Here's my routine (with 6 pts). One MAJOR thing I've learned though is that your routine MUST be fluid and open to adjustment. When I first started, I wanted all of my "routine" to fit into a nice, neat, timely package. This would stress me out to no end when x'o'clock rolled around and X set of expectations (that I had for myself were not complete). So here's what works for me now:
- 0630-0700: arrive on unit, review Kardex, get general idea of pts
- 0700-0730: get report from night nurse & do chart check together
- 0730-0800: review chart to make sure nothing was missed; review AM labs; print all labs & procedure results to place in pt's bedside clipboard (I do this partly for myself and partly for the docs to make it easy to see everything, instead of having to look through the BIG chart or the computer)
- 0800-0900: initial assessment of all pts (in order of acuity based on info I received from night nurse), find out what their immediate needs are, answer any questions that I am able to immediately OR let them know I will follow up after med pass, let them know what the plan of care for today is, review 0800 VS (note: initial assessment is primarily focused on system(s) that is reason for visit, but I review entire body systems as well)
- 0900-1000: pass 0900 meds
- 1000-1200: deal w/ immediate pt issues noted during initial assessment (I used to chart all my initial assessments during this time period & would let almost nothing interfere with this; I realized I was neglecting some important pt interactions, so I changed this around...)
- 1200-1400: 1200 physical & pain reassessments, pass meds, do accucheks
- 1400-1500: lunch (I take 30-60 mins for lunch; unlike other nurses, I believe I deserve the time that's owed to me; since I pee only a couple times during my shift and NEVER take breaks, I make sure I get to relax and refocus myself during my lunch period, as well as enjoying my food and actually having time to digest it!)
- 1500-1700: nursing tasks (i.e., dressing changes), pass meds, do accucheks, and charting!
- 1600: physical & pain reassessments & chart them
- 1700-1800: final med pass, make sure pt's needs are cared for so I can do shift change w/o interruption, make sure they know that only immediate needs will be cared for during shift change (i.e., chest pain vs. needing more ice)
- 1800-1900: pull charts, make sure all meds & orders are in the system, sign charts, final check on pts
- 1900-1930: report & chart check
- 1930...: assist w/ anything that I didn't complete during my shift that I should have / am willing to help night shift with (i.e., IV that went bad at last minute, brand new admit, pt d/c's on my shift that didn't have ride until around 1900 hrs)
Although there are some time frames I stick to strictly (i.e., passing meds when they are due, doing nursing tasks later in the shift), most of the days' tasks are pretty fluid.
If I'm getting a lot of orders, I review the charts throughout the shift (not just at the end) to make sure that nothing was missed.
I also make sure to communicate w/ my pts & their families frequently throughout the shift -- even if it means I have to stop charting :angryfire temporarily.
I've also learned how to tell pts/families NO, when it's necessary. When I first started, I would jump EVERY SINGLE TIME I was asked for something. This resulted in lots of INEFFICIENT task doing. Now, I've learned to group things together. "You need more ice? Ok, give me a few minutes, and I'll get that along with my other 5 pts wants" (but in a much less sarcastic way).
I think the core of floor nursing (aside from the obvious patient safety) is time management. That is usually the hardest part for new nurses, and I think it directly contributes to burn out and feeling like nursing "isn't for me." In reality, the stress is overwhelming these nurses so much, that they don't have the chance to step back and take a good look at the big picture.
Unfortunately, it is VERY difficult to teach time management. I know some experienced nurses who regularly stay 2-3 hrs late to finish charting! That baffles me -- esp. that mgmt lets them get away with it! In any case, it's always good to find someone who's work you admire and see if you can work more closely with that/those nurse(s). I've found a few nurses who I admire greatly. None were my preceptor (who I rarely speak to anymore), but I find a lot to aspire to in the way they do things.
Good luck -- and, please, don't give up!