Vent, Rant, All of the Above- New nurse in trouble

mommyX2 · Feb 22, 2009

I know how you feel. I am also in med/surg and feel like I screw up constantly. When I think I have it under control someone points out something I did wrong. I feel like crap but try to learn and watch for it in the future. It just seems like so much to keep straight. As for shift reports, I get attitudes from night shift during my report. It doesn't matter. Some people can't be pleased.

UM Review RN, ASN, RN · Feb 22, 2009

:icon_hug:There are a few issues here. First, you admit that you have too many patients. Second, you admit to being unable to finish on time or do the appropriate documentation. Third, you say you're missing med orders.

Let's talk about those three.

The first problem I see is that, no matter what the ratios are supposed to be for that unit, you say that you have too many patients. This does happen in a lot of hospitals, and frankly, there's not much we can do about it. Filling out a paper might alert the BON to the hospital's problem, but if you research the history of this problem, you'll find that this is so common to nursing that we all try to work around it for a couple of years to get our time in and then we leave the bedside. Books have been written about the poor working conditions forced on nurses and how difficult it is for new nurses to adapt to the working environment. You are not alone by any means. But you are too new to leave the bedside. So that leaves you with trying to be more effective with your time, problem number 2.

Being unable to finish on time when you work night shift imight be the reason that the day shift folks are giving you bad vibes when you're giving report. You might be frank and ask how you could've done things more efficiently on your shift, which will start a discussion about what didn't get done and why.

Your goal is to improve your skills -- your clinical skills and your time management skills. If you had such a bad night that no one got done on time, that's usually a staffing problem. But if you're the only one struggling along and no one's offered to help you, if you feel that you have no support on your shift, these are things you need to talk to your manager about anyway. So your meeting with her will give you the opportunity to try to let her know.

What I'm getting from your post is that you're really struggling, but you are willing to try to do better. What kind of orientation did you have? Did you gradually work up to the full assignment of patients or did you just get off orientation a month ago and now you're regularly getting slammed with 10 patients? If you did, you might ask for more orientation. But the key here is to be receptive to learn how to do things more effectively, not just faster. There's a difference.

Missed med orders mean you need to radically change the way you're doing something. Is it possible that you're not checking for orders often enough? Our docs were supposed to alert us by putting a flag up and by folding the page over halfway. I got into trouble a couple of times because one doc did neither of these things. He'd come in, write stat orders and then I swear it was just like he'd go home and kick back with his stopwatch to see how long it'd take to get to the order, the jerk. :angryfire You'll get faster with this task once you put it in mind to check the orders every couple of hours or so. When you work night shift, this is probably the most important thing you can do for all of your patients -- make sure that the chart is up to date and accurate so the patients get what they need asap so they can get better and go home.

Because you're new, you're under the microscope. Accept it and try to think of it like the learning experience that it is. There's only one way to get experience and you're doing that now by sticking it out and going to work every day. It's a difficult, stressful job, but one that you can master if you really want to. You've already come a long way. I think you can learn to do this and do it well, from what I've read so far.

Lastly, I believe that every new nurse needs a whole bunch of these on a regular basis, so here you go::icon_hug::icon_hug: :icon_hug: :icon_hug: :icon_hug: :icon_hug:

HouTx, BSN, MSN, EdD · Feb 23, 2009

I agree with advice from previous posters - but would like to add. If you honestly believe that you will be unable to handle the patient load you need to invoke Safe Harbor. It may not change anything about the nightmare shift you are facing, but it will do a couple of things

1. Serve as permanent documentation that staffing was inadequate - these have to be analyzed and trended. This may provide needed support for a nurse manager who is trying to improve his staffing, but has been unable to do so.

2. Provide a framework in which to understand any problems that may arise. It does not 'protect' you from med errors or missing treatments, but it does make sure that the situation is taken into account.

You asked about computerized charting - and whether it would 'help'. Well . . . . it would probably prevent orders from being missed IF they are put into the electronic record immediately. However, in most EMR systems, physicians refuse to input their orders, so they still have to be transcribed by someone and this can still cause delays. EMR systems usually require clinical staff to make more frequent entries because times are automatically recordedand they don't allow 'block charting' at the end of the shift. Some computerized charting systems actually create more extra work or interfere with 'normal' patient care processes. >>. We need systems actually created by nurses for nurses.

KalipsoRed · Feb 23, 2009

You know, you sound like me! I newer though. I've almost been a nurse for a year now. First six months I spent on days feeling the same things you do about giving report to nights. Now I'm on nights and it got an itty bit better for a few weeks but it now feels just as stressfull as days. I work telemetry/step down. Yes, healthcare will suck like this until our patients refuse to put up with it. I personally cannot take it anymore. I hate being anxious and crying all the time. I use to be a happy, calm, and dedicated person. I miss work like crazy now, I don't sleep well, I feel like crying every time I go to work....or worse I just don't feel anything at all. I would rather go back to being a janitor making $10 an hour than continue to do this. I think I'm going to look into public health, a doctor's office, or a clinic.

SuesquatchRN, BSN, RN · Feb 23, 2009

No advice, just a big hug and mug of virtual hot chocolate.

emtstudentnurse · Feb 26, 2009

Thanks everyone's advice, suggestions, and hugs. :yeah: :yeah: :yeah: A few things have come up since my original post. Before I'll address a few things. My patient load is usually not troublesome as far as number of patients. It's the patient acuity. I work at a rural hospital just outside a metro area. We see everything that doesn't ship out. We have high patient acuity on a regular basis and sometimes it's just luck of the draw on assignments. If you have the rooms across from either station then it might be a long night. I don't have a problem with the acuity or assignments really. I try to be very diligent on checking MARs and orders, but I've made two errors. The first one I cried over it, completely freaked out told another nurse then realized that I'd given med 45 mins early. I haven't made that mistake again and fortunately it was ibuprofen. I think the reason I'm looking forward to computer charting is the paper work I have now. For assessments we chart by exception with the option to check the wdl box. I have a hard time checking that on every body system, it seems that I'm saying I didnt check. Even if I only write AAOX3, I feel better. Filling out assessments and the rest of nurse's notes on 6 patients takes awhile for me to write, add in interruptions. After my initial patient assessment I immediately chart anything out of ordinary or related to admit dx. Then fill inthe blanks later. I guess I'm overwhelmed trying to get paper work done and chart checks and maybe read progress notes. Now I try and schedule my shift which works sometimes or anytime I have down time and do something early so its done, like pulling 0600 meds. I had an extremely long orientation. It took me awhile to get it until a supervisor took me aside and said what everyone else had said but different so the light went off. :idea: My first month of orientation I was in an internship class along with working on the floor. Then I was still on orientation the second and third month. I think I had an adequate orientation.

After taking a step back I believe my core problem is the amount of paper work and time management, which I'm continually working on.

At this time I'm still waiting on having the meeting with my mgr since it was rescheduled. But since then I've learned some new things. First, I didn't get SALTs. To make a long story short, the morning after that shift I made the dayshift charge mad so they went through my charts from the shift before and did the write ups but didn't qualifly for SALTs. I can deal with this, it's been reviewed and yes I documented the sores, no the profile wasn't completed yet but way under the first 24 hrs after admit started on dayshift, and yes I didn't notify the supervisor about the IV situation at 0645 since they were gone. I can live which this, learn, and proceed.

There are two things troubling me right now. I spoke to one of my charges about the situation trying to gain some insight. I'm usually the first one to ask for constructive critism. After a very vague conversation where I was beginning to become upset but not crying, I was told maybe I didn't want to be a nurse. Maybe I should go back to ems, maybe I wasn't cut out to be a nurse, and not everyone who comes from ems can be a nurse. This was coming from a nurse who was a paramedic before. At first, I thought I really connected with this nurse because we had that in common. One of my nursing instructors was in ems first, and it was great, she understood how I viewed things and taught me how to think like a nurse. But this charge is different for some reason. But, after she said this she did say I was a smart nurse. Thanks, now crying asked for a break. :crying2: I know that you are not able to make a decision able my nursing ability, I just wanted to get that off my chest. The other was giving report this morning. I had a nice night with darling patients since none of them were close to station. I had everything done and was waiting at 0630 to give report. After reporting to one nurse I was waiting on the second. I went to the other end to find them. Unable to, I went back to first station. Finally at 0715 I found the nurse sitting in the back drinking coffee. I told them I was looking for them to give them report. They just sat there so I went back. I started giving report, and they picked up the newspaper and started reading before I finished with the first patient. I finished report, got my stuff and left. I'm just irritated about that, but not sure why.

Maybe this is just one of the many brick walls I must encounter. :banghead: I'll just have to either learn how to climb a wall or a solution around it. Thank you to everyone, I truly appreciate the replies, support, and having a place to vent without fear.

Post Script- I figured out how to use the smilies, forgive my overuse. :redbeathe

I_love_my_job · Feb 26, 2009

Thank you all for taking the time to post. This is encouraging to me as well. I have similar challenges at work and I'm trying to work smart so I won't get burned out. For instance, I take a lunch and try to take at least one other break. In the past I wouldn't stop to eat or sit in the break room long enough to gather my thoughts and organize the rest of my shift. Realizing I needed "me time" was very important.

Midway through my shift I made notes on what I had left to do and put checkmarks next to the item. I felt empowered by seeing all the checks especially when my assessments were charted two hours before the end of shift because it always seemed I had some emergency to deal with at the end of shift and then I'd be late since charting hadn't been done. Now I do the second assessment charting well in advance.

I've also noticed I was leaving later when I had a particular hall of patients. Those patients were always more acute. Mmmmm....now I know I was getting stuck a lot of the time with heavy patients. Just last week I had wonderful mostly self care patients. Not one needed prn pain meds, no calling the MDs and minimal orders. What a day...few and far between though.

Good luck with your meeting. I hope your NM backs you and offers some real helpful advice. I once sent an email to mine....no response to this day. Silence says a lot!

UM Review RN, ASN, RN · Feb 27, 2009

I had everything done and was waiting at 0630 to give report. After reporting to one nurse I was waiting on the second. I went to the other end to find them. Unable to, I went back to first station. Finally at 0715 I found the nurse sitting in the back drinking coffee. I told them I was looking for them to give them report. They just sat there so I went back. I started giving report, and they picked up the newspaper and started reading before I finished with the first patient. I finished report, got my stuff and left. I'm just irritated about that, but not sure why.

Could it be that your irritation stems from the disrespectful and rude way you were treated by this nurse? Picking up a newspaper and reading it while you are giving report is very rude. If you are treated like that by everyone, I would suggest moving to another unit, because having to put up with that kind of behavior on a daily basis is symptomatic of a highly toxic environment. In that case you need to move on because it'll poison you.

emtstudentnurse · Feb 27, 2009

Only about 10 nurses actually treat me like that in general, out of maybe 50 nurses total. This one nurse with the newspaper does this to me on a regular basis. Lately, I've heard that it's harder for new nurses to work on a floor that they were a tech on. I'm seeing this a little more each day. I think it's crazy because I've been off orientation for for over 2 months, and now the dynamics are changing. I'm looking into other opportunities now. I don't believe I'll make it a year on this unit. Thanks for all the advice and insight. I am grateful to everyone.

emtstudentnurse · Feb 27, 2009

Update: Just had my meeting with my mgr. Over the phone. I'm working tonight, not on floor, watching tele. It's really hard to defend yourself or anything else for that matter when meeting is on phone. Bottom line was next time I'm supposed to restrain patient to restart IV. Don't think so. I've already had my quick cry and got it out of my system. Going back to work now.

Mahage, LPN · Feb 27, 2009

I had everything done and was waiting at 0630 to give report. After reporting to one nurse I was waiting on the second. I went to the other end to find them. Unable to, I went back to first station. Finally at 0715 I found the nurse sitting in the back drinking coffee. I told them I was looking for them to give them report. They just sat there so I went back. I started giving report, and they picked up the newspaper and started reading before I finished with the first patient. I finished report, got my stuff and left. I'm just irritated about that, but not sure why."

What the heck? I hope you loudly and clearly asked her if she intended to take report or not. If she said not, I hope you reported her! I have been treated disrespectufully, but that is about the worst I have heard of on getting report.

Mahage