skills help

Happydoggie · Jul 12, 2005

Hi wow, this thread really helps for us new nurses!

l've just started nursing in MS ward for 2 months now and need advices and guidance in prioritization... Am very overwhelmed when all the things come at the about the same time: pre-op preparation, post-op pt comes back, call bells for bedpan, doctors visit, feeds/medcine due, iv drip runs dry, phone calls (ward clerk work 0800-1600 only).... :crying2: HELP!! WHICH FIRST?? WHICH NEXT??

pie123 · Jul 13, 2005

Rosemadder, where do you work? I live in NC. Will you PLEAAASE be my preceptor???:) :) Thanks for all of your advice!

Rosemadder, when you're done precepting Kellyo, will you fly out to Las Vegas & precept me? Thanks :)

Long Term Care Columnist / Guide · Jul 14, 2005

A few more little tricks of the trade:

If you know you're getting 2-3 post-ops during your shift, pull all the paperwork you'll need (standards of care, frequent vitals sheets, and other flowsheets) and put it in the rooms where the patients are to be placed. You can also have your IV pumps and VS equipment ready as well, and if there's a little downtime, you can even start filling some of your paperwork out ahead of time.

I also do this with admissions, even to the point of having the IV/saline lock primed and ready (if it's a direct admit) and bringing in a slider board if I know the patient is elderly and/or in pain for an easier transfer from gurney to bed. I like having everything in place beforehand, as it looks better to the patient and family if the nurse is ready to receive them when they arrive on the floor.

Of course, it's not always possible, as a few of our ER nurses will call report two minutes before they bring up the patient, and there's a couple who often don't even call at all, but just bring them up and then get upset because nothing's ready. :stone And if I'm getting two admissions and an ICU moveout, or an admission and a fresh post-op at the same time, sometimes I don't get all my ducks lined up in time, and then I'm behind all day. But for the most part, I've got this stuff down to a science because I'm often the PRN nurse, meaning I'm the one to do the admissions and receive the post-ops, so I HAVE to be organized. To say the least, an ounce of prevention is worth a pound of manure---er, excuse me, a pound of cure---and when everything goes according to plan, my patient is welcomed to the floor by a calm, cool, and collected nurse, which helps the hospital garner good Press-Ganey scores.........not to mention helping ME keep my sanity.

Happydoggie · Jul 27, 2005

A few more little tricks of the trade:
If you know you're getting 2-3 post-ops during your shift, pull all the paperwork you'll need (standards of care, frequent vitals sheets, and other flowsheets) and put it in the rooms where the patients are to be placed. You can also have your IV pumps and VS equipment ready as well, and if there's a little downtime, you can even start filling some of your paperwork out ahead of time.
I also do this with admissions, even to the point of having the IV/saline lock primed and ready (if it's a direct admit) and bringing in a slider board if I know the patient is elderly and/or in pain for an easier transfer from gurney to bed. I like having everything in place beforehand, as it looks better to the patient and family if the nurse is ready to receive them when they arrive on the floor.
Of course, it's not always possible, as a few of our ER nurses will call report two minutes before they bring up the patient, and there's a couple who often don't even call at all, but just bring them up and then get upset because nothing's ready. :stone And if I'm getting two admissions and an ICU moveout, or an admission and a fresh post-op at the same time, sometimes I don't get all my ducks lined up in time, and then I'm behind all day. But for the most part, I've got this stuff down to a science because I'm often the PRN nurse, meaning I'm the one to do the admissions and receive the post-ops, so I HAVE to be organized. To say the least, an ounce of prevention is worth a pound of manure---er, excuse me, a pound of cure---and when everything goes according to plan, my patient is welcomed to the floor by a calm, cool, and collected nurse, which helps the hospital garner good Press-Ganey scores.........not to mention helping ME keep my sanity.

Thanks for the pointers. Guess it takes time and experience to get things sorted out...

grinnurse, RN · Jul 27, 2005

Hi wow, this thread really helps for us new nurses!
l've just started nursing in MS ward for 2 months now and need advices and guidance in prioritization... Am very overwhelmed when all the things come at the about the same time: pre-op preparation, post-op pt comes back, call bells for bedpan, doctors visit, feeds/medcine due, iv drip runs dry, phone calls (ward clerk work 0800-1600 only).... HELP!! WHICH FIRST?? WHICH NEXT??

Hi Happy-

I just recently started MS too, about 7weeks ago and it is hard to decide which to do first. Hope someone will give us some pointers. This is what I would do,

#1 pt on bedpan or call doc if 911

#2 pre-op teaching (depending on when scheduled) intial VS on post op.

#3 IV bags

#4 meds (unless insulin, diabetic meds. or other meds for GI that are scheduled to be taken b/f breakfast)

Don't know if this is correct............hopefully we will have someone that responds. Good luck on MS!!

marylyric · Apr 24, 2006

Time management is the key to becoming a successful nurse...It is one of the most important skills you will need.
1. One thing I have learned is never put off charting at all...it doesn't take but a second to write a note ...for example if someone calls out for pain meds quickly write that note before taking them the med (you will find that it takes only seconds). The nurses who work late are the nurses who save all their charting until the end of the day--this will never work plus you can't remember adequately what you did when and for whom--also writing yourself notes to chart by later is not a way to save time...just do the charting throughout the day.
2. Never put off something when you get a lull in time that you can do then...for example: if you have a dressing that's due that day and you get a moment -do it then...don't think "well I have all day, I'll do that later"...later many never come. Do what you can as soon as you can.
3. Pull your meds (if the facility allows) early and have them ready to give. A normal routine for me during a day shift caring for 8 med/surg patients went something like this:
a.get report (I always come in 15 mins prior to shift time to get a jump on the day--it helps a lot)--I've only been out late twice since becoming a nurse.
b.pull 8 & 10o'clock meds from pixix and put in patients drawers (don't open them--just put in the cups and have ready)--put a dot beside their time frame in the Mar so you will know you have pulled them. Flag any scheduled narcs that will have to be pulled at the time to be given (up to the 10oclock meds). make mental note of pain meds that can be given this am and what time.
c.do assessments being sure to check ivs for infiltration (if any are going bad--turn them off ..you can restart in a bit), if anyone asks for pain meds at this time --tell them when they can have them (or if it's time run get them depending on how many more patients you have to assess--if you're down to assessing one or two then take the pain med back after you finish as long as the patient is not 8/10 in pain)....all these assessments should not take very long -the more practice you get the faster you can do them--save the patients with 8 oclock meds until last and you can give them as you assess or run them back if it's not quite time. If someone has questions about their care (labs, md plans, etc)..make a note and tell them you will get back to them with that information--later on you can look this up as it is not priority.
d. now quickly chart chart chart as fast as your fingers can write--charting the assessments and first note, don't double chart --anything on your graphics does not need to be repeated...most new nurses overchart --avoid this as it wastes time. If there were any real problems noted this will be the time to page your md unless you know he's coming at that time. You can wait on him to call while charting.
e. if it is 9 oclock start giving 10 oclock meds (which you have prepulled). this doesn't take long when the meds are ready. Save the patients with NG, Dopphoff or Peg meds last and the patients getting schedule narcs you can save until 10 oclock (so you can pull the narcs on time).
f. after med run now go back and finish charting assessments if you have not finished or you can restart those iv's at this time (personally I wait until I have the assessments done). (of course if they were getting blood you're going to have to ask the charge nurse or iv team earlier if they can restart your iv)--if they can't you'll have to restart that one on your own when you find the problem (not later).
g. straighten and neaten your area as you go. After charting assessments (or during), make sure your vitals have been charted and double check them (CNA's should be telling you if their are any problems with vitals but you need to make sure you know your cna's habits--this will come with a little time). This is also a good time to check your I& O's and make sure they are charted and voiding as necessary.
h. now start treatments...dressings,etc. Be sure you take everything you need when you go to do dressings and take extra...also check fluid levels as you go on IV fluids, bring an extra bag in the room if you're going in and hang on the pole until you need if you know you're going to need them.
I. EAT LUNCH
J. Pull afternoon meds-put in drawers.
K. If you have most of this done in the am you will be ready for unexpected things plus doctors orders coming in, admissions, discharges...etc.
I know is seems overwhelming at times but this is the time to prioritize problems...is an IV going bad a problem...not really if you catch it in time--as long as the patient's arm is not swelled up--(then of course you will want to grab a hot pack or ice depending on which your facility does) you can wait to restart the IV for a little while...if the MD comes in and asks about it ..just tell him the iv went bad and you're going to restart it. Utilize your CNA while also letting them know you are there to help if needed. Don't do things like bed changes when the patient wets the bed unless you have time. If you have time help the CNA if at all possible so when you are busy they can expect you to do your job...i've found that a team approach works best with CNA's and if you have time to help someone on and off the bedside commode then do it...if not let your CNA. If you are willing to do some of their tasks when they are busy and when you have time they will be much more ready to help you.
Hope this helps some. Anyone feel free to private message me if you want to talk...!!! GOOD LUCK

Thanks I AM GOING TO PRINT THIS AND TRY TO MEMORIZE

CarVsTree · Apr 24, 2006

Foleys that won't drain: sometimes when foleys won't drain, you just need to "vent" them. On the bottom of the urimeter, there is a dial (for obtaining samples, I presume). Hold the urimeter up (so the urine goes in the bag) and open the dial, this will let some air in. Then "milk"tube from foley to bag. The urine should flow much better now.

When really bad, I sometimes have switched out a bag with urometer to just a plain foley bag. This also helps.

Tell your techs that your getting an admission as soon as you know. Then ask them to get the slider, toiletries, urinal, bedpan, pump, scale if nec., etc. I used to do all of this when I was a tech. w/o direction but find that when I tell techs I'm getting an admission they do nothing to prepare. If I tell them what I need ahead of time, they are happy to do it.

If you have a med to IV push over 5 minutes. Push in between assessing your patient and giving other meds. That way you're not just standing around.

If you have PRN pain meds to give out, pop in and ask your patient how their pain is and if they need anything, before you get their scheduled meds. The patients feel cared for and you make only one trip to the med room. Enter your pain assessment right away (ours is on the computer so I can go right from my med screen to the pain screen and back).

If I think of more I'll add another post.

My daughter wants to see the angry fire face, please take no offense :angryfire