Organizational strategy struggles!

[2020newgrad]

Hi everyone,

I've been lurking here since before nursing school but this is my first time posting. I graduated from 1 year accelerated BA to BSN program in May and started my job on a post-op/med surg floor in September. It's an interesting place to work in that it's really 2 units tied together - one side is largely medicine patients, the other side is entirely post-op (GI, urology, ENT mostly) with most of our patients coming directly from PACU. Now the cardiac unit has become a COVID unit and so some of those patients come to us also. We have 5:1 ratios on both sides, push to 6. It's a great place to learn in that I see everything, but a challenge in that I feel like I'm learning two+ types of nursing at once and each requires a different approach.

All of which is to say that, a week from the end of orientation, I still don't have my organizational strategy figured out. I've had a total of 6 preceptors (two primary, but a third of my time has been with the 4 subs) and each does things entirely differently and I've tried each of their methods and haven't found my Goldilocks "just right" one. I'm not the fastest writer so the "write everything out" method leaves me with notes for only two or three patients by the time I need to get moving on assessments. Some nurses just use the "brain" visual tool in Epic plus a jotted down checklist, but I found out the hard way that I need more than that down on paper. So I'm working toward the right balance of writing enough down, but not more than I have time for. Any pointers?

Thanks so much!

[JKL33]

Oh thank gawd. I thought this was going to be about someone giving you some kind of nursing school assignment on organizational strategies. In which case I was going to say drop out now.

As to your actual question, understand that some of this is going to get easier once you have a better handle on what is truly important. The reason write-it-out often doesn't work is because no one has time for that and half of it isn't important enough to write out anyway. So when it's all written out the important stuff is again lost within all the junk.

Can you use a brain sheet for imperatives and then refer back to Epic for everything else? You do need to get used to using what's available in the EMR very routinely, otherwise you will be writing down so much that you don't need to.

Anyway...it'll be okay. You'll find your stride. ??

[2020newgrad]

Thanks so much! Yes, I'm working out over time what to write down on my "brain sheet" - I use the back of the printed shift assignment for now but am thinking of making and laminating a template for myself. On our unit we also still use paper "cards" for each patient in addition to the usual Epic charting - with the most pertinent, up to date info on it for report. I think maybe what I need to do in order to avoid spending too much time "getting organized" is to just review my orders against that document and update it, and make more use of it - then refer to my Epic tools throughout the shift and bring my med printouts with me on med passes. What you say about figuring out what's really important hits home! And I'm glad it's not just me and writing out everything is impossible for everyone. This was so reassuring and I really appreciate it.

[meanmaryjean, DNP, RN]

I am also supremely pleased this was not a post about an assignment.

In addition to the excellent advice above- I would suggest at the END of your shift- take a critical look at the notes you made- and see what you needed and didn't need to have in your pocket. That will help guide you on what is truly important- and what can be looked up PRN. 

I hope this is helpful. 

[JBMmom, MSN, NP]

The hard thing about answering your question is that, as you already pointed out, everyone has a different approach because it's what works best for them. One thing that I found useful was to design my own template making things check boxes or small blank spaces so it was in the general layout that made sense to me but minimized the amount of writing I had to do myself. I have found over the years that when I can make the whole picture of the patient make sense to me I don't need as much written down. Of course with 5-6 patients you need to write some stuff, but minimizing the effort gives you the most time with your patients. You're still in the very early stages so writing things down to have them handy is helpful, you'll rely on it less as your progress. Good luck!

[2020newgrad]

Thank you both so much! This is a nerve wracking phase of the learning process - still figuring things out but heading out on my own. Having a supportive broader nursing community helps so much. I'll definitely try your suggestions, analyzing my notes at end of shift and using a template.