[wishingmary]

Because this is a long post, my real question is at the bottom.

I am 6 months post NCLEX/RN so I've been on the cardiac step-down floor for that length of time but I just can't get everything done before the end of my shift due to paperwork. Granted it seams most RN's leave on time or 30 minutes later; I don't go home until 1-2 hours after I give report.

I have many times contemplated what it is that I'm doing besides running non-stop from the moment I hit the floor and wolfing down lunch in 10 minutes if I eat at all during my 12-hr shifts.

I have an aide and thank God my manager limits me to 5 patients. This is suppose to be sweet. I feel guilty because other nurses have to take 6 - 7 patients.

I get to work at 0600 so I can get my before-shift paperwork done before night shift leaves at 0630 - I come in 30 minutes early because night shift that is suppose to be there until 0700 don't so I end up losing time with prn's.
This is a gripe I have and not why I'm writing.

To get to the point... I can't say "No" to my patients. I find I'm doing work that should be delegated because it takes too much time to explain why I'm too busy, go find the aide, and hope they meet my patients' needs. It takes less time to just do it. At least I'm not routinely walking my patients like I was at first.

Second big time engulfer is I teach. I do a lot of teaching to my patients and families. It seems that CABG patients don't get pre-hospital teaching as most are emergency or done in short order. In fact the post-surgical patients I see (NEURO & Cardiac mostly) have had little teaching. This in a way makes sense if they had their surgery on Thursday or Friday as I work Sat-Monday and it isn't until M-W-F that there is formal education presented in the floor classroom. I also believe that patients act like they haven't received any teaching just so they can hear different nurses explanations of things - the detective thing.

Third big time engulfer is calling doctors. They want you at the phone when they call you back so I try to use this time to chart. Problem is time is a fragmented thing. I chart a lot too. My manager says there is no doubt what happens on my shift with my patients. A typical entry for the day is 1/4 page. When I sit to chart I like to write not only what is happening but what I'm doing about it, some things are just drawn out a bit because I'm doing things in all rooms.

My goal is to work in critical care but I have to prove myself on the floor before they will hire me since I'm a new grad even though I worked there as an aide. New grads haven't worked out in the ICU with few exceptions from years ago.

I need to prove myself on the floor so how about just clocking out on time and then finishing my paperwork?

[batmik]

I always charge for overtime. A co-worker gave me an example of why this is important, beside the fact that nursing is my career not volunteer work. What if you do something, such as hang an iv, charting, dc an IV or really anything and you are called into court? If the hospital looks at the time log and sees that you were clocked out will their malpractice insurance cover you and will they support you?

Most new grads do have more overtime then experienced nurses even when given lighter assignments. I don't think you are unusual.

In addition ask the staff about your peers that are very organized and ask for their tips or pointers.

But do charge for time that you are there. Even 15 minutes of overtime pays for gas for a week!

[donmomofnine]

It is illegal to work off of the clock. Your facility will face huge fines if this is a practice there.

[MrsWampthang]

There is nothing wrong with being a detailed charter; it might save your butt someday down the road as most law suits don't make it into court for years and the only memory you will have of the incident is what you wrote down. If you are giving detailed descriptions about your shift then you are a nurse that lawyers will have a hard time with. :hatparty:

As for getting more expedient, that will come with time. The more often you do things, the quicker you will get. And you will learn to delegate as time goes on, so hang in there. Look around and watch your peers. Is there certain things they are doing that you could learn to do and make your workload easier and faster? Ask the seasoned vets what their secrets are for getting done so they can leave on time or close to the end of their shift.

Good luck!

Pam

[Jolie]

Never work off the clock. As someone mentioned before, you could find yourself in a legal bind if you made an error after clocking out. Also, if you were to hurt yourself, you would probably not be eligible for Workers' Comp. These risks are just too big to take. Time management skills come with experience, and your manager or mentor can help you with these issues. It sounds like you're doing a great job for your patients. Don't be so hard on yourself!

[meownsmile]

It just takes a while to find your organization and how you can get things done and out on time. Give it 6months to a year anyway. It took me a while to start getting out on time, and your supervisors know the stats on new hires and organization. Thats why they havent conferenced with you about it yet. You must learn though that once the next shift comes on and is getting report, your shift is over,, no more call lights, no more phone calls, no more one last things. If someone comes and wants your help, defer them to the oncoming nurses, your done for the day. Thats what the next shift is for and any supervisor will tell you there will be things you HAVE to leave for the next shift.
Just a couple things to help maybe. Try to get assessments done early, and start shift charting early (1-3pm) if you are 12 hour, between 12-1pm for 8 hour shifts. I found if i dont get the charting done by 3pm, im there at least an hour over trying to finish. The patients dont know you are off shift so as you move along charting, they see a nurse and need something. That delays you even more. The nurses on the next shift are competent, let them handle it. You have to learn to hand it over and let it go. The other nurses appreciate the help (maybe), but your managers wont when they see you continuing to get overtime.

[yellow rose]

I've been a nurse for about a year and I work on a very busy step-down unit!!! Time management is hugely important, but it really only comes with practice!
And just when you think you're learning....tonight I didn't leave until 8:30 pm!!!

[wishingmary]

Thanks to everyone for their support. I thought that patient care ended when you sign out on the time clock and gave report. I know now that if giving report is the sign off, then I won't accept the verbal report until my before-the-shift paperwork is done or 0650 so I don't get caught with prns.

The idea of dumping on people is hard to swallow. What I mean is stopping patient care once I give report when I know I haven't been able to pass my 1800's, leaving an IV bag that is about to empty, onclogging an NG tube that just quit, or dressing a wound that is currently draining even though I may have already done it once before. This isn't a common occurrence but I don't want nurses following me feeling like my inexperience is going to make their job harder. I guess the problem is just letting go even though I know things need to be done.

Changes I have made is I try to tape report at 1700, just before passing meds and then giving the on-coming nurse a quick catch up verbal. I do most of my charting between 1400 and 1600 or at least half of it. I was told that I have to chart on both shifts not just day shift. Other nurses said I don't.

Usually when I clock out on time but don't it is for paperwork but not always. Thanks for reminding me about the legal issues of giving direct patient care off the clock.

I also write on my "brain" the odd med times I need to pass meds.

Off the subject, I feel good about a decision I made regarding a patient I had Monday. He became tachy up to 144 bpm. The patient was only tired and didn't know his heart was running fast. He had just gone for a 4-day post CABG walk. He said he could feel a gentle squeeze over his sternal area for a few minutes. Got him back to bed. Pulse Ox 94%. BP nml. He was very calm and just watched TV with his wife. I put 2L O2 NC on him. I was reminded we have standing orders for Verapamil for sustained tachycardia but I was afraid to give it because only two days previously we had problems with him being bradycardic (40's & 50's). QRS complexes were narrow and he was in sinus rhythm. Called the surgeon. He didn't return my call because he was in surgery and I didn't press the issue since he was OK except for the tachycardia. No more walking. After ranging in 130's to 140 for a few hours. I called again and reached him in surgery. I told him my fear of giving him Verapamil so he gave orders for loading dose of digoxin. Again patient in no distress. It wasn't slowing things down. Another doctor came to see him and ordered 60mg Cardizem IV. I got the order changed to 15mg IV for same reason. Continued to give the po digoxin q 6 hours and I heard it finally slowed it down the next day.

This slowed my whole day down and why I was so late getting out Monday. His surgeon did see him when I was still his nurse at the end of the day and told me to just leave him alone. He wasn't in distress. That made me feel good that I did the right thing for him.

Still, his tachycardia took up 9 hours of my day and why I was so late getting my patient care and charting done - 2100 .

[donmomofnine]

Give yourself some time! You are going to do just fine!

[batmik]

I work on the same type of floor that you do and also started there as a new grad many moons ago.

I really commend your rationale for not givingn the iv Verapamil when the patient had a hx of bradycardia. That is the kind of thinking that separates nurses who just carry out tasks from those that look at the bigger picture.

The fact is working on a tele unit with open heart patients this is going to be a very common occurrence. It seem like 30-40% of our patients have some tachyarrhythmia post surgery. Digoxin has a peak that ranges from 1-5 hours after giving it IV so it is likely you won't see a decrease in rate that quickly. Also we aren't allowed to give 60mg IV cardizem on our floor, the max in 20mg.

Nursing is a 24 hour a day job. You can't wrap everything up and put a bow on it before you hand off to the next shift. You can only do the best you can. I don't think what you are doing is dumping.

Just the other night I got an admit at 10:55p, I got the whole admit assess/history done and gave the stat meds but ran out of time to enter the admit note in the computer. I had no qualms about leaving that note for the night shift to enter(we have a spot that states who obtained the information). I got a lot more done than most nurses would have whose shift ends at 11:30p.

Don't be so hard on yourself.