Today was a non stop busy day on the unit. To start everyone was scrambling to get through report because the unit was short staffed for the day. Instead of 4-5 patients on a regular shift we had 6 to start with. Even the charge nurse was taking 3 patients. It also was a little interesting because once again my preceptor was unable to show up because of family obligations and she asked me to work with another nurse on the unit for the day. This is a bit frustrating because the timing for my shifts to finish up is coming up soon and with only 2 more shifts remaining I need to stick to my schedule of shifts I have arranged to meet the deadline.
So with all that going on the nurse that my preceptor assigned me to work with for the day was fantastic. I felt like I was very helpful with the patient load and busy circumstances. Some of the things that I noticed that my nurse was very good with were helping the rest of the staff throughout the shift. Their attitude and approach to nursing was really refreshing. There was a noticeable amount of altruistic and patient centered care that was done in a way that made the busy and stressful day enjoyable and almost easy to deal with.
When I think of skilled nurses I usually think of the actual ability to perform tasks and the knowledge base needed to make critical decisions and accurate assessments. Today was the situation where I witness how a nurses' "other" skills can make a difference in not only the patients care and overall experience but the unit as a whole. Even though throughout the shift we were able to perform and do some great care and perform skills such as removing a JP tube, dressing changes, insert new IV lines, discharges and admits I feel that the I was able to get so much more education on how the "other" things a nurse does and how noticeable of difference it was.
Wednesday, April 11, 2012
Tuesday, April 3, 2012
Fifth Day
My preceptor was back for my fifth day and I was ready and excited for the shift. My confidence was really starting to make a difference as the learning curve of charting and other procedures on the unit were becoming more familiar. I felt like that this shift I was able to ask better questions with the patients in my assessments and didn't forget as much. I also felt more confidence from my preceptor as it was showing that I was more capable and able to do more in less time than previous days.
I had two patients that I was taking by myself and I felt that I was able to do most all of the care and charting with minimal assistance. I felt that the time it was taking me to perform tasks was becoming more efficient with less mistakes or questions.
Today I reviewed all my SMART goals with my preceptor so we could be sure to focus on them. Although I did not complete the goals with a full patient load I was able to do all of the following with my two patients and assist with others during my shift such as: admit a patient, discharge and teaching, review medications, complete all the charting and chart checks.
There is definitely a learning process as you advance in skills and the amount of work you have to do in a certain time frame. I feel that I am getting closer to meeting my SMART goals fully and should be able to by my final shift. I would understand that I am learning a lot and it can be hard to internalize all the information I receive from my preceptor but I do feel that i am grasping on to the main ideas and points of care that will lead me to attaining my goals.
I had two patients that I was taking by myself and I felt that I was able to do most all of the care and charting with minimal assistance. I felt that the time it was taking me to perform tasks was becoming more efficient with less mistakes or questions.
Today I reviewed all my SMART goals with my preceptor so we could be sure to focus on them. Although I did not complete the goals with a full patient load I was able to do all of the following with my two patients and assist with others during my shift such as: admit a patient, discharge and teaching, review medications, complete all the charting and chart checks.
There is definitely a learning process as you advance in skills and the amount of work you have to do in a certain time frame. I feel that I am getting closer to meeting my SMART goals fully and should be able to by my final shift. I would understand that I am learning a lot and it can be hard to internalize all the information I receive from my preceptor but I do feel that i am grasping on to the main ideas and points of care that will lead me to attaining my goals.
Sunday, April 1, 2012
Fourth Day and SMART goals
My SMART goals are:
For my fourth day it had been a few weeks since my last day due to scheduling conflicts. With the time between the days it took a little bit to remember and refresh myself to the unit, charting and staff. My preceptor had to cancel on me last minute and with the limited time I have had with my preceptors shifts I needed to come in. My preceptor asked me to be with another nurse that was trained by them and that was excellent for the day.
I was able to focus on care for two patients on my own with minimal assistance from my nurse for the day. Also for the day I spent some time focusing on SMART goals. One thing I was able to do is look up and discuss medications to meet goal #4. With the medications I wanted to focus on ones that are most commonly used on the unit. With pain control being high on the list of patient priorities I have several pain medications as well as other common medications used in conjunction with or often on the unit.
Also through discussion with my preceptor and with the nurse for fourth day I came to a decision of my Issue Paper topic. I will be focusing on the issues and concerns both with nurses and patients related to patient hourly rounding. I feel that on my unit this isn't always a priority and that there is some great information to discuss about hourly rounding.
The patients that I focused on and cared for in my was a patient post operation recovering from a colon cancer removal. They had been on the unit for a week at that point and was making great progress. Pain was being controlled PCA and later moved to PO pain meds as the diet was moved to full diet. Getting the patient ambulating and controlling pain was a priority. I felt confident in carrying out the orders and care for the patient with minimal care.
For the other patient I focused on was an admit awaiting surgery that was in severe pain. They were not able to go into surgery yet due to some labs out of range. I also focused my care on another admit that came in later that day and was able to do the majority of admit assessment and charting.
1. I will be able to carry the full patient load with minimal assistance from my preceptor by the end of the preceptorship.
2. I will be able to admit all assigned patients to the unit in a timely manner and delegate effectively throughout the admit process with minimal assistance from my preceptor by the end of my preceptorship.
3. I will be able to complete patient charting in a timely manner on a full patient load with minimal assistance from my preceptor by the end of my preceptorship.
4. I will learn 7-10 medications actions, doses, indications and contraindications and educate the patients who are in my primary care about their drugs prior to giving, as well as with discharge, with minimal assistance from my preceptor by the end of my preceptorship.
5. I will be able to give report on all assigned patients with minimal assistance from my preceptor by the end of my preceptorship.
For my fourth day it had been a few weeks since my last day due to scheduling conflicts. With the time between the days it took a little bit to remember and refresh myself to the unit, charting and staff. My preceptor had to cancel on me last minute and with the limited time I have had with my preceptors shifts I needed to come in. My preceptor asked me to be with another nurse that was trained by them and that was excellent for the day.
I was able to focus on care for two patients on my own with minimal assistance from my nurse for the day. Also for the day I spent some time focusing on SMART goals. One thing I was able to do is look up and discuss medications to meet goal #4. With the medications I wanted to focus on ones that are most commonly used on the unit. With pain control being high on the list of patient priorities I have several pain medications as well as other common medications used in conjunction with or often on the unit.
Also through discussion with my preceptor and with the nurse for fourth day I came to a decision of my Issue Paper topic. I will be focusing on the issues and concerns both with nurses and patients related to patient hourly rounding. I feel that on my unit this isn't always a priority and that there is some great information to discuss about hourly rounding.
The patients that I focused on and cared for in my was a patient post operation recovering from a colon cancer removal. They had been on the unit for a week at that point and was making great progress. Pain was being controlled PCA and later moved to PO pain meds as the diet was moved to full diet. Getting the patient ambulating and controlling pain was a priority. I felt confident in carrying out the orders and care for the patient with minimal care.
For the other patient I focused on was an admit awaiting surgery that was in severe pain. They were not able to go into surgery yet due to some labs out of range. I also focused my care on another admit that came in later that day and was able to do the majority of admit assessment and charting.
Thursday, March 15, 2012
Third day
For the third day my preceptor was charging on the unit. I didn't receive any info about if my nurse charges until after this shift. I now know that I cannot be at any clinical shift my preceptor is charging which is a third of the shifts. This is going to make it extremely hard for me to schedule because one of the days that I was going to make work is the days my preceptor is charging. The other day I have a stats class that morning and so I am going to see if I can make arrangements to miss that class on that day for a few times in hopes that will be enough to finish my hours.
I think today was a great day for learning. I was able to go over a lot of terminology as well as help the other nurses on the unit for various different tasks. I felt part of the team more this day because I was able to assist with a variety of patients as nurses.
Today I was able to see how some of the prep for a shift and planning goes into a unit. The coordination of everyone and other units was really well done and interesting as well. We talked about my SMART goals as well as some topics for my Issue Paper.
I was able to help several new admits and get their aldrete scores and assessments, watch a portable wound vac be placed, and my charting is getting better as well.
I think today was a great day for learning. I was able to go over a lot of terminology as well as help the other nurses on the unit for various different tasks. I felt part of the team more this day because I was able to assist with a variety of patients as nurses.
Today I was able to see how some of the prep for a shift and planning goes into a unit. The coordination of everyone and other units was really well done and interesting as well. We talked about my SMART goals as well as some topics for my Issue Paper.
I was able to help several new admits and get their aldrete scores and assessments, watch a portable wound vac be placed, and my charting is getting better as well.
Second Day
Today we started with four patients. Three of which were admits from my first day so it was nice to be familiar with the background and see the progress. Of the three previous patients the dx were an incisional hernia for one and a ileocecal mass for the another and the last a left pneumothorax. The newest admit had appendicitis and was post op for a lap appy.
It was nice to be remembered by the patients I had in my first day and have them interested in you as much as you are interested in learning about the dx and care planning. We had a lot of expected admits and were expecting to discharge three of the four which we did. It was nice to feel busy and have a little more stress to get multiple tasks done while discharging and in preparation for a new admit. The time really flew by there when we were going from one thing to the next.
There was JP drain in the patient with the incisional hernia that I was able to remove while being observed by my preceptor. The patient was ambulating well and their pain no longer was being controlled by a PCA and was managed well through po meds. This patient was discharged today.
The patient with the left pneumothorax no longer had a chest tube and was being dicharged after a chest x-ray. We spent some time doing some teaching for the follow up visits that the Dr needed for the pneumothorax and further instructions. While this was being done the lap appy/appendicitis pt wanted to leave right then and there and was pressuring us to get out. They had a long drive ahead of them so we did our best to hurry up the process.
During these two discharges a new admit with a lap coly/ and lap appy arrived. I did the initial assessment and aldrete scores. My preceptor even mentioned that my charting was getting better and faster by the end of the day. So I feel I am getting more familiar as well as understanding what needs to be charted and not forgetting other things that take up time to go back and get.
The last admit was a sysoscopy that I also did the assessment and aldrete scores. This patient was experiencing nausea and vomiting coming out of surgery and we did our best to help with some meds for that. Pain management was one of the main priorities for all of our patients to get them ambulating feeling better.
The patient with the ileocecal mass was not expected to leave for a few more days but was able to be taken off the PCA and transition to PO pain and other meds. Helping them stay comfortable and keeping on top of the pain was a priority here. It was nice to transition from PCA to PO pain meds because that means the patient is making progress as well as no longer needing to chart all the PCA checks.
It was nice to be remembered by the patients I had in my first day and have them interested in you as much as you are interested in learning about the dx and care planning. We had a lot of expected admits and were expecting to discharge three of the four which we did. It was nice to feel busy and have a little more stress to get multiple tasks done while discharging and in preparation for a new admit. The time really flew by there when we were going from one thing to the next.
There was JP drain in the patient with the incisional hernia that I was able to remove while being observed by my preceptor. The patient was ambulating well and their pain no longer was being controlled by a PCA and was managed well through po meds. This patient was discharged today.
The patient with the left pneumothorax no longer had a chest tube and was being dicharged after a chest x-ray. We spent some time doing some teaching for the follow up visits that the Dr needed for the pneumothorax and further instructions. While this was being done the lap appy/appendicitis pt wanted to leave right then and there and was pressuring us to get out. They had a long drive ahead of them so we did our best to hurry up the process.
During these two discharges a new admit with a lap coly/ and lap appy arrived. I did the initial assessment and aldrete scores. My preceptor even mentioned that my charting was getting better and faster by the end of the day. So I feel I am getting more familiar as well as understanding what needs to be charted and not forgetting other things that take up time to go back and get.
The last admit was a sysoscopy that I also did the assessment and aldrete scores. This patient was experiencing nausea and vomiting coming out of surgery and we did our best to help with some meds for that. Pain management was one of the main priorities for all of our patients to get them ambulating feeling better.
The patient with the ileocecal mass was not expected to leave for a few more days but was able to be taken off the PCA and transition to PO pain and other meds. Helping them stay comfortable and keeping on top of the pain was a priority here. It was nice to transition from PCA to PO pain meds because that means the patient is making progress as well as no longer needing to chart all the PCA checks.
Monday, March 12, 2012
First Day
For my first shift it was hard to know what to expect coming on to the unit. I was nervous and excited to find my preceptor and to get to know them. In all my clinical experiences working with other nurses' it's been interesting to see how they go about their planning and how they use their time. I was expecting to see how the time management was taken care of as well as how the unit worked together with the patient load.
We had five patients, four of which had PCA's. This was good for me because I have not had any other experience with a PCA. This gave me a great opportunity to get to know the system and regular charting of a PCA. I expected to learn something different from each patient and feel like over the shift that I my confidence increased and that in turn helped me give better patient care. My charting was getting faster but was still fairly slow compared to my preceptor.
During the first shift I wanted build trust with my preceptor and I feel I was able too. I also wanted my preceptor to like me. It may sound funny but I didn't just want to barge in and step on others toes. As much as I want to learn I am making sure that I am still the student and showing that I am eager to learn as much as possible. My preceptor is very knowledgeable and makes things look easy. I felt comfortable in asking questions and my preceptor was able to effectively teach me and answer my questions. I never felt like I was in the way and felt very welcome on the unit.
We had five patients, four of which had PCA's. This was good for me because I have not had any other experience with a PCA. This gave me a great opportunity to get to know the system and regular charting of a PCA. I expected to learn something different from each patient and feel like over the shift that I my confidence increased and that in turn helped me give better patient care. My charting was getting faster but was still fairly slow compared to my preceptor.
During the first shift I wanted build trust with my preceptor and I feel I was able too. I also wanted my preceptor to like me. It may sound funny but I didn't just want to barge in and step on others toes. As much as I want to learn I am making sure that I am still the student and showing that I am eager to learn as much as possible. My preceptor is very knowledgeable and makes things look easy. I felt comfortable in asking questions and my preceptor was able to effectively teach me and answer my questions. I never felt like I was in the way and felt very welcome on the unit.
Subscribe to:
Comments (Atom)