A VERY frustrated nurse

joemomma35 · Feb 21, 2015

It takes experience to become efficient at getting out on time. My first 6 months or so, I was considerably later than my coworkers and I ate a lot of crap over it. I was also very thorough and assigned to the most challenging units in my facility, and I made sure that the management knew that.

Eventually everything became second nature and I was pretty consistent at getting out at a reasonable time as long as nothing major came up.

If they're really on you a lot, then just clock out early on some late nights. It's not fun to work for free, but you're still in the learning stage and it's much better to be able to keep your job than to lose it over a few hours a week of lateness. Try to be open with the manager about it, tell her you're learning and trying your best to get out earlier. I wouldn't necessarily mention that you plan on clocking out early, because they legally cannot encourage you to do that.

And do your best to not openly complain about it. No hospital wants to pay out the extra money to someone who is consistently late, even if it's not really your fault - you're new, and practically every new graduate has those feelings of self doubt.

dannibeeRN · Feb 21, 2015

What you're going through is all a part of being a new nurse. I'm sure many of us have had similar experiences. The biggest issue for me was learning to delegate. I was a CNA for 6 years before I became an RN and I was so used to being the one being delegated to. I quickly learned delegate to my techs and ask for help from my charge whenever I was drowning. Speak up for yourself and your sanity.

As far as "what's the big deal about staying late?" You will soon see that hospitals are all about their money and most places don't like to pay "unnecessary" OT. My hospital has to pay double time anytime after we work a full 12 hours so they do all they can to get us out on time.

Hang in there! You're new and probably feel like you've been thrown to the wolves but things will get better. Work HARD on your time management. Set time marks for yourself. For example, finish passing meds and charting initial assessments by 2200 or finish your care plans by 0200. Once you find the right flow, life will be so much easier.

MatrixRn · Feb 21, 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.

Whoa! 10 care plans per patient! Clearly I do not work in EPIC, and if this is the charting system I am glad that I don't.

I worked nights as well, we had a tech until 11pm, after that we were on our own. And yes, at night no tech and putting someone in full restraints will make you late in the AM no doubt.

You are doing well, just keeping plugging away. :yes:

NightOwl0624 · Feb 21, 2015

I think there is some really good advice on this thread!

I remember being brand new, running around all shift wondering what in the world I was doing wrong (as the more experienced nurses were sitting around, reading, on the internet, etc). I remember their encouragement and time management tips, and they were right, it does get better.

Currently, there is a nurse on our unit who has terrible problems with time management. She is not new, about two years in. She regularly stays late to chart (or punches out and hides while charting, which in my opinion is not ok). Even when she is having a calm, quiet night she cannot get her work done. EVER. This is what I have noticed about her:

1. She goes by task and will not group things together. For example, if a medication is timed for 0900 and an antibiotic is timed for 1000 on the MAR, she will go into the room twice to do each thing separately, where as most nurses group things together. (I bring all meds that can be given, do wound care, assessment and chart the major things all at once before moving on - when possible). I don't know if this is an OCD thing where she has to do each thing separately, but she literally runs around all night for nothing.

2. She cannot say "NO". You could go ask her to clean out the entire refrigerator in the break room and she would stop everything and go do it. People take all kinds of advantage of her.

3. She cannot focus on her own stuff. While she wants to be helpful and sociable, she needs to focus on her tasks at hand and not get into every conversation or go off and help other nurses when her own stuff needs attention. I sometimes think she may have an unaddressed ADD issue.

4. When charting, she seems to want to "reinvent the wheel". For example, in EPIC I often use a template (as in copying in my last assessment and go line by line updating or filling in as needed). And doing care plans should not take hours, really, especially if one already exists for the patient.

Not sure if any of this applies to you, but want you to know that even more experienced nurses may have problems and need help. I understand where you are coming from, having 7 patients is more than I would want to handle each shift. However, I think others are right when they say that management DOES see this as a big deal and it WON'T be tolerated for very long.

Good luck, you can do this!

RNJill · Feb 21, 2015

Wow, 7 patients is definitely a lot. (I had 5 on a specialty/med-surg-ish unit and that was quite enough. Anyways though, no matter what happens you have to get out earlier...NOT just for the facility but for your own mental health!!! 16 hour days will burn you out so fast!

A couple of ideas...1) it is okay not to be able to finish everything that is ordered/happens in your shift. Even for the super type A amongst you cannot be dealing with a new admit, carrying out orders put in at 1850 and doing shift report simultaneously. Nor should you always be staying late to do all of that stuff. There is another shift who can at least assist with if not complete the "overflow" tasks. Do NOT feel guilty about this!! Be calm and honest about the status of patients/tasks and know that you will graciously return the favor for someone. Seriously though, this is a move that can save you upwards of 30-45 mins (IMO)

2) Chart at least some as you go. You probably can't chart your full assessments in real time but even completing some of the charting in the moment (part of an assessment, pain scores, etc) will cut down on the burden later in the shift when your brain is getting fried and you have new admits.

3) With patients who constantly call tell them very kindly that you we be back in x time and will bring coke/pain meds/etc. This may cut down a bit on unnecessary calls; if they still call about piddly things remind them sweet that you'll bring it in with their meds. In the same vein if you have a unit secretary asked them to take numbers of family members calling...that way you aren't suddenly pulled to the phone and out of your routine.

3) Find ways to make the most out of the first couple of hours of your shift. Lay eyes on everyone at least quickly (bedside report, although torturous in some ways, can help with this), assess/address immediate needs. This way, even if things hit the fan you cut down on the chance that patients will feel like they haven't seen their nurse for several hours. This will help you feel like you're more in control.

4) Cluster your meds!!! Often if one is once a day the pharmacy will adjust if for you without an MD order.

5) If you need help and someone asks, accept it!! Don't be too proud...it will make a difference in your day.

6) This is possibly a little controversial, but don't agonize over the silly parts of our charting. Definitely chart accurate assessments, I/Os, relevant pages to the MD, but all of that care plan/goals for the patient/etc is just garbage not worth spending precious minutes fussing over.

good luck! In a few short months you'll be amazed at how far you've come!

Nurse Katelyn BSN PCCN, RN · Feb 21, 2015

I can relate, I have gone through similar situations at my job as a new RN and it's hard. You will get faster with time.

7 patients is a lot of work and it's tough. Try not to get caught up in what your tech's think (easier said then done I know!). Your both there to do a job and give great patient care. Don't be afraid to delegate too. Ask and look at what the tech's are trained to do. If it's not critical, delegate it with a balance.

Have you tried charting in the room before? It was very helpful to me.

Good luck

whofan, ADN, BSN, RN · Feb 21, 2015

If you are running behind, I think it may also be a team work issue. A busy med-surg floor requires teamwork, with the aides and the other nurses. Every couple of hours the more experienced nurses should be asking you and each other if they can help you catch up, by doing a task such as toileting/or other ADLs. It can be hard when you first start, but time will get better, and if the teamwork is off then maybe you need to float to other floors and find one that is a better fit. Not everyplace is for everyone. Many nurses at my hospital hated to float but I found that I was unhappy on my floor due to various reasons, and I volunteered to float and once I found a consistently nice area to work in I transferred. Do your best, and as hard as it sounds don't get the attitude that it all lies on you. Nursing is 24 hours, and day shift has more procedures, doctor visits, families, and other activities. Just go in do what needs to be done and if you don't get 100% done then pass it on. Ask for help when you need it.

Gooselady, BSN, RN · Feb 21, 2015

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

Well, there you go (((hugs)))

Your coworkers are getting done on time because they aren't completing their shift's work Oh, the irony. Your feet are to the fire about over time and how expensive that is to the hospital, but are your less conscientious coworkers having their feet to the fire about incomplete admissions? Leaving the med rec incomplete is like a 747 taking off without engines. Durrr.

So money (naturally) is more worthy an issue than incomplete shift work. Unfortunately welcome to nursing in the real world.

My dear friend who still works at my previous hospital reminds me of you. Very conscientious and thorough, really using her assessment skills, really intent on the patient getting the WHOLE of their care. She would totally call a doctor at 1 am for a Geodon order. People know we are friends and commented to me "is there any way you can tell Susie that her reports are wayyy too detailed and long?' I know that's how Susie IS and thinks. To her, it's not done correctly or well if it's not ALL done, period.

Still, you and Susie work in the real world of nursing where the irony is just too much sometimes! Susie has to speed up, and so do you. It's really not a ding on you personally, you can't look at it like that. Your time management is NOT a reflection of your worthiness as a person. Your time management is like any tool, it's how you USE it that counts.

I think you will have a ton more job satisfaction if you take a long hard look at how you manage your time, and then reprioritize your priorities. You are very likely doing more than you need to do here and there. Shaving off five minutes several times in a shift is 15 extra minutes of charting! That's a lot of time.

What you BELIEVE must be done in a certain way should be examined, too. There are several correct ways to do a single thing. Some of those ways save time.

ALL nurses as new as you struggle with time management. I doubt your manager is shaming you publicly for your over time, or even thinking badly of you. She's just informing you. You can choose to accept the information as neutral, rather than a generalized, sweeping 'knock' against your credibility as a good nurse. It's a choice every new-ish nurse must deliberately make, to not take it all so personally :) Even when it is

You are already a fantastic nurse, as conscientious as you are :) Just allow yourself to be polished by the real world of nursing. I think you will be FINE, I really do!

ComeTogether, LPN · Feb 21, 2015

Regarding the issue with your techs..... Maybe I can offer some insight....

You mentioned you're new, and I've worked with several new nurses who were OH SO flustered. I can tell you from my experience that a lot of time they would overwhelm me because they were overwhelmed. I would just encourage you to make sure you aren't so flustered that you aren't piling things on them that could wait, or could be better prioritized.

Seeing your tech in the hall and saying "204 needs cheerios, 203 needs the bed pan, 212 needs a shower and 202 wants to change" may feel like you've delegated those tasks, but the tech is going to be completley overwhelmed with all of that info. Again, I have no idea if this could even be your issue, maybe you have lazy techs, I don't know. I just know i've had this problem in the past.

I really liked getting a verbal report from my nurse, just letting me know what was going on with my patients. Don't assume the last shift passed anything on, some do and some don't. When they would pull me aside at the beginning of the shift and prioritize the needs of the patients for me it would be very helpful, and it would let me know what they needed help with the most.

The other thing I would suggest is that doing the small things and not leaving every little thing up to the techs can go a really long way in them not getting overwhelmed. If they are good at what they do they work really hard and the job is extremely tiring, so even just filling ice pitchers etc. can free them up to do other things like toileting etc.

Mr. Murse · Feb 21, 2015

I don't like beating around the bush, so I have to say........4 hours late would be considered excessive no matter where you work. Surely you can understand why, and if you can't understand why then that may be part of your problem.

Two things that scream at me from reading your posts: learn to delegate better and ask for help.

Also, cutting corners is not always a bad thing. There are corners to cut safely and legally that don't put patients at risk. Learn to not be OCD about things, while still being through and accurate.

If most of the nurses you work with are getting out on time or close to it, and you're regularly staying 1-4 hours late, then it's something you've not yet caught on to, not them being bad nurses. I highly doubt you're the only one doing everything right and everyone else is cutting dangerous corners and skipping tasks. Maybe some of them are, but I doubt all of them. Which means you have some figuring out to do. Find a competent nurse who you respect and ask for tips.

And again.......learn to delegate and ask for help.

Seas · Feb 21, 2015

It looks like you need improvement on time management. You don't think it is a big deal, but it actually is. We don't have unlimited time for charting as we get paid for every minute. If you stay late for hours on a frequent basis, you will get in trouble. 4 hours is way too much for charting, even for a new grad.

ClaraRedheart, BSN, RN · Feb 21, 2015

Clock out at the appropriate time, hide in the back room if you must. Finish your charting. Time management comes with time. Charting late WILL happen sometimes. Just don't let management find out. I think that if you've had an unusually harsh assignment or had to transfer or deal with emergencies on your shift, perhaps staying late will be forgiven or overlooked, perhaps chalked up to circumstantial. If you're new, you should have some time to get the hang of charting quickly. You will eventually. I've only been on the job for about a year, but if I'm done with shift and behind on charting, I can chart like a boss and get it done quickly :)