How can I be in two places at the same time?

[sistasoul]

Hi all,

I need suggestions and/or advice. I have been a nurse for a year now on a neuro/ortho floor. Still having issues with time management. I do OK until I have an admission come in. Especially if it is after 8 pm in the evening. My shift is supposed to end at 11 PM. The other day I had an admit come up at 9 PM. At thsi time I stil had all of my 9 and 10 pm meds to give out. These meds were time consuming because one woman had multiple blood pressure meds at nine and ten and I had to take her BP and heart rate before giving her her meds. Another lady I had to give everything through her NG tube and she had a feeding due. This same woman had 2 different IV antibiotics that needed to be hung with all tubing to be changed. Another patient I had had a blood sugar fingerstick with Lantus and novolog insulins due plus PO meds. My other patient thank God had just PO remeron.

When the new admit came up at 9 PM she immediately needed a breathing treatmnet. I called respiratory and arranged that and then told this patient I would be back in to her to get her settled. I checked on her in between giving my meds out to make sure she was OK. By the time I got in to do the admit on this lady it was 10:30 PM. I The first thing she needed was the commode so I ran and got her that out of the bathroom and helped her to it. She had some cellulitis on her lower extremities and SOB so she needed some help. Then of course the oxygen tubing is not long enough so off I go running down the hall to retrieve an extender. It is true I could have called an LNA to get me an extender but by the time an LNA would have been available to get it I would have been able to get it faster myself. Then she needed pain medicine. I frantically looked through her chart for an order for pain meds. No order. So off I go to call the Doc and get something for the poor lady. By the time I gor her settled with pain med and toileting done it was 10: 45. I noticed she needed a finger stick. I proceeded with that and ended up giveing her 8 units of Novolog and 66 units of Lantus. The Lantus was what she took at home. Then she proceeded to question me as to why she needed the novolg at night and why her blood sugar was 330. I explained that the solumedrol was causing her blood sugar to rise. She did not fully understand and this took another 5 minutes to explain to her. It is now 11 PM and next shift is coming on to get their assignments. I still have the entire admit to do and to check the orders and to give her about the 10 meds she still had due. Needless to say by the time I gave report and did the admit it was close to 3AM.

I was told if the patient comes up before 10:30 PM it is my responsibility for the admit. The admit data the admit history, full assessment, ensuring orders are entered accurately and checking meds from the med rec and giving those meds that are due.

Sorry about the length of the post. I am just really frustrated and don't know how I am supposed to get all of this done while still haveing the 9 and 10 pm med pass and still get out on time. Thank God the lady had been there before and the admit history had been done. SHe had a rather lengthy medical history that would have taken an hour to go through with her and never mind that she was HOH bilaterally. Please don't mind the spelling as I am a terrible typist.

I asked my charge nurse how was I suppose to get this all done and she told me if I knew the admit was coming late to start the 9 PM med pass early. This didn't really sit well with me.

How do you all handle a situation like this? The admits are time consuming especially when it is really hard to keep the patient on tract with the questions that need to be answered.

Thanks

[JessicRN]

Sorry I agree, you have an hour leeway with meds. Also If you get report which you should, and they say the patient is on O2 then prepare to have the extender in advance if they are on IV meds needing IMEDS have them available as well. Not sure where the patient came from or how many patients you had but a patient coming from the ED who needs immediate breathing treatment and pain medication that is inexcusable at least in our place? Also when a patient is admitted in our place the aide does the vitals and such and settles the pt. The nurse comes in says hi does a quick assessment then leaves. When she/he has time, then she does the admission. If you are crazy busy and can't do the complete admission inform the charge nurse she will have to assess the situation and maybe leave it to the night shift

(do not make a habit of this but no night person will fault you if you truly are stuck).

[zofran]

I agree with Jessic...we do it the exact same way where I work. (CNA settles the pt.) Also, we have 24 hours to get the admit done.

The way I see it, the admit paperwork is often my lowest priority. If others (or the new admit) need pain meds, nebs, help to the bathroom, etc....then those things are more important than the admit paperwork. I just tell the next shift "This pt arrived at nine, I got her a breathing tx, and called the doc for a pain med order, I didn't do the admit yet."

Most nurses are cool with this, it's not like you ignored the pt for two hours. Some get pissy that you didn't do the admit. Oh well, thats why the place is a 24hour facility.

[clemmm78, RN]

What is the policy in your facility? I agree with passing the meds a bit early if you have notice. Obviously, if you have five people who all have 9 pm meds, not all can get them at exactly 9 pm. You have to use your judgment. Certain medications must be given as closely as possible to the set time, but you do have leeway with others.

Policy re admission: when I was working on the floors, the ideal situation was that the admitting nurse had all the work done. However, that's ideal. We are only human and if work is so busy that you can't get it all done, getting the essentials done was good enough - even if it did tick off the oncoming nurse. Most of the nurses were ok with it because they would have found themselves in the same situation at some time or another. The trick is not to be doing this consistently.

When you received report that the patient was coming, were you given the info about her needing breathing apparatus? Were you expected to do the actual physical stuff on your own or do you have other staff to do that?

I've worked with nurses who feel they have to do everything on their own and end up burning out. You need to be able to delegate the work to the proper people, if you have the resources.

Finally, who was in charge? Whenever I worked charge, I made sure that the staff wasn't overwhelmed if I could help it. If a colleague had an admission and was overwhelmed, I could either take on the bulk of the admit work or take over the med passes. Not all charge nurses will do that, but I've been known to go to a charge nurse if I was overwhelmed and say exactly that I need help.

Good luck next time. It is frustrating, I know.

[onetiredmomma]

Ask your charge nurse for help at the time. Be specific: can you call for pain meds for this new pt.... If your facility policy is the admitting nurse must do the admit, get together with your co-workers and assess the reality of this. Late admits should get settled in, get their immediate needs met. I always try to do the history and a focus assessment. The next nurse has to do a head to toe assessment anyway so if time is tight, they should be able to do that. Try to ask questions when you get report that will help you get set up for your pt. SOB? get you CNA to find a commode, make sure the CNA knows what you need them to do. Finally, don't go into pt rooms after report! If you forgot something ( clearing pumps) don't let the pt con you into helping them to the bathroom! As others have said, don't make it a habit but allow yourself to let the next shift take over and do what needs to be done. On the other hand, be willing to take over from them as well! Good luck!

[MERRYWIDOW46]

Medications have a 2 hour window, an hour before to an hour after they are due and can be given at any time during that period.

I had the same situation Friday, discharge at 3pm, informed at 4pm I was getting a PACU admission. By 4pm I had all charting for the day done and was working on my notes. Needed fingersticks and 5pm and 6pm meds to be given.

PACU arrived at 6pm, at that time I only had one patient who had not gotten meds. ALL documenting, including notes were done. Therefore, all I needed was to focus on the admit. However, I still didn't get out till 8pm instead of 730pm.

I have found that it is best to do everything humanly possible as early as possible to avoid getting stuck for hours with a late admit. Time management is essential to work/life balance.

Also, the charge nurse could help if it is crazy busy. However, at the end of the shift she also has alot of things to get done.

Work on your time management skills. Good Luck.

[Kooky Korky, BSN, RN]

Surely you can start your med pass before the exact minute. We have an hour leeway before and after. Are you really waiting til the exact moment?

As someone said above, it sounds like the ER, if she came from the ER, should have done the breathing tx and even sent the equipment with her to re-use.

You should have had an aide get the commode and 02 extender, VS, and anything else that you could have delegated. That way, you could have started the paperwork.

But, as someone else said, you have 24 hours to complete admission paperwork in a nursing home. I don't think that's true in a hospital or is it?

Also, if Night staff weren't that busy, could you have asked for a little help? It seems ridiculous that you had to stay an extra 4 hours to do the paperwork when you were legitimately busy with other very vital activities.

And, yes, you should probably have tagged or at least conferred with your Charge Nurse to see if anyone else could have pitched in a little or if she would allow you to leave the paperwork for Nights.

It sounds like you are very conscientious and a great nurse, Sista.

[Kooky Korky, BSN, RN]

Ask your charge nurse for help at the time. Be specific: can you call for pain meds for this new pt.... If your facility policy is the admitting nurse must do the admit, get together with your co-workers and assess the reality of this. Late admits should get settled in, get their immediate needs met. I always try to do the history and a focus assessment. The next nurse has to do a head to toe assessment anyway so if time is tight, they should be able to do that. Try to ask questions when you get report that will help you get set up for your pt. SOB? get you CNA to find a commode, make sure the CNA knows what you need them to do. Finally, don't go into pt rooms after report! If you forgot something (clearing pumps) don't let the pt con you into helping them to the bathroom! As others have said, don't make it a habit, but allow yourself to let the next shift take over and do what needs to be done. On the other hand, be willing to take over from them as well! Good luck!

Con? Wow.

[swifty1031]

Sometimes you have to let others do some things. I know it can be hard if you are a person who does everything for herself (I tend to because I know it will get done). My director has said on more than one occasion that a hospital is a 24HOUR facility... meaning pass on things you can't get to due to time. That certainly doesn't mean leaving everything for next shift, but occasionally you have to leave something if you are overwhelmed (which clearly you were)!!

[enchantmentdis, BSN, RN]

You're right --you can't be in two,3,4,5,6 places at once. Don't expect management(especially) or anyone else for that matter to help you. They all understand already what is going on to you; and it is sad; and you have my sympathy since i've gone through it for 15 years and i know where you're at. Because of their own agendas, time constraints, and not -care attitudes of some, you will go unhelped. And when you start to ask for help be extremely careful--egos abound and no one wants to take responsibility for your overwork. Some will want to help but can't. Some won't want to help and won't, and others will stand by with their mouths open and won't know where/how to help you. Some will try to help but won't help you enough or at just the right time. It is then, when you are completely overwhelmed, dead-tired, feeling hurt, after you've nearly multi-tasked yourself into a grave during your shift, --a family member will approach you with hands on hips and say to you , "I want to speak to your supervisor NOW!" You will find your way. Working for a not for profit organization is much easier. Changing professions might be an even better option. If not you are in for the long-haul-enjoy the ride.

[sistasoul]

Sorry I agree, you have an hour leeway with meds. Also If you get report which you should, and they say the patient is on O2 then prepare to have the extender in advance if they are on IV meds needing IMEDS have them available as well. Not sure where the patient came from or how many patients you had but a patient coming from the ED who needs immediate breathing treatment and pain medication that is inexcusable at least in our place? Also when a patient is admitted in our place the aide does the vitals and such and settles the pt. The nurse comes in says hi does a quick assessment then leaves. When she/he has time, then she does the admission. If you are crazy busy and can't do the complete admission inform the charge nurse she will have to assess the situation and maybe leave it to the night shift

(do not make a habit of this but no night person will fault you if you truly are stuck).

Thank you for the tips. We do not get verbal report from ED but rather a vague written report that is faxed up. Also, I have no idea what meds the patients are on until they come up to the floor with orders. Sometimes there are only a few orders written depending on how busy the hospitalists are.

[sistasoul]

What is the policy in your facility? I agree with passing the meds a bit early if you have notice. Obviously, if you have five people who all have 9 pm meds, not all can get them at exactly 9 pm. You have to use your judgment. Certain medications must be given as closely as possible to the set time, but you do have leeway with others.

Policy re admission: when I was working on the floors, the ideal situation was that the admitting nurse had all the work done. However, that's ideal. We are only human and if work is so busy that you can't get it all done, getting the essentials done was good enough - even if it did tick off the oncoming nurse. Most of the nurses were ok with it because they would have found themselves in the same situation at some time or another. The trick is not to be doing this consistently.

When you received report that the patient was coming, were you given the info about her needing breathing apparatus? Were you expected to do the actual physical stuff on your own or do you have other staff to do that?

I've worked with nurses who feel they have to do everything on their own and end up burning out. You need to be able to delegate the work to the proper people, if you have the resources.

Finally, who was in charge? Whenever I worked charge, I made sure that the staff wasn't overwhelmed if I could help it. If a colleague had an admission and was overwhelmed, I could either take on the bulk of the admit work or take over the med passes. Not all charge nurses will do that, but I've been known to go to a charge nurse if I was overwhelmed and say exactly that I need help.

Good luck next time. It is frustrating, I know.

Thank you for the tips. My charge nurse has to take a full assignment herself. I try not to ask her if I can help it.