Travel Nursing and Organization

[KalipsoRed]

So I quit my med-surg/cardiac job in October to go home and care for my father. He has since gotten much better and I ran out of money so, after being rejected for a few jobs in my town, I got on with a travel agency. Unfortunatly my med-surg/cardiac job did not require me to get ACLS certified, so I'm only allowed to do med-surg until I get that taken care of.

Anyway, so far I have found it somewhat enjoyable. I went from the warm south to the far artic north as my first assignment (not what I was wanting but money talks more). I've always had an adventrous spirit, so even this frigid weather isn't dulling my excitement at actually getting to move around. Which brings me to my issue. I like this and I'd really like to be a good competent travel nurse. I'm having the same issue that I use to have in my old job, not that I entirely expected it to go away, but I'd really like to get rid of it.

When I go to take care of my 4 - 6 patients I do every task I possibly can and end up charting late. I've NEVER left work on time....my best is generally 30 minutes post what my clock out time is suppose to be. I realize that charting is important, but I really have no clue how people get all the tasks done AND has time to chart. I've tried other people's way of organizing, I've tried to make my own sheets to organize my self, and I've sat for hours meditating on how to start my day different or plan my day in a way to where I can get all this done. I have yet to be successful.

As this is my first travel experience I'm also having issues with other things. For example, my last hospital taped report for a good 8 months before we switched to bedside reporting. Bedside reporting is sooooooooo much faster and more in depth. But I'm trying to do it their way, thus I find that I'm having a hard time judging when I should go tape. My shifts are 8 hours instead of 12, so I'm cut by 4 hours. How do I shorten that to do list? Lastly, in my first hospital experience, we had nurses aids (God bless aids!) and sometimes I would kinda let the aid take the floor by themselves for 20 - 30 minutes so I could chart in a more 'chart as you go' kinda fashion. It really helped me get my paperwork done. However, this place that I'm at right now has no aids. Nurses to complete care for their 4 -5 patients. That is something I've never experienced and am not sure how to organize that. (I was a nurses aid for 4 years. That work is not what I have a problem with, what I dont' know how to do is all of that work AND my nursing work AND chart for all of it.) Any suggestions?

[tnbutterfly - Mary, BSN]

Moved to Travel Nursing forum where I hope you will get some helpful information.

[KalipsoRed]

Thanks, I tried to find that nursing board earlier and didn't see one.

[ERRNinMI]

Being organized and getting all your work done can be a tedious task. I work in the ER and we have anywhere from 4-6 patients at a time. They can be patients who have been there for hours, or new patients who need the immediate work up. The first thing I do when I come on shift is get report, (obviously) and then I use post it notes or a small piece of paper and make a list of all the things I need to do for that patient. Things like assessment, vitals, give meds, redraw blood, needs xray, waiting on labs, etc. This helps me evaluate what needs to be done NOW vs. what can be done later. Many times although we have techs who can help us, they often are hoarded by the lazy nurses, so I do most everything myself, and let's face it, you are only one person, and you can only do so many things at once. We use all computerized charting, and we chart by exception, which makes charting pretty tolerable. I'm sure the tasks are much different on the floor vs. the ER but it's all about prioritizing your tasks, and charting as you go would probably help. Hope it gets easier for you!

[KalipsoRed]

Thanks for the response. I'm just wondering if I'm capable of being a traveler or not. This is my first assignment and I've worked 8 days, with a day long paper/computer/procedure orientation and a day long floor orientation. I hear this is more than some traveler's get. I'm not taping report like I should be, mostly because I've never 'taped' report and so I'm having a hard time judging at what point in the day I need to do that. It seems that when I think about doing it, it feels to early in the shift and I'll just be giving a bunch of updates. Then I try to waid closer to end time so that I won't be giving two reports and I get caught up in doing orders. My other issue is that I'm use to working 12 hour shifts and they work 8's. I haven't figured out how much I should be making sure I get done before the next shift gets in.

When I worked a 12 hour day I use to say that any orders past 1730 unless they were now or urgent would be alright for nights to pick up. My shift ended at 1930 so this gave me plenty of time to pass 1800 meds for 5 patients, check to make sure my charting was up to date, and organize my papers to be ready for report. If I got done with all that then I would go see if there were any new orders and try to finish them before nocs came in. The biggest difference seems to be that working 12s means that most doctors have come and gone by 1700, so I never felt bad about leaving night shift with a few because there arent to many MDs who come write orders on their shift. (I worked nights too so I really do know that they don't have as much stuff to do as days on MOST nights.) Working and 8 hour day means that MDs will be writing orders my entire shift, so what is a good time to say that I didn't leave the next shift with my work?

Also this surgical floor gives nurses on days 5 patients with no aids, techs, LPNs, CNAs, nada. The nurse is the only caregiver. So how does one go about taking care of patients that need to be walked, set up for baths, linens changed, meals, and vitals while passing meds, checking orders, hanging IVs, doing dressing changes, wound care, checking drains, and charting? On nights they do this with an 8 to 1 ratio! Really I'm just not sure how to get this all done.

Nobody has complained real heavy yet, but I feel like they are getting impatient with me. I'm trying to keep up and I don't leave until it's done. I'm getting out about an hour late every day, but I'm trying to do all this AND remember where all their supplies are, how to chart in their computer system, and who their doctors are.

In a relm of being over whelmed with 10 being me crying like a mad woman and pulling out my hair and 1 being me relaxing in Cancun, I feel like a 4 or 5. Just sorta frustrated because I can't seem to put it all together fast enough, but not like I'm letting anything important fall through or leaving anyone with work that they shouldn't be left with.