Where does it all go?

[Sothatswhatitis, BSN, RN]

Hey all! I'm a new nurse and finishing my second week of caring for patients (along with my preceptor). I am enjoying the work and the challenge that comes with it, but I know that I need some help. The thing is, I have such a hard time keeping everything straight in my head.

I mean, I've been coming in at least an hour early to read about my patients so I can... well, do better. The thing is, after actually starting the shift, I feel bewildered. It's like I haven't read about my patients, I can't put together a coherent clinical story (why they came, the treatment they received until now, what needs to be done for them, etc) for them and I forget who has what diagnosis with what comorbidities. It's very frustrating and disheartening.

I try to keep thinking it will come with time, but I had similar problems as a PCT (which I did for nearly 3 years): What was their diet? Can they get up? Are they diabetic? So I would check my brain sheet to find out. But now the responsibilities are much greater and I want to remember everything better. To be able to give report with some fluidity and cohesiveness. Instead I sort of ramble, with no clear clinical narrative. And after a short while, my preceptor has to jump in. I even forget/leave out events of the day that are important to pass on to the oncoming nurse.

So.... What can I do to improve? Any tricks you use for remembering information and putting it in a nice and neat clinical story?

Thanks in advance :)

[Davey Do]

Well, first allow me to commend you on your initiative, Sothatswhatitis.To go in early to gather information on your Patients shows that you are a dedicated professional. And secondly, welcome to AN.com!

You know, I've always been absent-minded, but it's gotten worse here lately, so I can relate to your situation. Feelings and emotions just makes the whole logic thing more difficult.

You're writing things down on your brain sheet. That's good. It takes time to prioritize and be able to convey voluminous information in a concise, succinct way. Keep practicing- you'll improve with time and experience.

As far as forgetting things, I've found that if I need to follow up on something, I put a little box next to it. When the follow up is completed, I put an "x" the box.

I've also come up with my own form of shorthand. For example, NMC means "non-med compliant", medco means "med compliant", CTS means "commits to safety" and so on and on. These abbreviations allow me to focus on other important info while getting some background on Patients new to me.

Good luck to you in your endeavor to be a better caregiver, Sothatswhatitis. I believe you have the makings to be a very good Nurse.

The very best to you!

[Susie2310]

Are you using a brain sheet? It sounds to me as though you may need a good brain sheet to help you organize/prioritize your care and to help you give an organized report with pertinent patient information. If you type "brain sheets" into the search box on this site, you will find a wide selection of brain sheets that members have posted. There is a lot of variety; some use SBAR format; some are specific to particular areas of nursing.

[amoLucia]

Sensory overload??? As in really TMI!

I ask because I question if every detail that you try to cram into your cranium is absolutely VITAL to know? I wish I had the luxury of knowing all there was to know about all my pts, but it was impossible. So I soon learned to prioritorize and let go the other stuff.

I figure there's 3 levels of info to know - 1) info that's ABSOLUTELY POSITIVELY important to know; 2) info that's NICE to know if I had the priveleged luxury of time; and 3) all the 'fluffy' stuff.

I focus on the critical stuff. Other info I just bypass, if I hear it and it sticks, that's nice. But otherwise it goes in one ear and out the other. It does take some thought about how to filter your inflow info, but it gets better with practice.

[Cat365]

It helps me to take a few seconds to picture the patient in my head. The name I couldn't tell you most of the time and since I work ER the room number doesn't always help because I might have had multiple people in that room but if I can picture them I can tell you the important things.