PLEASE HELP ME.....Tell me how you do it

Dear Cupid09,

I, too, have just finished up orientation not too long ago, and I still feel overwhelmed at times! I have been off orientation for 5 weeks. I can say that it is starting to get better each week that passes, but I am still learning, and I feel that I still have alot to learn! I am working on a med/surg unit that is very busy, plus I have been floated twice to a different med/surg floor!!

Time management is an issue for me too! I have asked my preceptor about how to make things easier and she said that it just takes time! I think I spend too much time charting if that's even possible! It seems like I have no problem doing my assessments, but it takes me a while to chart simply because I want to make sure everything is charted, because they pound the saying into our brain at school..."if you don't chart it, you didn't do it!!"

Right after report I make sure all of my patient's labs are within normal limits and are in the charts. Then I start on my assessments, making sure I see the most critical patients first. I depend on the LPN or the CNA to let me know of any issues the patients are having, since they see them before I do. I think I may start meeting all of my patients first before I do the assessments, however, since that way I can actually see that they are all okay myself, and determine which one will need more attention throughout the day.

Here is where I think my problem is.....Right after I assess a patient I immediately chart the assessment, I can't try to remember it all later! I also try to get everything done with each patient, as well as get anything they need: dressing changes, IV fluids, IV tubing changes, waffle mattresses, pain meds, etc. Stuff that is not urgent, I write down on my "to do" list. Stuff that can be done right away, I do then.

I think I get too bogged down into getting it all done at once. Maybe if I try to meet them all first thing, let them know I am their RN, and do a quick visual assessment then I can determine which one will need the most attention that day. At least that way I have actually seen them all, and then I can get going with my assessments.

Let me repeat, I work on a very BUSY med/surg floor and I have had up to 12 patients at once!! I too, would welcome any advice that you seasoned nurses can give!! I run my booty off all day and I hardly ever sit down for lunch before 2:00 p.m.

I hope it gets easier for you Cupid!

Nursing is a 24 hour a day job, and while I do not advocate leaving things undone for the next shift, understand that the next shift is coming in and can take up where you left off. There will come a day when you can clap eyeballs on a patient and within seconds ("Hello Mr. Jeffries. I'm Ruby, and I'll be your nurse today") you can tell whether he's alert, oriented, breathing OK, having real pain issues that must be addressed immediately or can wait while you see your other five patients -- hopefully for as brief of a time. In the meantime, plan and prioritize -- on paper if you need to. Don't get caught up cleaning up someone's poop until you've made sure that your other patients are all safe, breathing and otherwise able to wait.

Once you've made sure everyone is breathing and safe for the moment, take a quick look at your labs, meds, treatments, orders and such. Mrs. Peters was incontinent, Mrs. Pho has a dressing change due, but Mr. Olson has to get to radiology before they close -- which can you delegate? When you find yourself spinning your wheels, take a break. Yes, I know you're very, very busy and you have far too much to do to take a break, but take one anyway. You'd be amazed at how a little downtime clarifies your thinking, consolidates your planning and helps you think your way through critical issues.

Some patients and families suck up all your time to the least good -- don't let them. Plan a graceful exit line, then use it. Your CNAs are there to help you; you aren't there to help them. Let them help you. And remember -- as long as everyone makes it through your shift safely and without complications, a missed bath is no big deal. Really.