Overwhelmed new grad, need tips

roser13, ASN, RN · Mar 30, 2011

"Also a pt choked yesterday on her meds that were crushed and mixed in applesause and she was turning blue. I was watching 3 other nurses deal with it so that I would know what to do if it ever happened to one of my pts. They didn't do the heimlich maneuver. They kept trying to get her to cough. Then they went and got a machine to suction her. I am confused. Why would they do that?"

Just a guess since I wasn't there....the Heimlich maneuver works when a solid object, such as a grape, a piece of meat, etc., is blocking the trachea. Since the "choking" was apparently caused by crushed meds and applesauce, it is possible that the patient aspirated some of the mixture into her lungs. Coughing (assuming that the patient continued to pass air) would help expel the aspirate.

canchaser, BSN, RN · Mar 30, 2011

In a mental challenged group home i work in, doing the heimlIch requires additional paperwork. So I was told to do it lastly. Silly I know and I don't no what the extra papers r and I hope to not find out.

Sun0408, ASN, RN · Mar 30, 2011

Give yourself time.. YOU are new to the facility and to nursing. School does not get you ready for dealing with 20 plus pts. It gives you the basics to build on. You will be on your own and you will still have questions. No amount of orientation will get you ready for every little thing you will come in contact with. It does give you the basics again to build on. Questions will come no matter how many years you have been a nurse. When you have questions ask them, also ask how this nurse does this or how they know to do that. Ask how they get the med pass done. Many will tell you they have worked with the same pts and know them, how they take their meds etc..

It all comes with time, experience and PRACTICE lol :) Stay strong and be humble :)

*Posh* · Mar 31, 2011

Ask the other nurses for tips but do not take any short-cuts they may suggest, no matter how tempting it may be. A lot of nurses do this and it's easy to form bad habits, especially as a new grad. If it doesn't sound or feel right then it's not the thing to do. Older patients will have issues swallowing. First and foremost, that is one of the reasons you do need to watch them take their meds. If they are coughing - they're breathing. I was taught a very important lesson when I first graduated and I still use it every shift: elderly patients especially have a hard time using straws just to drink. Can you imagine using a straw while trying to take a pill? I put water in a cup and take away the straws of my elderly and stroke patients. It's much easier for them and they are usually grateful for the tip. Trust your gut, take lots of notes, be confident and remember that we never, ever stop learning. Good luck!

josinda421 · Mar 31, 2011

I dealt with the same thing as a newbie. Here's a tip that worked for me.

For AM shift look through the MAR and flag your am meds and injections on one side(say right side) and your pm meds(including BS) on left side. This will allow you focus on one side at a time. For ex: you have a 9am and 12pm med. Give your 9am and sign then, switch your MAR to the left side of the book. This will allow you to group all your pm meds together. If you like you can even list all your am injections and BS on a note pad according to the room number or resident and your pm injections and BS on another side of the note pad, so that way you don't have to flip through the MAR looking for who gets what, allowing you to save time.

Also keep in mind you can always give meds 1hr before for 1hr after. Say you have a 9am and 10am meds, you can give this all together. Don't worry, with time you'll get better.

AKA_Glamour_Pearl · Mar 31, 2011

I'm not a nurse yet....4weeks left!! Anyway, you have to realize that it's going to take time to learn how to do everything and get your flow and rhythm to how to best do your job.

I've seen nurses start passing meds as early as 8:30am, when the "scheduled" time states 10am. My preceptor does this and she's one of the few nurses who isn't running around trying to catch up and passing meds 2hours late. I've only seen her get behind one time and that was the day that she had to administer 5 blood transfustions.

So, take your time and find your flow. Sometimes when we feel rushed, we make mistakes. It's easier to explain why you were late, than to explain why you gave the wrong patient the wrong med. Remember, do no harm. :)

As far as giving meds. I've never seen anyone get all the meds for their patient at once. Don't try that. That is a disaster waiting to happen. I mean, I've seen nurses get acetaminophen for the patient in room 200 and maybe insulin for the patient in 215. I've never seen a nurse get ALL the meds for all of her patients and start passing. Sounds like a disaster. It would be for me, at least. I wouldn't do that.

Know your patients and know your drugs. If you know that Mr. Wilson is not a risk for aspiration and he can take his meds independently, then I suppose it's ok to leave him with his cup of meds. Personally, I like to watch my patients take ALL of their meds but I understand that some may not feel compelled to watch over him like a hawk.

You will have some patients that like to take one pill at a time and they have 12 different meds to take. I'm patient and I wait. You will have some patients that will throw all the pills down their throat and take a gulp of water.

Just know your patient.

You also know that you shouldn't leave a patient with a narcotic, so if you're going to leave a patient with meds, it shouldn't be the patient will the narcotics. I would definitely make sure that that medication is taken before I left the room.

Anyway, please don't rush. You're new (like I will be) and that's all there is to it. You're going to feel "dumb" on days. You're going to feel like you're holding up everyone sometimes, but do it the right way. Like one person stated earlier, the other nurses have more experience and they may do things differently, or possibly have bad habits. You do it the right way and eventually you will find ways to improve your performance. Be patient. :)

BrookeeLou_RN · Mar 31, 2011

Give yourself a break.. you have only been at this for 2 weeks. Med passes are hard but do not cut corners.. very bad habit and dangerous. Ask your preceptor to tell you how it is possible to go faster without being dangerous.. Speed comes with experience, and when you get to know the patients. The suggestion of flagging the meds in the MAR is helpful.

You will be able to do this just give yourself time to grow!

canchaser, BSN, RN · Mar 31, 2011

Relax, the more you pass them the more you will learn the PT's meds and fly through them. I work as an agency nurse in a group home, pass 32 meds. The only saving grace is that all pt's get them crushed. But I have to learn the med cart each time. Find the estrogen pills, the liquid colaces, ect. In time u will now the med cart like the back of your hand and you will know each pt's personal preference for meds. I've got 18 years experience and it takes me till 11:00 starting at 0700. So I think u are doing just fine.