oh M Gee how do you guys do it?

[AngelofSeduction]

so today we the orientees were on our floor and i have to say the nurses are really supportive.they keep telling us we are going to be fine once we learn the routine. we shadowed nurses today and did vitals but i cant help to think omg am i going to get this. me and another classmate did vitals together and it took us forever to do it on 6 patients and on top they expect us to do a complete head to toe. As if that wasnt bad, me and the other orientee was changing a patient because he urinated and for the life of me i couldnt position the chuck under the patient with the pad correctly. we fumbled around and couldnt figure it lol. good thing the patient didnt speak english. we were laughing so hard cause we felt pathetic. i see cnas and pcas do these things 1 2 3 like it's nothing. the patient even asked me what was wrong with my head? and he even asked an LPN to come help lol smh. smh i can't be a nurse and be that slow it's like i fumble with everything. but fast forward i am still in classroom orientation learning about different procedures ( it's like nursing school) but how my concern is how am i suppose to remember the policies and all these books they give us to read. i really need some tips for when i start preceptorship.

1) how can i prepare myself?

2) what is a preceptor looking for?

3) how do i make myself proactive? i know people keep saying be proactive in your learning. what can i do?

4) how can i figure a better way to do a quick head to toe assessment. sometimes i find it hard to hear lung sounds ( i hear other noises through the stethoscope)

5) i am a writer so i need to write things down in order to do things so seeing all these tasks, orders and such how do nurses remember what to do?

6) i want to grow and learn and want to learn something new everyday because i hear everyday you learn something new so how can i approach this experience and learn everything i can and make the best of it and apply what i have learned in school?

7) it seems like there is no time to " think critically" with all these tasks. i know it comes with practice but when will i have time to look into the patient chart to put it all together. some patients have a lot of history. or do nurse focus on what the patient is there for and what they got during report?

[thinwildmercury]

Why did it take you forever to do vitals and head to toe assessment? Did you not get this practice in nursing school and in your preceptorship? (genuinely curious, not being rude).

[iPink, BSN, RN]

As an RN, you are now admitting you can't hear lung sounds?

1. You can prepare yourself by reviewing and keeping a folder of information that is critical of your survival on your unit.

2. An orientee who is prepared and willing to learn and follow direction. Takes constructive criticism and doesn't equate that to bullying.

3. Being proactive is not sitting there having your preceptor tell you what you need to do. You are actively doing something without being asked. If you are unsure of how to do something, you are looking it up and going over steps with him/her.

4. A head-to-toe assessment in nursing school is different then a head-to-toe assessment on your unit. Eventually you'll be quicker and do more of a more focused assessment. I don't do babinski checks on my adult patients, only my newborns. However, maybe that's done on a neuro floor. Time and practice will help you hone your skills.

5. From your post, I didn't realize you were a writer. I digress. Yes, if you need to write things down, a small pocket size notebook may do the trick for quick references. For example, common meds on your unit that you're unfamiliar with or have forgotten in pharmacology will help you. The last thing you want to do is go into a patients room and have them or the family ask you about the med you're about to administer and you look lost.

6. Everyday you will learn something new. Nursing school only taught us a small amount to pass NCLEX. The real world of nursing will teach us much much more.

7. Critical thinking is important. Review and study at home and don't be afraid to ask plenty of questions. I started on a critical care floor. We use to come in a half hour before our shift to look up our patients' trending labs, pertinent history, and orders.

[AngelofSeduction]

Of course i did. And it took forever because we had to do it on 6 pts along with thorough h2t. Im just trying to figure out how people manage their time

[AngelofSeduction]

I do know how to listen to lung sounds . Im just saying sometimes it's hard to hear and trying to block out other noises. People who have been doing it for a long time might not have that problem. Im just starting but thank you for your tips

[calivianya, BSN, RN]

With the lung sounds thing - you have got to make sure you can hear them. Turn off the TV, wait until the patient stops talking, tell the patient to be still, ask the visitors to be quiet for a second, do whatever you do to make sure you hear them. I always say, "I'm going to take away your TV for a second, but I promise to turn it right back on!" IMO, lung sounds are arguably one of the most important parts of the assessment that we do as nurses. You're right, they are hard to hear with other noises, so you have got to make the other noises stop. If you don't know what the patient was like at the beginning of the shift, you're not going to be able to tell if he/she is getting fluid overloaded later, or if that gurgling sound right after you gave him a snack is new aspiration or what.

If you still can't hear them after you turn off all of the other sounds, get a better stethoscope. If you can't hear with a master cardiology/cardiology 3/whatever, get an electronic stethoscope that records the sounds so you can play them back louder. Lung sounds being hard to hear are not an excuse for not assessing them. Just think - if your patient gets fluid overloaded and goes into respiratory distress, and you don't catch it quick enough because you weren't sure if those sounds were a change or not because you didn't hear them the first time, how are you going to explain that to the attorney questioning you if the patient or his family sues?

That is my best tip for learning. Act like you could be called into court on everything that you do, say, or chart. You should know what you're doing and the rationales behind every action that you take well enough to defend your actions in court. If you aren't sure why you're doing something, or why you're giving a certain med, look it up even if it slows you down, and then write it down so you can study it when you get home. That is a good way to be proactive in your learning. Good luck!