Starting over

martymoose, BSN, RN · Jul 3, 2018

You are totally psych-ing yourself out for some reason.that will be your answer

Ad515 · Jul 3, 2018

You are totally psych-ing yourself out for some reason.that will be your answer

I guess you are right. I'm just so unsure of myself and feel disorganized. I keep telling myself one day at a time.

sallyrnrrt, ADN, RN · Jul 3, 2018

Not meant to be crash,

But one day at a time.....

For SIGNIFant TENURE..... will enhance your confidence, skills, performance etc.....

My sincere best wishes....

Please keep us informed...

Sally

meanmaryjean, DNP, RN · Jul 3, 2018

Do you have a brain sheet? If not, you need to get one. That is the first thing to manage your time wisely- having all your tasks written down in an orderly fashion.

what specifically is your time problem? Meds? Assessments? Charting?

Night__Owl, BSN, RN · Jul 6, 2018

Get a brain sheet, and stick with one job. You say you've had "several" jobs over three years, sounds like you haven't had enough time at one place to really get a feel for things. Sticking it out at a good facility is EXACTLY what you need to get yourself "caught up."

Ad515 · Jul 8, 2018

I did take your advice and I got a brain sheet sheet together. Thank you so much that helped tremendously.

Ad515 · Jul 8, 2018

Yes, my goal is to stay on the job for a long time

and build my skills up . Also, to get my time management together. They are really taking their time with working with me and making sure I am comfortable before being on own. I really can't complain about the staff. They are all so helpful and I they actually want me to succeed.

Ad515 · Jul 8, 2018

Charting I am still a little slow, but I guess that will come with time. Meds I have to relearn and read up on them on my days off. I'm always scared to give blood pressure meds and diuretic, when their b/p seems low to me. I usually ask several times before giving it. I can't really judge when to give or to hold.

_firefly, BSN, RN, EMT-B · Jul 8, 2018

Like any job, you will see that your med surg job is very redundant with only so many things to learn. At first it is all new but shortly it becomes almost automatic.

For meds, you will see the same 30 or so ordered all the time. There are tricks to help. Look online for 'tricks to remembering drugs' or similar. Look up the ones you see on orders. Have a drug book or app handy or use the one on your work computer if unfamiliar. I was open with patients if a new strang drug was added and just ask them if they knew why they were taking it. Then of course I'd also look it up. Just because it is ordered doesn't guarantee it is appropriate.

Sometimes docs chart what drugs are being ordered for what diagnoses. Or call and ask or ask another nurse. I think there has to be a culture of helping each other out on the floor because otherwise it is the patient who pays.

As for parameters of when to give or hold meds, these should be added to the order by the doc. If not it is really just nurses judgement. All you really need to know on BP is what is general ranges for starters. Systolic 120 normal. Systolic below 100 is a concern. Systolic above 140 (particularly above 160) is also a concern. Stroke patients or head trauma often need to maintain elevated bps. That's kind of it. Too high, you ask if the doc wants to add bp meds, too low you hold bp meds and consider to call for an order to bolus the pt with fluids. Don't take patients with very low bps walking or discharge them home on foot as they may pass out.

Lastly, consider combos that have additive effects. Like you wrote, Lasix and BP meds. Check the history of how they reaponded if these were given together at those doses before. Are you also going to give them a large Dilaudid dose at the same time and then they want to take a shower? I just tell patients my concerns and space out administration of meds or hold some if I'm concerned it is too much at once. Then I will discuss with the prescriber and other nurses sometimes too. Docs add crazy things to orders sometimes and it is your job to question all of it just as the patient will be questioning you.

mtmkjr, BSN · Jul 8, 2018

Good suggestions here so far. I would just add that for skills type things, like IV pumps, watch Youtube videos (making sure the videos come from reliable sources of course...)

I am a refresher nurse and was a little overwhelmed with new technology and relearning the old basics. Watching videos on my off time has been one of the most helpful things I've had available to me.

And a huge ditto for the brain sheet! I have a template that I use specific to my unit. When I get report, I can circle items, and fill in boxes and not forget to get the info I need. Reverse for giving report, I can give an organized report and not worry that I've left anything out because I put EVERYTHING on the brain sheet. I take report in blue. All new orders and changes thru the day written in green. Important allergies, precautions, etc. in red. I have a timeline that I fill in from my work list so that I can see the day at a glance, and plan accordingly.

Of course, things fall apart sometimes, but it gives me a starting point and I find I'm much more organized doing it this way.

caffeinatednurse, BSN, RN · Jul 9, 2018

I was in a similar position a year ago. I started out in med-surg, left before my year was up, spent some time unemployed (due to the superior job market in my area), ended up in LTC for a year, worked as an RN supervisor, and then landed in med-surg again. I was lucky and landed in a great hospital with a great preceptor (now mentor) who ended up being one of my best friends. I have learned so much from her, and continue to learn something new every day, even though I've been off orientation for nearly 7 months now.

You can do this. Do not psyche yourself out of a great job and learning opportunity. Take each day as it comes. Find your organization style so that you can process the necessary information you need to give and get a decent report. Try to learn something new every day. Find out who your resources are - whether that be RT, PT, your CN, the MD who doesn't mind answering questions, or a seasoned NA who has your back when the census skyrockets on your unit. Before you know it, you will have been there a year and you'll find yourself showing the new nurses and float nurses around the unit. Chances are, you probably already know more than you think you do. You just have to learn to trust yourself and your intuition. Don't be afraid to ask questions. Find a mentor. You can do this.