I orinally posted this in the "First Year in Nursing" forum but I think it belongs here since I need advice from experienced RNs.
Anyway, I'm a new grad on a busy med-surg floor, day shift (yuck). I would have preferred nights but oh well, this is what I'm stuck with until I quit, which will be sooner rather than later. In the meantime, I desperately need to figure out how to manage my time! There's one senior RN who's always begging me to go eat or take a break, and I always say I can't because I'm always behind, and we don't get paid for overtime so I want to get out as fast as I can at the end of the day.
Things start out ok at the beginning of the shift but things get nuts and I feel so stressed. I've been modeling my preceptors' behaviors and they way they do things, but it doesn't work for me. This is their routine, and the model I've followed:
- After getting report, do AM chart checks. This is where we check the previous shift's charting to make sure orders were entered into the computer and/or carried out by the previous RN.
- Get the labs for each pt from the unit clerk, report any critical labs to the MD.
- Go to the MAR of each chart and on the report sheet, jot down the times of the meds due for each pt.
- Pull out the MAR for the first pt and their meds. Administer that pt's meds, and then do the assessment.
- Repeat #2 and #3 for the rest of the pts (usually all 5 pts have their first meds due at the same time, i.e. 9AM)
- Chart all the assessment findings and a short narrative on the nursing flowsheet. If any pain meds are given during the shift, document on the pain mgmt flowsheet and follow-up with the pt 10-30 mins later to re-evaluate their pain), and chart on the re-evaluation
- Enter pt acuity in the computer system (must be done by 11am)
- Near the end of shift, do final charting on the nursing flowsheet.
- Close charts (do 8-hr chart check, if any new orders done after 14:30, endorse to the PM shift).
It doesn't seem like much on paper, but I find it so overwhelming. This is how all the experienced RNs do it and they always have time for breaks and lunch, yet I struggle and am always behind despite the fact that I never take breaks or lunch, or even go to the bathroom. Factor in all the other crap that goes on during day shift, like dealing with all the MDs, case managers, social workers, phone calls, etc., I don't know how to deal with it all. When I ask for help from the other RNs with certain tasks, most of the time they're too busy.
At 15:00 I stop to give report to the PM nurses, and then I have to go back and finish all the charting I didn't finish during the day! I wish they taught us time management in school, but maybe this is just one of those things you can't teach. If anyone has any pointers though, please share them. I've only been on my own for 2 days, and I have major insomnia from worrying so much about what mistakes I possibly made during my shift. Please help!
Thanks so much!
Nov 1, '07
Thanks so much for the suggestions. DudeNurse, I'm going to try out your schedule tomorrow and over the weekend.
I should have added in my original post that we don't get relief nurses for breaks/lunch, we have no LVNs on our floor, and most of the time only one CNA for the whole floor. I live in CA and because of the ratios, they're phasing out the CNAs/LVNs. I'm already struggling with the 1-2 CNAs we get (they do SO much!), so just thinking about what it'll be like when they're gone makes my stomach turn. I've seen people in some of the other forums talking about how they want to move to CA because of the ratios. Ha!
I'm going to talk to the RN in charge of scheduling tomorrow to see if anything is available on night shift. I don't know if things are any less stressful on night shift, but it'd be nice not having MDs, case managers, social workers, etc in my face all day! If there isn't anything on night shift, I feel I'll have to resign. I'm terrified that I'll lose my license if I stay (my orientation was only 5 weeks and it wasn't very thorough).
Please keep the suggestions coming and thanks for everyone's tips so far.
Last edit by NTPinky on Nov 1, '07
Nov 1, '07
I've only been in practice for a little over 2 years and believe me I still struggle with time management at times...but I still somehow get out in time...Here's how I do my day (7A-7P shift):
0653 I get my assignment (normally I have 8 patients with an LVN and a Tech), I look at all my patient's labs in the computer ( I religiously do this before I get my report)
0700 I get report from the night shift ( I like to do bedside report so I can see my patients...mini assesment.. and point out anything questionable to the night RN)
0730 I go to the patients bedside chart to check their meds and the ones I have to give ( LVN gives PO meds) and patients vitals signs and previous I/O's
0745-1730 From my mini assesment, I now go do my assesment on the ones I feel needs to be seen first (priority)..FYI: when I perform my assesment I don't do head to toe unless it's called for. I focus on what they're in for...I do my assesment all day long without having to spend a whole lot of time...even when I'm hanging an antibiotic or just handing pen and pencil to my patient...we call it "eyeballing" a patient. I chart as I go..at least the flow sheet... In between I give meds (IV) scheduled at this time, make calls (MD, lab etc) if necessary, checking/following up orders, prepping patients for tests/procedures, patient teaching....2- 15 minute break and 1- 30 minute lunch, reassesing patients, finishing charting.
1730 I total my I/O's, PCA pump..clearing pumps (IV, PCA)
1800 double checking orders/charting, making sure patients questions and concerns were addressed
1830 reviewing my report for the next shift
1850-1920 Giving report to the next shift
1923- clock out
Last edit by KulRN on Nov 1, '07