Recognize weakness after first week on the floor

trixie333, ASN · Nov 23, 2009

It seems from what you are saying, is you don't have experience with all the different propblems a pt. may have....you can't just open a jar of "experience" however, you have to walk the miles and put in the hours....it will come together very quickly for you, because of your assessment skills. Meanwhile, while your walking your first steps of this journey, review your CARE PLANS

from school, or better yet, ( I did this years ago) buy a great reference book of care plans, and review frequently....nothing better than this to get a quick handle on pts. with comorbidities (i.e. Fresh AKA, w/ DM and PNA). Some of the plans will just jog your memory, others will teach you something, all will help put it together....Hope this helps....it really helped me years ago....(the book I got was a critical care care plan book, had more info. than I could use, but it fit the bill)...

jjjoy, LPN · Nov 24, 2009

I hear ya medicrn16! Of course it takes time and experience to get where you want to be; but until one gets there, doesn't one end up *having* to go through a time where they DON'T fully understand what they're doing and why? When they don't see anything beyond today's task list? Is it even possible for an inexperienced newbie with their own workload really be expected to NOT be task-oriented at first? Yet it's been drilled in school that task-oriented is unprofessional and poor practice.

And even when one is experienced, when the workload is heavy, all nurses have to prioritize, which may mean NOT getting a chance to really see the big picture on each patient, or NOT looking up answers to many questions that come up. So some of the most foundational points of good nursing practice (holistic, therapeutic, big picture, non-task-oriented) are often the lowest priority in acute care nursing. After all, many nursing tasks take priority... such as monitoring patient stability, keeping up with meds/IVs, keeping on top of new orders, etc.

medicrn16 · Nov 24, 2009

Thanks for your responses trixie and joy. You both hit on good points...but Joy, it's much closer to what you say. Making the transition from medic to RN has been TOUGH! Like the other day I had a guy in for SBO. Then I see on the order sheet an angio of the neck and cancer blood work. Huh? Turns out the guy has been in remission for CA for 5 years and his doc heard he was in the hospital so wanted to run some tests. Didn't get the lowdown on that until after work...but it's kinda stuff like that.

In school, as a medic and an RN, I was not satisfied with just learning definitions, descriptions, etc. I had to know the why and the how. My mind is so detail oriented. As an RN, I just really don't get the opportunity to really delve deep due to lack of time, etc. It's just strange to be part of someone's care for such a short period of time, you know? I had to d/c a pt the other day who had been there (not on my floor for all, but hopping between several) for 280 days! Seriously? She was in my care for three hours! So, in that 3 hours, between passing morning meds, labs, etc. I'm supposed to be able to adequately assist this lady in transitioning from 280 days in the hospital to home health? Ugh. Stuff like this drives me bat #&%^ crazy

This is a different life. I am part of a huge team that assists patients to successfully reach their goal of discharge, rather than being a part of their initial crisis in an ambulance. Guess I just feel like I don't help much. Not quite as rewarding as I thought it would be. Like the other day I had an admit, MCC hit and run. Guy was wearing a helmet. Had broken ribs, road rash, and a possible vert fx. During my assessment I noticed his breaths were very shallow. He was oxygenating well, but still, LS were diminished on the lower R. After scd's and teds, I talked to him about incentive sprirometry. His pain was at a 7/10 which he said was acceptable to him. I explained to him that pain management was important in order for him to breathe and walk, etc. If pain was keeping him from doing these things, he would not recover very quickly and would set himself up for more trouble. I demonstrated the spirometer and asked him to show me that he understood. He didn't think it was any big deal, but when he tried, he could not even reach 500. Started coughing, etc. I taught him how to splint his chest with pillow and he said to me he could not believe that in just 24 hours, his lungs had become weak. Then he asked for pain meds. Right before I left, I peeked into his room discretely to see what he was doing...and he was using the spirometer by himself, splinting his chest, and doing exactly what I taught him to do. To me, that was the best feeling in the whole world. I was convinced that I helped him on his road to getting better. I guess I just want that for ALL my pts and I don't get to feel that way very often.

Thanks you guys for reading and 'listening' to me :redpinkhe

llg, PhD, RN · Nov 24, 2009

I think you are becoming a great nurse, medicrn16. You just need a little more time and experience to "put it all together" and develop that feeling of confidence and belonging.

You might want to spend a little time (maybe not immediately, but someday) ... thinking about the different types of nursing, differences between different units, etc.

The "issue" you have brought up in this thread are ones that vary a great deal among the different specialties. In some departments, the interactions with the patients are relatively brief, 1-event only, types of interactins (such as an ED, PACU, L&D, etc.). In other units, the care is very long-term and you develop a long-term relationship with the patient and work as part of a team to meet long-term goals. In other units, it is somewhere in-between. This is one of the more complex issues that makes some units a "better fit" for some nurses than others. You'll probably be happiest as a nurse when you find that right fit for you.

Another such issue is the degree to which you as a nurse get to see the patient outcomes. On some units, you may not see the patient actually recover to the point of going home -- and that can be disappointing for some nurses who get a profound sense of fulfillment in seeing that. Other people don't "need" to see that end result and are equally fulfilled in helping the patient at just one particular moment in their care -- even if that ocurrs early in their stay. Again, that is a "fit" issue that can be important in finding your niche, but that you might not have thought about as a student.

It sounds to me as if you are thinking through these issues very well and that given a little more time and experience, your distress will ease. Hopefully, a little support from us at allnurses will help a bit.

medicrn16 · Nov 24, 2009

LLG...you made my heart sing :loveya:

'Becoming a great nurse....' have waited years to hear that. Thanks for the boost. You hit it exactly right! While I've been reading and writing this post...it didn't even occur to me that this was the 'problem'. Not really a problem, just the type of floor I am on. Funny how your feelings can totally cloud what's going on because as a new nurse, you're already dealing with so much! Thank you thank you for your objective view and finally drawing out what's in my heart that I couldn't adequately verbalize (write!).

I have been told that critical care is right up my alley, and I believe this is where I want to go. We have a trauma step-down ICU at our Level I and these pts teeter between ICU and where I work now on the floor. Treatment is VERY aggressive, and there is complete immersion in the pts care. Ratio is 1 to 3 optimally, or if you have a relatively 'light' pt (one that might move down to lower level of care within 12 hours) then you might have 4. But that's the max.

I guess I considered it a problem because I just don't like it (the type of floor). I mean, people are great, etc. Not the floor, but the level of care. Other RNs don't seem to have a problem...so I figured it was me. But,the reality is they probably don't want that higher level. I was surprised in school how many people did NOT want CC. I guess it's the medic in me that wants to be there in crisis situations all the time (okay, not ALL the time...but at least have the potential for a crisis).

It should be noted that I have depended on allnurses throughout school and into NCLEX (passed first time at 75!), and now in my career. It is like second family and I always get good advice. Thanks so much to all of you! You RNs ROCK!