Struggling on Medical Floor!

Ruby Vee, BSN · Dec 10, 2011

can anyone relate? ......
i've been off orientation for almost two months on a cardiac floor, and my confidence is shot way down! new to floor nursing and have just realized that i am horrible at managing time. constantly feeling pressured about getting meds passed on time and completing necessary tasks. i've unintentionally let written orders go unchecked until the end of the day. from the moment i set foot on the floor, it is just non-stop. i never take breaks because i would just be stressing about everything that needs to be done for my patients. everything is task oriented at this point, and its hard for me to make time to research my patients and get "the whole picture" of what is going on with them, and i hate that.
i feel so guilty that i am unable to provide the best quality of care. at the end of the day, which never consists of me leaving on time, i constantly think about anything i may have forgotten to do, which there usually is something i forgot or didn't chart, like an ivsite d/c'd, or didnt give a prn laxative post surgery, per unit protocol. i've overlooked having cardiac enzymes drawn on a new admit on time. sometimes i leave things for the next shift, which i feel awful about, just because i didn't have time or felt so rushed during the day that it was overlooked.
there are a couple other new nurses on the floor that seem to be handling their job much better than i, and hardly ever stick around late to finish up. i feel i cannot keep up, and honestly wonder how anyone can stay on top of things on a unit like this... but they all seem to.
also, i feel i make a lot of mistakes, am stressed, inadequate, and worry that one day it could be a mistake that would harm a patient, or that i may miss a sign in my patient to indicate they are turning critical.
i love the patients, like the co-workers. i don't know if i should give it my all for a good 6 mos to a year, or start looking into transferring somewhere else. nursing is not for everyone, and i'm starting to wonder of its not for me?
any advice on how to improve time management, build confidence, and/or how to realize when it's time to move on or transfer to another area? can anyone relate? would greatly appreciate it!

the first year of nursing sucks. it just does. the only way to get through it to the other side is to just go through it. hang in there -- one day, it will just "click." honest -- it really does happen!

take your breaks. you'll find that it refreshes you and you'll think better after your break. use the time in the break room to eat, drink, pee and relax. you'll also find colleagues in the break room and it's an opportunity for team building. as you become part of a team, you'll find your work day easier and more fun. and listening to someone else vent about how they couldn't find the duoderm patches and looked all over for them and then found out they were stockpiled in the nurse manager's office will make it so much easier for you to locate the duoderm patches next time you need them.

don't compare yourself to anyone else. just don't do it. you have no idea what that nurse who looks so perfect may have forgotten. or what horrible mistake she's made. just be the best you can be.

you will make mistakes. everyone makes mistakes, even your perfect colleagues. what matters is what you do after you've made the mistake. recognize that you've made a mistake and immediately own up to it and set about to mitigate the damage. figure out how it happened and don't make it again. learn from it. and don't worry about what other people with think because i can promise you, they've all made mistakes, too.

the first year of nursing sucks. get through it. don't let it suck you right out of the profession.

vashtee, RN · Dec 10, 2011

I made up a day planning grid when I was in nursing school, and I still use it every day.

There is a column for each patient, and each hour of the day is listed in rows. Before I start working, I just list all the tasks I need to do throughout the shift for each patient in their column, and then cross them off as they are done (or add things in as needed). I write abnormal labs and procedures at the bottom, as well as anything else I might want to mention to the doctor. It's VERY effective, and very helpful in getting yourself organized, and I share it with all the students who pass my way.

I tried to attach a copy of it, but it didn't work, but it's sort of like this (imagine there being multiple columns):

_______pt #1____________ pt#2_____________

_______Room 100A________Room 101B________

dx_____GI bleed___________ PNA_____________

8-9_____________________ IV abx/turn pt_____

9-10__med_______________med______________

10-11____________________turn pt___________

11-12_ blood sugars_________RT tx_____________

12-13_IV abx______________IV abx/turn pt______

13-14_____________________________________

14-15_med________________turn pt___________

15-16_____________________________________

16-17_____________________IV abx/turn pt____

17-18__blood sugar__________coumadin________

18-19___IV abx_____________turn pt__________

IVF ____HL________________D5NS @100_______

tele____SR________________A-fib_____________

diet____CCU/CCD___________low Na+__________

.......... wound care [_].............. high fall risk

........... PT [_] OT [_]...............soc svc consult [_]

.......... 2D echo [_]..................CXR [_]

.......... WBC ^ 16.1................ INR 3.1

......... Hgb 8.8.......................crush meds

......... constipated..................stage 1 coccyx

betterlatethennever · Dec 11, 2011

My suggestion for u is to understAnd the pathophysiology that is taking place with ur pts disease process Nursing is not a task oriented job we need to critically think. If u understand the disease process then u can anticipate and evaluate what's is happening. Learn the gold standards for different diseases(pneumonia,MI,stroke,etc). Cluster tasks together, Stay organized write things done. Know ur pts history. Give it some time. Good luck too you.

NickiJules · Dec 11, 2011

Thanks to ALL for the amazing tips and encouragement! Greatly needed and appreciated!

I am going to sit down, and using different pieces of advice given, think out a new plan for my work day. By trial and error, I hope in time To create a system that works best for me. And I know it will be quite a while until I feel somewhat comfortable in my job. In the meantime, it's just going to suck. :rolleyes:

I like the idea of patient rounds/quick assessments at start of shift. Also, will make a point to step away from the floor and breathe, take breaks. It is so important for me and my patients! I will start q2h chart checks so no orders get missed. One thing I need to work on is delegating, as well. Also considering switching to night shift, as someone mentioned may be ideal for a newer nurse.

Thank you, vashtee, for the planning grid. I love the times columns! I will try this and see if it works for me. I really think it will help me set time limits for myself, and keep track of all that needs to be done, so nothing gets missed or forgotten. Very cool!

I am new to this site and am now so happy I found it! Thank you all so much for taking the time to reply! Feel free to keep sharing, please!

NickiJules · Dec 11, 2011

Agree! I get frustrated because i've noticed I tend to be more task oriented, at this point, getting caught up in what needs to be done (meds, charting, completing orders, physical assesments, checking VS, etc). I get impatient with myself, but I am sure in time this will change and critical thinking skills will improve.

Mrs. Jo RN · Dec 11, 2011

Nursing school does not reflect the real world. First, stop comparing yourself to the other orients.

YOU need to come up with a plan on how to organize your day. I did it with a list of the patients I was assigned to take care of. This was a letter sized sheet of paper provided on the unit. Every nurse fills theirs out differently. I only put on the things I needed to do. If they were on I&0 I put a diagonal line thru that. If they had IV's I noted how much was hanging and the rate. I would quickly figure out in my head about what time it would run out and put a small number on my cheat sheet. When I did my assessments, the only thing I wrote on my cheat sheet was abnormals. I did an organized head to toe on every patient. If I looked at another nurses sheet I might have a few ideas about her patients but not entirely. Create a code that makes sense to your brain. If they don't have paper like this, create one for yourself based on the most common things you do with your patients.

I too introduced myself to my patients and made rounds before I started looking at med pass. A simple Hello, my name is Hilary, I am going to be your nurse today goes a long way. I ask them if there is anything they need currently, if they are comfortable, or if I can see that they are not I fluff them up. I tell them the minimum we HAVE to get done today. Two walks at least a half a hall longer than you did yesterday, etc. I love that most rooms now have white boards in them. If yours do make sure you put the date, shift, your name etc. on it. I'm deaf in one ear so I would write that on there too. I tell them I will be back to see them more in depth in just a little bit, but that I just wanted to introduce myself and see if they needed anything. Like the person above said, this REALLY reassures your patients, AND it gives you a good chance to do a quick check and triage who you need to see first.

Another nurse I worked with used a watch with an alarm that he set for all his med times.

When I see a doc walk on the floor and he has one of my patients I check the chart.

The nurses you think are "getting it" might be just as scared as you are, they just hide it better.

I have learned in life that a few of the best words are ask and tell. Ask for help, tell someone you need help.

Good Morning, Gil · Dec 11, 2011

This is something that many new nurses struggle with, so don't feel alone there! My time management is not always the best either (I'm a new nurse to acute care, as well), but here are some things I have learned.

1). You can't do everything yourself all of the time. You need to learn how to delegate (I know this is hard for me being in a new place, too....but you have to. I work in ICU, so we don't have CNA's anyway, but there are times when I need to say to another nurse who may just be sitting there. "Hey, can you please scan this order for me? I'm swamped right now." In the place I worked before, we did have CNA's, and that was tough delegating at first, but if you help your CNA when you can, they will be glad to help you (most of them, and they will respect you as a nurse for working hard and not just delegating everything).

2). Teamwork....if you help another nurse, they will be more likely to help you when you need it.

3). Make sure your supplies are stocked in the beginning of the shift, if possible, to prevent running around back and forth. Also, when you do your head to toe assessment on your patient (which shouldn't take longer than a minute or maybe 2 if they're more complex), eyeball your room, and supplies. Do you have suction equipment ready? (if not, you could have a pt aspirate with no yankeur nearby). Do you have the syringe you need for that NG? Do you have flushes for your IV's? That way, when you make your next trip back to see your patient, you can grab those supplies and stuff them in your pocket (clustering your care).

4). Be kind to yourself. Our job is hard, and it takes time to learn. Learn from your mistakes. You forgot those cardiac enzymes once...do you think you will forget those again? I once did not draw a full ionized calcium green top for my patient and then had to redraw.....do you think I will do that again? no, because I wasted time, etc.

5). I and many other new nurses are with you. It takes a year to feel completely comfortable in a challenging position. My time management certainly needs work, too, but these are things I have picked up that have helped me.

6). Don't think about work on days off! But, maybe study some to help you put the whole picture together.

Cuddleswithpuddles · Dec 11, 2011

A quote that is pretty appropriate right now...

“One of the reasons we struggle with insecurity is because we’re comparing our behind the scenes with everybody else’s highlight reel.” - Some smart guy I forgot the name of

Often, you do not see other nurses sweating and worrying in private.

You have no clue how many nurses took a bathroom break, cried in the stall, straightened themselves out and carried on.

You do not see your coworkers' sleepless nights.

For all you know, some of them could have anxiety and depression because of their jobs.

For all you know, one of them could be on Allnurses.com right now in crisis mode and on the verge of quitting.

But, often, all you see are slightly tired smiles and friendly kvetching in the break room.

I think every nurse has moments of extreme stress and hopelessness in their behind the scenes reel but not everyone shows it.

Don't think you are alone and a failure for having them. :)

traumagirll99 · Dec 11, 2011

I wanted to comment after reading this thread and it is off topic, sorry in advance. But first to the OP, hang in there...it does get better, you simply have to find a system that works for you and you have been given some excellent suggestions here. Your sense of confidence will grow with your experience level.

Now for my off topic comment...After reading this thread it reminded me of why I originally started coming here. It was so refreshing to read a posting here that did not contain any negative responses. This in my opinion is what allnurses should be about, helping our fellow caregivers and offering if nothing else a sincere "hang in there". So many topics here now seem to quickly turn into displays of negativity towards our profession and each other. I know that being a nurse is hard, frustrating and can pretty much suck some days...but it was nice to see our better side for a change.

LilMissAlwaysCurious · Dec 11, 2011

Don't worry, in time you'll figure out what works best for you... Trial and error. As for me, the moment I clock in at work I go in the computer and open my Pts chart:

1. Review my orders. It gives me an idea of what I need to do for my Pts (any pending procedures, specimens to collect , routine vitals or q4, strict I&O, if they're on any protocol like K & Mg replacements, etc). While I'm getting report I verify if there are certain orders that still needs to be carried out.

2. Look at labs and vitals. Keep a close watch on trends and not just normal values. The pt who previously had a saturation of 98% is now 92% (although still normal is quite a big change) I would probably monitor him closely. Be proactive rather than reactive.

3. Check your MAR. It'll clue you in on the Pts medical history. And also write down the next available dose for Prns.

4. Get report and ask for clarification if something doesn't add up (if there's a tele order but pt not on tele, the nurse proly got a phone order but forgot to put it in and just dc'd the tele or could be h/she didn't see the order).

5. Assess pt according to acuity. I always do bedside shift report so I do a mini assessment right there (very important for neuro pts to ascertain they're at baseline) and then a full head to toe while passing meds.

This works for me every time.

TriciaJ, RN · Dec 11, 2011

The best thing I can think of is to design a worksheet that works for you. Put down all the pertinent info about each pt and use it as your to-do list. When you check charts for orders q 2h, make sure you add necessary info to your worksheet.

This may seem cumbersome and time-consuming at first, but once you've developed your own system and made it work for you, you won't look back.

Good luck to you.