Struggling on Medical Floor!

  1. 2
    Can anyone relate? ......

    I've been off orientation for almost two months on a cardiac floor, and my confidence is shot way down! New to floor nursing and have just realized that i am horrible at managing time. Constantly feeling pressured about getting meds passed on time and completing necessary tasks. I've unintentionally let written orders go unchecked until the end of the day. From the moment I set foot on the floor, it is just non-stop. I never take breaks because I would just be stressing about everything that needs to be done for my patients. Everything is task oriented at this point, and its hard for me to make time to research my patients and get "the whole picture" of what is going on with them, and I hate that.

    I feel so guilty that I am unable to provide the best quality of care. At the end of the day, which NEVER consists of me leaving on time, I constantly think about anything I may have forgotten to do, which there usually is something i forgot or didn't chart, like an IVsite d/c'd, or didnt give a PRN laxative post surgery, per unit protocol. I've overlooked having cardiac enzymes drawn on a new admit on time. Sometimes I leave things for the next shift, which I feel awful about, just because I didn't have time or felt so rushed during the day that It was overlooked.

    There are a couple other new nurses on the floor that seem to be handling their job much better than I, and hardly ever stick around late to finish up. I feel I cannot keep up, and honestly wonder how anyone can stay on top of things on a unit like this... But they all seem to.

    Also, I feel i make a lot of mistakes, am stressed, inadequate, and worry that one day it could be a mistake that would harm a patient, or that I may miss a sign in my patient to indicate they are turning critical.

    I love the patients, like the co-workers. I don't know if I should give it my all for a good 6 mos to a year, or start looking into transferring somewhere else. Nursing is not for everyone, and I'm starting to wonder of its not for me?

    Any advice on how to improve time management, build confidence, and/or how to realize when it's time to move on or transfer to another area? Can anyone relate? Would Greatly appreciate it!
    merlee and NP Joel like this.

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  2. 22 Comments...

  3. 5
    Time management comes with lots of planning and practice.

    First thing, stop freaking yourself out and then get yourself organized.

    The first thing I do is check the MAR and write down blood sugar times, who needs BP done before med pass and figure out who to pass meds on first.

    Try to consolidate, remember to take everything you need into a room so you don't need to run back out to get something.

    This may seem pretty small but I refill the water picture for the med cart when I'm headed down to a patient's room near the ice/water machine. It may seem like a small thing but by filling it on that trip I've saved myself 50 ft of time.
    txrn2011, favthing, NickiJules, and 2 others like this.
  4. 2
    Quote from itsmejuli
    Time management comes with lots of planning and practice.

    First thing, stop freaking yourself out and then get yourself organized.

    The first thing I do is check the MAR and write down blood sugar times, who needs BP done before med pass and figure out who to pass meds on first.

    Try to consolidate, remember to take everything you need into a room so you don't need to run back out to get something.

    This may seem pretty small but I refill the water picture for the med cart when I'm headed down to a patient's room near the ice/water machine. It may seem like a small thing but by filling it on that trip I've saved myself 50 ft of time.
    Before you get on to the ward, ensure you have written down notes on anything that maybe needed for that day, during handover write down anything thats required. Build confidence in your self by sticking to your time protocol, get to know the ward like its the palm of your hand.

    Perfect note: As the above poster has stated in response to your question OP, ensure you have everything you that is required before you walk the room.

    My advice is make a list, a pocket diary treat it as your companion. Write down everything you need to do, and tick the things off you have done.
    favthing and NickiJules like this.
  5. 4
    Welcome to nursing. Amazing how school does not get us ready for the real world? If your job is enabling you to learn, they answer your questions, and you can tolerate it, my advice is to stay there and learn all you can and get your skills down. There are many employers out there who will not take the time to let you learn or continue to answer your questions once younare off orientation, even though evidence based reseach tells us that it takes a year or more for a new grad to become comfortable at a job. Make a "brain sheet", and start there. There are many examples out there on the internet. Do the best you can, the most important needs first and ask your collegues for tips regarding how they "do everything"? I do not know where you are employed, but I felt the same way when I started as charge nurse in LTC. I was going crazy trying to get everything done I was supposed to. Then I found out about all the corners the other nurses cut! Obviously I understood why they felt they had to cut corners, but personally, as an RN, I could not lump 10 pills together that could have serious interactions just to make my job easier, even though everybody else did it. Also I refused to sign my name to orders that I had not performed. Hello, not good! Obviosly I did not last long there. But if You can, learn as much as you can, pace yourself, and by god take your freakin breaks! It is the law! Plus your body and your brains needs those measly minutes! My goodness, when are we as nurses going to stand up and demand to stop being treated like this? Nursing is so dysfunctional, it is truly amazing. sorry, off on a bit of a tangent, but the more I experience and learn about my chosen field, the more amazed I am at how horrible many situations are. Just on the news yesterday, I think a pt in Cupertino got operated on the wrong side and people on the street were reacting to the news stating, wow I thought we had really good competent care here in san jose area, and how they couldnt believe it happened. Hello people, its truly ridiculous when the public has no idea what is really going on in their hospitals. They think they are safe, HA! This is the time we as nurses need to educate the public. If anybody has any ideas I am gung ho to help. My previous ideas did not pan out, but I am welcome to more. Smething has to change. Thanks for the vent.
    favthing, NickiJules, Sisyphus, and 1 other like this.
  6. 2
    Dear Struggling,
    I can kinda remember what it is like be new the this world of nursing. I first need to tell you to relax and don't be so hard on your self. I don't know what is your patient ratio, but mine is 3:1 when we have staff and 4:1 when we are understaffed. I ALWAYS, the first thing, go to each of my patients rooms and, introduce the care team and take a few precious moments to spend quality time with each of them. Ask about there day, concerns they have and there needs, if any. This method seems to work for me about 80% of the time. It really does cut down the ringing of the call bell. Patient can sense when you are in hurry, so if you make them feel validated and important they sense that you have the situation under control and they are in safe hands. If you get them what they need in that few first moments, you shift will go much better.
    BTW, I work on the Cardiac transplant unit with artificial heart devices and LVAD patient. (Dick Chaney)
    Secondly,you need to priortize the care of your patients. Depending on what can wait, save the busiest patient for last. If there are things that can't wait, then do that patient first. You mentioned that you work with cardiac patients, priortizing their care will help indentify area early and address them, call the doc, drawing time sensitive labs. Think what is most important when recieving your report. Try to pick out the information that is the most important and pertinent to the care of the patient.
    Thirdly, delegate, delegate and then delegate some more. I don't know if your CNA, NCP's UAP, but utilize them. Give them the tasky stuff to do, the stuff that an RN does not have to do. You take care of the things that are priorties and RN assigned.
    Don't give up, I am sure you are a great nurse. Try the time management skills you were taught and listen to your gut, it will never mislead you. Delegate the duties that can be assigned to someone else. Ask your co-workers for help, if you see they are not busy.
    I hope some to the suggestions help. have a great day
    favthing and NickiJules like this.
  7. 2
    I can relate. Hospital nursing is not for everyone and I was overwhelmed, so I left. However; the year that I did orthopedic/medsurge was a good learning experience . You will never leave the floor feeling like you have completed everything because it seems like there is always something to do. Time management comes with time and experience but i can tell you what helps me.

    1. get report on my pts
    2. Go see them and quick phys assessment
    3. check charts for any new changes or orders
    4. check the MARs and start passing meds, fingersticks and etc for each pt , one by one
    5. i chart on pts in between
    6. I look at priorities, such as hanging blood or getting specific tests done
    7. when all of my medications and treatments are done, most of the time, i will sneak in a small break, most hospitals provide phones so that if there is an emergency or someone needs to talk to me , i can still communicate.
    8. You never want to chart at the last minute because this is one of the major reasons why we can not leave the floor on time and you always have to remember that a code or unexpected issue could happen at any moment.
    Floor nursing is not easy and can be very stressful, but i have learned that time management and organization is the key where ever you are working.
    favthing and NickiJules like this.
  8. 2
    Every new nurse goes through this have no fear!

    What everyone has posted is great advice. I always make a plan before even seeing my patients - the time you put into creating an organized "brain" will only make your shift run more smoothly and ultimately save you time at the end of your shift. So after my plan is complete I round on my 6-10 patients - check vitals, pass meds, assess wounds, go through their plan of care with them etc; and if it is a day shift, I offer to help them into the shower (unless they are full assist then I wait until i've completed my rounds) and I set up the required patients for their breakfast. I chart in the patients rooms as studies show that patients are less likely to use their call bells when you spend some time with them each shift. The rest of the day I pretty much follow the same principle of cluster caring.

    Of course it doesn't always go to plan and the floor can become a very stressful place. Just remember, nursing is a 24hr job, so if something doesn't get done on your shift, the next shift will get it done.

    Also don't compare yourself to other nurses on the floor, everyone gets into the groove in their own time. I'm glad your co workers are supportive and nice.

    All the best, hang in there! It gets better!
    favthing and NickiJules like this.
  9. 2
    It took me just over a year to not feel like total crap about my shifts at work and feel semi organized. And then still I have nights where I don't know what the heck I'm doing, but I write everythingt down on my sheets. I do feel like working nights as a new grad gives you more time to be a nurse and think with your head instead of just passing and passing and passing meds and and talking to the families.
    favthing and NickiJules like this.
  10. 2
    Make a "to do" list, highlight your tasks with highlighters, cluster your tasks per patient and get them all done while in the room.
    Also, before med pass, make a round just to meet your patients and to tell them you will start with medicines after making your rounds. So, they know they will wait a litle. ASk them if they have any immediate needs like a pain medicine. If not, tell them you will be there soon to get their meds. Doing this saves me a lot of anxiety.
    favthing and NickiJules like this.
  11. 2
    Hi there,

    It takes time to develop your own nursing style, I know for me I think it was probably a good year before I felt on top of things at the end of the shift. I can give you a tip for the missing order thing, I used to write a plan for the shift but stopped when I realised that Docs dont always let you know when they change something. So I stopped writing a plan and checked pt. charts every couple of hours- never missed anything once I stopped writing a plan. I work in ED now and I can also pass on my tip for having way too much going on..... Sort out one patient at a time. Finish doing everything that you can for each pt. one at a time so you know that when you get to your third or fourth you don't get bamboozled or forget/miss something you should have done for the first pt. For example, if the pt. needs vital signs, and ecg and a shower, do the lot then move on to the next pt. In terms of priorities, ABC pain.. Don't think '"oh I'll come back and do that later" If it needs to be done just do it. It also helps to have a mentor. Just pick someone who you think is a great nurse and observe how they do things, ask for tips, and most of all- take a deep breath and stop being so hard on yourself! I'm sure you will be fine if you give yourself some time.
    favthing and NickiJules like this.

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