i am a new grad on a med-surg floor. like all of you, we are under staffed, and the theme for the day is caos. how can have the craziness work for me. please help, i need some organizational tips. when disscussing the matter with my orientee group, my peers from other units that are not on the floor with full patint loads yet because they are awaiting results or their unit has upheld thier agreed lower ratios for orientees said: "priortize" more times than i can count. of course i priortize. but what do you do when you have a patient being transferred to icu, one upset and crying because she is not satified with her treatment, another that is an obs patient with time running out for the doc to admitt or dc and he is just going for a tee, and another that is going to rad. all this upon arrival just after a lacking report, without time to assess the patients. of coorifice the icu patint is the clear priority, but what do i do about assessing these patients before they go all over the hospital? what if some thing happens and i'm asked why this or that was not reported before the patient left the floor? i can't say well, i was too busy.

i really need some down to earth tips for dealing with these kinds of days. i complained about being given a full load without thought a of acuity and having a distracted, busy charge nurse as a preceptor. now i feel that i am being viewed as a "whiner" :crying2:by my superiors. all i really want to do is get experience, learn and do my job safley.:chair:.

Hmmmm... Sounds like one of the typical beginnings of 3-11 shift on the Med/Surg floor where I work. I feel your pain and will first say that yes, the ICU patient transfer is your priority. Usually, I prevail upon the nurse from the previous shift who had the patient needing transfer to stay to help with the transfer and give report to ICU for the sake of continuity, and they've usually been fine with that-- It only makes sense.

I would then approach the upset/crying patient, introduce myself and quickly let her know I will address her concerns and problems as soon as these other urgent needs are attended to. I BRIEFLY explain the need for patients to go for their tests, to ICU, etc. I find that taking a short time to show a needy patient that I hear them and will eventually help them is worth the few minutes, and they usually calm down.

With patients leaving the floor for tests or procedures, I just do the best I can. If the report I just received indicates that they are stable, I will introduce myself as they are being placed on the stretcher or wheelchair and maybe quickly assess their lungs if they're in with a respiratory problem or check their incision if they're post-op, for example, and send them on their way. There's not a whole heck of a lot you can do when everything happens at once like this. I often feel like a pinball-- pinging and bouncing from room to room to telephone to family member to-- well, you obviously know what it's like, troublennc!

You also said: "What if some thing happens and I'm asked why this or that was not reported before the patient left the floor? I can't say well, I was too busy." Well, sometimes things happen and they are often beyond your control. The truth is, we ARE too busy, but it's like that guy with the plate-spinning act on the old Ed Sullivan show, trying to keep all the spinning china plates on top of the tall, wobbly sticks. (I'm sure this is WAY before your time... :) ) Once in a great while, one of the plates came crashing down, but you just have to do the best you can to keep the other plates in the air. I tell myself I am one person with two hands and two feet and I can only do one thing at a time. When I get nuts, I can't think *OR* prioritize, so I take a deep breath and ask myself "what is the next thing?" and do that.

Also, don't be afraid to ask for help and to delegate to your PCT's (aides). Coworkers respond best to direct requests (with please and thank you, of course) better than whining or responding when you're in melt-down mode. Believe me, I had to learn this the hard way.

I wish you all the best... It WILL get easier. Please be patient and kind to yourself as you learn and grow. We all were there once and I continue to struggle to deal appropriately with the kind of chaos you described.

RN-PA

thaks for your reply. It's nice to know that others relate instead of quipping "baptisim by fire, that's how I did it". If I here that one more time.... Maybe, I just wanted to hear something encouraging. At work, no one would even make such simple suggestions. I don't get that. Everyone knows how nursing school brainwashes in our heads that every little thing is a sequential must. While in transition from nursing school to the real-world, preceptors should stress how to best handle these busy situtations. I have been telling myself that I made a huge mistake going into nursing, and that I am too much of a 'buy-the -book' person. I know I can be a great nurse if I find my groove with a little real-world help. I've only been equipt with what I was taught, so suggestions such as yours are a big help. Again, thanks

You're welcome, troublennc!

I had a pretty rough start in nursing and because of my personality, I still struggle with the atmosphere of chaos, the "what ifs", and sometimes anger about the situation and stress. Every day is another chance to find new ways to cope and to *TRY* to go with the flow without losing it. Please take good care of yourself when you're not at work: Try to eat nutritiously, get enough sleep, cry prn, vent prn-- here on allnurses or with a good friend or family member, sweat (excercise-- get those endorphins going!), pray a lot, and don't be too hard on yourself.

Oh, and aspire-- as I do-- to follow the quote below by Mr. Swindoll.

WOW...I may have worked where you are working now...the scenario is very similar to one I have lived through and have it behind behind me now...WOW...scary.

I agree with RN-PA...you will learn to prioritize according to the needs of the pts. This is a skill learned in the trenches...and asking for help is not a sign of weakness or the inability to handle an assignment. As a "former preceptor" , I have heard certain nurses say " she/he will never be a nurse,can't handle the stress" or they will cue up the saying about being thrown to the wolves themselves as graduates...hmmmmm...could this be a reason for the shortage in nursing...probably one of them anyway...A preceptor should not be given the charge nurse designation unless she/he is preparing you for the position in the future...having been one myself, I can honestly say that assisting the new grads was always my #1 priority...these things cannot be learned from a book...it takes time and patience and then more time and patience...and lots and lots of nurturing from preceptor and self...don't give up on yourself,troublennc...if the unit has given you a full pt load already, perhaps you should speak with its director and ask for a re-assessment...short staffing does not mean they should overload you at this point in your nursing career!!!!

Will keep you close to my heart...keep us posted and updated...

Susannasue,

Thanks! At least I can know how I feel about this situtation is not unreasonable. I have talked to the director and she has decreased the load, however, it is just for a couple of weeks (mid sep). So, I will ride this out for now and see what happens. They really pushed me too hard, too fast. I really was thinking this is nuts and was going to quit altogether, but now I am thinking more along the lines of researching how friends and classmates feel about other area hospitals that they work in. Just to reserve a way out if I need it while I regroup.

hi troublennc...l work in a busy ER and multi-tasking is always a challange...we are very short staffed a lot. l've been doing this a long time, l keep a mental list in my head and prioritize it constantly.....sometimes the criteria of priority is who ever is breathing best is at the bottom of the list...l will tell you, you will get better at it...but sadly, nursing may never change...good luck...and welcome to nursing...LR

My second day on the night shift, a pleasent elderly TIA patient wandered off the floor while I was securing an IV line in another room. He could not have been gone more than a couple of minutes but he was pretty agile. He made it to the roof of the building. (No one knows how). We could not find him for an hour. I even whent up there with enigeering and security, scary sight. Nervous wreck right? Well, my thrid night, a nurse on the ambulatory unit set a pump for 8 times the amount of heparin (not on a protocol) than she should have (pt the was to be admitted) because she read the label wrong:nono:. I received the patient from a 2nd shift floor (more experienced) nurse that did not notice the high infusion rate:rolleyes:. In the end the patient was ok,I called the pharmacist, the surgeon, and the rad involved with the pt and everything turned out ok, but I still cryed. Eventhough It was not my mistake, I was very stressed. The patient could have been killed. I worries me that because I am not experienced I may not notice such a IGNORANT mistake in the future at this high pace.

A friend of mine's mom had cp today, and I was so worried that she may have been admitted to my hospital. I was grateful when I found out she was not. That's pretty bad, Huh? :imbar

Well, I'm really scard Sh***less about all of this now.

I was told this type of thing happens everyday, and I am getting good experience. Pt's on roofs and increadibly wrong dose past two experienced nurses?????? I don't know if I can live like this ya' all.

Pray, please pray

Time is the essence!

you poor darling, how awful for you as you begin your nursing career. Remember... time, it all takes time! Delivering good nursing care takes TIME!... Don't allow anyone to force you to rush & be at risk of making a mistake. Nurses don't make mistakes... we BURY them! Seriously, you have already been exposed to how an oversight or mistake can be VERY dangerous & put a life at risk. You will learn, it takes time. Give yourself that time, take that time. Don't worry about what other people's opinions are, they're just another human inhabiting the planet same as the rest of us. They bleed red blood & other bodily fluids, just as we ALL do!!... BELIEVE in YOU!!... You've already done the hard yards by passing your nursing studies & graduating. The practical side will come... all in it's own good TIME. You will learn as you go, mistakes & all. Be gentle on yourself & don't allow yourself to get upset ( as much as possible, of course. We're ALL human.) Remember, no-one can do EVERYTHING & we cannot be in 5 different places at once.Take it one step at a time, deal with one thing at a time & never be afraid to ask for help or say; " I don't know". Better to speak up at the time rather than later say; " I should have".... You will be fine, hang in there & ask the angels to guide you, listen to that inner voice... ALWAYS!!

Cheers from "Down Under"

Grace.

Grace Oz,

I know, I just am in disbelief. The reality of the posibility of hurting a patient became so apparent. I mean it really has hit home. Mistakes are made, but seeing those two nurses with experience make such a obvious med error just scares me. I don't want to get as complacent (sp?) them. I hate this sick feeling in my stomach, but I also worry about what will happen when I don't have that feeling and become comfortable. Hard to explain.

Thanks for your encouragment, I really appreciate your words.

Troublennc:

Let me congratualte you! Baptism by fire is not the way to orient someone. Keep them to their promse re lighten load til September. I sense that your on a very fast paced unit and have had many serious life threatening situations hurled at you.

Sounds similar to me 25 years ago, but patients were LESS ACUTE then. I'm always the one to have the escapee patient, find wrong drips, CVP line placement by MD --who forgot to insert catheter and running IV solution (dated technique) etc.

Take each of these experiences as a learning step. They will happen to you throught your carrier. Use them to build upon.

YOU found the wrong Heparin solution. Three cheers!!! Double and triple checking is what makes the hallmarks of a great nurse---also admitting your mistakes and learning from them. Would I do it this way again or how could I have handled it differently to improve my practice later? Some nurses never WANT to learn...just put in time for a paycheck-----people are that way in life in other careers too. Problem is we hold someone's life in our hands so have much greater responsibility for our actions.

You sound like a caring mature individual, realized needed help + regrouping, took action aand hopefully will have pressure eased off. My hats off to you!

Support is a good thing. Talk with your former classmates, for they may be in the same boat! If not, then maybe a different unit with different rhythm may be helpful till you have a few more months/yrs experience.

Good luck and come back to vent/ get support anytime!