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Cassie, I hear what you are thinking! Being a new nurse on a busy floor is like hell on wheels sometimes, but almost all of us on this new grad forum are on the same boat together. I also have a big interest in one day pursing L&D but for now, I am glad I am getting this experience and working out the hard days on tele. There is a lot to learn and some days I wonder if I could handle it in the middle of a delivery going bad or a rapid c-section... I question that. I know comparing tele/med to L&D is much like bananas to celery but in terms of being able to stomach my own anxiety and stress, I think I need more time to work out a few more "quick get on my toes" situations before I have to handle the stress L&D. I don't know if that helps you any, but it is something that helps me.

Yikes! That is scary. It's also scary when an order gets taken off under one impression but another nurse reads the order differently. My last nursing clinical in school was with a facility that implemented 100% computer documentation and the physicians had to enter their own orders and it goes straight to pharmacy electronically. Hopefully with everyone going in the direction of electronic charting, it will minimize that errors.

I'd recommend looking at similar posts to yours. This place is a wealth of information and words of wisdom.

I'm nearly 1 month post boards and just out of orientation. I just made a post about my stress too! I'm usually still charting to 8-9pm and sometimes still doing tasks after shift change. It is so overwhelming, I think we just need to find our pattern. I've come to accept that at 6pm, I started gathering thoughts for report, chart vitals and I&O, get night shift documents ready then do whatever I can before they start coming to me to get report, then I give report and then finish what needs to be done. I don't think its fair to night shift to delay the start of their shift because I am behind. I am going to either be late with a dsg change or late with report, I'd rather be late with the dsg change. Especially on a crazy day with 3 discharges and 3 admits. I come home with my feet aching and pounding, starving, coffee deprived, and just want a hot shower and crash. I lay in bed thinking about my day, sometimes I call the unit back and make sure something gets keyed in or that I needed to pass on something. I will do what it takes to make sure my patients get the care they need. I just try to keep that my focus, my patients. I'm just as overwhelmed as you are. But 1000's of nurses have done it and we will keep doing it, together.

There is only one hospital by me that does it, they pay very low for the area and the NGRs aren't promised a position. Sounds scary to me!

I'm on day shift and most of the time it goes something like this... Just finished getting report and am trying to set up my binder for the day, map out med times (look for early meds and 730 glucose checks) and a transporter comes to find me for a that I wasn't told about in report. Stop what I'm doing, look at the chart, ID the armband with transporter, grab a set of vitals on pt and do a focused assessment before letting them leave the floor. Get back to getting my paperwork in order. Secretary pages me to tell me a patient is requesting pain meds. Go to pt room assess pain, no pain meds on MAR, page MD for orders. Start doing vitals and assessments, MD calls back. Stop to get orders. Go reassess pain pt and give meds. Finish vitals and assessments, do early meds. Med missing from machines, call pharmacy to get med tubed. Pt comes back from procedure, get them settled in. Secretary calls and says another pt is having chest pain. Stop to assess that situation, spend 15-20 minutes checking BP, giving subl nitro, getting that situation under control. Secretary calls while in room and says another pt is wondering when they get their AM meds. Can't leave chest pain pt at this point. Chest pain pt has new IV meds ordered and IV goes bad with flush, charge nurse kindly steps in to attempt IV after I had two failed attempts. Deal with that situation, chest pain relieved, MD on unit and sees pt. Resume giving AM meds. Transporter finds me to send another pt down for test. Another pt having pain. Medicine missing still not sent from pharmacy. Call them again. I can stop there because any nurse knows what I am getting at... everytime I step into a room I ask about pain, I ask about food and water, do you need help with anything, is your IV feeling ok? I ask a million questions to try to cover bases so the pt doesn't have to call me. I just feel so torn in fifty directions and wish I could tackle it all. I can't leave a chest pain pt, I can't leave a pt getting blood for the first 15 minutes without a doubt. I'm slowly, slowly, starting to realize I can't be in 5 rooms at once and on the phone with the MD and talking to transporter or pharmacy. Is this the new grad blues, how do you find your inner peace in the middle of chaos? What's the advice or kind words you've been told you can pass on?

DanaNP, I use the patient safety check on the flow sheet. If there is a particular issue, like a known DVT I'll document the extremity q1-2h "+2 pedal pulse, cap refill I went to the bookstore today and grabbed a bunch of 1st year nursing and charting books, it's nothing I haven't really heard, its just a matter of me getting a grip on doing it under pressure. Right after something happens I feel so drawn to catching up on tasks that stopping to document seems like something I can make notes about and fill out later, but I am changing that school of thought. Documenting the event should be of equal importance with catching up. If something happens, pt condition changes, someone needs to read my notes asap, I need to have it laid out to be viewed. Thanks for all your input, like to hear more. Hope this thread helps other newbies. As for the two week old comment, I feel like that :)

Being an RN now, everything in school that was "hard" has made me a critical thinker. All those late nights looking up meds, dilutions, push rates, careplans, interventions... it sticks with me today and helps me prioritize. I kind of wish some instructors would have pushed us harder. I might be the crazy one here saying that! Just know, all the crazy hard stuff crammed into your head will be oneday useful to save a life. :)

Hold your head up high! Even if you do have to repeat a clinical, keep your eye on the prize, your RN!!!

Sorry, it didn't look like that when I was typing it up, it won't let me edit it now but I'll make make sure to adjust it in future posts! :)

The nursing student inside me is over thinking. Bstewart40, your opinion matters in such that if you encountered a problem in the past, I'd like to know your opinion on what happened and what you could have done differently. I always feel there are too many mistakes for one person, one nurse to make, I want to hear and learn from others. I understand what you mean though, our policy is to educate but of course any patient has the right to refuse any treatment and we can't force them to wear the TEDs or tele. I once heard of a confused pt who kept taking the tele off and the MD said well, we can't make the pt wear it and we can't. But the lingo of documenting I guess is where I need to be sharpened. Netglow, for the APIE/PIE charting, thanks for bringing that up. That is something I'll keep in mind with abnormals. Any personal experiences though, please bring forward if you feel comfortable!

Thanks for responding. I looked at that book and a few others. Good information, I am hoping for some personal insight/experience with charting though.

I'm considering both too. Online is important to me. What are you looking to use your BSN for? I want to get it for advancement. I know both are great schools but I am kind of leaning towards LSU because the program is more established. Thinking of sending in app for Spring 13 but might hold off.

Want to bump this thread, see a lot of beta blockers without parameters and it makes me nervous. Anytime we are considering hold a drug, we have to call MD. I would have called given hx of hypotension. Very interesting to hear the refresher on the FS curve, hypotension & FVE.

i'm a two week old new grad! in clinical, i was only exposed to "click click" "scan scan" computer charting, and making "clinical notes" as needed. the tele floor i work on is a whole different way of charting. it is our policy to chart by exception. the main part of this that i'm trying to get a good grip on is the 24 hour flow sheet and the nurses notes. initially, i was trained on the way to open my note with things like vital signs and abnormals. gradually i've seen on an and by coworkers - don't double chart things like vs on nurses notes and on the graphic sheet b/c if a discrepancy was created on accident, it could knock you credibility in a legal arena. so, i started to get more careful. on our 24 hour flow sheet, if something is "abnormal" we are to make a nurses note entry about it. usually if its weak pedals i'll say "bilateral weak pedals noted, skin warm and dry" if its adventitious breath sounds i'll say such "posterior bilateral lower lobes decreased, pt denies sob, resp even and nonlabored." those are things i'm okay with and come up with wording, state what i see. lately, i find i'm staying at work till 9pm-10pm after shift trying to finish up charting because so much happened during the day, 2-3 discharges, 1-3 new admits, pain relief requests, pts receiving blood or returning from cath lab requiring q15 vs that i get so caught up in rooms that i get swamped with charting entries. that's my goal #1, is to be more efficient at charting during the shift. my goal #2 is to learn more lingo to chart. (point of this thread =] ) i've read things like don't say "pt resting comfortably in bed, resp even and nonlabored" because how do you know the pt is "resting comfortably?" i've had preceptors tell me "if something is not there or is not observed, such as you don't hear a murmur then don't say anything about it because what if you can't hear it? only say what you can assess, observe and what the pt states." it can be confusing. there are other cases where a preceptor has told me in reference to a c/o of 10/10 chest pain to notate "hob at 45 degrees, no facial grimacing noted, pt requests snack" (which was the case) those are the entries that don't immediately pop into my head as something to say. so here are some questions i have.. - if the flow sheet has "pt safety check" on there and the option to check boxes for resp even and non labored and option to check for no c/o pain, would you use the flow sheet or nurse note q1-2h? - if you gave a pain medicine at 1200 and at 1245 the pt is "sleeping" do you wake them up or do you entry "pt in bed with eyes closed, resp even and nonlabored, no signs of pain observed?" --- what signs of pain are you looking for a in a sleeping person? facial grimacing? - if pt refuses to wear ted/scd/tele, i make entry and state education offered, verbally explained, needs reinforcement, those sorts of things.. do you call the md or do you wait for rounds? i know part of it is i'm a two week old baby nurse and have a lot to learn. i read a bunch of threads on charting on here, i hope if the things i brought up on this thread will provoke some new thoughts, suggestions, from experience point of views on these types of charting entries and how to learn when you can make time to chart. advice to get more efficient? advice on charting entries you've made or seen that could be better or worded differently?