TX_TeleRN

I agree. Planned OT is easier to handle than last minute OT -- and it shows your boss you're a team player when you occasionally pick up an extra shift. Unless I have to go to work, I turn my ringer off at night. And if work calls when my ringer is on, I do answer the phone and politely say "no." Most CNs who are professional accept the "no" without asking "why not?". But for those who do why not?, I just tell them that I already have plans without going into details (i.e., plan to lunch with friends, run errands, or just plainly rest my tired feet).

Frankly, you are doing alright! MY ! Some nights will be good ... Some nights will be long ... And some nights will be very daunting... Just hang in there! The only thing that I would recommend is: talk to your preceptor to review what you could have done differently to make matters better and learn from this experience. And... Don't leave before your preceptor, as your preceptor cannot leave before you either. You are almost cut loose to be on your own. When you start solo, you'll feel even more overwhelmed and "forgetful." But that's OK! Stay calm as best as you can so that you don't make any big mistakes. It is better to go slow, and do things right to prevent hurting anyone. Speed will come as you gain your skills. Work on figuring out a system that will suit you best in managing your time. You will get the hang of remembering details with your assessments to chart later. For example, every RN-to-RN report is given differently so I found that by making my own report sheet (as many other RNs do), it helped me find info more quickly. And when I assess a pt, I quickly scan my sheet to verify what was given to me was correct, and I make corrections so that I could chart later. It's more pages to carry, but I dedicate 1 page per patient so that I can reuse these sheets until the pt discharges or transfers off my unit. I recommend that you also check out blogs on time management and/or report sheets. I think it took me a good 2-3 months on my own before I was able to leave before 8pm! I solicited other seasoned RNs to learn of their routines and see what components I could use for myself. Now?? I think there has only been a handful of times when I left on time (i.e., just 12 hrs to my shift), but for the most part now, I am content if I only run 15 min. late. Hang in there!

Can you make arrangements with your family members to see if they can have you shadow a nurse at their current/former employment entities? You won't be able to do hands-on things due to liability issues but it is possible for you to observe procedures/tasks. Continue to review your notes and case studies. They will help you familiarize your thinking process and anticipate/plan what needs to be done. Our school had us use "Clinical Nursing Skills: Basic to Advanced Skills" by Smith, Duell & Martin that provided an inventory list and broke down step-by-step on procedures. It helps cover the basics before actually performing a task, if you feel nervous that is... On occasions, I flip through my NCLEX study guide: "Illustrated Study Guide for the NCLEX-RN exam" by Zerwhekh & Claborn. If you are a visual person, this book may be a good tool. I use it as a quick reference to refresh myself when I come across a case that is not familiar to me. If you are considering telemetry, make sure you study your EKGs and know what needs to be done, as some rhythms are lethal and/or require immediate actions. Your 12-wk orientation will cover this, but it helps to be prepared before class. Class portion will likely be fast paced, so review, review, review! before you get there. During your clinical portion, take advantage of IV starts or anything you can observe or get your hands dirty while you are under the tutelage of a preceptor. ASK QUESTIONS! As for critical thinking... You may have your book-smarts: symptoms = X diagnosis = Y interventions. Most likely, your patient will have multiple things (current problems as well as predispositions/histories) that are wrong with him/her, and that's where your critical thinking comes mainly into play (i.e., CHF, legs edematous, anemia with h/o MI, DM and ESRD. How do you help this pt???). When in doubt, ask questions from other RNs or charge nurses and learn from it. Watch how RNs work (i.e., their routines, time management, how they talk to pts/family/docs, how they assess, how they deal with difficult pts/family/docs, etc.). Observe several RNs because each one works differently. When you get a chance, try their methods and see what works for you. Time management is a BIG thing as a floor nurse. Good luck!

If you think "the notebook" is bad... Check this out. One time, we had a pt on our unit who had a laptop and camera setup in the room so that family can watch (record?) pt care. Sadly, I cared for this pt for at least 2 consecutive days, and NEVER ONCE did I see a family member come visit the pt.

I sure hope that orientation would be longer than 4 days! But irregardless, it is great that your managers and HR are willing to help you find another job rather than terminate you. My orientation class consisted of approx. 13 GNs going into Med-Surg, Telemetry, or ICU. By the end of everyone's orientation (we all came off at different times), 2 RNs were terminated (b/c they "didn't fit in") and by end of 1 year, another 2 RNs either switched to part time or left our hospital. I don't think these departures were all appropriate, as I strongly believe these talents could have been kept if management would help them find a unit more fitting. I myself am not a believer in the accelerated nursing programs. I too started nursing school in an accelerated program, and I ended up switching to a traditional one without any regrets. Why? Once I made the switch, I realized that I had to relearn and reapply the things I had "supposedly" learned in the accelerated program. Don't get me wrong... I retained the info long enough to pass my exams, but it was too much information in too short amount of time that the material didn't have time to set in in my brain. By slowing down, I could breathe/relax long enough to focus on the concepts and applications. Nursing is not a by-the-book job, and you must be able to think critically. So don't let this deter you from nursing if you want to be a nurse. Slowing down will only help you focus. Take advantage of your orientation by using your time wisely to improve your clinical skills, and don't be afraid to ask questions. Once you've mastered the skills needed, you can consider going into a higher acuity. Good luck! :[anb]:

I concur with Bx_RN2B and GooeyRN. You're taking too many OT shifts. Stop or limit yourself to 1-2 OT shifts per month. You need time to recover. From your posting, it does sound like you are well overdue for a vacation in order to recharge! Turn your ringer off when you sleep. Use your caller ID to determine whether to answer the incoming call. Don't let them guilt you to take on OT. Sounds like the staffing shortage is issue for your unit. Perhaps with the lack of resources to do OT, your manager may realize the need to hire more people. You need to focus on yourself first and foremost. Otherwise you will not be able to help others. Good luck!

Bedside nursing is not for everyone. I, for one, cannot see myself doing bedside nursing forever, and yet I think I'm fairly good at it because I communicate well with people. I was originally hired to work nights along with another classmate. I have a very supportive manager and she took both of us off orientation at different times per our "readiness." Fortunately, my boss allowed me to stay on orientation almost as long as the other new grad because I didn't feel ready. Also, one of my biggest concern was whether I could switch my sleep cycle back-and-forth to work nights. By the end of my orientation, my unit had an opening for day shift and my boss allowed me to switch into day shift. I'm sure this was after my preceptors agreed that I could handle the day shift load. This was a big anxiety reducer for me. My classmate ended up quitting After months of unemployment, she accepted a job in a rehab unit as a bedside nurse on days, but I think it is a better fit for her because these patients are stable, therefore less anxiety for her. I've been out of nursing school for only 2 years, and this was a career change for me. It was EXTREMELY scary and challenging for me when I went off orientation. I was nauseated and lost sleep before going to work, but I think for many new RNs that's the routine. So take a deep breathe and reflect on each day to see what caused problems for your shift/anxiety. After doing that for a few shifts, I found that TIME MANAGEMENT was my biggest issue b/c I struggled to get my tasks and charting done AND clock out by 7:15pm. I was constantly clocking out late (usually 8:45pm or after 9pm). How did I fix this? I asked other RNs how they managed their time, tried their routine, and saw what components worked/didn't work for me and incorporated it into my own routine. Now? I leave at most 15-30 minutes late instead of the after 9pm as before. So... reflect after your shifts to see what was good and what was bad to help you reduce your anxiety. Do I still get nervous of the unknown? Not as much. Why? I'm on a telemetry unit and after a while, you get the hang of the population. At times, I get cases that I'm nervous about because I had not treated such a diagnosis before. But that's what charge nurses are for. I just let the CN know after getting report that I may need help with that case because of XYZ and they say, "OK." Instead of getting anxious though, I approach these cases as a new learning experience to break the monotony. Don't be afraid to ask for help. Other more experienced RNs and CNs are there to help you during your shift. They may not have the time to do things for you (and you shouldn't expect them to!), but they are there as your resources. With the economy today, it is unsure as to what will provide you with job security. If bedside nursing is not for you, look into other avenues/niches of your interest. Are you good with computers? If yes, perhaps look into computer charting development teams. Or if you're good with starting IVs, join the IV team at a hospital. Or become a PICC nurse, home health RN, educator, diabetes teaching, clinician, nutritionist, research, insurance companies, school nurse, etc. Or you can pursue a MSN and go into teaching others to become an RN. IF you can tolerate working as a bedside nurse for a couple of years, I think the experiences will make you a better teacher/researcher/developer, should you pursue these avenues... My ! Good luck!

You should definitely deflate the balloon whenever a patient complains of pain. Echoing others who have replied, advance the catheter 1-2 in. more before reinflating. I would request for a UA, if there is not one already ordered to ensure no UTIs. Good luck!

You may have to look at GN positions or positions with orientation for newhires. Acute care and critical care setting is a bit different from LTC. In this case, networking with other RNs is a best way to find out who can your resume to the right hiring manager. Gear your resume towards potential skills you have if you did not get to use them much in the past years. Make sure you have an objective in your resume to help HR/hiring managers understand which position(s) you want. Med-surg acute care setting may be your best bet at this time to sharpen/refresh your skills. Write a kick-ass cover letter and individualize them to each potential employer. I recommend you keep a hard-copy in separate folders with your notes (ie., when you sent to who, who you talked to and when, what you talked about, etc.), so when someone calls you back, you'll have a quick access to recall info and won't fumble when you talk on the phone. Keep resume and cover letter short and simple. A cover letter needs to attrack your reader to want to read your resume. Keep resume to one page with appropriate info (i.e., there's no need to put hobbies or personal info about your family). List other skills you may have from previous jobs, if it's applicable. Focus on your positives. Your cover letter can be used to "explain" why you changed jobs so frequent but you must frame it in a positive way to your advantage because changing jobs often shows a manager that you won't stick around and why should they invest in training you if you're going to leave in 1 year?, right?? So... for example, you can write something like: I enjoyed working with the elderly population. Working in a long-term care setting has given me many opportunities to improve my therapeutic and communication skills, but at this time I would like to redirect my nursing skills to work with the acute care population. ... etc... Also explain why you quit the last job, but no need to delve into details. If manager is curious, you can explain yourself during face-to-face interview. Good luck!

Check with your local hospitals. Some of them have programs geared towards volunteers by high school students interested in health care. Also, ask around to see if you know of any doctors or surgeons who is willing to let you shadow them for a day or a procedure.

Janfrn gave a very good list. I would also add: Don't be lazy. I sometimes see preceptees sit/web surf instead of working/learning. You're not hired to play/goof off. Use this time to learn. Also, it's very important to learn to work with PCTs. They are there to help you too.

At our hospital, we use computer charting as well, and we practice giving report in front of the computer screen with pt's chart open for proper handoff. You'll get the hang as to which RNs need/give too much details and which RNs need/give little info. I've learned to adjust my reports according to the different RN styles/personalities. But... I am one of those RNs who believe it's important to be told which IVF/IVPB/any continuous Rx drip is going on and at what rate so that when I enter the room, I can verify if it's correct to what's ordered. I've had my share of nitpicking RNs criticisizing this or that... I learn from them though because sometimes it makes a good point. I.e., don't be a witch about it if it's over something silly so that others don't call me a witch. Or i.e., share these learning experiences with student nurses when you precept them so that they know what to expect and how to handle these situations. We're only human, so there will be mistakes. That's why it's important we communicate pertinent info and check each other to provide safe and quality care to our patients. Good luck!

I would recommend starting out any change of shift reports with either "Will you be back tomorrow morning/night?" and/or "Have you taken care of this patient before?" These questions can help you determine how to direct details of your report. If it's brand new to RN, you should give a full report irregardless to whether these are normal tasks to your shift, because you still have to communicate these needs to the next nurse who will be doing those tasks (ie., dressing changes, feeding, etc.). I'm a day shift nurse. I find that if I open with "I'll be back tomorrow morning," the night RN writes less about daytime tasks and focuses on what she needs for her shift. So when I know I'm not coming back, they actually write down more to pass on to a new day RN. I think that's fair. :uhoh21: HOWEVER, if the census is low and there is a chance for cancellation, I ask the night RN to write down a full report irregardless whether I'm back the next day. It's totally your call... As for antibiotics, I agree with a previous post. You should know why they are on it, as it may explain certain lab values or pt's symptoms. But then again... That goes the same with many meds we give to pts, right? Good luck!

I agree with Chocolateheals' advice as well. I took advantage of tutors (at my school, it was done by teachers too), and I think there were only 3-4 people who used them. My tutor would even formulate test questions at end of tutor session and help me think through answers when I had trouble. Also if you are a visual learner, I would recommend the "Illustrated Study Guide for the NCLEX-RN Exam" by JoAnn Zerwekh and Jo Carol Claborn. These authors also publish illustrated aids. Check them out at your bookstore and see if these would be worthwhile for you.

Pharmacology was very overwhelming to me while in nursing school. During clinicals, a RN once told me that it gets easier when you practice, as you will learn (look up those drugs you are not familiar with) as you go. There will be some drugs that are given more often on your unit. :typing For your exam, I would recommend you pull out your pharmacology text book and your drug book as well. Read up on each class of drugs and understand what and how each class of drugs work. Make a table so that you can compare similarities and differences (highlight them in different colors) to help you learn. No need to get wordy on your table; just focus on key facts. Your drug book should have a "nursing impliclations" (or similar section). These usually show you what you need to look for before / during / after giving a drug. It helps RNs focus on what needs to be done and what needs to be taught to patients. At my school, they tend to focus on these types of questions. Also note to which population you are giving these drugs to, adults or children. Some drugs have toxicity levels, so consider these numbers when you study. :typing As mentioned in previous posts, Digoxin, increases contractility of the ventricles and lowers heart rate. It's usually given to patients with heart failure or those with atrial fibrillation (dysrhythmia). You hold this drug if the pulse is less than 60 beats per minute for adults (or 100 bpm for children!). Make sure to check patient's pulse for a full minute if patient is not on telemetry. All antihypertensive drugs and diuretics should be held if BP is low (i.e., Why diuretics? These will make patients pee more, therefore lowers volume to heart. Review your diuretics to understand which are potassium-sparing, etc., as diuretics will affect your electrolytes. Now focus on the different classes of antihypertensives: ACE inhibitors, Beta blockers, Calcium channel blockers, Nitrates, etc. and understand how each type works. ACE inihitors should be avoided for those with renal insuficiencies or renal failure. These may cause a dry, annoying cough. [Again... Look at your "nursing implications" of your drug book!] Beta blockers also lower heart rate, so you would hold if BP is low -OR- if pulse is Calcium channel blockers... Look at your patient's calcium level. Typically not used in second or third degree heart blocks. Nitrates are often used for anginas or acute chest pains. These may cause headaches. Avoid use if patients have taken erectile dysfunction meds (i.e., sildenafil (Viagra)). Don't discount female patients, as some may Viagra-type meds for pulmonary hypertension. Hope this helps! Good luck on your exam.

You have received (as have I!) many good technique advices with your post. My advice is more for your self confidence: Don't let your failures get you down. Bring in RNs who are good with IVs and have then help you as you KEEP TRYING! I recall my orientation. My first month, I did very well with IV starts. Then??? I had maybe 2-3 months of always hitting the vein but could not advance or would blow the vein. I was scared, but my preceptor kept pushing me to try. After each failures, she would recap what I did right and what I did wrong. Then one day, I started getting them as if all the advices I'd received finally sunk in. You may not get it every time, but that's OK. Don't get nervous and stay positive. Don't let yourself be your worst enemy. Good luck!

I am glad that you have found a preceptor that stood out and influenced you in a positive way. During my orientation, I had 2 primary preceptors, and they were both great. I gave both of them a thank you card and a spa gift set as a token of my appreciation. It doesn't need to be grand or expensive.

I concur with abbynurse28 and rbezemek. I had a fellow classmate who started work with me. This classmate was very book smart but was shy/nervous to jump on opportunities and worried too much about memorizing implementation steps. Skills can be learned in school/books, but you won't be good at them until you do it. Some may come to you quicker than others. Before I do my skills that I am not 100% confident, I ask an experienced nurse to go in with me. Before I go in, I run through the steps verbally with the experienced RN as a check. No biggie. IF you want to ponder on things, perhaps these are a few points to consider during your clinicals: 1.) Observe your preceptors how they work. There are some RNs who are very calm and others who get overly excited during stressful moments. Watch each person's work ethic and professionalism. See how each person work (i.e., time managment, routine, etc.). 2.) Practice your communication skills. Learn to communicate with fellow staffers (RNs, PCTs, secretaries, patients, doctors, other hospital personnels). Make an effort to pronounce things correctly (I'll always be working on that!, esp. drug names). Don't be scared to talk to people, but think before you speak (i.e., don't be long-winded). 3.) Even if you get nervous, try to not to freak out. Stay calm and confident. It's important to show your patients and their families that you know what you are doing. If you don't know, just tell them that you'll look into it and get them an answer. Don't lie or leave it with "I don't know." Focus on school to get your license. You'll be fine! Good luck!

I concur with most of the replies you have already received. You will be fine. If they did not feel you are ready to be on your own, they would have extended your orientation. I remember my first day off orientation: 1 week before Thanksgiving. I clocked 13.5 hrs to do my shift. Why? I'm slower than everyone else because I was nervous! :smackingf The other nurses on your unit know that you just got off orientation, and they should not mind assisting or answering your questions. You should already be taking a full load assignment near the end of your orientation with your preceptor so there should be no surprises. Keep your confidence and remember you have been trained to do this job. And when in doubt, just ask other RNs or your charge nurse. Find what works for you. You do not have to do exactly what each "teacher" tells you to do to make your routine flow better and be an effective nurse. You'll be fine! Good luck!

Depending on how many years of experience you have under your belt, you could consider case management, work for insurance companies, school nursing, or even consider home health to set your own hours, etc. Good luck.

I'm still a fairly new RN on days, and I especially forget things when my orders change. Just do the best as you can, but the key thing (as many others have already mentioned is to find a management system that works for you. I use a separate report sheet that I made for each pt I get for the assignment. I reuse them as I get the same pt again and discard them after pt discharges or transfers. Then after I get report, it now takes me about 15 min to get organized on a single time grid page that has spaces for 6 pts. At the top, I have space for name/room #. I use top margin to write extra codes for me (i.e., TC=total care, iso=isolation, NT=non-tele, DNR, etc.). I have space for PRN meds, blood sugar (i write Q6h or ac/hs in corner of box and draw 2-3 lines needed for my shift). I can write names of meds in squares, tasks, doc name/time when i called, etc. in appropriate squares. At the bottom, I have blank spaces for whatever I want to write in it (i.e., Foley, IVF-type @ rate, PICC, JP, HD, dsg chg, NPO for test-name, specimen due, etc.). Don't need to write a novel, just key things needed for pt this shift. I can always refer to my report sheet for details. This time grid helps me keep tract of who I should see first, and keeps me on tract from forgetting things. I've seen other seasoned RNs use something similar w/ less writing on them. They make their own time grids with a list of tasks checked off for each pt. Just take the idea and make it into what you need it to be. Ask other RNs how they manage their time. Try their system to see if and what works for you and incorporate it into your system. Good luck! Perhaps I'm still new, I need more info than a check mark so I prefer to write things in. And when you see your pt at start of shift, scan the room to note what supplies you'll need for tasks you have to do on your shift. It'll help keep you from running back and forth all the time.

I concur with Timothy. I used to fumble very badly in receiving and giving reports until I made/use my own report sheet. It helped me be more organized to ensure that I have information on all the systems. In addition to his advice, I usually start my report asking the receiving nurse whether s/he has worked w/ patient before and if receiving nurse has had a chance to review pt's chart. That way, I can go faster on some things, and slow down on reporting pt's change of condition instead. We use computer charting at our place, so I prefer to give my report at a computer while having access to pt's chart. This allows me to show pertinent information (i.e., critical lab values, orders to be done, PRN meds I gave, etc.) to the receiving RN. Although on another post, someone mentioned to leave the "feelings" out. I agree, but if pt and/or pt's family acts/re-acts a certain way, then I make it a point to mention it in my report. As for fears of giving report, I would recommend practicing. Tape yourself, or have a peer (at work or nsg buddy from school days) critique your report. I confided in one of my work peers and she worked with me to overcome my fears. By the end of my orientation, she told me how much I have improved and how thorough/efficient my reports have become. Good luck to you!

I don't know how to attach my file, but I use two forms that I made to help keep me organized during my shift. It's in MS Excel. If interested, PM me and I'll send it to you via e-mail. The first form is a table/grid that I can organize my tasks for each patient. I take about 10 min to fill this out as I review charts/orders after getting report at start of my shift. Above RM/Name, I write my codes: iso (isolation), DNR, TC (total care), ... In the time boxes, I write meds, dsg chg, called doc, etc., to keep me organized and help me remember what to chart later. At the bottom blank spaces, I write key things only, IVF/rate, Foley, PICC, daily wgt, samples to collect for lab, procedures for the day, The second form is my report sheet. I work on a telemetry unit so I change it to what I need most on my unit. I reuse this form while pt is on unit and try to only discard it after pt transfers out or discharges. I found that I was "hunting" too much when I made my form as a checklist, so I allowed more space to write in. I use chart label at Rm#/Name and add additional doctors' names below it. I write up-coming orders/procedures/labs, etc. at bottom white space. I use different colors for each day I provide care. It works for me. If it works for you, great!; If not, I tried.

I agree with this response. Perhaps the shift coordinators for both shifts can get together to communicate issues and concerns of their respective nursing staff. Maybe a realistic list of tasks can be prioritized between the two shifts to alleviate replications and/or overloaded tasks. I work on days mostly, and I do get aggrevated when orders that I was unable to complete are also not carried out by the night RN but find out what happened. The night RN may have had a challenging/busy night too. Just my ...

I feel your struggles. I too changed from another completely different field into nursing. Many family and friends challenged me for giving up a lucrative career to go into nursing. So, in regards to this portion, I concur with "jessi1106" that perhaps shadowing a nurse for a few days to see the good and bad of it all. Speak to RNs if you don't have that option, especially those specialized in field(s) of interest. As for pre-nursing, GPA (at least in TX) matters so study hard and get good grades. Believe it or not, this was the easy portion of nursing program for me. Once you're accepted into nursing school... Don't fall behind on your class work. They may give unrealistic amounts of reading and/or assignments. Many people use flash cards, and that may, or may not, work for you depending on what type of a learner you are (i.e., visual, audio, hands-on, etc.). I wasn't good at learning from reading books so I focused more on lectures. If lecturer isn't very good, then I relied on the books. If you're computer savy (esp. w/ MS Power Point) and your teacher posts his/her presentations, then you could manipulate the printing views of your lecturer's presentations into what works for you. Also, some teachers know how to use MS Power Point and they would insert their notes in each slide. Look for them. I used to print an original copy for class to take my notes. Then in preparation for exams, I reprint all applicable slides to an illness on single-faced page and put each illness side by side to look for similarities and differences in, for example, signs and symptoms, and highlight them in different colors. I also transferred my notes from class and textbook onto them, etc. I think you get my point. COMPARISON IS THE KEY !!! Schedule your study time AND study breaks. It's important to allow yourself some downtime to destress. Make sure you work in sleep! Don't throw anything away until you've passed your boards. You may need to refer to them.Good luck to you! You can do it!