To be the best nurse I can be

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I have found that even after 7months of working in med/Surg I am still having a hard time. Most days I do fine my patients are fine but I find myself constantly missing things. I get thrown off by the littlest things. The main thing I'm trying to concentrate on is doing my assessments right away, and chart them as I do them but I worry about orders not being carried out and meds to be given. I feel as if I should know more and catch more mistakes do more but that isn't happening.

The whole point is, how can I be a better nurse?

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Specializes in Certified Med/Surg tele, and other stuff.

Do you have a brain sheet? It was my most important tool when I worked the floor. I had all the med times, and part of it was an important 'to do' list for each patient. I'm lucky to have bedside med scanning. The status board turns red if a med is late. I do not miss paper Mars because things get missed. I also carried a multi color pen (still do) to write new orders in green, stat in red, etc..That way I could glance at my sheet and have glaring reminders, lol.

You also need to look back at those first few days on the floor. I bet you have come a long way. It usually takes 1-2 years to get your routine, so don't beat yourself up!

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I think it's important to develop a routine that works for you and then stick to it as much as possible. I work 11p-7a mostly here is my routine

2245 look up pts, fill out my brain, check orders

2300-2330- get handoff report, make sure pts are breathing

2330-100- review 00 vitals, give report to my cna, pass 00 & 01 meds, assess, take note of IVs that need to be changed, fluids need refills, check dressings change anything that doesn't look good, see what supplies need to be restocked in the room, q6h bgts, suction and trach care, make sure chest tube oasis aren't too full etc

0100-0300 call house docs / residents if needed for orders, check for new orders & chart. 2am quick rounds

300-400 get ready for morning chores pull all 5&6am meds, get supplies for blood draws, dressing changes, trach stuff, bladder irrigation etc.

4a-6a- review 0400 vitals, med pass, blood draws, dressing changes, IV changes, trach care, make sure outputs are good, 4am pulse ox's, give charge report

6a-715 review for new orders, call docs who arent on floor yet if i need something, final pain pass and make sure IV fluids are full so days doesn't hate me! Chart.

715-745ish - handoff report

Of course things happen I never sit for two hours and chart but in general if I can stick to my routine I find I miss less. If I am really busy I don't chart until after morning report. This happens if a pt dies, I have a long rapid response, or 2-3 admits or just a really bad team. I try to at least chart my review of systems- everything else is low priority til I have time. I tried charting my assessments as I go but it's just to hard since I am doing a lot of cluster care and hoping my pts can get some sleep (ha!). I find that I can remember my assessments now that I am more comfortable I always have a good picture of the patient in my head. I do take note of things like what is tony appliance is, what size cath etc otherwise I wouldn't remember

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I think my biggest problem is being able to read all the crappy doctors writing and making sure it's been done or in the computer.

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Yeah reading dr handwriting is hard! We went CPOE a few months ago and it's a lot better except you have to keep checking the computer b/c the drs don't have to be on the floor to enter orders.

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Yeah reading dr handwriting is hard! We went CPOE a few months ago and it's a lot better except you have to keep checking the computer b/c the drs don't have to be on the floor to enter orders.

I think we are going fully computerized by April, I cannot wait till them. I think it's going to make everything a lot easier in general.

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