I'm 7 months into my Pediatric med-surg position straight from college and can appreciate still the basis of your question, as things can get quite overwhelming. As with the practice of nursing in general, it's all about prioritization. But to get to this point, you need to start by sizing up your patients before you even see them. First, try to ask yourself while scanning the Kardex before your shift, what things might be missing or needing clarification from the outgoing RN. The Kardex gives only a basic picture of the patient's condition and what's been ordered, but tends to be scant on the specifics. A lot of the "small things" the outgoing RN may have experienced on their shift may benefit you and your patient too, but most of the time, be prepared to ask direct questions to get this info. Once you have this basic info, your patients with the most issues you should assess first. Whenever possible, try grouping tasks so that you're making less trips to the patient's room. For example, when appropriate, while going to do your initial rounds for vitals, try to take your scheduled meds with you as well so that you can take vitals, do your assessment, and give the meds before moving on to the next patient. With this in mind, patients with pain issues should be a priority, as effectively managing their experience of pain will make for a happier patient and less trips for you. Once again, anticipate this need based on what questions you ask during report, as a post-op kid who's required MSO4 q 2 hours for the past 12 hours and is due for another dose you'll want to assess first, provided the rest of your patients are stable and safe, therefore requiring no immediate assessment. Once again, prioritization of care based on that which yields the safest level of care for your patients always comes first. And with the time you save there, you'll now hopefully have ample time for charting, the true drudgery of the profession...
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