Why am I staying so late after shift ends while others leave on time?

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I'm a new nurse, just started my current and first position on a medsurg unit a few months ago. I work 3 to 11pm and usually have 5-6 patients. When I come in, I get report, which seems like forever, haven't actually timed it, but I'm going to start and rush these other nurses. Round on my pts, do vital signs and daily assmts at the same time. Come back to computer and chart VS & DA, put in my 3 or more care plans. Write my notes for each pt. I leave my outcomes and I&Os for 2200 because it's basically end of shift and the measurements are more accurate at this time. After charting VSs, DAs, CPs, and Notes, I pass medications. Accuchecks. After passing 1700 meds, I chart them. Then I'm trying to complete the last two pt's that I didn't document anything on earlier. Meanwhile, it's chaos in between. 1900 nurses are coming onto shift and want their report. I don't even fill out those report sheets, I write on my own sheet and they just have to take notes. After, I'm still finishing up on documentation, and getting ready to pull and pass 2100 meds, more Accuchecks, etc... Of course chaos continues (pt's wanting this and that, new admission, or like yesterday, I had to DC a pt right when I came onto shift, but I made her wait until I did my routine, then I DC her about 1830). I had a new admission that arrived on the floor at 2005. So I had to do the whole shebang for her. I suck at med reconciliation, I usually get stuck and need help with entering that into MediTech. On a good day, I get out about 12am, but I'm usually out between 1 and 2am. I feel like such a slow poke, especially with other nurses getting out on time. What am I doing wrong? What is your routine if you work 3 to 11 shift? I don't even have time to go over lab values. If I see that they were in during morning shift, I figure that the morning nurse already reported abnormal or need-to-know labs to doctor. I don't think I work slow, I work as fast and as accurate as I can. I'm feeling incompetent, but I'm fighting through this. Any advice? Please. :(

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

How long are your assessments taking? I spend no more than five minutes on assessments. I make patients wait for nonessential stuff until I'm finished with whatever task I'm currently working on. I've developed 'escape routes' to get away from overly talkative patients and families who want to monopolize my time. I don't start on admissions immediately; I finish up the med pass first.

TheCommuter is right, you'll have to get better at letting your patients wait on certain things while you're finishing up things you have to get done. If people are asking you for things, there is nothing wrong with saying you have to round on all your patients first. If someone needs to get on the bedpan, there's nothing wrong with going next door and assessing your next patient, while grandma finishes peeing. If someone has to wait 15 minutes for their percocet, it's no big deal. I have found that people very rarely mind waiting a little bit, as long as they trust you to actually follow through, and don't feel like you're blowing them off.

Can you document IN the patient's room? I know it seems like it makes everything take longer, but you'll be able to get things charted (especially your assessments) without all these can-I-get-a-cup-of-ice-and-another-blanket interruptions at the nurse's station. You might as well do it as you go, because someone WILL find something to take up your time for the rest of the shift.

Sometimes I combine med passes. If I'm in a room at 22:45 giving medication and I know the patient has a 00:00 heparin shot, they will get their shot while I'm in there.

I know you feel like you need to be doing everything (and then some) for your patients, but you shouldn't feel bad about taking steps to take care of yourself, and make sure you get out on time so you can rest. I'm not saying just do the bare minimum to not get fired...I'm more trying to point out that your patients, their families, and your bosses don't care about your physical or emotional well being, and people will work you to death if you let them.

Also, with the med rec things you're not good at, try making notes and saving them. I have papers that I made that tell me step by step how to discharge a patient. LITERALLY step by step, not just "do med rec," but which tabs and buttons to click and where to find them, because I am awful at remembering how to do stuff like that.

I'm pretty new (8-9 months), and I understand how you feel. Charting in real time as much as possible has helped me stop getting

behind at the end. Just try it for a few days and if it doesn't help you can always try something new!

Ask the other nurses on your shift if they have time saving tricks. I BET they do. Don't feel incompetent, time management is what's hardest for EVERYONE at first!

Specializes in Med-Surge, Tele, PCU, CVICU, NSICU.

It takes a good 6-12 months when beginning your first job to get your routine set and learn the best time management skills that work for you.

I agree with charting in the room, I've learned to be able to chart and "listen" at the same time that way I am getting those two things done at once. Also clustering your care as best you can, giving as many meds at the same time as you can with your times.

You've only been in a few months so maybe you just haven't gotten the routine that works best for you in yet. What works best for you won't work best for me and vice versa :)

You got this! And congrats on the beginning of your nursing career!

Specializes in Hospital Education Coordinator.

I tell patients "no" sometimes. I let them know at the beginning of the shift that I will be in every hour anyway, so whatever they need can wait till then unless it is a medical urgent matter. Can be said in a nice way "I do not want to disturb your rest" type of thing. Ask your co-workers if they have noticed anything about your routine that could be altered to save time.

Specializes in Emergency & Trauma/Adult ICU.

You've gotten some good suggestions as a starting point. And it is only natural that speed/efficiency comes with time & practice.

I would be a little surprised if you have gotten no feedback on this from your charge nurses. If I, as charge, see someone still on the unit more than 30 minutes or so past the end of their shift, that gets my attention. I find out what I can do to help them wrap things up. And if I were consistently seeing the same person there so late, whether a new nurse or not, I would definitely be investigating that a little further. Ask your charge nurses/supervisors and your former preceptor(s) for input.

Specializes in Med/Surg/ICU/Stepdown.

I think there is a component that you're not thinking of: the unpredictable. Occasionally, I have everything I need done by 1800 (I work days) and I can feel it in my bones that I'll be out on time, but then something unpredictable happens--a fall, a code, RRT, late nurse, etc. And then everything I worked so hard to do falls by the wayside and the next thing I know, I'm leaving an hour late.

The reality of floor nursing is that you can do everything perfectly and in a timely fashion during your shift, but you can't anticipate the curve balls, like a D/C or difficulty entering something into Meditech. It's the nature of the beast. My best suggestion to you is to perfect the "little things" that cause speed bumps so that when you encounter one, it's far less time consuming to recover, and you can be on your way quickly.

Don't worry. Time management will come with time. Learn to prioritize. You don't have to leap out of seat every time a patient or family member call. Learn how to delegate. And nursing is 24/7 don't get stressed about getting every single thing done. This can be hard and other nurses may be ****** but it is what it is. If I stayed for trying to get every single thing done I'd never leave on time. I do my job and when 12 hours is up, I'm done. I try my best not to leave anything for the next shift but occassionally it happens.

Specializes in Med-Surge, Tele, PCU, CVICU, NSICU.
Don't worry. Time management will come with time. Learn to prioritize. You don't have to leap out of seat every time a patient or family member call. Learn how to delegate. And nursing is 24/7 don't get stressed about getting every single thing done. This can be hard and other nurses may be ****** but it is what it is. If I stayed for trying to get every single thing done I'd never leave on time. I do my job and when 12 hours is up, I'm done. I try my best not to leave anything for the next shift but occassionally it happens.

Such a good point. We are all a team. It should never be days vs nights (even though it is). We are all here to help each other to the benefit of the patients. Do what you can and then move on.

Today, I actually clocked out at 11:28pm! And I got everything done. Six patients, two discharges to nursing homes. I came in, did my daily assessments, and just as I was about to check on my third patient, the nursing aide tells me that another patient I haven't seen yet, is having a seizure. So I rush to the med room to pull out the ativan and I'm preparing to give it IV push, and turns out the patient was faking. So I just did his vitals and assessment. Same with his roommate and continued on. Began charting and had two patients left to chart on, but paused to pass meds and deal with the usual chaos. I'm proud of myself tonight. Still didn't check on lab values like I wanted to, I only checked the ones I was alerted about on the Meditech status board. I did have a clinical instructor and nursing student call nursing home and give report on one discharge, so maybe that would've caused me to clock out at midnight, if it weren't for them. Let's see what tomorrow brings. Keep the advice coming please :-)

Make sure your reports aren't taking too long... are they organized and efficient? This might have been a "rounding up" but it shouldn't take more than a few minutes to give report on a nursing home discharge.

How long are assessments taking? Like Commuter, I don't think I take very long on each one... but mostly it's multi-tasking, assessing mental status while I'm meeting the patient, taking note of skin/IVs/dressings/strength all at the same time. Depending on where you work, it may be appropriate to give a quick once-over with the head-to-toe and a focused exam on the patient's problems.

Are you walking into the room with all the supplies you think you might need? If you're passing meds, for instance, you can bring an empty cup (fine to fill at room sink) if you're not sure they have water at the bedside. You can fill their pitcher afterward or have an aide do it if you're lucky enough to have plenty of help. If you're hanging an IV, do you have all the tubing, labels, and maintenance fluid you'll need? When you meet your patients a quick glance at the IV pole will let you know whether you might need to replace those things during the shift. Anticipate that and bring in the supplies sometime when you're going in the room anyway. Same with tube feeds and dressing supplies. Even if you happen to know that your patient loves apple juice, you can bring one in with you.

Do you know how to type? On my floor the nurses who are consistently late are the ones who don't know how and take longer to chart their assessments and write notes. If this should be a problem for you (or anyone else who might be reading this thread for advice), there are free online programs that will teach you very quickly. This is a valuable skill and much easier to learn than most people think.

Take a week or two and at the end of each day (after you've clocked out, maybe after you're home) take note of how late you were and think back over your day to see if you can identify areas where you might have spent too much time. Then take a week to hit each of those areas hard. Tell yourself "This week I'm going to see if I can make my reports more efficient," "This week I'm going to focus on charting each assessment in ten minutes [or whatever seems appropriate]". Focusing on one thing at a time will help you hardwire good habits.

Above all... it sounds like you are a thorough nurse. You've got to improve speed/efficiency, as you know, but I bet you're doing a good job. I have seen nurses who "always get out on time" and it's because, frankly, they are cutting corners and doing a crappy job. Become one of those nurses who gets out on time AND does everything s/he's supposed to.

Specializes in Gerontology RN-BC and FNP MSN student.

I worked 3-11 for years and got out late more than on time. There is so much to do on this shift. I am telling you, I switched to 12s and was so happy I am finally getting my work done and clocking out 90% on time. Afterwards, I realized I needed twelve hours to do a shift. It's been so much better for me.

Also please find a minute to check your labs. That is so important, I would hate to see something not be addressed because you just didn't check them. It wouldn't look good on you and you really need to address the labs. It only takes a second to look at them, more time if you have to act, but at least the ball is not in your court if you've addressed them and notified the NP or Doc of the abnormal values. Usually the lab will call you for critical labs...but a lot of times they need addressed even if their not critical. PT/INR s for example.

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