Sunday, October 23, 2011

Getting it together

Orientation is almost over. I'm doing really well. I still feel like time tries to get away from me, but I definitely have a better handle on it than when I started.

High points of what I have come to grok over the last few weeks:

Don't compare newbies to veterans. Nobody expects me to have the same speed or skill as my preceptor. She's been an RN for seventeen years. She has a ton of practice, she has the routine down, and she almost never needs to stop and look anything up. Of course she's going to be faster than I am. I still get my work done during my shift; I just expend more effort and have less time to sit down.

Teamwork is key. The patient care tech or CNA can handle a lot of the most time-consuming tasks-- from routine vital signs and blood sugar checks, to turning patients and giving bed baths. I do all of those as well, but I'm also responsible for tasks that only a licensed nurse can do. I need to remember to delegate early and often, to keep the tech as busy as I am.

Not everything happens on time. Morning meds are scheduled for 0900 and are considered on time within an hour either way. Some days there's just too much to do between 8 and 10, so not all the meds get passed within the window. This is not the end of the world. Make sure time-sensitive tasks (like IV antibiotics) happen as scheduled, and catch up on the rest as soon as possible.

Sometimes there is only one right way. Blood is a good example. There's a very specific procedure for transfusing blood. It involves many checks and verifications, with dual signoffs. It has explicit time constraints as well, but there are vital safety concerns and no step may be skipped or half-assed.

Sometimes there is no right way. Every nurse has their own intuitive system for managing their workload and getting the work done. No two do things quite the same way, but if they all do their jobs, none of them is wrong. This isn't really something teachable or memorizable. It has to be developed through experience.

Saturday, October 1, 2011

Swim. Don't Sink.

This week, after a little more classroom training, it was time for actual patient care! Two twelve hour shifts on the floor. I've heard this fellowship starts out easy, and only slowly ramps up to a full patient load, so I wasn't worried.

On day one, my preceptor had six patients and assigned one to me. When not busy with my patient, I followed the preceptor around to observe and assist.

Day two: "Ninj, here are your five patients. The preceptor will be here in case you need help. Go."

That's slightly less gradual than I was expecting.

I think I did really well. I managed the routine stuff on three patients by myself without needing much prompting, and the other two with assistance. When non-routine things happened I either handled them myself, or went to get the right help. I delegated tasks when necessary. Since I'm not yet very fast and I don't have my routines down, I had to delegate more than a few times.

I need to work on my time management skills.

In fact, that's probably why the fellowship has switched away from the gradual ramp-up. Time management is the hardest part of this job, and caring for five or six patients is at best an exercise in controlled chaos. A minimum load just wouldn't pressure me to learn all the necessary skills. An easy first day was helpful, so I could learn the unit layout and stuff like that, but after I got oriented I'm kind of glad to start the real work right away.

I may have been kicked into the deep end, but so far I'm treading water just fine.