4th semester in ADN program...in need for advice

Scarlettz, BSN, RN · Feb 25, 2012

You sound alot like like me! I am also a 4th semester nursing student. I was pretty on the ball my 2nd semester because I had a strict instructor- so I had to be. My 3rd semester was a breeze because my teacher was laid back and we didn't have to do computerized assessments.. So, I am sort of out of touch all over again!

Here are some tips:

Patients do not like when you keep coming in and out of their room for assessments. So, when you do your morning vital signs do your assessment right away. They are up at that point anyway. If you are allowed, bring in a piece of paper that lists everything you need to check so you do not forget anything. Once you are done with the first patient go on to the next patient - take his VS and do the physical assessment. Of course you will need to fill out some of it later (I&O and % of meal eaten.)

Predict what your nurse/instructor will ask you at the end of the day. I once forgot to ask if a patient was passing gas in maternity, so I just assumed it was going to be asked again.. One time I forgot to check the L of oxygen a pt was receiving, so I always look now. Once my teacher asked what the flow rate and solution of the IV running was, so I check it now. You can also get some of this information from the computer/chart.

Sometimes it's easier to make beds when patients are sitting in a chair or away at tests/PT. I make it a point to change the linens at this time. So much easier to maneuver in the room and you don't have them watching you if they are away from the room.

Practice what slows you down. Apparently my teacher thought I was slow at making the bed. So, I practiced at home. I also wrote on my notes: Fitted sheet, pad, top sheet, blanket, and pillow cases. That way I remembered to gather all my materials.

I also wrote down: assessment ______, teeth _______, bath ________, bed __________, BG (if you check blood sugars) ________, VS ________ on a piece of paper. That way you remember what you have to do and cross them off.

I have had a patient and aide say I looked nervous/scared before. I wouldn't let this get to you. It's a new environment for us. It's going to be awkward. Many people in the program have been PCTs or work in the healthcare field. Just do the best you can do and you will definitely learn new ways of doing things easier/faster with experience. I have gotten more comfortable with certain tasks. I assume I will grow to become more comfortable with others. It just takes practice and time.

I have even had patients help me out with working certain machines and wheelchairs, lol! Just say "Thank you." They often know how to do things because it has become a way of life for them.

As far as meds go-- that's hard to rush. Just get as early as start as possible. Safety is more important than speed. If there is a particular nurse that you know gets crabby about time, ask your instructor if you can pull meds with her first. We used to always pull meds early with a particular nurse that badgered everyone about meds. Again, this also takes time. Just do your best and be safe.

G'luck!

golosa82 · Feb 25, 2012

Thanks for the pointers! Yes I tend to forget sometimes about the Iv sites and what solution is being administered and when my instructor asks me I think to myself DARNIT!!! I was just in there and forgot and my instructor is so strict about things like this and I feel so stupid to forget things like that. My self esteem right now is pretty wounded b/c I've had such a bad week that any criticism I get hurts thats how bad its gotten. My previous semesters in particular 2nd semester I was doing everything with confidence and it wasnt so bad as this semester. It's been a year since we were back in the hospital so that does affect our skills and our routine of doing things. Im just frustrated and hope I can find my way through this challenging tunnel.

Merlyn · Feb 25, 2012

Thanks for the pointers! Yes I tend to forget sometimes about the Iv sites and what solution is being administered and when my instructor asks me I think to myself DARNIT!!! I was just in there and forgot and my instructor is so strict about things like this and I feel so stupid to forget things like that. My self esteem right now is pretty wounded b/c I've had such a bad week that any criticism I get hurts thats how bad its gotten. My previous semesters in particular 2nd semester I was doing everything with confidence and it wasnt so bad as this semester. It's been a year since we were back in the hospital so that does affect our skills and our routine of doing things. Im just frustrated and hope I can find my way through this challenging tunnel.

First calm down. You are not stupid. what you are describing is what all of us have gone through. Your assessments will come with practice. As you go on in nursing you will be able to take in the whole patient at once. On an Report sheet, you will develop a short hand. Something like BP___ P___ R___ T___ IV____Feeding____Skin___ and so forth. You will always carry this piece of paper, after 40 years I always carry this piece of paper.Your instructor is 'so Strict" about things because they are important. Nursing can be overwhelming, but with practice it can go from maddening to confusing. You'll do fine.

RN/Mom · Feb 25, 2012

I am also in the 4th semester of an ADN program where we are required to care for 4 patients. My best advice is to be very methodical, fast, and learn to prioritize in terms of what you must do NOW and what can wait until later. You also need a very good report sheet (I made one myself where each patient has one side of a piece of paper and I keep it folded in my pocket at all times and add to as needed.)

First, just about everyone in my clinical group gets to the floor about 3 hours in advance in order to prep for everything we will be doing that day. We check orders, review labs, look at previous nursing documentation, read MD notes, look up all meds we will be giving, etc. That helps us plan/prioritize our day. In some cases, we find that there are orders that need to be renewed or abnormal labs that need to be followed up. If so, we inform the MD before the day starts to save time later. Then we get report from night shift which usually gives us additional info on the pt's statuses.

As soon as I am done with report, I grab a v/s machine and start running. You really, really have to be methodical about it. And to be methodical about your assessments, you have to be prepared ahead of time for everything going on with your patient. I go into the most critical pt's room first, talk to them a bit to see how they're doing (which starts the Neuro assessment & pain assessment), explain I need to do their v/s and a quick assessment, and then get started. I do the head to toe within about 5 minutes (sometimes while the BP cuff is inflating and the temperature is being read). I assess and jot down any O2, or IV/NGT solutions they are receiving (double checking on my report sheet that it matches what is ordered). I check all IV sites, flush any saline locks or central lines, and jot down their locations/patency, etc. I then assess and jot down any tubes/dressings/wound drainage devices in terms of location, insertion site assessment, and character of drainage. If it's an immobile/incontinent patient, I check to make sure they are clean, and will quickly reposition them if needed. I'd say this whole thing takes about 10-15 minutes. Being prepared for everything going on with the patient ahead of time really cuts down on the time I am there at bedside because I know what to focus on most.

If I find something going on with one pt that cannot wait, such as severe pain, I must deal with it then and there (after making sure the other pt's are at least alive/nondistressed/comfortable even if I have to wait an extra 10 minutes to start their assessments and v/s). If I find something that can wait an hour, such as infiltrated saline lock on a stable patient, it has to wait a bit. If I find something that can be delegated to a CNA (such as a linen change), I delegate it. I then finish my assessments on the next 3 patients which, if all goes well, takes no more than 30 minutes. After that, I start my charting. At the same time I am charting, I am also checking am labs, reviewing trends in v/s, and notifying the MD of anything urgent I may find (and of course charting that I did so).

As soon as I am done charting, I follow up whatever tasks I put off, such as an IV insertion, before I pass meds. I then get ready to pass meds. I double check all my pt charts for any new orders. I make sure all piggybacks/IV solutions are on the unit (if not, I call pharmacy then and there so it's not given late). I then review the meds I will be giving, decide the order in which I will pass them, and see what I need to re-check/re-assess (e.g., v/s, a certain lab) before I give them. After meds are done, we have to reassess our patients and chart again. If there is a little bit of time when that is done, we can help with ADL's. Not too long after that, however, it is time for fingersticks, insulin, and noon meds.

It might help to make a list of your priorities/objectives while on the floor that day, with the times they're due, and check them off as you complete them. This will help you organize your thoughts and stay on track when you're feeling frazzled -- just refer to that list. There are always unexpected things that come up in any given day, but you have to learn how to prioritize/delegate. Plan for these things ahead of time if possible -- i.e., know before you enter the room when your post-op patient got his last PRN pain med and know which pt's are incontinent/immobile so you can ask the CNA first thing in the morning to check on that patient.

I know how stressful it is, though! There is a lot of pressure that gets put on you as a student. For me, it's really been about learning how to prioritize, staying organized, preparing ahead of time, and being methodical.