nursey246

DONE!

Love this!

I think one of the biggest time suckers is inefficient charting. You want to chart everything right away but sometimes it's not always possible and then before you know it, you're late with more important things like meds or you miss something when you were too focused on charting. I also would try to clump things together, almost too much. I'd clump so much together that I'd be in a room for over an hour and it was inefficient and I wouldn't see my other patient. Efficiency is key!

I love your story. Good luck in nursing school, the profession will be better with you in it!

Haha I agree. And I love your profile pic.

It was a normal shift. I started out with the typical two patients. One stable and one not so much. My not-so-stable patient was a 50-something guy with a wife and 4 kids. He had a massive ischemic stroke from an unknown origin last night. He was intubated and his neuro exam was so poor that he didn't even need to be sedated. He only had minimal reflexes. His wife sat at his bedside, utterly broken. She looked to me for any glimmer of hope and I had none to give her. My second neuro check was worse than my first. I tried to have my nursey poker face on, but she saw right through it. I immediately called the doctor. An emergency craniotomy for decompression and bone flap removal was in our very near future. When the doctor quickly came by to tell her what needed to happen or he would become brain dead soon, she lost what little grip she had on her sanity. She became inconsolable and walked away because she just couldn't take it anymore. I asked my charge to watch my patient while I looked for her. I found her huddled on the floor in the bathroom, sobbing uncontrollably. I wanted to sit next to her and console her for a while, but time was a factor. We were getting ready to hit the OR in a matter of minutes. I had to get her to pull it together and FAST. First, I hugged her while she sobbed snot onto my scrubs for about two minutes. I told her I was so, so sorry while she cried. I then looked her in her eyes and said, "Hey, you can do this. He needs you right now. He needs you to be strong for him right now. You can do this. And I will be there with you the entire time." With tears in her eyes, she said, "okay". "This is what we are going to do, okay?" I said. "I'm going to walk with you back to the unit. We're going to talk to the anesthesiologist and answer some important questions. We're going to call your son and let him know he's going to surgery now and that everyone needs to get here and meet you in the waiting room. I'm going to pack him up and we're going to take him down stairs. All three of us will ride down the elevator to the OR together. You'll give him some good smooches and I'll take him back. I'll be there with you every step of the way." She pulled it together. She blew her nose one more time, dried her eyes, and held her head high. "Okay, let's go," she said, as we walked out of the bathroom. She answered the anesthesiologist's questions and we started packing him up. I could tell it was taking every ounce of strength she had not to hop in that bed with him. As we were making our turn to the OR, I told her to get some smooches in. I tried with all I had in me not to cry as I watched her sob into his shoulder and smear tears all over his cheek. He came back to my unit after surgery and didn't look so great. By the end of the shift, I was taking him to hospice. After I extubated him and gave report to the hospice nurse taking over, she sobbed as she said goodbye to me. I wanted to get out of there before he died because after the last 12 hours, I don't think I could have taken that and still gone back to the unit to take care of my other patient. I'll never forget her. I'll never forget the strength she had summoned from deep inside of her to get herself out of that bathroom. That kind of strength she had to find underneath those tears she was crying; the kind of tears that make your throat burn. I pray that if I'm in that situation, I'll be able to find it. I think that I could because she showed me it was possible. And as I said my goodbye to her and told her I was praying for her, my phone in my pocket buzzed. After I walked out of the room, I checked it and saw that I got a text from my coworker. "You're up for the next admission and report is on the phone."

I was going to write a list for you but this is basically every single med I would say.

After I get report on my two patients, I print and interpret my telemetry strips and verify their alarms on the monitor. I then decide which one is less stable (or more labor intensive if they are both stable) and start there. At 0730, I complete a full assessment, turn, mouth care, check my drips for appropriate concentrations and rates, check lines that need to be changed, tuck and fluff them. Then I hop on my EMR and check out all of my active orders. I chart my assessment, vitals, and work lists, and give my 0800 meds. I order more drips, if needed. I check what's going on for the day by looking at any radiology/special procedures/tests scheduled and then peek at the latest MD note. Then I talk with the patient and family and let them know what's up for the day. Side note: Families of patients in critical care are naturally very emotional and concerned. I always make sure to over communicate with them about plans for the day. This establishes a professional relationship and allows you to assert your nursey authority. You're running their care for the day; you're in charge. If you are confident and professional, it puts them at ease and makes them feel safe with you. They need to trust you. If you give them any reason to doubt you as a caregiver, they will be stressed to the max all day. Stay confident! Even if you're not sure about something, be confident in your communication. Provide a structured plan for the day. The more structure, routine, and communication you can provide these patients + families, the better everyone's day will be. Usually, by this time it's around 0750 or 0800. I then grab my 0800 + 0900 meds for my next patient and repeat the above process with them. After this, it's usually 0830. I then grab my 0900 meds for my first patient and administer those. If that's done efficiently, I'm done around 0915-0930 with all meds, charting, and care. Being done this early allows you some cushion time for when physicians round, ask you a bunch of questions, and enter new orders. After that, I'll check on my other staff members and see if they need anything. If one of my patients needs a bath, I'll grab my tech and knock that out. And if no one really needs anything, I grab a snack! At 1000, I go to my second patient's room and do a 1000 neuro assessment and chart it. I'll give any 1000 + 1100 meds and change any IV or enteral tubing due or start new IV's/change central line dressings that are due. I'll grab my tech and we'll do their 1000 turn. Then I'll go back to my first patient, do their 1000 neuro exam, their 1000 + 1100 meds, turn, and change lines/IV's at that time. Theoretically, I'm completely charted and caught up by no later than 1030. It's important in critical care to constantly be caught up. You never know who is going to deteriorate or code and that can change in seconds. You also never know what may be coming through the door at any time. Critical care time management is very different from the floor. I've worked in both areas and it was a huge learning curve for me at the beginning. But once I became efficient at managing my time, I was more aware and able to catch things before they became a bigger issue because I wasn't so worried about how far behind I was. Something to always ask yourself when trying to figure out what to do first is who is more stable? Things may seem like an emergency to everyone, but you have to use your critical thinking skills to know who truly needs you more this very second. Everyone will need you all at once sometimes, but you really have to think about who cannot stand to wait. So remember to stop. Breathe. And think. Who is more stable?

I will most likely be there; still waiting to hear back from my employer if everything has gone through! I would LOVE to meet you!

I hope the next table doesn't puke this time.

Woo hoo! I am honored, thanks so much to everyone!

I'm not a fan of real time charting .. but I am at the same time. I'm not because feel like the patient thinks I care more about the computer than them. However, when it comes to time management, it's glorious because you're constantly caught up. I work in critical care, so I always have two patients. I assess my first one and chart my assessment in the room. Then I go get meds and go see my second patient, do my assessment, chart it, and by that time it's 0800 and can pass my 0900 meds. Then I go back and give my 0900 meds to my first patient. We also have a code documentation thing that's done real time and it's great. Afterwards, you can focus on the patient's care or comfort the family.. not frantically charting and looking at scrap pieces of paper. And if I'm in a rush, what I'll do is quickly chart my abnormals in my assessments and go back later to chart those things that never change. That way, I'm always accurate and on time. Real time charting can slightly hinder patient-nurse relationships (in my humble opinion), however it is GREAT for time management. There's no "wait.. when did I do that? Were his lung sounds diminished or clear? Did he have a murmur.. I can't remember?" anymore, no re-doing anything because you can't remember. I think if you look at your real time charting with the same, although slightly less, priority as your medications, you'll find yourself clocking out on time and a lot less stressed.

22 gauge is fine. That nurse you gave report to needs to chill.

The most I would expect would be writing themselves up. No firing. Brand new RN, overwhelmed with their new job and forgot to toss their sharp? It happens. They need to know how serious it could be and write themselves up and move on.

I've been there, done that! Unless they were infected, like the other people who commented stated, you're good. Honestly, I've got much, much worse things on my face at work.. last week my coworker accidentally splashed pee in her face when she dumped in the toilet.