How to Deal with the Chaos of Med/Surg - page 2

by RachelRN89 7,306 Views | 18 Comments

I'm a new grad nurse and I started on my unit this past August. I've been off of orientation since mid October. On my unit there's a 4:1 patient ratio and I work the 3-11 shift. Since I've gotten off orientation I'm really... Read More


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    I work in the u.k..and when i worked in stroke i would look after 12 patients a shift..often at night i would have 21 patients and i would be the only trained member of staff with 2 care assistants..it is hard work juggling your workload but it does get better in time..do u have other staff to help with you patients?
    stephaniemaried likes this.
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    You'll get there with practice! I used to feel overwhelmed when I was a new grad but you get into your own routine and you will learn to manage your time more effectively as the months go on. But remember that even experienced and the most efficient nurses can have a hopelessly stressful day and can fall behind- it often depends on the type of patients (and family members) your dealing with.

    Good luck
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    I am also a new grad, what I do if I am seriously overwhelmed, I think of my pt scenario as a prioritization questions and it help me think through who needs help.

    If that does not help, I just go to the pt that could potentially die, if I don't do anything. IF their acuity is pretty equal and no one is in immediate danger, i go see the pt that i have to do less.
    stephaniemaried likes this.
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    Quote from samjoe
    I work in the u.k..and when i worked in stroke i would look after 12 patients a shift..often at night i would have 21 patients and i would be the only trained member of staff with 2 care assistants..it is hard work juggling your workload but it does get better in time..do u have other staff to help with you patients?
    Yikes!
    stephaniemaried likes this.
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    I was just lurking and decided to join the site, just to reply to your question! Ha.
    So I am a charge on a M/S-Step down ICU floor. Many new nurses ask me the very question that you are asking. I usually tell them that it WILL get easier. There will always be hard days (of course) but time management is often learned and practiced, and not something we are just born with. Another thing I tell them is when you are flustered STOP for a second, get out your paper. Look at your patients and figure our your priority at that second. If there is an Antibiotic that has to be hung Q6 hours and another patient that has one Q24 hours. If they are both late, hang the one that is due Q6 hours because it will be due again sooner. Allow yourself a second to STOP and think. You write all your meds down at the beginning of shift right? I also suggest a to do list. That always helped me to. You will get it, just keep working at it. Look at other more experienced nurses and how they do things. Ask for advice. Every nurse has something for you to learn from. Take those things that you like about other nurses and create your own time managing, awesome nurse!
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    Lovetheoutdoors,
    Thanks so much for your response and encouragement! Honestly, every day gets better and better. I feel so much more competent/organized than I did when I first started this discussion. It's amazing how much you learn in such a short period of time. I get flustered very easily, and it's hard for me to think straight when I do. Your advice about stopping and taking time to think is very helpful and I should do it more Thanks for your insight and advice!!
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    Honey, don't I know exactly how you feel! Im 2 years into being a med/surg RN and have worked at two totally different hospitals on opposite coasts. Seems like med/surg is pretty much the same everywhere, minus different RN/patient ratios. However 4 patients can feel like 10 and if your CNA happens to not be very helpful you could drown with 3 patients. I joined med/surg as a new grad to gain experience, and after 2 years of misery I'm still trying to figure out how to get out! I wouldn't take anything for the knowledge I've gained, but I fear I'll lose my mind if I stay in the chaos much longer. My advice to you is to stay at least a year and just suck it up- it will be so worth it for the experience. When you have moments of panic, hide out in the med room or bathroom and take some deep breaths and gather your thoughts. I pray a lot too. Accept the fact that your day will not go as planned. Make sure you're using a user-friendly report sheet- I made my own and I have a checklist of things I must chart for my shift. It helps on those chaotic days where I don't even know what my name is. Get your ACLS and anything else you can obtain. Then after your year is up, get the heck out and try something new. Good luck, and know that you're not alone! And find a nursing mentor- someone older and experienced that you can trust.
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    1:4...on 3-11!? Oh my, you are lucky! I work 3 to 11 on med/surg and tele and have 7 to 11. Never less than 6. Every single shift is chaos for me. When you have that many patients to care for (on top of that, admissions) and then charting on that many patients, there is no way the shift could not be chaotic haha. And we just got talked to about needing to have better "customer service" skills. Okay, let me work on that once you higher ups work on fixing the staffing issue!! To answer your question, it's not just you. It's the fact that we are expected to do so much, with so little help. You will get better at managing your time and will find that the chaos will turn more into an organized chaos. Good luck!
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    Quote from Nurse ABC
    Try not to get flustered and remember as long as everyone is alive it's ok.
    This is the single simplest and useful piece of advice new grads can take from this forum. Obviously we do a lot more than just keep patients breathing, but at the end of the day, and you're feeling frazzled, just look back and say "at least they're all alive!"

    Like another poster above, I also used a to-do list while I worked med/surg. I had struggled for a while with getting all of my morning tasks completed before dayshift arrived. Eventually I started sitting down in that really still part of the night around 4-4:30am and making my list. I would divide up a scrap paper into however many rooms I had and put down everything I expected to do in those rooms from now til I leave. For example, scheduled meds would go in, accu checks would go in, foley empties, drain empties, anticipated pain medications, placing people in CPM's, pulling drains etc.

    A to-do list serves several purposes. First, if you have a list of things to do, and a patient calls out to go to the bathroom at 5:15 am, you can refer to your list and see what else needs to be done with this patient on your shift. Why not take their meds, pain pills, ice packs, ice water, etc etc with you. This will prevent you going in the room three other times to do all of these things as you remember them.

    Another excellent reason to make a to do list: Lets say someone codes on your floor and its 5:45 in the morning. Not the best time, but nevertheless that's when they usually go. Anyway, so you're scrambling around working on this patient, eventually they get them off to another floor or whatnot. Then what? Your adrenaline is pumping and you're probably going to have a hard time focusing. Hey, what's that in your pocket? A handy list of all the tasks you need to do this morning! Just start checking them off!

    Same scenario as above, but the patient coding is your patient. So you're in the room with the code team and then transferring them to ICU, leaving all of your patients with no nurse. One of your coworkers can use your to do list to make sure your patients are all taken care of. This exact situation happened to me many times, where I'd be behind for one reason or another and my wonderful coworkers would come find my list on my COW and start checking things off for me.

    And finally, my home run point for why to-do lists are good for floor nurses.... Once you've crossed all your stuff off, you can go home and sleep easy, knowing that you haven't forgotten anything, that all your stuff was charted and that everyone was taken care of!

    I used to use just a brain sheet and would often get confused with the massive amount of numbers and letters and stuff scratched all over the page. When I started supplementing my notes with a to-do list (typically just for really busy times - like the end of night shift was when I used it most), I noticed that I was much more relaxed, much more efficient and was able to easier anticipate my patients needs. Win-win for everyone!
    KatRN 821 likes this.


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