A VERY frustrated nurse

RNnewbie2014 · Feb 20, 2015

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

allnurses Guide · Feb 20, 2015

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 · Feb 20, 2015

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

allnurses Guide · Feb 20, 2015

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 · Feb 20, 2015

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.

RNnewbie2014 · Feb 20, 2015

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.

cardiacfreak, ADN · Feb 20, 2015

Do you have a charge nurse? It is okay to ask for help, and it is okay to delegate tasks to others if they are capable of completing those tasks. Hang in there, time-management isn't something learned over night.í ½í¸‰

allnurses Guide · Feb 20, 2015

One thing I have learned...nursing is cyclical. You will get those awful shifts now and then, but then it gets better. Eventually it comes around again. And then it gets better again. And round and round it goes. Hang in there. You obviously have everything it takes. You will find those hell shifts get less frequent as you grow into your role.

jadelpn, LPN, EMT-B · Feb 20, 2015

Op, bring the computer on wheels with you room to room. You need to do an assessment before you can do anything else. And monopolize your favorite tech for the first couple hours of your shift. "I need you to be my wingman until your first break. Come with me...." And be 100% sure you chart as you go.

The hours after a shift and things are not as fresh in your memory as they are when the occur. Chart as you go, go down the line. Have your wingman help with the turning, repositioning, cleaning, doing vitals as you assess....and getting that diet coke while you are finishing your shift assessment.

Best wishes!

valpo_rn01 · Feb 20, 2015

If you're using EPIC, you can make yourself a custom "canned text" care plan or two, so that you don't have to type the whole thing out on every single patient. You would only need to fill in the blanks. It takes a little time to set up, but will save you hours in the long run. Ask your EPIC support people for help.

JustKeepSmiling, ADN, BSN, RN · Feb 20, 2015

Why are you typing out long careplans in Epic? They should already be there or you can pull in a new goal and you just have to document the progress or resolution.

onedayitllbeme · Feb 21, 2015

I feel ya girl (or guy)! I've been at this gig (days) for about 7-8 months and I still have those days where i don't clock out until 8:45pm for no great reason. Usually I clock out before 8. There are some corners to be cut in epic I'm finding. Do I really need to put the whole daily cares as I was taught? Mouth moisturizer versus teeth brushed? I don't think so. I chart more by exception and the charting police haven't come after me yet (and yes they exist) NO shortcuts with pain or its charting of course but I really try to chart to what is required and helpful.

My weaknesses are staying too long with patients I think and just taking too long to do chart checks, call doctors, and there must be more. I'll figure it out I hope.