"Could it be that you have troubles with organization, goal-setting, or planning?"
It could very well be. But how to work on it? I need time to organize and plan, and there's just not that much time available when working. I'd come in early to try to get some extra time preparing and planning. Of course, oftentimes the assignment changes so you can't plan ahead.
It seemed like there was never time to do everything. If I checked for new orders, I didn't get the meds passed on time. If I passed the meds on time, the new orders weren't taken off in a timely manner. I wrote lists, made check off forms to try to make sure I didn't miss anything, tried to plan ahead, but there's always something new, something else that needs to be done now - a new admit, a request for pain meds, someone vomiting, a high temp, doctor on the phone, etc. Planning and organzing can only get you so far.
Goal-setting. Do you mean in terms of what to accomplish each day during orientation? Giving all meds for a certain number of pts? Try to get certain procedures on the checklist done? Do all assessments and charting? Whatever I'm working on, generally the orienting RN is busy doing everything else and must be found to ask questions to and so everything I do takes that much longer. And the orienting nurse gets annoyed at the frequent interruptions from me, but if I just plow along, "saving up" my questions (like for an hour, not a whole shift), I'd end up with several things being quite behind schedule because "going back" and doing things takes even more time. If the preceptor tells me to go it on my own for awhile and comes back to find me far behind schedule, she wonders at how I could "let" everything get so backed up.
Again, there's no time during the shift to sit down and discuss what you did when and why and how else you could've handled it. By the end of 12 hours, I'd be kind of fuzzy on the details of my day. I could sit down, review my notes, recall certain choices... but I need some quiet and calm to gather my thoughts like that. None of that til at least 30 minutes after the shift is over.
I am a thinker. An analyzer. And much of nursing is action. Of course, there's reason for that action, but there's often not the time to fully process the whole line of reasoning. You need to get from A to C quickly without spending time pondering B and it's relationship to A and C.
Thanks for your thoughtful responses! I'm still working through why I had such a hard time and what do now. Like looking at those 3-D "hidden" pictures - sometimes you just can't see something even though you're looking hard.