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A VERY frustrated nurse

Posted

This is going to be a serious vent session... Well, needless to say, I got in trouble for staying 4 hours late at work consecutively for the past 3 days due to have terrible nights... I have struggled with time management a lot due to the fact I am new RN and have only been on my own for 4 months now! My vent is...

I have 7 patients... We 7 different needs.. Medications.. Pain medicine.. Neurovascular checks.. Neuro checks.. Multiple things going on considering I am on a med surg unit with post surgical patients anywhere from a vascular surgery to an AV fistula being placed...

I want to know WHY is it such a big deal for me to stay late? I mean charting is very lengthy! And every shift for the past two weeks, it's always something.. I come on shift and CVP is leaking.. Not to mention its been leaking all day but I am the first person to truly acknowledge the issue.. Tell the on call doctor about it and I have to start peripheral IV of course......... Well also this same patient had colostomy bag come off at the same time! Naturally... So I have to get all the essential things I need for that.. A new bag, some paste, and the donut protection barrier.. So by the time I start an IV and finish that its like 2045.. Not to mention I have another patient who is calling out for cereal... milk.. diet coke every 5 minutes.... And my techs NEVER help or if they do, they act like its annoying to me told what to do?!!! I say please...... The night after I had a patient who became disoriented wondering why?! A seasoned nurse looks and sees that the patient has been off xanax for 2 days now and the pt takes it every day at home... Now this patient is refusing everything.. IV abx and PO meds.. And naturally both IVs that the patient goes bad.... So I end up having to restrain this patient eventually (calling doc of course) not to mention getting kicked twice! It took 5 of us to get the IV in.............. Then the weekend before I had patient with no pedal pulse after a vascular surgery that the day shift nurse got report on from PACU yet when they came up to the floor didn't check pulses.. so I had to call on call doctor.. and the doc wanted me to check pedal pulses every hour times 4 then every 2 hours times 4.. I have 7 patients to take care of.. Can they seriously think I will be caught up on charting??!!!! I am just so frustrated.. I am frustrated at nurses who don't give two craps and walk out ON TIME every time.......... Not happy at all.. I love my job because I love being a nurse but the charting and the way some of the staff is ridiculous.. and I just want to cry because I look so incompetent bc I stay late so much......... I just want some comforting is all..... I just feel like I am just never gonna get it

Also, the patient I had to restrain was not oriented to place at all.. Hallucinating etc.... And the seasoned nurse told me you have to start on an IV on a disoriented pt regardless if they want it or not since they aren't in their right mind and don't know what they are saying...

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

The seasoned nurse was right.

Incremental overtime is huge when it comes to the unit and the hospital budget. It matters a LOT. The fact that others get out on time is not indicative of poor care on their parts. It is indicative that it is both possible to do it and that you can learn from them.

It doesn't matter if the tech gives you the cold shoulder. You aren't there to be friends. As long as you are respectful and polite there isn't much you can do. New nurses need a lot of help and that can wear them out. It will get better as you get better. Ask them and move on to the next thing. Do hourly rounding with purposeful questions. If a patient always asks for a Coke, bring one every time you enter the room. Address the four Ps before you leave...pain, potty, personal items and position.

Find out how others manage their day. If you aren't using a brain sheet very shift you need to start immediately. And keep your chin up. What you are experiencing s normal. Nobody thinks you are incompetent. They do think you are new and that you need the feedback.

Edited by not.done.yet

Well, I say that they don't care because they leave things for me constantly that in my opinion should have been done prior.. And all the nurses on my unit that report off to me on day shift have been a nurse either as long as I have or little longer not much longer.. Most nurses on my floor are not experienced.. At least on that particular day shift rotation.. I mean I had a patient crying in my pain as soon as I come on and the day shift nurse that reported that pt off to me knew that pt was and KNEW that pain medicine could have been given... That is the sort of stuff that stresses me out.. I guess I just catch on a little slower.. I think I am going to start taking my C.O.W. into the rooms during my assessments to see if that helps. And I usually write out sheets of my medications, labs, diet, iv site and fluids and if they ask for pain medicine frequently, fill it in my medication list on the times.. Sometimes I don't get to do it though if I have multiple patients requesting things as soon as I come on.. And I try to start passing medicines as early as 2030 but my tech sometimes doesn't even have vital signs done therefore I am not going to give a BP medicine without knowing a blood pressure and heart rate..

SierraBravo

Has 3 years experience.

OP I have to chuckle because I feel your pain, I've had days exactly like you described. Do you have EMR? We use EMR and I find it so useful. Also, if you bring your computer with you then you could chart a little bit in the room while the patient is in the bathroom. Finding your stride is difficult when you're new, but know that eventually you will.

BrandonLPN, LPN

Has 5 years experience.

It is no huge mystery as to why a 4-month RN is staying over to finish while her more experienced co-workers leave on time.

It does not mean the nurses leaving on time don't give a crap about their patients, nor does it mean the new nurse is incompetent.

No one expects you to function like a seasoned pro right out of school.

but don't fall into the new grad trap of thinking that your seasoned colleagues "must" be cutting corners because they leave on time. They leave on time more often than you because they have more experience than you do. Which, when you think about it, only makes sense.

Even though I understand your frustration and the pressures your facing as a new RN, I can also see the concerns from management when one staff member is frequently staying behind 4 hours late.

And I agree with Brandon, a lot of new grads who are still learning time management skills often develop this attitude that their seasoned coworkers are some what lazy and must be cutting corners or leaving things for you to come along and find and solve. When in reality, they are just experienced and have become more efficient with practice. You'll get faster too with time.

Instead why not try to focus on further developing your skills or talking to your manager, educator, preceptor or mentor about your frustrations. They might be able to help or offer some advice or wisdom.

You sound like a very competent new grad, I'm sure you can push through and be successful.

Good luck.

danielle2000, MSN, RN

Specializes in Family Practice. Has 1 years experience.

Let's keep it real you are doing your job. Some seasoned nurses simply cut corners. You have to put foot ass with your techs. You are an RN delegate with assertiveness and keep it moving! In time you will get it and devise a system to make your life easier.

I just am saying from my experience that they are... Hence my manager thinks this new nurse hired (very sweet girl, I have no problem with her) has caught on quicker than me with time management yet when I come on the shift.. This nurse missed 3 medications to be exact that were all due on day shift schedule.. Yet because I am staying late and being quite thorough in my opinion, I am getting in trouble with my manager... My manager thinks its absurd I am staying as late as I am and I got in trouble for it...... Thinks I should be catching on by now..

MatrixRn

Specializes in Management, Med/Surg, Clinical Trainer. Has 20 years experience.

I hate to say it, but what you describe is common for new grads. [i lived through very similar to you when I first came out.] Nursing school does not prepare us for the reality of nursing. We go to clinicals and see a few patients and all the while we are supported by our instructors. Real nursing is just not like that.

I have to agree with the other poster in that staying an extra 4 hours to do charting is not something that you want to do. If you are doing your charting that late...there is little chance that it is accurate. The time stamps will be off and you are bound to forget items. I would suggest pulling the COW around with you everywhere you go. Even if you cannot chart fully, at get the time stamp in and open the areas of the record that you will later fill in.

Their are so many issues about staying late to chart......1) if you are working you must get paid for your time, so if you stay 4 hours you must charge for 4 hours. It is the law. 2) OT, few hospitals want to pay 4 hours of OT for someone to chart, when the other folks can get it done, 3) taking 4 hours to chart on your patients is incredibly long, especially if you have an EMR. Consider reaching out to your educator to get support on streamlining your charting.

Nursing is about delivering nursing care, yet it is also about charting what tasks we have done. In this business [and nursing is a business], charting is how we show we have value. Take credit for the nursing items that you do!!!

How do you show value in fetching milk? Answer: you don't. The value comes for nursing when someone, again does not have to be you, documents the input of fluids.

Many of items above should be delegated off to the techs--- soda runs, cereal and mild duty or reapplying a colostomy bag etc. It does not matter if they are unhappy doing their JOB ask them anyway, and if they do not comply talk to your charge nurse. It is not an option for them to shirk their duties. You are a new nurse on a new floor, you will need to set boundaries and expectations as to how you want the care of YOUR patients to be handled by them.

As to the CVP and the missed pedal pulses, well this is where you set boundaries with your fellow floor nurses. You do not need to be ugly, however the next day after one of those 'missed' events, say hey guess what happened to Mr. Jones after you left yesterday and fill her in. No judgment, just give the facts. If the nurse is a good one she will make a mental note to pay more attention to her hand-offs in the future.

As time goes by it will get easier. Give yourself a break you are just learning.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 14 years experience.

I want to know WHY is it such a big deal for me to stay late?
Staying late costs the hospital money. Staying four hours late every night seriously costs the hospital money. Since hospitals are businesses first and foremost, a nurse who stays on the clock four hours past the end of the shift is cutting into the budget.

Another forum member wisely mentioned that compassion is not efficient. Although the seven patients have their different needs, they can be prioritized. The guy who calls for snacks and soda hourly can be made to wait. The patient who is being combative doesn't need an IV line restarted immediately. Yes, some things can be completed late.

I only spend 15 to 20 minutes with each patient. In this 15 minutes I do a quick assessment, administer medications, change any dressings that need to be changed, then move on. This might sound cold of me, but the patients are not my personal friends. With an average patient load of 8 to 10, I do not have the time to keep catering to someone who rides the call light for incessant snack requests.

I chart immediately after I've done the assessments and medication pass. The techs do as I say. I get out on time. Time management is king. Good luck to you.

And this past week has just been miserable.. Some days with 7 patients I leave at 0730.. BOOM perfect.. Just these past 3 days I have been leaving late because of chaos.. And we chart on EPIC.. The girl who preceptored me was very thorough on charting so I super OCD about getting a green check mark by the patient's name before I leave... Also, I have came on as night shift and none of the medications on the PTA have been reconciled or wrong dosage.... When I go to pass medications and call out what I am giving, uhh no ma'am I don't take that or are you not gonna give me this? So I call the doc to get Geodon ordered for a patient who HAS to take it and get chewed out for calling about reconciliation of medications at 2200.. I really don't care about doing all these things.. It's just I am going to be late if I have to do tons of things like that so I feel like.. Oh well, I guess.. I know over time perhaps it shall get better.. I love taking care of people and I guess being speedy gonzales is not really how I would like for it be but just how it has to be lol

See I have never been told a tech could put on a colostomy bag.. I am timid when it comes to delegating.. I have done it but I get sour looks.. Next time, I am going to tell my secretary if she looks at me and tells me a patient wants a blanket or diet coke.. I am going to tell her that If a patient requests items like that and I am currently busy even with my charting, to please take those items to them.. I have told my tech 2 or 3 times to get a patient a sprite and once I saw that is just wasn't going to be done, I just do it to myself rather than hear the call light dinging away

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

Absolutely you MUST get better at delegating. There is no way to survive otherwise. Too bad on sour looks. Not your problem. If the secretary calls you for something the tech can do ask if they called the tech and state you can't get in there. If someone is in pain at change of shift let that nurse know you still have other reports to get and ask her to give the pain med before she/he leaves! They know very well it's not ok to hand that over and let the patient suffer! You don't have to be confrontational, just matter of fact. Partner with your techs. They can share valuable info with you and you with them. The more you are able to partner with them, the more pride they can take in their job, the more they will sense you respect them and the more cooperative they will be. It isn't being bossy, it's developing a working relationship.

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

If I read that right, you've stayed FOUR hours extra, THREE nights in a row. THAT'S a big deal. Like it or not, the almighty dollar rules your hospital and that is a huge red flag to them. I know you think you can't do it any other way, but I'm kindly telling you that if you don't figure out time management quickly, they will find someone who CAN

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

Exactly. Three shifts that go four hours over is the equivalent of working an entire 12 hour shift just for charting. I don't think there is a hospital anywhere that would not find that excessive. You can do this. Find the senior nurses on your floor and ask for some tips/help.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

You really need to delegate. These techs are shirking their duties because they have been allowed to. When you give up and get the drink yourself when they are (presumably, based on your post) not doing incontinence care for the 20th time while you're asking...you are showing them that they don't really have to do tasks as delegated by the RN. They know that if they don't do it, you will. If they are refusing to do their jobs, they need to be reported up the chain of command.

I've had days myself where I barely get anything documented, and it generally takes me an extra 15-20 min, but never more than an hour. That included in an LTACH where I'd have five patients sicker than med-surg ones and on ventilators with huge wounds (some of which could require 2 hours of just wound care.) Ask yourself what about your documentation requires over half an hour per patient. Regarding getting the dot to turn green, someone where I work showed me how to get a "required admit documentation" tab on the main screen where you first select the patient. I can't remember what she did, or else I'd try to give you the steps...but someone in your education dept. should know how to do it. You just click on the tab and it's one flowsheet that has all the required stuff--minus the education plan and the Braden scale. The education plan can always be added onto later; even if you only add one item, it's done. Now if your admit rolls up less than an hour before handoff though, let go of that need to finish it all. Nursing is 24/7/365, and there are things that it is fine for you to pass on. For the PCS, what I do is copy forward the previous one, then BEFORE validating it, go down the flowsheet myself and change what needs to be changed. That way it is all my assessment, and if there is an error from the previous one I'll catch it, but it saves time not to have to enter data into every. single. box.

As others have said, four hours late is a huge expense for the hospital. That's why it's such an issue.

Well, it wasn't every day it was wed morning. And the night before I left 2 hours late. I think what takes me longest to chart is on my care plans. I may have 10 care plans to chart on per patient and type it out. I was just really behind on medicines wed morning and it was because of the restraining of the patient. It took an hour with all of us in there. I'm working tonight so here's to a new perspective!! I really am trying I promise yall! Like I said, I have gotten out at 0730 and 0800 before. I had been doing really good and it was like I lost my element for a week. We just don't have much help really. We have a charge nurse who takes 6 patients and no PCCs at night at all. I will keep yall updated on my progress. I want to be great at what I do.