!! I appreciate it.

Indy, LPN, LVN · Feb 5, 2006

Actually, I don't write down all the meds. That's what the MAR is for. I write down stuff that I might forget. 7am med pass is a zoo for me. Nevermind that we start at six; it still takes a while so in the "meds" spot I've been writing down things like 7AM PREVACID and BG (blood glucose). If that patient doesn't have any meds that time of the morning then I may not see them from 5am to 7am after the meds and blood sugars are done. Then again, lab wakes everyone up at five, so anything goes.

And your idea of the flow sheet- I passed that along to a senior student recently for her to try out on practicum.

NYNewGrad · Feb 7, 2006

On our unit we try to write down report for oncoming nurses, unless it was a zoo that day and there wasnt any time. Then when we give over report verbally it goes much faster since everything is written down.

When I come in the AM I read through the computerized pt summaries and higlight with yellow highlighter new orders or other impt stuff that were not included on the written report that I want to stand out when I flip through the pages. As the day progresses, I will jot down on the old report any significant changes or new orders that will affect oncoming nurse.

When the day winds down, I usually rewrite the report including the old info and the new info that I had updated throughout the day. In this way I usually cover everything. If the day was really hectic, I can always just pass on the old report that had my new info jotted down, although it might be a bit messy.

We're experimenting on my unit with standard report forms that sort of just prompts you to fill in. Basically it includes name, age, dx, pmh, resp satus, mental status, abnormal VS/labs, activity, diet, skin status, iv access, bgm, procedures, etc. We fit 4 patients on a page. In this way we're prompted to fill in everything and no one forgets to report some of these things. The one issue we have with the fill-it-in report is that although we leave room for misc., some nurses stop thinking out of the box. Like although we dont ask about to fall in hct, hgb etc - if he came in with GI hemorrhage please add that in! overall though i think report giving and taking has gotten easier and simpler with these sheets.

GeorgiaBoy61 · Feb 13, 2006

Mind if I get a copy too?

GaBoy61