FinallyRNStatus

Hi I just thought I would reply with my experience as a student and RN. Although I think people vary on what will mentally or physically exhaust them. The level of exhaustion I felt as a nursing student commuting 1.5hr+ far exceeded the level of stress I felt as a practicing RN commuting 1.5hr. I think in your case you are a FNP student. As a nursing student I traveled 1.5-2hr each way commuting to school and clinicals. My nursing program was 3 days class/lab 8am-4:30pm and 2 days of clinicals 7am-3:30. Additionally, after getting out of class at 4:30pm I would have to go to the hospital to do a patient lookup, with traffic meant it took 1hr commute, then 6-8pm I would do my patient look up. I was lucky to get home by 9-10pm. At this point I was mentally and physically drained, yet I still had to start my (exceedingly "more important" than sleep) care plan and usually not be done until 2am or later. Then have to get up at 5am for clinicals. The lack of sleep may have made clincals that much more tiring, but even on weeks were I didn't have patient look up. I was so tired after clinicals I could easily go to bed by 7 or 8pm. Something about clinicals is very draining, all my classmates agreed on this!!! Basically as a student I was putting in 40-42 hours of classroom/clinical time, plus 15-18 hours of commuting, and 30 hours+ of studying each week which mostly took up 24 hours of my weekend. Myself and a few friends that had a commute similar to mine, hit a level of exhaustion that most students didn't seem to get to. Local students still were able to have a social life and work part-time and most didn't seem to stuggle with exaustion as much as the commuters. Maybe because their life was more balanced since they took breaks from school! The ones I saw just as fatiqued as me were people working PT that had kids, people that worked overnights PT mid-week during school, and people who were insane and worked FT in nursing school. As a nurse I commuted 1.5 hours to my first job. My orientation was 5 days a week 7am-3:30pm. Even though I was still putting in 40 hours a week with a 15-18 hours of commuting, my level of exuastion was never as severe as when I was a nursing student. Later I switched to 3 12's with a 3 hour commute and I felt more refreshed overall during the week, but would have to pull over for coffee and naps on my way home. As long as I got 6 hours of sleep I work up refreshed the next day. I think my stress levels were much higher as a student with the amount of studying and constant tests. Today my job is 20-30 minutes from where I live and I have never felt so fantastic. I even feel like I could pick up another per diem job with all this energy! :) For me commuting and school, were by far the largest reason I struggled with constant fatique for 6 years! Once you are out of that hostile cycle your level of fatique with improve significantly I believe.

Thank you Rebel Nurse! I chalk it up as experience to get me to where I need to be, hopefully at a place I like more! I would love to be in the ICU actually. We'll see what doors open and what is meant to be will work out. Jade RN - thank you for suggestions about different day, different pen color. I like that. Some patients I did see on several days. Generally I was too busy to document everything as I went, but I did as much as I could document in the room. Written pie notes were really the largest time killer. mmc51264 - I too like using the worklist manager. Ours only shows medications or IV flushes which helps keep me on track with those; can they be set up to show other tasks too? thenightnurse456 - so many helpful tips thank you! I like doing a quick walking round to to check in on the patients and do a quick eye-ball assessment and see if they need fluids/pain/PRN meds as well. I noticed this helped me make less trips and could be done in under 10mins too. I was beginning to cluster my care better towards the end. I'll have to try the other tips on such as tucking in patients at my next job! Wow no techs!!! My it must have been busy, how many patients did you have?

Thank you for all your feedback and valuable input. I appreciate having some nurses understand why I want to use a brain sheet and not look at me like I have two heads! I actually was let go because I could not improve my time management in time before my 8 week orientation shift ended. On one of my last shifts I had 2 patients with an RRT!!! I was like S*** ... I give up. I was trying so hard but every shift I had an RRT and just could not finish my Pie notes/documentation fast enough to make up for that lost time. I think if I had the the night preceptor the whole orientation I would have been ready to start on my own. Her teaching style was more hands on with a lot of feedback and worked better to help me learn and improve in my weaker areas.

Hi fellow nurses: I'm a new grad about ready to complete a 9 week orientation on a tele unit. I'm really struggling with time management. First I was orienting 5 weeks on days (-1.5 weeks for hospital orientation/classes). My day preceptor expected me to manage 5 patients from day one with little mentoring/guidance except on things I've never seen before (ie chest tube). To be fair, I did complete 5 weeks worth of preceptor shifts on the same unit as a student nurse, so maybe she had high expectations for me. She was never around to answer questions, I would have to hunt her down. Her approach was more or less "sink or swim". If I was busy and forgot to give a med or implement a new order, she taught me by watching me fail miserably and telling me she hoped I learned my lesson. This added a lot of stress to learning my role as a RN. It is a very fast-paced tele floor. Med-surg RN floats use to 6-7 patient load, say they dread coming to our unit because they get their "booty kicked". I've always known time-management was an issue for me, but I never figured out how to improve in my weak areas. I could barely stay afloat managing 5 patients on day shift orientation, especially when you throw in a discharges and admissions, but I was always overwhelmed and behind. Basically I felt like I was completely on my own for the whole 5 weeks of day shift orientation. My day preceptor never helped me implement reading recent doctors notes, delegate to the CNA's, check on pending labs or call on labs that should be ordered, or give change of shift report. A couple times I attempted to give shift report on a pt only she had received report on or admitted; I was lost, obviously. Towards the end I finally gave shift report, but I was so busy on days I was clueless on what to focus on. All I knew was what the pt was admitted for, chief complaint and system assessment. Since I NEVER got a chance to read doctor's notes or assess the trending labs/ tests, I was always completely clueless about what the plan was for the patient unless the night nurse mentioned it and there were no updates. I was suppose to have 2 weeks on nights, but once I switched I became completely overwhelmed with all the new information and they gave me an extra week. I felt like my night preceptor had to catch me up to speed on everything I didn't learn the last 5 weeks on days!!! I was really slow with assessments, and multi-tasking while in the patients room. Thanks from some excellent tips from my night preceptor, now I can assess most patients in under 5min and with the easy patient's complete assessment/medpass in under 15min/per patient. It's the other 1-2 time-consuming patients that hang me up which I try to save for last. (ie 1:1 patient; confused, agitated non-adherent patient; angry demanding IV drug abuser; chatty cathy; non-english speaking; patient with 8 wounds). The hospital I'm in has a large population of repeat admission IV drug abusers that are usually demanding and very difficult. Currently, I've been slow to figure out the "night nurse routine" (ie chart checks???) and it takes me 1.5-2hr to: read at doctor's notes for the last 2 days, assess/sign tele strips, write nurse notes with average of 6-12 problems for 5 patients. All the night RN's say it is the most time-consuming part of the shift, but I'm sure it takes me at least 30-45min longer to write nurse notes. Other than learning to write faster notes, I don't know what I can do to save time. Because I was so overwhelmed with information, I've found using a brain sheet very helpful to organize myself and have a list of my main tasks, priorities, new orders, documentation,assessments, VS. My employer is not happy with my time-management because I've been clocking out 30-45min late all through my orientation and is worried I'm not ready despite extra time they have given me. I feel safe and ready, but haven't been able to save myself an extra hour d/t RRT's on 2/3's of every night shift I've had. However, my current preceptor keeps encouraging me to stop filling out my brain sheet at the beginning of my shift. She says it is a "time waster" However a majority of the information I write on it is comes from shift report, new orders, VS, abnorms from pt. assessment. I maybe spend 5-10 minutes reviewing my orders/careplans and filling in pt times meds are due, diet, name/room# to keep me organized. She writes much of the same information on her 5 printed patient care plans, so I don't understand why it is a "time waster" for me and not for her to write notes to stay organized. Does anyone else feel filling out brain sheets are wasted time? Am I missing something here? I feel it helps me be: more organized+group tasks+decrease amt of time sifting for pt info = time efficient. Any advice about brain sheets or helping me with time management would be much appreciated.

Asystole - what a excellent response! Being a visual learner this analogy has helped me greatly! Perhaps you are a visual learner too?

As a new nurse I'm constantly trying to understand the difference between time-saving real world practices and what I was taught in nursing school. I come here to better understand the TONS of conflicting information. It is better to be a young nurse asking "weird questions" than the nurse that accepts what floor nurses tell them and become that same nurse USING these unsafe practices! I applaud the person posing this question---it shows critical thinking skills! It's much scarier to be the nurse that has stopped questioning their current practices!

This question is similar to the one posted. In school we learned to push the med for the time stated then push the IV flush for the same push time. A teacher told us that is not how things are done in the real world. She said the patient IV port (not running fluids) holds 2ml so the first 2ml of medication can be simply pushed into the IV line (not necessarily slammed) because it will not enter the bloodstream. Then the flush can be given over the amount of time the drug is recommended to be pushed. Is this an acceptable practice? Also I've heard that you can push an IV med into a distal port running compatible IV fluids. This in therory dilutes the medication and gives it over a slower potentially safer time period. What concerns me about this method, is depending on the IV fluid rate, how do you know how fast they are exactly getting the medication? With a fast running IV line, could the patient actually be receiving medication too quickly, even in a distal port?

Thanks for the input. I'll talk to my bankrupcy attorny then make a final decision. Tenebrae - What do you mean by the same procedure would cost you only a taxi ride home? Do you not pay for healthcare where you are from or is it much less costly?

Here is the deal. In nursing school, all I could afford was Student Accident & Sickness Health Plan which is basically low-end "insurance plan" that has a $2,500 deductible and will only cover a max $10,000 of an emergency/sick health care bill. It was $100/month and I couldn't really even afford that at the time but health insurance was required for nursing school. During clinical one day I nearly fainted during a venipuncture procedure. I've had a history of fainting while standing during non-blood related activities, so I agreed to be taken to the ER for an evaluation. They were unable to determine the reason for my fainting spells. My insurance didn't cover a penny of the $1800 visit, nor was I able to pay it during the last 1.5 years of nursing school because I did not have an income. I feel $1800 is a lot to charge someone without insurance coverage for a 2 hour hospital stay, ECG and bag of IV fluids ... but hey that's healthcare for you. Lol Now I just accepted a job offer from the same hospital I have this medical bill collection with. In some ways I feel I should pay the bill off once I get an income from working there or at least settle the debt for a smaller payment. It is the LEAST I could do considering they just offered me a job, and are providing me income. For once I might be able to pay it! On the other hand it is an old debt and I have a huge amount of student loans to start paying off. I am in the process of filing bankruptcy from credit card debt that went into collections when my husband was unemployed for 8 months. I feel it is ethical to pay it, especially since they are giving me a job! :) Any opinions?

In NJ when I worked in Casinos myself and other employees were allowed to collect partial unemployment for weeks we dropped under full time hours. This was often for most employees in my department since we were on-call workers. I was SHOCKED I qualified for partial unemployment considering I voluntarily left my previous job where I could pick up as many hours as I wanted and was basically a full-time employee. So its not too surprising to hear PA also has very liberal labor laws. Now this may be a reason for increased taxes in our area, maybe not, I don't know the politics regarding use of unemployment benefits. From my understanding payment is calculated from hours you earned by working full-time hours in the past year (or at least in NJ this is how it is calculated). Isn't unemployment taken out from social security you've contributed to? I could be wrong or maybe I don't understand the whole process. However, I don't think that employees that are given full-time work should be so disposable to employers that they can be called off and not be compensated for days they already committed to, cleared their schedule for, and possibly had to set up and pay childcare for. I don't feel wanting to be compensated for a day you were suppose to work a "sense of entitlement" especially if you are repeatedly called off for shifts and your income substantially drops by half and you can't pay your bills. First and foremost, everyone works to pay their bills. End of story.

In California I was able to collect 6 weeks of disability pay that I applied for through that same office unemployment is filed. In addition to that I had 6 weeks of paid maternity leave that is required in CA. It was hard to live on a reduced paycheck (60% of normal income), but quite a nice 3 months off with my newborn. In Colorado I don't think they had paid maternity leave. If they allowed paid disability for new mothers I didn't know about it, I had to sell my car to afford my 6 weeks of maternity leave.

Thank you for your informative post RNinthemaking1986. I was wondering if employers were allowed to check your credit if the application only requested consent to perform a criminal background check. I've been waiting to file bankruptcy for 4 years because I knew it might make me ineligible for private loans while in nursing school.

I know this is an old post, but I found it truly helpful in discussing the pros and cons of bankruptcy and how it can potentially affect getting a job.

I agree with RunBaby. You don't really need to list everything you did at clinicals. But I agree not all programs have the same clinicals so its good to list them if you have room. I only listed tasks I completed during my preceptorship. I kept it short, but listed how many patients I was able to care for and what the floor specialized in. ie med-surg/stroke, tele, ortho ect.

Follow your passion! Get into the ER ... I think you've waited long enough to follow what you REALLY want to be doing. If you spend 30 years in the VA for great benefits and never follow your dreams you'll regret it. Life is short. The way I look at it is I would rather enjoy the ride than save up all fun for when I'm almost at the finish line. Things won't be quite as fun if I can't take some well planned risks. I'm going to get some tele experience than make a beeline for a level 1 ER position!!! :) After you've got some great years under your belt you can reapply for the VA and be one of those "experienced ER nurses" they are stuck on hiring! Of course you are going to get a higher acuity level of patients at a private hospital...especially if you opt for a level 1 trauma center.