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Tips for speed without sacrificing accuracy?

NICU   (2,643 Views 17 Comments)
by cherokeesummer cherokeesummer (New Member) New Member

cherokeesummer works as a RN (OBGYN).

7,268 Visitors; 739 Posts

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Please help! I'm on week 3 (the end of week 3) of my orientation, and its been about a total of 5 days or so in the actual unit (the rest of the time has been classroom or other stuff).

Anyway I had very little exposure to NICU in school, even though my internship was a NICU one, it was hard to get a lot of hands on b/c I was a weekend student and had a new preceptor every week, they didn't like to hand over a lot of care but I did as much as I could - however it was a much lower level nicu then what I'm working in now. Also that was 6 months ago...so I'm kind of "new" and in a new hospital. Anyway enough of that...

My preceptor has been great, she is very nice and understanding and really helps to clue me in and help me remember stuff. I can always approach her with a question, I won't have her anymore after tomorrow though b/c then I get a new one. Anyway, today I had two "stable" non vented babies and I somehow just got off track, almost forgot a med and just was behind for a large part of the day, mostly towards the end, thankfully she did a lot of the end of shift stuff for me so I would not be late. I don't want to have that happen again. I need to figure out how to be faster but not miss anything. I'm slow when it comes to assessment b/c I want to be sure I don't miss stuff - I start 30 mins early get their feeds warming, then go in to assess them - sometimes it takes less time, sometimes the whole 30 and sometimes longer, depending on how many interruptions I have or if I have meds to give at the same time, or if the baby is really fussy, and flailing around. I know I need to get this down to a smoother and faster method without feeling so bad.

Any tips? Right now I feel so bad. I cried on my way home from work. I know it could be a lot worse. I know this is what I wanted and still want to do, but I have to be hard on myself b/c nobody else is going to say its ok, you can be slow LOL, so I need to make sure I"m not slow but at the same time be accurate and thorough.

Please please please please share any tips or advice. I really don't want to cry at the end of shift b/c I feel like a loser, and I know I can do it, I just have to figure a way out to smooth things.

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1 Like; 34,206 Visitors; 6,372 Posts

It just takes time. You can't rush yourself, or you will make mistakes. Don't be too hard on yourself. I don't think your preceptor is dis-satisfied with your performance, and neither shourld you be.

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cherokeesummer works as a RN (OBGYN).

7,268 Visitors; 739 Posts

I agree, she doesn't seem dissatisfied with me at all, in fact she said I was doing well. But it stinks for her and me that she had to remind me to speed it up, and remind me of things. I know that is part of being a new learner and all but I want to be able to do things and be a good nurse, I know it takes time, but I'm afraid I wont' get it and will be slow and end up being told sorry you stink! I hope it won't come to that, but there is always that worry. :):)

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crissrn27 has 8 years experience and works as a newborn nursery.

10,459 Visitors; 904 Posts

Give yourself a break! You have only had 5 days on the unit! You seem to be doing a great job for that amount of time!

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RainDreamer has 8 years experience and works as a NICU RN.

1 Like; 12,432 Visitors; 3,570 Posts

It takes A LOT of time to get a routine down and have good time management skills. As time goes on, you get better and better.

I remember those first few months when I was on orientation, wondering how I was ever going to handle 2 babies by myself because when I'd get behind my preceptor would help out .... and I knew after orientation I wouldn't have her to help out all the time. Just believe me that it gets better with time, I'm sure you hear that all the time .... but it's true!

By the time I was on my own I was able to handle my own assignment. But I had experience working in a well-baby nursery for about 5 months before I came to the NICU. That helped out with time management skills because we'd have 6-8 babies at a time. So even with that experience, I was still running behind sometimes with my 2-baby assignment in the NICU. So it may take you a little longer since you had no other nursing experience before now .... it's just part of being a new nurse, getting the time management skills down, and that's totally normal.

I write EVERYTHING down! Even in my round blocks I still write everything down that I need to do so I don't forget. I used to forget so many things. I'd get done with a round, get the baby all tucked in, isolette closed up and covered, lights turned off and then OOOPS, I forgot to take the temp! So I write everything down in those blocks. Under 2100 I'll make a list ..... temp, diaper, abd girth, BP (I used to always forget to take a BP too, so I write it down now), weight, chem strip, and whatever else I need to do during that round.

I start my rounds a little early too, especially if they're on feeds. So if I have a round due at 2100 and the baby is due to eat, I'll start my round at 2030 or so, depending on how much stuff I need to do. My first round always takes me longer because I get all my "extra" stuff done then. We only have to take BPs q shift, so I get my BP in that first round. Same with weights and chem strips ..... just once during our shift, so I try to get in there and get that done the first round. So I know my first round takes longer, so I start it earlier. Then with my next rounds I just get in there and do a quick, but thorough assessment, looking for any changes. Get a temp, change the diaper, etc. But before I ever get into the isollete I make sure I have EVERYTHING I need right there, so I don't have to run around to get stuff, I just have everything there and ready to go. If milk needs to be heated up for the feed, then I put it in hot water and let it warm while I do my round.

The best advice I can give you is to start your shift by getting organized and writing all your stuff down. Get all your ducks in a row, so to speak. Get your sheets all filled out and all your times filled in. Know what you need to do and at what time. For the first 15-30 minutes of my shift (time varies depending on how heavy the assignment is) I get my charts and my sheets, then write down when everything is due. I write down when all the rounds/feeds are, when any meds are due, when any labs need to be drawn, etc. Once I started doing this at the beginning of my shift, then it made it SO MUCH BETTER! I was able to get everything organized, then get in and do my stuff. Sure there will be times when things throw you off and you have to adjust accordingly, but if you have a fairly stable assignment and it stays stable, then this makes the shift go by rather smoothly.

I hope this isn't too scattered and helps some. It will get better with time, I promise you. Good luck to you!

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wjf00 works as a RN.

4,362 Visitors; 357 Posts

Don't get too regimented in your approach. For instance if your baby is screaming, feed first and do vitals later. Let your patient set the schedule. If the baby is sleeping I will start late. If they wake up early start your assessment early. If the bath is due that night, it doesn't have to be with the first care time.

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cherokeesummer works as a RN (OBGYN).

7,268 Visitors; 739 Posts

Thank you everyone, these tidbits of advice and encouragement are greatly appreciated. I just wish the "instict" was something that could come overnight LOL. I want to be able to go to the baby's bedside and know what I need to do from head to toe without having to stop and think and double check my list to make sure I didnt' forget to get the girth or forget to check tube placement, etc. I'm trying to get a system down of things to do, i.e. to avoid forgetting to check tube placement I will do my listenting to lungs/heart/bowels and then I will go straight to the tube to check placement - that way the steth is still on me, as a reminder to do that. It helped me to keep remembering!

So I am trying to find a few new ways of doing things and hopefully over time I will get that.

My other issues are as follows:

- report and documentation with different preceptors and nurses - our facility does charting by exception however one person I worked with says no you write down everything, a note about every system. This person was a preceptor so I did what they said. Then I gave report to someone and they were like you don't need to write all of this, its chart by exception, you really don't need to do that. So I get CONFUSED!

- knowing when to respond to alarms! I swear someone is bradying, or desatting constantly - and on some occasions nobody even looks in that direction, like its not a big deal but then sometimes they look like wow this is serious...when will I know when to respond or not? I can't tell you how many times I have gone to the bedside as soon as I hear the alarm and baby stops whatever they were doing. Its like as soon as I come close to the isolette the alarm stops. I don't want to keep running there all the time if its nothing big but I also don't want to be sitting around if the alarms are going off - I feel like I'm supposed to respond b/c they are going off for a reason. So how do you know? And what do you do? I.E. for desatting, one baby was desatting down 70, 60 and back up and down adn up and down...do you just stimulate them? Do you scream for the nurse to come help...LOL oh wait I am a nurse...LOL but I feel like I have no clue on some of that stuff. Everyone I ask says, it depends on the baby. But if I'm not that babys nurse how do I know if its a serious need or not?

Sorry to run on LOL, I'm sure this will come with time! Thankfully I've worked with all great nurses, nobody has "eaten their young" yet with me LOL! :trout:

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brissie works as a RN.

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Please don't beat yourself up. It is going to take time to become familiar with your job and all the little tricks of the trade that can help you cut down on time. You have only had five days on the floor. I can remember when I first started working on the floor and my head was spinning for weeks. You sound like a perfectionist, which is a good thing, but don't expect to be perfect in the first five days or even probably for your first year at least, and even then you will always be learning and becoming a better nurse. Keep your chin up.

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brissie works as a RN.

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Also I had the same problem with one nurse telling me to do something one way and then another nurse would tell me to do something another way. Get out your unit policy and procedure manual and check for yourself to see how something is supposed to be done. Find a way that works for you and as long as it works and is compatible with unit procedures stick with it.

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preemieRNkate has 7 years experience and works as a RN.

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As far as responding to alarms, I feel that it is good that you are so attentive and go over to see WHY the baby is setting off his/her alarms. It's better to show initiative than to sit on your butt looking like you don't hear something beeping. And when you get to the bedside, if you can't figure out what the problem is, ask for help! Maybe I'm speaking for myself, but I would much rather have you ask me for help and maybe I'll find a pulse ox off than to have you not say something and have a baby in real trouble. You're on orientation. You're not supposed to know everything. Good luck!

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11,138 Visitors; 1,289 Posts

I think tincture of time is the magic pill for time management. You will eventually find an assessment routine that works for you. I pull everything out of the babies bedside drawer that I need for an assessment and lay it all out, that way I dont' forget. We have to change the sat probe site every shift, that is the thing I forget to do the most. I usually don't fret and change it at the next assessment.

As far as alarms, I am the same way, if an alarm is going off, there is a reason for it. If I was a parent on our unit I would cringe if alarms were going off and staff wasn't responding. Our monitors have 3 different sounds, one is a beep with a couple seconds in between, that means a parameter isn't picking up. Then there is a low pitched alarm which means the kid is having minor issues. We then have a higher pitched panic alarm that means get over there pronto.

I think you will learn a lot just by being on the floor more. Give yourself some time!

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1,306 Visitors; 87 Posts

cherokeesummer, I'm not a NICU nurse, but I'm seriously considering it. I can tell by reading your posts that you are already a good nurse. I think you are going to be a fabulous one in the future! All the best. :)

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