Too Slow; How to become more fast????

[KdubsRN]

I graduated in May and got a job as a nurse on a post-op lung surgery/medsurg floor with tele. I am on my 12th week of orientation and am still too slow. I have taken 4 patients twice at night and twice on days. I did well with 4 pts until my last 4 pt day shift. I need to be able to take 5 pts by the end of orientation. I really want to be able to speed things up. My preceptor can't figure out why I am so slow and neither can I. I am always doing something whether its charting(we just started electronic charting), giving meds, dsg changes, etc... So its no because I am slacking.

Does anyone have advice? Some of the nurses gave me an organization sheet they use; I started using the organization sheet about 4 weeks ago which has helped. I'm on the meeker side and feel bad cutting pts off when they want to talk but I have learned to do that as well. Sometimes I have passed by pts who are just calling "nurse! nurse!" and I go to see whats wrong even if they're not my pts. Usually its nothing important(pillows, phone ringing and pt can't reach it because they're weak) but I always wonder what if they fell out of bed or something??? so I check. I also found that when I am the only one charting by the tele screen, there is no one else but me to go check on the pt if someone starts alarming, which takes time as well. I know its sad, but I have started charting in empty rooms where I won't be bothered by the tele alarms. After all there are 4 or 5 other experienced nurses there as well to answer them.

I've finished my charting on 4 pts as early as 10am and as late as 5pm and this is my initial assessment that needs to be charted. NOT good. I really need to be able to do initial charting by 12pm. I've found that with 4 pts everything gets done that needs to be done, I've just been charting late because of interruptions or because by the time I'm done with morning meds and assessments its time for 12pm meds and reassessments. I don't know how much longer my manager will allow for orientation. After 6 weeks of orientation I was told that I would need to think of other options if I did not pass orientation. It is my 12th week now. How can I become faster at what I do??? Please help!!!

[xtxrn, ASN, RN]

Sounds more like you're doing too much. Focus on YOUR patients for a bit, until you get the time management better under your belt (obviously, if someone is flat-lining, or sprawled out on the floor, don't leave them ).... be a bit selfish, and let your co-workers know what you're doing, so they know it's not to snub them :)

How much are the techs helping? Be sure to let them know what you need done while they're in the room, that they can do :)

[iloveny68]

I don't think that this is uncommon for a new nurse. I just passed my 1 year "nursiversary" on a crazy busy med surg/tele floor. I was always staying late to finish charting - and it wasn't because I was slacking off during the day. I was constantly in motion. Here are some things that have helped me:

1.) Better delegation skills to support staff. I used to feel as a newbie, that I had to do EVERYTHING. Well, I can't - no one can. I think that I have built up enough goodwill with our CNA's by helping them out when I can, that I don't feel bad asking them to do something that would allow me to pass meds on time, chart things before I forgot, etc. Yes, I have occasionally gotten some attitude - a new nurse WILL get that. But for the most part, I have come to realize that yes, I can do support staff work, but they cannot do mine.

2.) Morning med pass is not a time when I can "chat" and get to know my patients. I come in, assess (I actually start assessing in rounds), make sure vitals and labs are ok, and admin meds. I explain to my patients that I will be back after med pass to assess them further, and ask if there is anything they want me to bring back, or any concerns they have that I need to address. Add those to my to do list, and move on. When I get back to them, I am able to assess, get to know them, etc. Assessment time is a great time to get to know your patient and be fully present with them. Most patients are understanding about how busy we are.

3.) After rounds/report, I sit down and enter in the beginnings of my assessment with what I observed. This at least gives me a start on things. I fill in as the morning goes on.

4.) My brain - it has taken me almost a year to come up with the best system for me. I take report on a pre-printed "brain" that the US generates, and then I keep my to do list on my MAR, along with VS and pertinent labs. This way nothing gets forgotton. I flag all my med times, IV times, and really try and plan ahead and group things together in a way that works for the patient and myself.

5.) Anticipate the unexpected - Fill out trip slips as soon as you see the order for a test, procedure; order IV pumps, tele, etc. as soon as you get report on a new admit that is coming up to you, make sure IV's flush well before you get stuck with an IV med that won't run.

6.) Be flexible, be resilient, be resigned, that yes, sometimes you will have to put assessments in late, patient care always comes first. Good luck!

[Davey Do]

I can give you no better advice then xtxrn or iloveny did, KdubsRN. However, I can write that I appreciate your concern, your perspective, and problem-solving method.

I can also identify with you, on two accounts:

I had just broken out of Psych in 1986 to work as a Scrub in Surgery. I REALLY wanted to work in the OR. But, I was "all thumbs". I got so frustrated I wanted to cry. The Assistant Supervisor discussed the possibility that maybe Surgery wasn't for me. She encouraged me, but it was pretty obvious that I was not a "natural". Then, all of a sudden, I got good! It all came together! I started acting as First Scrub on some intense cases and I shined. Some Surgeons even got to where they asked me if I would scrub with them on certain cases.

This, too, could be you KdubsRN- it might just take some time before you blossom. I think it took me three months before I was able to make a showing in the OR.

But, hey- on the other side of life, I've now met a Nurse who outshines me. She has been a Nurse for two years and can outdo me. We worked together recently and she was able to competently complete all of her tasks in a shorter time frame then me. I've been working Psych off and on for 28 years and now, have been at this Facility for 8 plus years, and this Newbie has shown me up! I was once the King of Castle. I told her that I have to pass my crown on to her. She is better than me. Oh well. I had my 15 minutes of glory.

Your time is coming, KdubsRN. The best to you.

Dave

[Davey Do]

When I first got into Nursing, a Seasoned One said to me something like, "If you wait long enough, just about everybody leaves".

I've now met a Nurse who outshines me. She has been a Nurse for two years and can outdo me. We worked together recently and she was able to competently complete all of her tasks in a shorter time frame then me. I've been working Psych off and on for 28 years and now, have been at this Facility for 8 plus years, and this Newbie has shown me up! I was once the King of Castle. I told her that I have to pass my crown on to her. She is better than me. Oh well. I had my 15 minutes of glory.

Well, this Nurse told me tonight that she is leaving and that I can have my crown back.

Yep. Just about everybody leaves.

Hang in there, Kdubs. After a while, you won't be able to be slower than some Newbie.

[8mpg]

When I worked med/surg...this is how I did it...

0645 report

0715 assessments on all my patients

0800 started and finished all my meds (0900 meds)...by this time I have been in twice and the tech has stopped in once for 0800 vitals.

0900-0930 I ignore my patients. People always say...you cant do that, how can you do that, etc. Easy, I have been in there twice, the tech once. They can and will survive 30 minutes of their life while I get all of my assessments in the computer. It is simple as that. Assessments in the computer seems to be the burden that hurts most nurses as it is time consuming. I firmly believe if you can get this done early in the shift, you will be set for success.

0930-1100 various meds for certain patients. Perfect time to put my notes in for each patient. I put in simple notes for each patient every 2 hours. Its very simple unless there was a change. Something like "Patient resting in bed. No changes in status, will continue to monitor pt". I dont need an extravagant note. My assessment already sates the majority of the information and if nothing has changes, there isnt much to chart. Also, copy/paste the same note on different patients if nothing changed.

1130-1200 insulin time...find your cosigners (if you guys cosign insulin) and have them scratch your back when you scratch theirs. Dont hunt for people to cosign.

1200-1700 various meds and more notes. This is where I get all the nonsense charting done. We have "care plan reviews", "patient education", "care statements". I rip though it..its basically the same for everyone.

1700-1800 meds if needed and then I start my I/O's. This is another time I round on my patients, explain to them shift change is coming and that if they need something the time is now. At 1800 Im going to ignore them again to catch up on charting and start report at 1845.

[tcvnurse, BSN, RN]

I arrive about 20 minutes before my shift. I check labs, read the MD notes from yesterday, pull tele strips and read them and then take report. I assess my patients and chart them ASAP. AM meds mostly ate at 9-10 so I feel comfortable charting before making med pass.

I find with my last orientee--who has similar issues of time management/critical thinking/timidness-- that while she was OK at 'task' oriented stuff like giving meds, she was unable (for the moment) to put it all together. Meaning she didnt quite put together WHY she was giving meds for certain conditions, repercussions for later.

And also, because I think the nursing school she went to was not the best. I wish that she had been more curious, making an effort to look up what she didnt understand. I wish she had been more proactive about seeking out learning opportunities and asking questions. Sometimes I think she still feels like she's in school and doesnt quite get that SHE is responsible for these patients.

None of us were rockstars right out of the gate. Nursing is a demanding difficult profession and it takes a LOT of time to feel like you know what you're doing. Good luck.