Want to be a competent travel RN

[KalipsoRed]

Hi,

I've just started travel nursing. My first position was way up north and I'm not really digging the freezing cold. However I have found the people I'm working with very wonderful, luckly. I'm in the 8th week of my assignment and I have some concerns with my performance. No one has said anything to me, it's just what I'm feeling.

This place is still using MIS or FAMIS as their base computer system...if you know what that is you know how bad it sucks. Most of the charting is paper. The issue with FAMIS is that it gives you a print out each shift of what the patient needs, MD to RN communications, Labs to be done, etc. You would think that is great except once an action is completed by an MD, RN, RTT, and so on that person is suppose to go through a pretty lengthy process to take it off the print out so the next person doesn't think it needs to be done. Well as you can imagine most people do not take off an action once it's complete and thus it leaves a lot of guess work for someone who isn't familiar with the work procedures and policies. Also these nurses still do taped reporting...which I also think is sucky and doesn't really allow the on coming RN to ask good questions. And I'm working 8 hr shifts, which is new because I've only ever worked 12s.

So with all these changes I feel like I'm missing to much stuff. I haven't missed anything really important yet. But I did miss a patient scrub (I work nights and his surgery was scheduled for 17:00, so it was more like something nice I could have done but not really my responsibility....and that's even if they didn't have a standard policy for how close to a surgery a scrub should be done. My last hosptial required that the scrub be completed no more than 4 hours from or less than 2 hours until the surgery.) I'm not so disturbed that I didn't do it as I never even noticed it was something that needed to be done. I've missed bits about dressing changes like applying creams around edges or things like that. It's just that all this information is scattered throughout the profile and not really something that is reported in report so I can write it down for myself.

As I have 7 to 10 pts without an aid, I don't really have time to spend 30 minutes scowering the profile to find everything I'm missing. I've made it a habit (really this is what I always thought people did anyway) of reading the last 12 hours of orders before I start, but some orders that I've missed were written before that period of time.

I guess what I'd like to know from some experienced nurses is how you guys figure out polices and procedures at every new place (because most places don't give you a book anymore, its somewhere online)? I've done the whole asking gig, but I kinda feel that these people are annoyed that I'm still asking so many questions and I've been there 8 weeks. Are ya'll able to pick up every new hospital floor's groove in 8 weeks? I'd also like to know if it is common for hospitals to ask nurses to take 8 patients without any assistance. This is post surgical floor, a lot of GI, hips, knees, and some thoracotomies and pacemakers. Most of these people are in their 60s, 70s, and beyond. While 60 and 70 year olds can be very active, it has been my observation that ALL people post hip and knee surgery need help out of bed even if it has been 3 or 4 days since surgery. Furthermore, GI surgeries are the same....it's just hard for people to sit up to get out of bed. If you are a nurse that has been able to successfully care for 8 people, keep track of it all, get to them so they don't have to wait 20 + minutes to pee, and do your paper work in an 8 hour shift AND leave within 45 minutes of then end of your shift, I'd really like to hear how you do it.

Thank you!