Published Mar 16, 2013
CCNP-FL
1 Article; 58 Posts
Hi fellow nurses:
I'm writing today just off of the worst shift I've had in quite a while.
The patient load was fine, I had seven lovely patients, but somehow I just messed everything up between 5a and 7a. I ended up staying 40-minutes late to undo some mistakes I made and I'm just really down on my skills.
Fairly new as an RN, I've been in the field for four-years (previously as an LPN and a CNA). I really pride myself on my meticulousness and patient education, but today I just seemed to get everything wrong, miss all the worst possible points.
To add to this, one of my favorite PCAs told me that, "Man, I like you, you're a great guy, but I would never want you to be my nurse if I came here." It really floored me when he said that. Everyone calls me the "spaz". I get my charting done, I connect with most of my patients well, but I can never seem to live down my craziness. I arrive 30-minutes early every day to check the orders, get things ready, and somehow -- like today especially -- I miss things.
I try my best to calm down and stay focused, maintain composure, be effective...but things just seem to fall through the crack. I keep telling myself I've only been on the floor for 6-months...but, I don't know.
Thanks so much for letting me share, I could use some good suggestions. If it helps, I'm really this way in everything I do, I've been thinking of seeing someone for ADD, OCD, and such...but I'm really opposed to Meds.
Any suggestions are greatly appreciated -- thanks for the help!
eatmysoxRN, ASN, RN
728 Posts
Do you have a good brain sheet? I swear I would be in much worse shape without keeping one. There are tons of great ones on here. I personalized one to help me and I suggest everyone do so. Post its also keep me organized. Maybe ask coworkers for suggestions? Best of luck to you.
~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
chrisrn24
905 Posts
You should concentrate on what you spaz about. Is it when you're doing task A and you get distracted by tasks B C and D? Is it making sure you leave nothing uncharted? Or what?
I find it is helpful to make a list. As you're going about your day, write tasks down to complete and either little check boxes and lines to mark when I'm done. I might have my report sheet littered with things like "find L's insulin _____" "reorder A's Klonopin ____" "neuro check room 5 0300 ____" etc.
That way when I remember about L's insulin in Room 5's room I'm not mentally leaving room 5 and missing possible critical things while trying to remember to go find the insulin.
turnforthenurse, MSN, NP
3,364 Posts
I also agree with getting yourself a good brain sheet.
Write down tasks to check off. If a patient needs a UA or something, I write down "UA" and highlight it. If a patient's K was low and it was replaced and it will be redrawn at 2000, I write down "K 2000 ______" to remind me to look out for the next result or to draw it myself if the patient is a nurse draw. For blood sugars, I write down "AC/HS _____" or if they are Q4H, I write down "20 ___ 00 ___ 04 ___" to remind myself that they need to be checked at those times. I write down the result on the underline. If they are Q6H, I write down "00 ___ 06 ____"
If a patient is Q4H neuro checks, I will write down the times (20, 00, 04) and make a little box next to them so I can check them off as I do them. It's little things like this that save me from missing things. On my brain sheet, there is a little spot for me to check off that I updated the POC. If it's not there I swear I will forget, and our POC needs to be updated at least once/shift. There is also "IV" on my paper for me to put a check mark by to remind myself to make sure the IV is still good (
I also have sticky notes to write myself other reminders or if I receive new orders.
noyesno, MSN, APRN, NP
834 Posts
I also agree with getting yourself a good brain sheet.Write down tasks to check off. If a patient needs a UA or something, I write down "UA" and highlight it. If a patient's K was low and it was replaced and it will be redrawn at 2000, I write down "K 2000 ______" to remind me to look out for the next result or to draw it myself if the patient is a nurse draw. For blood sugars, I write down "AC/HS _____" or if they are Q4H, I write down "20 ___ 00 ___ 04 ___" to remind myself that they need to be checked at those times. I write down the result on the underline. If they are Q6H, I write down "00 ___ 06 ____"If a patient is Q4H neuro checks, I will write down the times (20, 00, 04) and make a little box next to them so I can check them off as I do them. It's little things like this that save me from missing things. On my brain sheet, there is a little spot for me to check off that I updated the POC. If it's not there I swear I will forget, and our POC needs to be updated at least once/shift. There is also "IV" on my paper for me to put a check mark by to remind myself to make sure the IV is still good (I also have sticky notes to write myself other reminders or if I receive new orders.
I do things pretty similar to turnforthenurseRN and it works out really well. I'd like to cosign her advice.
Morainey, BSN, RN
831 Posts
When I was a brand new RN, I would write post its so I could remember everything I had to do between 0500 and 0700. Easy to make a checklist and I could just take it off after I was all done. After awhile it became intuitive :)
anon456, BSN, RN
3 Articles; 1,144 Posts
I wonder if you might have a learning disorder or attention problem. I have an LD. I also have a very high IQ but the LD makes me rely on certain coping skills and checklists and other tools I have put in place to compensate for my LD. If I had not learned to compensate I would have made a lot of mistakes.I wonder if you can get yourself evaluated by a specialist in learning disorders and get some help to learn how to compensate. Doesn't mean you are not smart or dedicated, you just may need extra methods for how to keep yourself organized or less distracted. I agree a good brain sheet is worth so much, but there are also other things, too. One of my things I do is set alarms near the end of the day to remind me of things that need to be done near the end of shift. It also keeps me on track to what time it is, when I have one of those crazy nights.
tyvin, BSN, RN
1,620 Posts
Stop going in early just to set up. As long as you treat yourself that way you won't get it down. Relax and do your job.
Also your are an RN aren't you? Just because someone has a learning disorder or whatever doesn't mean they have to go on meds...it's called therapy. You are good enough; you just need to believe it.
canesdukegirl, BSN, RN
1 Article; 2,543 Posts
A few questions for you:
1. How much caffeine do you consume prior to your shift?
2. What are your eating patterns like? Do you eat healthy foods? How often? Do you eat breakfast?
3. What do you use for a "stress outlet"? Do you exercise, run, bike?
4. What's your homelife like? Do you feel happy/fulfilled at home? Do you have many distractions or other duties that you tend to after your shift?
The reason I ask these questions is that you seem like a bright guy. There are MANY reasons that we lose focus.
Too much caffeine can have a negative impact, making you scattered instead of focused.
Eating junk...you know it's terrible for your synapses!
Stress outlets (healthy ones) can help to center you and get rid of the static in your mind.
Regarding homelife, I will share this story with you:
I didn't realize it at the time, but when I was "missing" things at work a few years ago, I couldn't for the LIFE of me understand what was going on with me. I pride myself on attention to detail, meticulous planning, and timely follow up. But like you, I was aghast when I found that I dropped the ball a couple of times. I thought I was going nuts.
I talked through my concerns with my BFF, who is a social worker. I spent a long time talking to her. I vented, I questioned my skills, berated myself over and over. I hung my head, exhausted from my self-flogging. Patiently, my friend listened.
Just when I was at the point of tears, she leaned forward, took my hand in hers, smiled softly and shook her head. Then she said, "You don't even realize that this is the week of your Mom's death anniversary, do you?"
Nope. Sure didn't. I had subconsciously blocked it out. The result of that was obvious in my scattered thought patterns. I hadn't slept well, hadn't been eating much of anything, and was overly anxious about everything.
Funny how our feelings don't send memos to our brains, eh?
The point I am trying to make (and I can almost hear my Mom's voice saying, 'Land your plane already!) is that you need to take a look at the peripheral things in your life that might be affecting you negatively.
Hi everyone, thanks for the questions and support.
I have been busy finishing my RN-BSN Courses, working, and dealing with the changes our hospital is putting on us. That day was just particularly bad...
I eat healthy, snack healthy, but haven't been able to exercise like I used to. My Army National Guard unit has been pressing me to go into advanced practice and fill the care provider slot. I want to and am working towards it, I just feel stressed sometimes. I keep a meticulous brain sheet actually. I'll attach a pic. I avoid caffeine, just am always a bit jumpy when I forget to do something.
I think my being unable to run as much as I used to (I'm a half marathon runner and 5ker) is what is making me acutely jumpy these days.
I'm feeling good now and have had two great days since...was especially proud of my 5/5 IV starts yesterday. I guess that day was just going to show I'm still on a steep learning curve and still have much to learn.
Thanks for the support and letting me vent. I'm going to make myself take time to exercise! I've been instructed to take my 30 minute break today lol...and I have. Feels good, I think it's helping hah.
Kevin
. This is my personal brain sheet. Instead of writing by hand I type much faster and save it for next day as well. Assessment on left, orders, plan, results, on right. Labs in the resident format. Meds are printed out pt by pt by screen capturing the mak and printing. I'm highly organized...things just still fall through. Suggestions to improve the sheet?? I just came up with it when I saw one of the MDs do something similiar.[/quote']moderator note: removed dropbox link
moderator note: removed dropbox link
joanna73, BSN, RN
4,767 Posts
You've been working for 6 months, correct? There's a very steep learning curve, which develops over time. Aside from 15 minutes, I wouldn't show up earlier than that. Trying to be 30 minutes early is probably adding to your stress and a much longer work day.
I agree with others. Make sure you have a good brain sheet. I have 30 residents....if I didn't write things down, I would be lost.