CVSDnurse

I am on week 4 of orientation to the PACU from the Cath lab. Both areas utilize 100% electronic charting, although they use different systems. In both areas I have experienced your situation with one big advantage, the transfer of vital signs to the documentation system. In the PACU it is a "click" to pull the data from the monitor. As I am still trying to get a feel for my flow, but I have found that if I can enter a reading for vital signs at the correct interval, then return to post document in that field the correct assesments that was occuring, it is a bit of a time saver. You will see the biggest advantage to electronic records for patients that are "returning customers" because you will have lees to initiate, also it is nice to have all the information at your finggertips. While it is true that as you become more comfortable, it will get better (meaning you can get what you need faster), there is still a big role for your IT department. If you are an area of "champions", being the first to experience the electronic medical record, then there should be a flow of your needs to the IT/Meditech department to improve the workflow. In particular, there needs to be some work on having the monitoring system talk to the documentation system to fill in the vital signs for you. Also, the "duplication" that you are needing to delete when patients have been in both pre and Pacu needs to be evaluated. Is it just automatically autopopulating forward? (this should be a manual option to "copy forward") or are you eliminating the documentation of care previously provided? I would suggest talking with your manager to see what resources the IT department has for your area, and to request some if they are not in place. I have watched a lot of "little changes" take place in the 4 weeks I have been in PACU just around the new computerized physician order entry to try to make it easier. I also know it took a year to make the monitors and documentation system "talk" to eliminate the manual vital sign entry. In my years in cath labs, there was no way to avoid "late entries" when you are providing acute care to your patients, wether it was written or typed. Make sure you are finding how to make "late entries" in your electronic medical record. This is another discussion to have with your manager. As long as you provide the care, then be sure to "document it" so the lawyers know "it was done", you are doing a good job (even if it takes longer than it used to ) Scratch paper on hand, and your vital sign capture device holding a memory of events are a must.

I have been in the cath lab for 4 years now, at 3 different hospitals and every lab had its own quirks. I suggest you take some time to observe for a day or so in the lab, get a feel for the doctor/staff personalities and carefully consider the impact of taking call on your life. Remember that you do not get the extra 2 days off for your on-call weekend. It is a unique and very specialized area. A supportive and organized orientiation is necessary as it is nothing you learned in school. Nurses find themselves to love it or hate it. Good luck in your quest.

Ditch the computer-hand written in a format (and size) that works for you with abreviations that you know- keep all your cards- you will see repeat drugs and will not have to rewrite them for the next patient and you will retain the info.

1- ask to meet the staff-a lot can be learned from non-verbal interactions-make sure to ask them if they spend time together outside of work- will give you an idea about how well people work together 2-spend time eavesdropping in the cafeteria-amazinig what you hear but may be hard to pinpoint to the specific area 3-ask for a tour of the unit- you'll see things that will spark questions 4-ask why there is a vacancy- did someone leave vs. expansion 5-opportunities for advancement 6-have a list of specifics and don't be afraid to pull it out at the end, a good manager will welcome your interest, they don't want to waste training resources either-nurse/pt ratios, coverage for call ins, do they mandate OT, overtime rates, how vacations are decided if too many want off at the same time, how flexible are they if you need to have a last minute appointment (closing on a home), educational opportunities, orientation period, assigned or rotating preceptor, how are emergencies handled, MD interactions and responsiveness, how does the manager handle interpersonal conflict-do they let themselves get caught in the middle or do they have all parites sit down together for problem identification and solving, how is charting formatted 7- list the benefits-from uniform provision, insurance premiums and vacation accrual to tuition reimbursement and relocation assistance- for all positions and compare-it is not all about the hourly wage. 8-practice by starting with your least interesting options 9-visit and ask everyone about the various areas of the city you will be living in-online research Hope this helps. remember to never burn bridges and keep all options open even when you have found your "dream job"

The actual time at the hospital day of clinical was about 4 hours. Your instructor should be able to tell you that requirement specifically. The unpredictable time was the prep the night before. I would often spend 7 hours- at least 2 hours with chart review and then you need to look up every medication, diagnosis, procedure, ect. and write your care plan. As the semester progresses you will find there is repetition of these things that you research- save all your notes and keep a hand held index card organizer of medications so you will have some meds pre-researched. I found working double shifts on the weekends to keep my week days free to work best during nursing school. My advisor actually told me it would be impossible to work full time during school. Without the ability to be very organized and go without lots of sleep, she would have been right. I don't know how working moms ever make it through nursing school. Hats off to them.

my first charting note is a quick head to toe general assesment of areas not covered clearly in the checks, the next 4 hour chart is often "no change from previous note" but never leave out anything abnormal that you notified a DR. about!

When I first started at my current job, my first opportunity to work 12 hour shifts, I opted for 8 hours. I felt they would allow me to be there more frequently and in shorter bursts to learn what I needed to to practice competently and get my self up to speed. Now that I am comfortable here, I have gone to 12 hour shifts. I prefer them for 2 reasons: 1-I am there less often and have more time off 2-I am able to provide more patient teaching than I could in 8 hours. It is definitely a personal prefrence. I like to be busy rather than slow as that makes even 8 hours drag on forever. I feel I make fewer mistakes because I feel less rushed. I don't feel any more tired after 12 hours although some times my feet hurt a bit more. I definitly believe the improved quality of my care is more important than my feet. And I no longer "waste" my days off by catching up on laundry and house work. Not to forget to mention that the occasoinal 8 hour days are almost like a vacation themselves as they go by so quickly.

The most important thing I learned in nursing school was to "ask if you don't know" and that noone can know everything. They stressed the importance of experienced staff members and looking for a job that offers an adequate orientation. I graduated two years ago from Edgewood College, a small private college in WI with a BSN. My experience as a CNA before and during school gave me the advantage of being comfortable in relating to my patients as people during clinicals. I felt that many of my classmates who were expeirencing direct care for the first time were at a great disadvantage by not being able to focus on the skills of nursing because they were too overwhelmed by trying to be comfortable with such personal contact. When I entered a BSN program I worried about a lack of clinical time due to all the stories of how 4 year programs are all book work but found out that that was most definately not true. We averaged 14 hours a week on the floor. I felt very prepared for nursing with my education but the experience I sought out on my own made the transition much easier. My instructors all stressed that they were teaching us the basics but it was up to us to be honest about our limitations and to know that you will learn the most from your experienced coworkers by asking when you don't know or are unfamiliar with something. Reaizing your responsibility as a nurse to never endanger your patients by trying to "fake it" when unsure is the most important thing to learn. Having recently changed specialty areas, this point has again taken the forefront. You will earn more respect by asking and being safe than by trying to look good and making potentially fatal mistakes.

I have only recently gone from Long Term Care to a Cardiac Step Down unit. I think that one example of how nurses are over worked and under paid is that RN's are now resposible for rmoving arterial sheaths after coronary catheterization rather than Physcians. We are taking on the time consuming and very risky task that was once only for physcians so that they can "process" more patients. How nice it must be to be paid "per case" rather than per hour-how much better would nursing incomes be on days when there is shortages of staff if we were paid per paitent and task(I would charge for each call placed to an on-call MD when we have to explain the patient and tell the doctor what it is that we think the patient needs if only they will"give" the order.