Third night of orienting...needed to vent

[rosstat2]

Hi everyone,

Appreciate a little input.

I am a new grad nurse and on my second week of orienting. Started my third night this Friday (yesterday) with a preceptor. We had a total of 9 pts., with an LVN, and nurse tech. My preceptor told me I was ready to take the whole run by myself, asked how I felt about that and I told her that I was not ready and I would take 5 pts while she took the other 4. She agreed, but said eventually I would have to do the whole run anyways. Her plan was to have me take the 9 pt run and she would shadow me and be there if I had questions. Told her i was not ready to take the whole 9 pts. Of course it was one of those nights from heck and I felt like a chicken with its head cut off. I was just trying to keep up with things. I know it was only 5 pts. on my own, but it was busy.

I do understand that I will be having 9-10 pts a night eventually on my own, but I just felt a little overwhelm on my 3rd night of orienting. The past 2 nights I only had 4 pts on my own and those happened to be TPC.

My questions are:

1. How can I organize myself in order to take care of 9 -10 pts, be able to look at lab results, put out "fires" as needed. Do 24 hour chart check, be able to review h&p in main chart? I understand too that some nights are good/bad., but how does a newbie handle this.

2. Also, how do we handle nurses tech that have been working for a long time and will gladly tell you what you are doing wrong, or not helping you out, not answering call lights (and when they do, make comments that nurses are lazy - they can't answer their own call lights). I have personally gone in the room when the light is on if I'm close by and happen to see the call light come on because I wanted to avoid these comments from NT. Don't get me wrong, there are good techs and bad techs, how does a newbie handle the bad techs (I say thank you for all your help at end of my shift, but they don't seem remember that at all next time because they actually have to work)

3. Finally, I gave morning report and felt really, really STUPID because the nurse coming on would ask me questions and I did not have an answer. Is there a better way to hand off report (some nurse wants alot of info, and some don't).

Please give me some input for this newbie nurse. Tell me it does get better, and I won't feel inadequate and eventually will start thinking critically, will know how to organize myself, and will give adequate report to the next shift RNs. I really love nursing. I feel that I have to grow a very thick skin in order to survive my FIRST YEAR.

Thank you in advance to any input to anyone who was ever in my shoes. LOVE this site.

[SoundofMusic]

Um, what sort of facility do you work at where you have to take (gulp) NINE patients? Is this LTC?

I can't even imagine, unless you have superior techs or something that take care of it all and all you do is pass meds or something.

What is the acuity of these patients?

[rosstat2]

I work on a med/surg floor. Acuities run from 3-4. My duties are IV's IVPB and pushes, do new admits, update charting, call mds as needed. The LVNs give po meds and dressing changes, accu checks, call meds regarding BS. The techs are vs, passing out water, bed/bath.

[AprilRNhere]

There's no way you should be able to handle 9 patients 3 days into your orientation!

I was oriented for 6 weeks on med/surg and never took more than 4-5 until I was done with orientation.

[AprilRNhere]

Sorry- I didn't finish my post. For report...honestly- I felt dumb for almost 6 months. It was the part of the shift I dreaded the most. It helps to type out the important stuff ahead of time then refer to it as you give report. If they ask questions you don't know- just tell them you'll find out for them. More often than not (if it's something you need to look up in the chart) they'll prabably tell you not to worry about it they'll look it up.

It's just part of being new. You'll get through it- and suddenly be amazed at what you're capable.

I DO think 9 is too many though. My facility we don't take more than 6-7 on nights..and even that is rare.

[Nur_1996]

Hence, the reason I don't work in the hospital anymore

[Virgo_RN, BSN, RN]

Sounds like Team Nursing, no? We use the Patient Centered Care model at my facility, so our nurse to patient is typically 1:4. LPNs take their own patient assignments and work with minimal, not direct, RN supervision.

1) You need a good "brain" sheet. Your brain sheet should not only include important assessment data, lab results, and meds, but should also have check boxes for specific things you need to do, such as the 24hr chart check and reviewing the H&P. You will get better, and won't need the extra check boxes some day, but they are good for when you're first starting out.

2) This is an issue that is not unique to your facility. We use CNAs where I work, and while some are wonderful with a strong work ethic and are team players, others have a similar attitude that you have described. When you figure out the answer to this age old problem, please post it here because there are a lot of nurses who want to know! One approach would be to be consistent in your expectations of them and hold them accountable. Another approach would be to show an interest in them personally, be friendly, ask nicely, always say "please" and "thank you", and if you're right there and can do it yourself, just do so. A combination of both can be effective.

3) Try to find a consistent format for your report so you're not jumping around. Our facility uses "SBAR" for report, which helps to streamline things a bit and get everyone on the same page. S stands for Situation: Name, age, events leading up to admission and admitting diagnosis. B is Background: Medical history, significant events in the last 24 hours. A is Assessment: Head to toe assessment findings, most recent vitals, pertinent labs. R is for Recommendation: What is the plan for this patient, including both the next 24 hours as well as discharge planning. It might help to lay out your brain sheet in the order that you want to give report, so you can just scan across the sheet in a systematic fashion.

Good luck, and let us know how it goes. I'm really interested in this model of nursing your facility is using. It sounds like it could really work well if you have a cohesive team.

[Nurseismade RN]

I work on a med/surg floor. Acuities run from 3-4. My duties are IV's IVPB and pushes, do new admits, update charting, call mds as needed. The LVNs give po meds and dressing changes, accu checks, call meds regarding BS. The techs are vs, passing out water, bed/bath.

did you mean third night off orientation????

what you describe sounds like team nursing...and even though nothing is easy in nursing...your establishment seems geared to making sure that the Rn does only RN duties. Honestly, as a fairly new grad myself,with little orientation 3wks....I have had up to six patients inlcuding an admission and did all their po meds, dressings, IV's IVPB, pushes, check charts for new orders and update and sign off orders, call mds when necessary, photo doc new wounds, pass out water etc, clean up incontinent pts, vital signs on some pt that are not stable, do some adl's when assistants are shorthanded......

so I am saying to myself, mmm!!! 9 patients with a lot of the load taken off ..you have a great support team..sounds doable...but on the other hand the nine patients are ultimately your responsiblity....like I said earlier there is no easy solution.....