WEBBED CYCLE FOR DERAILED RN.

What do I mean by derailed RN? It is a fact that many nurses, mostly foreign educated RNs, get disorganized on the floor once they are off orientation. It is always difficult during the first few days after orientation, but you must be able to find your feet within a week or so.

However, few RNs remain in this disorganized state for weeks to months. Most of these RNs end up working more hours than they are paid for. A derailed RN could work extra from 1hr up to 4hrs, and cannot be paid for those extra hours because they are not considered overtime.

It takes much time for many foreign educated RNs to grasp the US charting system, especially the computer charting. Others simply don’t know how to plan their day or how to use the compact nursing skill. They therefore waste several minutes trekking to and from patient’s room performing interventions in pieces when those tasks could have been carried out together.

In addition, some RNs cannot tell which of the patient’s needs/requests is a STAT,NOW,LATER OR SOMETIME LATER.

Another time consuming issue worth mentioning here is the fact that few international RNs who aren’t conversant with the operation of an equipment spend several minutes fidgeting and trying to run the equipment. Please seek help if you NEED it!

And finally, some RNs don’t know the difference between roles to be performed by oneself and those that can be delegated. Don’t always struggle to do everything by yourself; make good use of the helping hands from your CNAs, charge nurses and colleagues.

A WEBBED CYCLE GUIDE FOR A DERAILED RN on how to start a typical day/shift in a medical-surgical unit:

a) After getting your assignment from the charge nurse, you first get your hands off report. In case your unit practices the RN-to-RN hands off report and the outgoing RN is not yet ready, don’t waste any time. Go in for the history, and your patients' am lab results:BMP,CBC,etc.

c) Next, glance through the vitals of your patients, note and compare abnormalities with previous vitals before taking any action.

d) Now scan through the chart and do your 8hrs or 12hrs chart check; in many hospitals, you do this at start of shift and at end of shift.For other hospitals, you only note orders during your shift and the night shift does 24hr chart check at midnight. Whatever the practice may be in your hospital, make sure no orders are missed.

e) Check the MAR with the chart to make sure discontinued medications aren’t being continued, and note due medications. Include all pending procedures etc in your plan of care, and plan for that.

f) Go in to do your assessments, listen to the concerns of your patient and discuss your plan of care.

g) Now that you have collected needed data, develop a plan for your day now. Give report to your CNA (s), prioritize and delegate roles correctly.

h) Start the day according to your nursing care plan and do patient education/teaching as you move along the care plan. Remember to make room in the care plan for admissions and or discharges/transfers.

i) Do your documentation after each intervention. Don’t leave charting for a later time. You may forget something, or get the timing wrong. Remember that if it is not charted, it was not done!

j) In the course of your shift, remember to do periodic checking of the charts to look out for new orders and note them, if any. A doctor might have sneaked in and placed a new order but forgot to flag the chart.

NOTE:

The DERAILED RN GUIDE above is just a model for guidance. There is no steadfast rule to this format; always use your best judgment and facilities available to plan your care.And once you find your feet,you can take off the webbed wheels.

In the course of your patients care, many factors may intermittently interrupt your stream of care. You must be able to accommodate these additional assignments and quickly return to normalcy.

FACTORS THAT MAY MAKE YOU A DERAILED RN.

1. Patient’s condition: unstable patient condition will demand frequent interventions and sometimes a change of the care plan. The patient could be in a physiologically unpredictable state in which the vital indicators keep on changing every now and then.

You will have to call MD frequently for new orders that may require new care plan. Also, a confused and agitated patient can distract your day or, worse still, a coding patient.

2. Patient’s families: occasionally, you get patients with families always at the bedside. They may either want to participate in care or they are there to provide emotional support. These families may try to direct the care of their relative, others will push the pca button for the patient, or request for a thing or two.

Another group of relatives will individually be on the phone or at your station for information about the patient.

3. Multiple requests from patients: some patients will always be on the call light requesting one thing after another. And if you happen to get two similar patients in the same room, they may be feeding each other with ideas and you got to use your professional expertise to take care of this kind of problem.“I need to do this now. I will help you as soon as I can." Or you can separate them.

4. Other disciplines like the pharmacy, RT, PT etc can also interrupt your care plan. On few occasions, you may be aware of this at start of shift and so can make room for them. The pharmacy in particular may delay in putting an urgent medication in the pyxis, or you may have to prepare and mix medications if pharmacist is not available.

5. Or in the event of transportation problem, you will have to run your errands.

6. Administrative interruptions: unexpected change of assignments, unexpected transfers, or procedures, and wrongly timed admissions can also cost you some time.

7. Missed physician orders: If some orders were not carried out by previous shift, you got to take care of that.All these distractions can make you a derailed RN.

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