graykitty

I'm a new nurse with one year of experience, working on a med surg renal floor. I feel I've progressed a lot in this first year, but still have a ton to learn. There is one thing that really bothers me, though. I'll usually have 6 or 7 patients each shift. I have all of my patients' info (from report, and notes taken as the night goes on) on my clipboard. For the life of me, I can't usually remember details about some of the patients without looking at my notes!I'm talking room numbers of assigned patients, diagnoses, who has fluids infusing, who has a foley, who is on tele, who is npo, etc. Now, as soon as I glance at my notes, I suddenly remember my interaction with them, and of course it's written there. But this is very troublesome for me. If I'm asked a question by the charge nurse, or I have to take a call from a doctor, I have to have my notes in front of me!!! Other RN's with similar experience don't seem to have this issue. Did anyone else ever start out with this problem? What can I do to improve my memory with details for 7 patients? When will it get better?I should include the fact that I started out late in this profession, and I am 57. I've been told by coworkers and supervisors that I'm a very thorough, good nurse. I've had no other cognitive or memory problems outside of this. I'm thinking that at 57, maybe brain cells are starting to die off!!!! Any responses or advice will be welcomed, thanks.

1-The people at the top who are only concerned with customer survey results. 2-The patients who view their experience as "hotel guests." The patient who you brought back from a code blue won't return a survey praising you, but the patient who was "neglected" because he didn't get his blankets fixed, pillows fluffed, or pump to stop beeping in the first 60 seconds of his call light going on, WILL return one and name you, which will affect the percentages of your entire unit. No matter that the so-called "neglect" occurred on a night when each nurse had a load of 9 patients, no CNA's on our 30 bed unit, and you were concerned with trying to keep at least 1 of your patients from crashing. What is wrong with this picture? Some of these administrators need to spend some time in the trenches. I love being a nurse but sometimes it is so disheartening...

AlisRN, what area of nursing are you in, with those ratios. I'm interested in hearing from others too. On my med surg/renal floor, our ratio is 1 to 5-8 patients. Also, from midnight to 7a we have only 1 CNA for our floor (30 rooms). So, I end up doing a lot of I/O's, v/s, etc. Without much help, it is so hard getting done on time. Recently, I reported for my 7p-7a shift, and found out I had been cut to a 4 hr shift that night. The hospital is cracking down on nurses with overtime due to staying over to finish charting. I was told to "chart as I see my patients, see my last Pt by 10:30p, give report at 11p, and clock out no later than 11:30p." I was lucky to have only 4 pt's and one new transfer to our dept. My 9p med pass was LARGE. Let me tell you, I FLEW through assessments, meds, and charting ( which I still couldn't do as I went). I finished with report at 11:40p, and still had to file a risk report on my transfer Pt. I clocked out at midnight. No way I could have done anything faster. What if I had more patients? And more meds? And a full admission (get dr's orders, etc) instead of a transfer? I have no idea how I could handle it all in 4 hrs and have ALL the required documentation done. Any nurses out there who do this regularly?

Thanks everyone for all the tips and comments on my op. My routine is, get report, meet all my patients put my name & phone # on their board, I can then assess mentation, ck if IV bags are low, if they need pain meds, etc. Then I get all my scheduled meds, any pain meds & IVF bags and my WOW. I do quick assessment (steth for lung, heart & bowel sounds) then ck radial & pedal pulses, edema, wounds, bruises etc. Pass all meds. Then go to next patient. Its difficult staying on track when you keep getting calls, "rm xxx needs something for pain" when you were just in there & they said they weren't in pain. So, you leave your current pt to go and get pain meds for that pt, and return to the room you were in. Sounds like some of you do all your assessments first, and then go back & pass sched meds. If I know from report that they're due for pain meds, I could grab it & give it when I do my quick assessment. The I shouldn' t have any of those interruptions when I go back to pass 9 pm meds, which is a huge med pass. Do any of you follow that routine?

Hi, I've been an RN for 7 months now, and still having trouble with time management. I work nights-- either 7p-7a, or 11p- 7a. It's a med- surge/ renal floor, 1 nurse to 6-7 patients, all computerized system, with physician order entry as well. My biggest issue, especially on 11p- 7a, is charting as you go. After getting report, I hit the floor at midnight. If I chart the assessment, look at labs, do the accuchecks, chart IV and wound assessments, and pass/hang any meds & chart them with pain assessment, I am easily into a 30 min round. At this pace, I will be waking up my 7th patient at 2:30 - 3:00 am, with some of them receiving their meds late. Our charge nurses feel this is unacceptable, because patients need their sleep at night. For this reason, I try to get my tasks done, leave place markers in the electronic chart of the actual time af ea pt's assessment. I get done seeing my 7th Pt by about 1:45-2am or so, then I sit down and chart, while the Pts are sleeping. 5am starts accuchecks again, line draws for labs, 6&7 am meds, and be ready to give report at 7am. This is in a perfect world, LOL! I clock out on time about 25% of the time. 7p-7a shift is sometimes easier, because you have more time to get it all done! However, the massive med pass at 9pm sometimes cancels out the "extra time" benefit... There are times when I finish giving my 9pm meds at 11- 11:15pm (if you happen to be my last Pt to be seen). We usually have 1 CNA for the whole 30-rm floor, and when you need a set of vitals, water, an accucheck done, etc, either you can't find them or they're busy with another patient and they'll be awhile. If I need a BP in order to give a BP med, I have to do it myself. At the risk of beating a dead horse, recent example: I'm scheduled 7p- 7a. Regular charge nurse calls off with family emergency. Person thrown in as charge is still being trained and doesn't feel comfortable yet as a charge nurse without someone seasoned to rely on for help. So, a seasoned nurse is called in to help (I'm advised at around midnight) and arrives at 1am. I am to give my 7 pt's to her and I can go home. Problem is, I passed meds & saw my patients from 8:30 till 11:30p, and didn't do any electric charting (had planned to catch that up at midnight). So, after giving report to the oncoming nurse at about 1:30- 2am, I did all my charting and clocked out at 5am! I never chat at work, nor do I ever take a lunch -- I'm never hungry at night and prefer to stay on track. I combine med passes and try to save steps by anticipating what my patients will need next. My teammates are wonderful and we help each other out when needed. I just wish I could speed up and get out on time 75% of the time! I won't cut corners and I don't want to leave knowing I left documentation undone. Does anyone have any constructive criticism that can help me? I had hoped that by my 1 year mark, I would have my time management skills very much improved.

Pull weeds (VERY effective when you're agitated), run or walk, snuggle with my cats, or sink into my hot tub in the backyard.

I have a tiny 2 br home & share it with my hubby & 2 granddaughters. They are loud, Tv is blaring, and at night it's too quiet & I fall asleep as soon as I begin reading. So, I go to my nearby 24 hr restaurant. As long as I buy something to eat, they don't care how long I stay. They have a separate room that's used for lg groups, and they let me sit back there where it's quiet. There's just enough noise, and people moving around that I don't fall asleep. And when I start yawning, that's my clue to go home! Thank you Denny's, i got through nursing school with your assistance & I owe you and the waitresses SO MUCH!

All of the posts on this thread are encouraging. Can anyone clarify something for me? I'm a new RN grad with no hospital experience behind me either. At a job fair I attended recently, I spoke with a Nurse Mgr in a hospital rehab dept about working there, full time, eves/nights. This hospital is an acute care hospital with a rehab department, same floor as med-surg. She explained that this would be a good starting job for me & would allow me to get my nursing skills down first before going to any other area. Since she stated that, "all of the pt's in the rehab dept are stable - they must be, in order to handle 3-4 hrs of rehab per day. If they become unstable, they get sent back to surgery, etc." I now have an interview set up for this position. If I'm only working with stable patients, what kind of nursing skills am I going to learn here, besides time management, organization, & psychosocial? Within 6 months to 1 yr, if I want to move to med-surg in the same hospital, will I have cut my own throat? Will I experience overwhelming stress because I've "lost" everything learned in school?Do I take the rehab job if offerred and keep looking for med-surg? Or should I turn down a rehab job and wait for a med-surg job to become available? That seems scary to me. I'd be losing all of my nursing knowledge from school if I sat around for 8 mos-1 yr. I'm so confused and I don't want to make a decision that may come back to haunt me. Of course, I may love rehab nursing, fall in love with my patients, and decide to stay for years. Any advice?

Being a new grad, I want to get as much experience as possible on a med-surg floor. I have an interview for a position in inpatient rehab. I've been advised that I should think twice about accepting the rehab job while continuing to look for a med-surg position. Some say that I will not be using the skills I learned in nursing school, and I will lose knowledge quickly. While it is a job (income & benefits that I need) and I will be getting experience, is this the "right" experience? Some have told me that if you are good in rehab, they will want to keep you. Nurse Managers make deals, such as "this employee is excellent in my department -- so can you search "outside" first to fill your med-surg position" or things of that nature. And as a result, it becomes very difficult for an RN to transition. Also, when a med surg Nurse Manager looks at your resume, are you at a disadvantage because you have not gained acute care experience for, say, a year or more? I don't like turning down a job offer. However, I do not want to make a bad decision on a career path right out of the gate, either? Any advice from Med-surg nurses?

The best way to learn is from our mistakes. We are not perfect. However, many find someone or some thing to "blame" it on. You are accepting responsibility: You get a huge pat on the back! My intuition tells me that you will do your absolute best in repeating the class. Count it as a life lesson and move on to be successful. I applaud you for your commitment, God Bless!

Yes, I agree also! Your first semester can be difficult just getting into a routine, and you must study, study, study. The more you have on your plate, the more overwhelmed you may feel at times. I returned to school to make a career change; I'm 55!! I'm also in my final semester, hope to be DONE in August. It has truly been a challenge, but so very interesting. Two tips for you: #1 -buy a recorder and record lectures if you are allowed to. Do your reading first, then listen to the tape to pick up anything you missed, and for reinforcement. You can even listen to it while in the car..., and #2 - do your own reading/studying first, THEN go over things in a small study group. You will glean things from the others, as they will glean from your ideas. IMO you won't get anything from a study group until after you have done your reading of the subject matter first. Congratulations on being accepted! Make your commitment to giving it your all, and refuse to give up!!! You'll do fine!