Working on a Busy tele floor and confused!!!

[newscarednurse]

Ok, I just graduated in December, passed my boards, and got a job on a very busy cardiac tele floor. We get a lot of r/o MI pts and post open hearts. I am on orientation for another month, but I feel like I don't know what the hell I am doing. It is so hard for me to take care of the patients and keep all of the charting straight. The biggest thing that I am having a hard time with is communicating with the doctors. I work in a teaching hospital and there are a million residents and interns. I get so confuse on who I should call for what problem, especially when there are 4-5 doctors on a particular case. Does anyone else feel this way?

[UM Review RN, ASN, RN]

I usually go by the doc who wrote the order (or his on-call) if an order needs changing. Other times, it helps me to discuss it with a more experienced nurse. If I really have no idea, I call the PCP and tell him the problem (SBAR) and ask if he wants to treat, take the orders, read back and lastly I ask if he wants me to notify/consult any of the other docs.

Before you call, check the doctor's progress notes and know which docs have already seen the patient. Know who is on the case and what their specialty is. It'll help to read them because you'll know what they saw and planned before the patient changed.

Hope that helped!

[CABG patch kid, BSN, RN]

I am also new, working on a tele unit, and trying to get super organized before I'm off orientation. Something I started doing is putting a red checkmark next to everything after it is charted (if it is something that needs to be charted). I do this with VS, meds, I&O, blood sugars, etc. Because my night is really busy from 1900-2400, sometimes I can't chart right away, no matter how hard I try, so the checkmark method helps me know at a glance how far behind I am in my charting.

I also have the same issue with 3-4 MDs on a case, plus there are different ways we have to contact them, depending on what network they are with. I think communicating with MDs is something that comes with time and practice, since we very rarely communicated with MDs as students, we (new grads) are truely learning how to do it now. And Angie's post is great advice, I wished I had checked the progress notes when having to call for something that was insignificant to the doctor but important to me and the pt. (it would have saved me a call, if I could read his handwriting better )

If you ever get discouraged, just think about how much you have already learned in the short time you've been at your hospital and how much more you will learn in the next few months!!