Poor Organizational Skills in Clinical??!!!

janleb · Apr 2, 2001

Hi, I am in my third quarter nursing( I can hardly believe it myself . Organizational skills are a definite must. Someone with more experience will have more advice i am sure but i will try. I always try to go into clinicals with a game plan(not hard to do with just one pt) talk to pt nurse and get an update. Find out if PT, resp, or test the pt must go to.Many times surgical pt are NPO check to see if this has been upgraded. I always scan their chart if it is available at this time. introduce myself to the pt and take a quick set of vitals and physical assessment. compare with the last 24 hours. if you find abnormal vitals tell your instructor and nurse. also if a pt seems to be having a problem, take a quick set of vitals, pain scale what the pt is feeling ect before going to the nurse so she can have these then when she calls the physician. Functional health patterns can usually can be assessed at this time mainly with just talking with the pt. physical assessment takes priority over bath, so this can wait. If you have visistors just ask if they can step out for a few minutes, be assertive. If your clinicals are like mine meds (narcotics, anticoagulants, insulin has to be checked by the instructor before it can be given.)so give time so you can hunt down your instructor. always check dosage and have another student check with you, I always bring the mar with me. If I am giving prn meds for pain, I assess pain on 1-10 scale give med and come back and reassess. I always make sure pt is pain free before ambulating, or ROM. I have been very lucky to have a wonderful, supportive instructor. What has helped me most is being assertive, and just doing what needs to be done. If I don't know something ask. I would rather ask questions than make a terrible mistake. I also make sure I chart as I go, I don't leave nothing up to memory. I could prob go on for days, but just like anything else you are going to have bad days along with the good. Janice

JennieBSN · Apr 2, 2001

'Janleb's' response was good. Very good. She hit on a few key points. Prioritizing care, and organizing your care so it goes with the flow of the patient's day (i.e., PT, xray, etc.). Starting with a quick assessment and vitals is a great suggestion. There's a book out there called 'the 5 minute assessment.' You might want to see if any of your instructors have it, or if you can get a hold of it via amazon.com or something. Being detail oriented is good, but first get an overall 'big picture' of your patient, do the basic and necessary care (meds, treatments, vitals), then smooth out the 'edges' with a long bath, chit-chat, etc. to get a thorough assessment. Whenever I had a hard time in school, I watched a classmate that seemed to be having an easier time than me to see what they did. Watch how some of your fellow classmates plan and carry out their duties of the day, and model after them. Hang in there! Keep your chin up!

angelaADSN · Apr 2, 2001

Hi Lauraw! I am in my 4th semester of nursing and graduate with my ADN this may. We also evaluate ourselves after each clinical day. Our whole class gets that lecture on organizational skill's every so often. BUT the thing about it is that there are 6 students on the floor with 3 patients each who all have to give meds, chart and any other skills that needed to be performed. And every one of these skill (just about) have to be done with an instructor present. Our Instructors have to sign after we do on charting. She has to look at the meds before we give them, and all of this takes time because we have to wait in line for her with our 6 students and 3 patients each. Then when we get behind, it is our fault. When really we were ready to perform a skill she was no where to be found. At the end of the day or on our evaluation she tells us we need to work on organization. The whole point of this story, if your case is like mine, when you get out you are not going to have an instructor to worry about getting you behind. And if that is one of the problems you can either confront her about it (which I chose not to because I plan on graduating in May) ha! or you can grin and bare it. Good luck to you! www.geocities.com/ajax_clean/StudentNurse.html

chili2641 · Apr 2, 2001

Nursing student,

It is ok to be book smart! Keep up the good work in nursing school. Mabe you are meant to be an academic in this field and not a bedside nurse.

------------------

Nursing assistant

JillR · Apr 2, 2001

Organization is probably the most important part of nursing and sometimes the hardest skill to aquire. The most important thing you can do is prioritize. See your less stable patients first, think airway, breathing, circulation then other stuff. For example, if you come out of report knowing that one patient is having problems breathing and this is not quite under control yet, but the other patients have been fairly stable, see this patient first and such.

Another really important part of organization is delegating. When you delegate, be specific about what you want, where you will be if the CNA needs you and what you would like him/her to report back to you immediatly, later or whatever.

The comments about organization sound like constructive critisism and if that is the worst thing they can come up with, then you are doing just fine.

Your instructors are right, it really just takes experience.

Ask yourself questions like, who is my most important patient to see at this moment? What labs do I need to check right now? What meds are essential and what ones can wait? What can I delegate? to a LPN? to a CNA? Am I way too overwhelmed and need help? Don't be afraid to admit when you are overwhelmed and need help. What needs to be done soon, but can wait a while? What can wait until I have the time? Sometimes you need to do a quick, very focused assessment first and then come back later to do a better one. Such as a patient with CHF, listen to lungs, check o2 sat, check edema, ask if short of breath, but things like bowel sounds and such can wait. These kind of quick assessments can take only a few seconds and this gives you an idea of the status of the patient initially, in case of a change in condition.

Ask you instructors for specific hints about what they would think helps and maybe ask other students in your clinical class that know you well, and also the ones that you think are well organized in clinicals.

One more thing, try to do as many things for one patient as you can at one time. For example you can do your morning assessment, give meds, do accu check, whatever you can at the same time if possible.

Laura, it really sounds like you are doing fine. Good luck.

Jill

MollyJ · Apr 3, 2001

Your teacher is talking about times when she sees you perform, so maybe she's talking about dressing changes, med administration, assessments. You can think of other times, too.

In nursing, we get more organized because we get good at creating a system that we generally always follow. In the ED, this meant I (on a stable patient) did my vitals, pretty much the same way every time, that lead me to the med list, allergies, tetorifice hx, pertinent pmh, then I asked cc, hpi and performed and wrote down my assessment and interventions. Because I became pretty slavish to how I did things, my charts tended to pass audit for things like tetorifice history, allergies and current meds (the things you can forget to write down if you have a hopping-all-over, jack-rabbit approach to doing an initial assessment on a patient). When I am doing a new role or task, I look to create that system that will help me do what I need to do.

Instructor is seeing you at times you are doing new procedures, med admin, dressings. Are you getting in there to give meds and finding you don't have an alcohol prep, gloves, a straw for the water glass? At the mediprep, look over everything before you haul it in. Do you have what you need? If Mrs. Jones likes to take her meds with apple juice or cracker, do you have it with you before you get to the bedside? If the instructor is seeing you run away from the bedside repeatedly during tasks like that, she knows your time management problems will multiply by a factor of 100 when you get 6 patients.

It's hard to create a systematic approach when you have a sum total of 2 or 3 months of experience, but work to evolve a system and do a mental inventory of what you'll need before you go into the bedside to do a procedure. Nothing like an isolation patient to hone this particular skill. This, and time, will help.

Finally, systems that help us are really important, but you may have to step away from your system for critical care patients or to meet preferences of your patients. Some anxious patients just couldn't wait to tell me bits of their cc and generally, if it became obvious that I wasn't going to be able to pull them back to "my" system, I went with their preference in order to be responsive to their needs (to feel heard). So don't become so married to your system that you cannot flex when needed.

[This message has been edited by MollyJ (edited April 02, 2001).]

sharann, BSN, RN · Apr 3, 2001

Hi Laura,

I'll be brief. Organization improves with experience, just as the instructor's say.I think to be fair, some instructor's are just plain mean, while other's have nothing to do but watch the students perform. This IS their job. You will be fine! I graduated 8 months ago and I'm still refining my organizational skills. You will too .

GOOD LUCK

NurseCratchett, NS · Apr 5, 2001

I think just about all of you have hit this right on the nose.....One more quick grain of sand recomendation....At my clinical site, if our instructor is busy and we need to do a procedure or give a med our primary nurse is allowed to witness..sign us off on it...observe us..etc..if she is willing....If my instructor is busy and I need to do this I go to my Primary Nurse and ask her to verify or witness...that way I get the things done without waiting and a liscensed nursed watched my actions and signed the charts to back me up....Has saved me alot of time and I actually got a compliment from an instructor for doing it...

janleb · Apr 7, 2001

Wow are you lucky, We are not allowed to have the pt nurse check us off. We are only allowed to go to our instructor for instruction when doing skills or med. But once our instructor observes us, she gives us the go ahead to preform skills independently

Originally posted by NurseCratchett, NS:
I think just about all of you have hit this right on the nose.....One more quick grain of sand recomendation....At my clinical site, if our instructor is busy and we need to do a procedure or give a med our primary nurse is allowed to witness..sign us off on it...observe us..etc..if she is willing....If my instructor is busy and I need to do this I go to my Primary Nurse and ask her to verify or witness...that way I get the things done without waiting and a liscensed nursed watched my actions and signed the charts to back me up....Has saved me alot of time and I actually got a compliment from an instructor for doing it...

DaltaBanaltra · Apr 14, 2001

I'm a nursing student in a BSN program and I'm currently suspected of having ADD- I haven't been tested yet but match the profile. It has been a real struggle for me to get organized when up until this point, I've been able to fly by the seat of my pants through everything!

A lot of what I have to do is planning. I write everything down, everywhere. Usually repeatedly since I tend to lose my lists. Before I even go to bed the night prior to cinical, I set up my stuff and make a list of all the things I need to do in the morning before leaving. At the end of each clinical I include in my class journal (which we have to keep) a self assessment, plan and a list of goals for the next week.

*During* clinical, you might want to have that list with you in your pocket and look at it. Try and even make it so that it's broken down by hours if you have the knowledge ahead of time- it depends on your setting. I find that a lot of rechecking keeps me on schedule.

I've been told the same things you have and you know what, it's all part of the learning process. We are not expected to be experts. That's why we're students- we are trying to learn professionalism, and it doesn't come automatically.

Remember too, plans are useless if you can't follow them. If you find yourself unable to do what you thought you could, crumple up the plan you have, toss it and make a new one.

Hope this helps. Good luck

MRed94 · Jan 31, 2002

bump