tdupuis

Wow cubbieblue, I feel like you took the thoughts right out of my head reading your post. I work on a medical floor and bad days are the norm for me as well, every shift I come home feeling not only physically exhausted but emotionally as well. I've been a new nurse for about a year, though only working own my own since January - I had a 6 month new grad prior to that. During my new grad I thought it was great! I was not aware of how much my preceptors helped me out. Now that I am doing everything on my own I'm very overwhelmed. I also feel like I am barely keeping up, that I am constantly missing things. I can't imagine 6-7 patients, I have a hard enough time looking after 5, so kudos to you! I also don't know why it has to be so hard. I've heard from friends, family "oh it will get easier once you get the hang of things" well I'm pretty sure I've got the 'hang' of things I just can't seem to keep up/organize myself properly to get everything I need to get done in a shift. It is also very discouraging when I see my coworkers leaving on time day after day, and I am there late day after day, I don't know what I'm doing so terribly wrong that everyone else seems to get their jobs done on time and I can't.. I'm a loss for what to do. I have asked coworkers how they plan/organize their days but it doesn't seem to help. Short of having someone follow me around all day pointing out things I do not need to do/take too much time doing I don't know how to change things I have been looking for other positions elsewhere but nothing has come up that I've felt confident/qualified enough to apply for (plus they are all out of town a good 1/2 hour to 1 hour drive for me, my current job is a 5 minute drive up the street) however I can't help but feel that I will continue to make the same mistakes/be slow at any job.

I personally do not see how anyone has the time to chart as they go. I have been an RN on my own now for about 6 months now and I must say even on day/evening shifts (we have 8 hour shifts at my hospital) I often do not have time to chart as I go. We have all electronic charting at my hospital, the only thing that is written is our MARs which we sign for in the book, and it is rediculously time consuming. We have to sign into the computer, the the electronic chart, then pick the patient then go into the charting section, then select the appropriate area/assessment you want to chart on - it takes at least 2 minutes just to get to the page you want to chart on! Also for us we also have more nurses on the floor than we do computers, and often times computers are being used by other staff members as well (doctors, discharge planning, pharmacy, etc.) so even if I do find a minute in my day to catch up on some charting I'm lucky if I find a computer to do it on. I carry around a sheet of paper with me with all my patient's information and I write down my vitals, assessments, IVs, etc. on there and keep it in my pocket then chart it later. However this isn't the best solution either because having all my charting to do at the end of my shift backfires (sometimes Drs go into the computer to look up vitals, etc.) and if they aren't in there when they check it they don't see it. This also backfires because leaving it til the end of my shift I have 5 patients to chart on and it takes me at least 5 minutes to chart on each, there's 25 minutes right there, plus having to record report (we still have taped report) and count our narcotics, I'm almost never out on time, however I don't see much way around it other than missing my breaks to chart which isn't fair either.

Thank you for all the support and feedback! It has made me feel much better :) I guess what spiked my worry/concern was seeing posts by others about being fired about 2-3 medication errors and just got me wondering if that's what I was in for as well. Unfortunately we do not have kardex's in our hospital - I wish we did! We do have 'report boards'. The way my medical and med/surg floors work is that the floors are seperated into 'quads'. For each 'quad' on my floor the RN gets 5 patients and the RPN gets 6. Anyways on these boards we have pt, room, MD, diagnosis, past medical history (if the previous shift has felt so inclined to write this in - some don't) and then three sections one for days, evenings, nights, where we write down things like IVs, catheters/I&O, vital signs, some assessments, pain, etc. but they do not give a full picture of how to care for a given patient the way a kardex would. The information that would be found on a kardex is in our computer system, we have computer charting. Our computer system is the slightest bit on the slower side and having to go into each patient and look up different things does take time - much more than being able to flip through a kardex binder in my experience! We also do not find out our assignment until we receive report as we split the patients up between myself and the RPN on my quad based on their acuity that day. Therefore it makes coming in to do research, looking things up almost impossible. I do come in about 20 minutes early just to get myself settled and look up common info: allergies, activity level, diet, etc. on all 11 patients in my quad only because I take over all patients while the RPN is on break and vice-versa. This makes organizing my day a slight bit harder, however sometimes I can if patients have remained the same and I know that, for example the patients I had yesterday are still the most acute in my quad, I can expect they will be assigned to me. I have been using some sort of report sheet to go off of but still manage to miss things. I have spent some time devising some new report/organization sheets and I have looked up examples and gained ideas from co-workers about what sorts of things to include on this sheet - thanks for this suggestion though! I must say I do agree with that we should have to, nor be expected to come in early on our own time to get ourselves organized as employers may begin to rely on this. I understand that nursing and the health care field in general is a different class of working environment however I think about the big picture, what other jobs/careers expect their employees to come in early to get organized in order to get the job done? I have only started coming in early since January, I was on a new grad initiative previously, because I know I am on my own now and I need to develop trial-and-error what works best for me. I am also hoping that as I build my knowledge base and organization skills I won't have to come in so early to organize myself. I had much better shifts the last couple of days and I will continue to utilize my 'brain sheets' to better organize myself, however I find I sometimes even forget to write something down haha.

Hello I am new to allnurses and I just wanted to share my story mostly because I still feel incredibly terrible about this and feel the need to discuss. I started working in a fairly acute care hospital in June 2010. I have had 4 medication errors since I have started and I am just terrified of losing my job. #1 Drew up and mixed a patient's IV medication that was due at 0600 on a night shift. I had put it in the patient's drawer (we have med carts) as instructed by my mentor (I was doing a new grad initiative) as we needed to attend to another patient at that moment. All the while looking after this other patient I completely forgot to give the patient the medication and the morning staff found the IV bag when they went to give the patient's morning meds. #2 Missed a dose of a patient's antibiotics. Patient was a transfer from the ICU and on receiving report the reporting RN mentioned that they had not had a chance to give the patient their antibiotic. After report I went about my business and completely forgot that this patient still needed to receive their antibiotic. #3 Went in to give a patient their evening medication and forgot to remove their Nitro patch. Whether is was found by another nurse on the next shift or the next morning when the nurse went to apply the new patch I'm not sure but either way still a HUGE no no. #4 Gave a patient their antibiotic IV instead of PO. Patient had previously been on an IV dose of this antibiotic but had been changed to PO. At our hospital we do not get new MARs printed everyday, we use the same one for a week so when a medication is changed the old order is crossed out in red and the new order written below. This particular medication route change I believe was on the same page and either I overlooked the route or had been looking at the wrong order (it is difficult to distinguish new/old orders even with the red marking because medication administration times, new drs orders for meds, etc. are also written on the MARs in red ink). I take full responsibility for all these errors as I was at fault and they were not 'system' errors. Thankfully none of these errors had a harmful effect on any of the patients. Incident reports were written up for all these errors and I was approached by management about #1 and #3 only regarding how to not let it happen again. The other two have not been discussed. I have never been approached regarding a reprimand nor a probationary period but I still feel like I am very close to losing my job. Every shift I come in to work I am fearful of receiving an email/phone call regarding termination/another med error. I am also very concerned that in only 11 months I have managed to make 4 medication errors. It worries me on a regular basis and although I tried to look at the positives (noone was harmed and I took these as a learning experience) I still managed to make the same mistake twice (dose omission). I'm not sure what I'm doing wrong or what else I can do to ensure I do not make further mistakes? I am most fearful of making a mistake on a day shift during 0800 medication rounds as we need to share the medication cart between two nurses, one gets it first for their patients, the other gets it after. I already feel so rushed in the morning with patient meals, pt requests, needing to get patients to their daily inpatient appointments and having to get through my medication pass in a timely manner so that the other nurse can do hers as well. Not sure what else I can do other than continue to take my time (as I know medication administration isn't the time to rush), ensure to do my 7 rights, and writting down any meds that remain to be given to a patient we get from a transfer etc. I now check all my patient's medication drawers to ensure I have given everyone their meds. I have also learnt to bring a baggie (for patches) or write down anything that may not be 'giving' patients a medication but removing patches etc. so as to not forget to do these once I am in the patient's room. I continue to lose sleep over these errors which unfortunately may lead to drowsiness/lack of sleep and may ultimately lead to further medication errors. I'm not sure how to get out of this cycle. If anyone has any suggestions for me it would be greatly appreciated.