Rookie nurse neds how to advice instructuring a day...

Peetz, BSN · Apr 4, 2010

Hi...
I'm a new nurse. I graduated a year ago right after the economy crashed in 09. It took me a year to get a hospital job as an entry level nurse. Well I finally got one and I was wondering if an experienced Tele nurse could give me some advice as to how to structure and prioritize my day. I have had two days on the nght shift Tele floor and my Preceptor is given 6 to 7 pt's and does not have enough time to sit down and show me how to structure my day. This is something I feel I need to start getting right now. From Beginning to end I need to know how to roll w/ the punches thru out the day. The facility and floor I am working at does not feel supportive and the seasoned nurses dont seem to even like working here. I am overwhelmed and I really wana get a grasp of this. Could someone give some good advice as to how to structure my day and try not to drown in the negative envronment I have to work with.
Wana make a difference... Thanx... : )

Your self evaluation skills seem to be in the right place, but have you thought about this:

Even thought the economy crashed, nurses were still needed and being hired. Have you asked yourself why it took you a year to get hired? Were you appying and being turned down? Were there simply no openings in your area? Were you being to picky about shift, wage and what not?

You have a preceptor who is unable to help you, she/he should NOT be a preceptor, that is part of the job. You are right in knowing that a well structured day is very important and I give you credit for knowing and realizing that. Sometimes the daily flow of a floor takes time to get into the groove of, sometimes how one nurse runs her day will not be the same as how you will run yours.

My advice is to take note cards and write down what you must accomplish in your shift. Then rate those tasks in order of importance, on your note card have the task, how much time it takes you to get it done and areas you could improve in with that tast. Arrange your cards in order of importance. If you are a visual learned this may help for you, if not, then it may just take time and trial and error. ( we all know the word error is bad in nursing) so hopefully there is not error.

It will take time to get comfortable and get in your groove, don't fight it. I am not a tele nurse but hopefully you find a preceptor who gives a crud or someone else who can give you some direction. Good Luck.

RNperdiem, RN · Apr 4, 2010

I do understand what overwhelmed feels like.

Here is the skeleton of my day.

Report

Check orders and print EKG strip off monitor

Quick check on patients

Assessments(High priority)

Chart

Morning meds

Doctors on rounds/check new orders

Run around trying to get anything and everything done

Noon vitals and assessments

etc.

As a rookie nurse, I had to learn to recover from repeated interruptions and remember where I left off.

KneKno · Apr 4, 2010

I would make a "skeleton" of tasks. All the hours down the far left of the page, the pateint names across the top. Then, for every hour, what needed to be done for that pt. 8, 12, and 4 were assessments, maybe some meds, fingerstick glucoses and coverage. Then, put in all the med times, any treatments (dressings, walks, etc). Now, check the time blocks for periods of time you can perform longer tasks (teaching). "X" the tasks out as you do them.

If you don't add in the times you have to chart, you can still get an idea of when you'll have time to do it. Try not to "save" charting for when you have time--it'll end up being the end of the shift. Can you put in vitals as you get them? If computerized, you can add narrative notes as you go, then fill in any extras when you can.

It always helped me to do a quick look at my patients, introduce myself and ask if they needed anything right away, explaining that I'd be back in 10, 15, 30 minutes, whatever it was going to take to get back for their first assessment of the shift.

Last--Take a lunch break! Don't skip it, don''t chart thru it. When you come back, don't stress on what you didn't do while you were off the floor, just jump back in with a clearer, calmer head.

Good Luck!

lifetimern · Apr 5, 2010

I am sorry your experience is so lousy! I will assume, since your preceptor is being asked to take her own patients while orienting you, that your facility's leadership does not put a high priority on nurse retention/orientation and you are, basically, on your own to swim or sink. Here is my advice:

Report - Create a report worksheet that breaks down patient information, assessment, and tasks that must be accomplished for each patient. Highlight the tasks that simply must be done in a timely manner so you don't forget (accuchecks, EKGs, ptt draws for heparin changes, test, procedures, etc.)

Quick check - Briefly, check with your patients - this is just to make sure they are alive and have no urgent needs - everything else can wait a few minutes.

Prep. Work - Check strips and analyze if not already assessed. I pull all my meds and place them in marked containers in each patient's drawer (some nurses do not feel comfortable with this, so decide what is right for you), pre-op/pre-procedure checklists, new lab results, new orders --in short, anything you can quickly take care of now that will save time later.

Assessment - Every patient deserves a complete head-to-toe nursing assessment. This is the longest part of my day, but it is necessary. Remember to prioritize patients -- see the sickest ones first. Complete tasks as you go. If Mr. Smith needs an IV, start one. If Ms. Doe needs her linens changed, change them. Get as much done as you can before you leave the room.

Chart - Don't put this off too long or you will live to regret it. Get it done as early as you can.

Hourly Round - I did this before it was a "thing;" it works. Assure each patient that you will check on them every hour -- then do it. It may seem like this will take more time out of your day, but I have found that patient call light use for insignificant things decreases giving you more time to complete tasks.

Be proactive and anticipate problems - try to stop problems before thay occur. If you see that you only have 50cc of NS in the IV bag, replace it now instead of waiting for the pump to alarm. It is correct to prioritize your actions, but never put off for later what can be done now.

Take advantage of any time-savers you have. If your facility has a system for recording report, use it.

Delegate. Delegate. Delegate.

Finally, look for a new job on your days off because not every unit or hospital is like the one you work for.

Good Luck!