match up: RBC vs. dotting i's and crossing t's

i'm seven weeks into my new job, and i'm already amazed at how different each day of work is now, as compared to those first few weeks on my unit, wondering what the heck i was doing masquerading as an actual nurse. now my days have routines and i can stay more or less organized despite discharging two patients by eleven am and admitting another. charting is still, more than anything else, the bane of my existence. More than confidence in direct patient care, the electronic charting system somehow manages to trip me up more than anything else. i forget to chart a med or the urinary output of my postoperative patient or the feedings and diapers of one of my babies. sometimes i've recorded it in one place but forgot the other two places where you have to document the same information. more than anything else i forget to document my teaching.

in my nursing orientation class for all new employees be they new grads or experienced nurses, the instructor addressed us newly graduated nurses and said something along the lines of - our focus here at the hospital is to provide relationship-based care. we know you will be more task-oriented at first, but we look forward to when you can step away from the tasks and really focus on your relationships with your patients. my personal experience, on the other hand, is that what i do better than anything else is seek to build relationships with my patients. sometimes to the fault of my hospital-required "tasks." vital signs must be taken every 4 or 8 hours, depending on the patient's status. but what about that time my patient was in the neonatal intensive care unit, squeezing in every possible minute with her baby who has taken a surprising turn for the worse? or what about when, as i'm on my way to administered a timed antibiotic to one patient, i stop in one of my other patient's rooms, only to find her in tears about these new and unexpected stresses of motherhood? how do i advocate for my teenage patient, who has no real home to go to and a history of abuse in her relationship with the baby's father but loves her child to pieces and desperately wants to keep her, while still accomplishing the necessary steps of involving social work and the department of child and family services?

these are my new, daily quandries. i still puzzle over how quickly to push an IV med i've never given before and how to interpret certain lab values, but as these things - relatively black and white - become more familiar and more clear, it's the deeper shades of gray that continue to challenge me in my nursing practice. technically i'm on probation until the end of may at which time my performance will be reviewed and my employment extended or terminated, i guess. kind of an eerie feeling of big brother, or this case, big sister watching over you. i know my charting is being reviewed regularly, and i find it interesting that despite all of the emphasis on patient satisfaction and relationship-based care that ultimately, what i'm being graded on in large part are the tasks.



one last note: because hooking my computer into the internet isn't the easiest thing at my apartment, i've been writing more in my journal than online, but i hope to break that habit a bit and make more of an effort to share with you here more of my stories both from inside the hospital and from the outside as they unfold.