What am I doing wrong? Argh...

[snwflknurse]

I just started on a busy med-surg unit in October for my first job. I did a little bit of clinical time on this floor, but it wasn't recent. I only had three weeks of official orientation, and am a part-time 24 hour week, 8 hour a day position. The other nurses are very helpful, but I just feel really inadequate and SLOW. The ration nurse to patient is 1:4 so I dont' think that's the issue.

anyways, just coming up on my 90 day review, and I have lots of concerns about ME. Maybe I'm just being too hard on myself, but I have had some super difficult, high-acuity assignments lately, and it seems like more nights than not, charting gets pushed aside out of NECESSITY, not choice, so I end up staying over. It's so frustrating, b/c something always seems to happen to make me get behind and I guess it irks me that others can sit at the desk and talk while I'm busting my butt the whole shift and then some. I guess I need to discuss with my manager about my charting...maybe I'm overcharting or something?! BUt I feel the charting should not only reflect my assessments, but what I did about it, and if I got called to court one day you would very clearly be able to see what happened with the patient while under my care. We do computer charting, and it is charting by exception, except our institution just instituted yet another required form for each pt. each shift that is adding to the workload, and has to be done at the end of shift.

Trust me, I don't LIKE staying over, and people are starting to make comments to me like "you're STILL here", etc. I'm trying not to take it personally but, I guess I've never struggled with efficiency before and so I can't seem to figure out what the problem is.

Here was my assignment tonight:

Elderly woman 3 days status post colectomy/colostomy. Required turns q2h and multiple (like probably 15 call lights). Sort of confused. Not to mention every time I went to assess her roommate (see next pt) she had to stop me for something

CHronic pain pt. back from an extensive abdominal/rectal surgery 1 hour into shift. Can you say PRN? prnprnprn...(and she already had an epidural running). Had to do three full checks on her, admission to unit charting, and get her up once.

Lumbar laminectomy pt, two days out with extreme anxiety and an even more anxious wife. PCA, very difficult to ambulate, turn for checks, etc.

Then, three hours before end of shift I get a GI bleed back from surgery. He had TPN, lipids, IVpush meds, PCA not to mention the three required checks when he hit the floor.

Plus, in true form, multiple problems with pharmacy tonight! I mean, it was just SOMETHING all night long!

please somebody tell me it gets better! I'm feeling very very discouraged!

[Kymmi]

It does get better. You will develop a routine and although things always will happen to disrupt your routine it'll be a baseline start. For example I chart as I go unless my patient is crashing or something needs done urgently. I find it easier to chart my assessments right after I do them and to chart events as they happen. I can chart a patient assessment in 5-10 minutes. We also chart by exception here and have computerizied charting. I find that if I leave my charting until last then it takes me twice as long to do and I'm sure I miss more details because its more difficult to remember than if I do it then and there. We have computers in each patient room so it's easy to chart as I go room to room.

[crb613, BSN, RN]

I also chart as I go. We do not have computer charting where I work so I carry my nsg notes w/me & chart as soon as I assess each pt. I usually work med surg & have 7-9 pts....I would have trouble remembering if I put my charting off until later, & I want it to be accurate.Where I work our notes are four pges long & we can initial the norms & hand chart the exceptions. I do not double chart. The ones that wait & chart until later in the shift are usually the ones in a fizz trying to get done. There are of course exceptions....If things are going nuts then you may have to put charting off until later, but as a general rule when I finish assessing my pts my charting is done. I am a new nurse too, & this is how I was taught, works for me. Good luck & you might give it a try & see if it will work for you.

[SandraDeeRN]

It will get better!!! You won't feel comfortable on the floor for about a year so don't get discouraged. Organization is the key to getting done on time. There will always be days where you stay over, it just happens don't let it get to you. At least when you leave you know you got your work done and the patients got the care they needed. There are a lot of nurses who always seem to be at the desk doing nothing, and where I work its the ones who are lazy or about to retire. Just ignore them. I am sure there is someone there who you can go to if you're have trouble. If you're behind, don't be afraid to ask someone for help. They won't think that you're not able to handle it because you're asking. At my hospital we have six patients for each nurse and night shift gets 8 to 9 so I know how it can be. Just hang in there and trust me, things will get better!

[meownsmile, BSN, RN]

Dont let people sitting around stop you.. Ask for help if you need it. It could be very well that they dont have the same type of indepth patients you do but if someone is sitting there is no reason they cant pitch in and help. If you are having to stay late and people are sitting there is a problem with teamwork on your unit. Dont be afraid to ask. Let them B&M if they want, but your reasoning to your manager if asked is that if they had time to sit why wouldnt they have time to help you so you can get out on time and the hospital not have to pay overtime.

[FellowRN]

Hang in there. I felt the same way when I was a new grad on a busy med/surg unit. It will get better. I think being a new grad on a med/surg unit is difficult because the diversity of the patients. It's alot to take in at first. After a while I was able to get into a routine that worked best for me. In time I think the same will happen for you. Good luck!

[Nursing On The Run]

I had the same experience as a new nurse on a basically Med-Surg floor (with tele).

With experience, I can see that yes, I was slow, but also that I was getting the heaviest assignments, and the least help from techs. My assignments became much better once I started being able to charge, and I realized it was because my fellow nurses were giving me better assignments, knowing I would be choosing their assignments the next time I worked. I'm not trying to encourage a victim mentality, but OTOH, I was so very hard on myself all that time, when half of the problem was my assignment, not me.

You also sound like a very conscientious nurse-- that turning every 2 hour thing for one patient. The techs should really be doing a lot of that, but perhaps you know they won't, so you step in.

ITA with the comment that if other nurses are able to sit and chat, there is a problem with teamwork on the unit, and you should hit them up for some help even if they B and M. It's about the patients, right?

I also agree with charting as you go. This can be especially important when it comes to things like suctioning trach patients-- if you don't note it on the bedside chart each time you do this, your patient's discharge planning may not take into account the copious secretions he can't cough up himself.

Try not to be hard on yourself. Do your best, ask for help, and try to look up one thing you had a question about, each shift. Makes work way more fun.

[Daytonite, BSN, RN]

Everyone has pretty much said what I would say about charting and the other people sitting around. I wanted to specifically address the problems with the pharmacy.

You sometimes just have to take the time at the beginning of your shift to check to see that you have all your drugs and IVs to avoid problems with the pharmacy later. Find what is missing early on and get a list to the pharmacy as soon as possible. If they still aren't sending them, then take the time to leave the floor and go to the pharmacy yourself to pick them up. This is what I used to do in one place where we had a lot of pharmacy problems. It never failed--if I forgot to check my meds at the beginning of the shift, there were always problems later on. I got to know the pharmacists by sight as well as by name!

As for patients who ring their call lights all the time, I used to park my carcass either at their bedside or right outside their room while I did my charting. We each had our own med carts and I used mine as a desk. That's why they have wheels. Have med cart--will travel. I almost never sat at the nursing station. I was always out on the floor close to my patients. I never once heard any of my coworkers complain about having to answer the phone at the nurses station for me all the time because I was never around. :roll