Policies, Procedures, Forms and Protocols, OH MY!

HouTx, BSN, MSN, EdD · Sep 5, 2014

Take a deep breath while I attempt to provide a bit of perspective that may help.

Think back to when you were learning to drive. Getting into the driver's seat was a HUGE deal... you had a mental checklist: seatbelt, mirrors, lights, start engine, turn signal, . . . etc. The first time you had to merge into traffic - YIKES!! What about parallel parking?? Changing lanes on the freeway? Trying to maneuver through your first traffic circle? Your driving test (ugh, right?)

Now - if you're like most of us, jumping into your car and heading out is no big deal. You still go through all the motions, but you don't have to even think about them because they have become an automatic part of your driving behavior.

I know it's hard to believe, but as time goes on, you will "internalize" more knowledge about nursing practice than you can even imagine right now. Each time you encounter something new, your magical wonderful "nurse brain" will organize it so that it makes sense - in a way that you will be able to recall and apply in similar situations. Frequently, you will have to stop and reflect - putting mental effort into "figuring out" something new. But after a while, you'll notice that you don't have to refer to the directions (policy, procedure, guideline, etc) any longer because it has become a part of your "normal" practice.

This will take time and effort. It won't happen overnight. It will happen. The change will be gradual. But one day, you'll have a moment of clarity in your very busy day... and realize just how much you know and how far you have come. According to studies, it takes at least one year to develop a reasonable measure of confidence and independence and ~ 5 years to become a "fully competent" nurse.

You've got this.

annieob · Sep 30, 2014

My facility has A LOT of documentation/transfers/protocol paperwork also. Something that has helped me is to use a binder instead of a clipboard to manage my paperwork. I use clear binder pockets (Staples® Clear Divider Pockets, 3-Hole Punched, 5 Set, Clear | StaplesÂ®), one for each patient, so that I don't have to worry about things getting mixed up between patients on a clipboard. This has been seriously useful since my pt load on my rehab floor is usually 9-10 pts. At the back of my binder, I have tabbed dividers with different references for lab values, important phone numbers, equipment use guidelines, procedure outlines, and blank forms for pretty close to everything we could need. It helps me avoid the dreaded search through the nurses station for the correct piece of paper, and I am more familiar with it since I see it every time I flip through my binder.

Another issue I have had is that everyday, I get multiple emails from our manager, clinical educator or MDS nurse about policy/protocol reminders. For example, today they emailed to remind us about new onset pressure ulcer protocols (interventions and forms to fill out, etc.) and new admission sets for hospice patients (a whole new set of interventions that need to be documented on). I have been losing track of a lot of that information, so I decided to start a Word document with alphabetical topics (Admission, Bladder Scan Protocol, etc.) and just jot down the key things to remember when those issues come up. It's nothing fancy, but I have it saved on a flash drive and can update it/print it out as new things to remember emerge. As a new nurse, it's just a helpful reminder and I feel like the more time I spend looking at it, the less I'll depend on it as time goes on. Hope those ideas help!

SunshineDaisy, ASN, RN · Oct 1, 2014

You will get used to it after awhile! It's a lot to learn! I wrote down everything, step by step so I knew (like admitting/discharging/transferring a pt), wrote down everything I had to chart on, had copies of papers I knew I'd need, like the PP said. That's what helped me learn. I've been working for almost 8 months now and still get stumped on things we don't normally see, like SCIP patients or something, but my coworkers are always helpful!

not2bblue · Oct 1, 2014

It is overwhelming. Do you remember your tests in nursing school, where you felt like the words were in another language and the instructor was unreasonable to expect you to know all this? :bluecry1: During your orientation they will throw everything at you. Just like in school it was very overwhelming- and you had to find a way to learn it. :yes:

I like the idea of the binder another poster suggested. The truth is, that would work for me too, but for other people that would drive them insane. You have to find what works for you. Start by listing all the policies, forms, ect you know. Leave space between to jot down where you would use that policy, form, ect. From here you will be able to come up with a way that you can organize this. You may only need the list. Particularly if your facility has a reasonable amount of organization with the forms you need.

Just like in nursing school, you felt overwhelmed and the sheer volume of knowledge and work seemed impossible, but you got through it, so will the first year of work. You will get through it. Ask for help when you need it. Yeah, you might get some snarky nurses that don't want to help you:no: :sarcastic: , but remember they might feel overwhelmed too. (Or they are just witches:devil:) Find out who you can ask and who will give you the answers. Don't plow ahead without asking if you feel that you aren't sure. In the case of nursing the phrase "it is better to ask forgiveness than permission" doesn't apply in so much. You will make mistakes because you are human, but you will grow and learn too. :nurse:

Good luck and when it feels like the pressure is too much, step back and breathe deeply. It will be OK.