2020newgrad

Hi! I'm a new grad on night shift on a med surg floor. At my hospital, transport goes home at 2200 and comes back at 0700, so if STAT imaging gets ordered anytime in between, I have to leave my assignment and take my patient six or so floors down to CT or US or whatever. Honestly this seems unsafe to me, especially since I've gotten stuck at ultrasound for a full hour before with a colleague covering the rest of my assignment - and we have a lot of early post-ops and a lot of cardiac patients on tele. We all know "being covered" is nowhere near the same thing as having your own nurse on the floor and checking on you. So I'm interested to know: what's your experience and your opinion, and what area of nursing are you in? How do you deal with it if you have STAT imaging ordered on one patient but another seems a bit "off" to you and you're not comfortable leaving for an hour? Thanks!

Hello! I'm a fellow nurse with ADHD, but I just started my first job in September so I'm still figuring these things out myself. I got a lot of the same feedback during orientation - finishing one task before moving onto another, etc. Here are some little things that help me during start of shift setup: 1. I arrive EARLY, about 6:20 ideally! My things have to all be in their correct pockets for me to feel in control of my day, and I get as much of my mental setup as I can done before report - usually, at least on my unit, assignments are finished by about 6:40, and I take full advantage of that. I expect that as I move through my first year I'll need less setup time, but right now it's essential. 2. Looking up patients. I take a quick glance through all the vitals, orders, most recent labs. I then do a slightly deeper dive on each patient starting with the most recent resident/fellow's progress note and take my notes, starting with the least stable seeming patient. I try to do the quick glance through before report and then the deeper dive and note taking after. 3. Making full use of tools available. We're on Epic, and there's a "Brain" screen that shows everything due for your patients each hour, from incentive spirometry to meds to pain reassessments, and also allows you to add "to do" items. There's also a "work list" screen for each patient listing all med and task due times. I print the work lists and update them throughout the shift. I bring them with me when I pull meds - I check off meds as I pull them, and cross them off when they're given. These tools really help avoid feeling "scattered". 4. SLOW DOWN. I still struggle with this daily. Realize when you're feeling scattered and frazzled and take a pause for a deep breath. The due time for your patient's eyedrops will never be as important as their safety. Don't skip steps if you can possibly help it - stick to your process once you find it. All these things are very much works in progress for me and still a daily struggle! I'd be interested in sharing notes as we both move forward through this year of firehose learning. ::Edit:: I forgot! I've recently started charting my assessments in the room right after doing them, when time pressures allow. It eliminates the need to take extra notes/ hold my findings in my very fallible working memory, and it also eliminates a big documentation task from my to do list later in the shift. Plus, if I missed something in my assessment, then I'm still in there chatting with my patient when I discover it and don't have to make an extra trip to the room. It's not always possible but when it is, even just for some of my patients (especially the most complex), it's really helpful

Hi all! So I'm a new grad (just finished my first week off orientation) on a floor that's half medical patients and half post-op, but the cardiac unit downstairs went COVID around a month ago so we now get cardiac too. There are floated cardiac nurses on the floor to cover people on cardiac drips, etc, and it's definitely an interesting learning curve for all of us, especially for me as a newbie, to have NSTEMI and new onset CHF patients. Well, I had a new CHFer recently who went into SVT on me. Tele called to say he was sustaining in the 130s, so I went in and got eyes on him, got vitals, called a rapid response and the covering provider from the room. His pressure was okay on paper in the 110-115/70 range, but his baseline was 150s/90s so I was uneasy from a hemodynamic stability standpoint. Then I stuck my head out of the room to alert the other nurses and get help, and saw no one. Somehow I didn't think to hit the urgent call bell to get people to come running and instead ran out the 30 feet to the nurses' station to alert people, then turned around and went right back to my patient. The RRT got to the room just as I returned so it looked to them as though I had left my patient unattended. I'd never even seen a rapid response before this and so I didn't really know what to expect. It was an odd and ultimately unsafe staffing situation that night - it turned out that between the 4 of us on the medicine side of the unit we had less than 4 years' experience, but I didn't realize until we were debriefing because I thought the two cardiac floaters had been there longer. Our resource nurse was also charge with a full assignment and was transferring a patient to the ICU at the time. When I notified my unit of the rapid response, just two nurses showed up, neither with more than a year's experience. Which would have been fine, except that I felt in out of my depth and stopped thinking straight and didn't delegate. The RRT nurse had to call me out because I kept running errands for her. She stopped me and said, "Where's your team to help you? You should be staying with your patient." Of course I know that, but I felt useless and it didn't feel like the support was there. The experienced nurses from the surgical side of our unit had been occupied with other acute situations and showed up 10 minutes into the rapid response. I made a bit of a fool of myself - the team asked me what his baseline heart rate was and I froze up and second guessed myself even though on reflection I knew it. Ugh. The patient's BP ended up coming back up to the 130s/80s and his sats were fine so it was a stable SVT; they tried metoprolol and diltiazem with little effect before a successful cardioversion to NSR with adenosine. It would have been really cool to watch if I hadn't been too busy feeling useless and incompetent (and feeling bad for my patient going through the misery of adenosine). The nurse educators and leaders from the unit had a huddle the next morning and filed an incident report for the unsafe staffing situation. The universal response from my colleagues was to tell me I did fine for my first time and that they were sorry I didn't have the support I should have, though I know personally that there's a lot I wish I'd done differently. In the end, I'm grateful (and my unit) get to learn these hard lessons from a situation in which the patient ended up fine. As hard as it was to get the feedback I did from the RRT nurse, I pulled her aside once the patient was stable and let her know how much I appreciated it and got some good pointers for the future, so I'm really grateful for that also. My questions for you all are: 1) How do you more-experienced folks mentally prepare for situations like this during each shift? Is there anything you emphasize in your start-of-shift review of the chart that a new nurse might not find intuitive? E.g., I recently was advised to pay closer attention to MEWS scores, which is something I'll be doing going forward. 2) Other than delegating and collaborating to make sure vitals, EKG, BG, etc. happen during a rapid response, what is your process before and after calling a rapid? Do you glance over crucial info (labs, baseline vitals, etc) before the team arrives or are you able to just hold it in your head from earlier in the day? I'm worried I might just have a crappy memory because I'm a nurse who needs things on paper, and so I fear I'll always be slow with that info when the team asks for it. I appreciate any and all tips. 3) How do you stay calm and grounded in these emergencies? What are your strategies for maintaining mental clarity and an atmosphere of calm? I really appreciated the resident who asked me to silence the Dinamap and the EKG machine because "none of us need cortisol spikes!" Thanks in advance for any pearls of knowledge and experience.

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.

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.

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!