Transitioning from one patient to multiple patients

missninaRN · Apr 3, 2008

I didn't think that taking 2 was hard. Once we were past 3, we stopped doing full care and I really didn't notice much of a difference between 4 and 5. That's as high as we've gone so far.

What helps is to organize yourself at the start of the day. I like to gather information first: I get report, check the MAR and Kardex, check the chart for new orders and lab results, and get the vitals from the aid. Then I assess, pull meds, and start med pass. After that I chart the assessments. Then it's time to check for orders again, pull meds for the next med pass, etc.

I chart throughout the shift, right after I round on my patients or any time there is a change. I also plan care so that I bring everything I need into the room at one time. So, if patient is getting IV abx, needs a dressing change, and the Dr just ordered a foley, I try to take all of those supplies in to the room and do everything while I'm in there. I keep saline flushes, alcohol wipes, empty syringes, packaged sterile caps for IV tubing, and "change by (date)" stickers in my pocket because I tend to forget those things when I need them. (I've gone in to DC a Foley twice and realized I didn't have a syringe to empty the balloon with me, which meant another trip to the nurses' station.)

I still forget stuff and find myself running back and forth, but I'm getting better at juggling care for multiple patients.

It can be done. Look at all of those nurses who are doing it. They had to start somewhere, right?

WDWpixieRN, RN · Apr 4, 2008

Prioritize and don't save things for later. I had the hardest time realizing I just didn't have time to hang around anymore being a go-fer or just socializing.

I had to get in and do things in a timely manner, keep up with my charting, and being prepared when something unexpected came up. I no long had the luxury of one patient....

Jump in with both feet and accept the challenge....it WILL serve you well in future clinicals....

locolorenzo22, BSN, RN · Apr 4, 2008

i 2nd that....I'm in my final semester and the most patients I've ever had is 6....but only 3 for meds/tx......in LTC we pass ALL meds, and do ALL tx's on ALL our assigned patients....it really makes you feel good when you have all your assessments done and it's only 10:45! However, when you're done with meds and glucoscans at 11..lunch at 12, and back at 1...off at 2:30....the last hour and a half goes by quick.....Just stay on top of meds, tx's and PAY ATTENTION in report....jot down ANYTHING that YOU feel is important..after a while, you get to know what is important and what isn't.....and if someone is leaving the floor soon for something...find out if they need their meds....and do that first....don't try to assess everyone right off the bat...cause if you hog the bp machine...I'll personally kill you.....lol. Good luck, it prepares you for being a responsible nurse....

mel236 · Apr 4, 2008

From my experience, I was bored with just one pt and had alot of extra time. When I went to having 2-3 pts it wasn't much different except that I didn't have as much free time. I found that using a "brain" sheet was very helpful in keeping the pt's separate. I could write down their labs, diet, activity level, and any other notes that would help in my care of them all on one paper. I have heard from students in higher blocks that it is actually easier to have multiple pt's than just one or 2. It also makes the day go faster!

Chaya, ASN, RN · Apr 4, 2008

I was very worried when we added more patients. However, with just one there was a lot of "down" time, waiting for equipment for VS or blood sugars, waiting for the instructor for passing meds, waiting for help turning/ repositioning. I found if I was at a dead end with Pt #1 I could usually make some progress with Pt #2 until I got the equipment or help I needed for Pt #1. Having 2 pts never took twice as long as having just one because of this (more like 1 1/2 times longer).

NURSEOK5 · Apr 5, 2008

prioritze your pt needs from report, if a pt has a 0730 med go ahead give it and do your assessment. When you have more than 3 pt's you can't do tpc.

The most pt's I hve taken care of as a floor nurse is 7 in a 12hour shift. The most I have seen in an ER is 12, I was the only nurse. Your skills will grow with you and you will prioritize automatically just from the shift reports that you get. Congradulations on your instructor realizing you are able to handle the load early..you may be being looked at for a team leader, you never know. The first time I was on the floor after passing boards I had 5 pts and I got overwhelmed and I had to walk off the floor and cry for about 5 mins. I regrouped and I have been able to handle what ever comes my way. Good Luck to you................:)

allnurses Guide · Apr 5, 2008

When I worked medsurg, I used a grid chart to organize my thoughts. Hours across the top, and patients down the side. I filled in the boxes with what had to happen during that hour (VS, meds, IV bag to be changed) for each patient, including times they'd be off the floor so I'd need to act around those times. Then I put in the stuff that could be flexible (dressing changes, cath care), according to when I had the best shot at doing it. If anything happened during the day that I'd need to chart but wouldn't have time right then, I made a quick note in that hour's box so I'd know when I did it. Could write down I/O amounts when I gave a drink or emptied a urinal.

Crossed off stuff as I did it, could see where I was in my "chores", and since I'm a "list person", it made me feel like I was accomplishing stuff when I got to mark it off.

Worked for me for a lot of years, I actually made the chart on my computer with the numbers across the top, and VS plugged in at the beginning of the shift etc. already written in. Had a fair number of nurses make copies and use it themselves.

Acosmo27 · Apr 25, 2008

Today was the last day of Rotation 2 of 3 this semester, and I got a great report from my professor, who also stated that she'd like me to begin taking on multiple patients to help prepare me for next semester. So I want to ask, was it terribly difficult to go from 1 patient to 2 or 3 during school for you? What did you do to help better manage your time? What did you find most challenging, easiest, etc.?
Thanks in advance :)

Hello! Wellll.... 1st semester we had one patient. I remember thinking how the heck will i be able to manage 2 pts!!?? Well 2nd semester we had 2 pts and it was tough at first, but the key is to stay organized! Now... 3rd semester we go to 3 pts and right now im think, how the heck will i ever be able to have 3 pts!! ahhh im nervous, but its a transition, hard at first, but it will become better and better.. :up: