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Discussion

Setting priorities

This question seems like I hasn't been posted in years. I really hope that this is the right board to post on.

I have my 1st nursing job and 1st job in healthcare all together. I'm in danger of being fired because I can't get off of orientation. They are giving me 3 more shifts to prove that I am able to pull it together and prioritize and organize appropriately. My preceptors feel I focus on tasks that can be done at a different time. I sometimes forget things too. Like my preceptor was upset because I forgot to clear a patients Iv pump when they were being transferred.

I have tried to use different colored pens and highlighters, divided my patient assignment sheet into different sections for each patients task but I still feel like I am always running around like crazy and forgetting things. People keep telling me prioritization and organization comes with experience but I have 3 days to prove I can do it.

Please help

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    One question: How much orientation have you had??? Six weeks?

    Four weeks? Three months?? How much?

    Something tells me that you aren't going to get it done in three

    more days, just by reading your post. You may just have to try

    a slower paced unit/floor/facility.

    I mean, I do hope you get to keep your job. If you do... take

    the advice to heart, about prioritizing and not over stressing the

    little things.

    Forgetting to clear an IV pump? That's a little thing. It really

    is. It's a matter of communicating to the nurse that you are

    reporting off to... hey, I forgot to clear the pump. Then you

    have to do a little calculating regarding how much fluid you

    gave the patient, and advise the oncoming nurse that they

    will have to subtract that amount.

    Again, you may just have to find a slower paced environment

    for now. I do wish you well. :)

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    I've never worked med-surg; I started in an ICU as a new grad. So...maybe these thoughts are helpful, or maybe not?

    1) WHY do they think you are not prioritizing well? Are you missing critical assessments (didn't notice that leg was pulseless?) Not acting on them quickly (couldn't find a pulse but didn't get a doppler and/or call a provider for 'too long'?). Are you not seeing your 'sickest' patient first, at least for a once-over? Do you have trouble deciding who the sickest patient is? (Most likely, the one with any recent changes...as in, "she was on 2L oxygen but I bumped her up to 4 at 0600 because her sat was 88, or he had a temp of 38.5 and got tylenol, his HR is low 90s but his baseline is 70.) Are they tracking your med passes and seeing that critical meds are late? (Mealtime insulin, abx, cardiac meds, etc...)

    2) Why do they think you are disorganized? Do you agree? Do you find yourself in and out of the same room over and over? Are you asking other nurses for help in the same room over and over? (Like, can you help me boost this pt? Then 10min later, oh, can you help me hold her leg up for a dressing change/wound check?)

    3) Are you not meeting Patient Satisfaction/safety stuff like houly rounding, med teaching, etc? Some places, you could probably give all your meds late and never do a dressing change but if the patient is happy then you've done your job (I exaggerate, but that's what it seems like!)

    I hope they can give you some specific examples of actual safety problems...which could include documentation problems (not clearing a pt's pump before transfer seems like a tiny thing, but if that's how your facility tracks I&O then maybe it's a bigger issue) so that you know what to work on. 3 shifts does not seem like a lot of time and I hope it works out well for you. If it's not too late (I know you posted a few days ago) could they put you with a different preceptor for these last few days? Someone with a set of fresh eyes to watch you work?

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    I'm not sure how much orientation you've had, but I do have some tips:

    + Patient safety is #1. Is everyone pink and breathing? Are your confused patients bed alarmed?

    + Chart as you go.

    + Cluster what you can. Give your 8/9/10am meds at 9. While you're at it, pull their pain med that you KNOW they will want. Oh yeah, they haven't pooped in a week - let's pull their PRN laxative. You'll get better at this as you get more comfortable with your routine.

    + Ask if your patients need anything before you leave their room - are they comfortable, do they have everything they need? I've written out lists of needs for my needy, call bell happy patients.

    + Delegate and utilize your CNAs. As much as you'd like to toilet/repo your patient while you are in there, sometimes you just don't have time for that.

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