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
Being a new nurse in a hospital environment is hard. The biggest this is developing a routine that works for you and knowing how and when to delegate. You will have techs that will give you an attitude and try to see what they can get away with. You will also have ones that are totally awesome. Now, since your having trouble getting everything done the next statement is going to sound crazy but once you get a routine going, its not, I promise. Show the techs that you are willing to help them out too, it will go a long way and they will be more apt to help dig you out of a hole the next time you need them. Utilize your hospital educator and see if there's shortcuts in your computer system that maybe you didn't pick up on in orientation. I worked agency for HCA when they just started using computerized charting. I was doing the head to toe several page form on my patient every time an assessment was needed because they were every four hours for that floor. The agency never told me about the nice little button that would take my first assessment and then just chart any changes...a staff nurse did about a year later...I could have kissed her (but didn't) and club the agency computer instructor (but didn't). Needless to say, charting got one heck of a lot less time consuming. My routine was always to assess everyone first, then medicate those in pain, and then depending on the time either chart then meds or start charting/pass meds/finish charting. After that I dove into care. Sure, incidents will come up like the hell day that you had the past three days, but hopefully with a routine you won't be stuck very late or very often. The hospitals will forgive OT here and there, but what they were pointing out was what they were seeing as a pattern, and if it was four hours even once a week, that's around 16 OT hours a month and it adds up when it comes to budget and you will see your patient ratio's get worse to compensate for that budget loss. Also, as another poster stated, nursing is 24/7...if an admit roles down the hall 30 minutes before shift change. I would suggest settling the patient into the room and doing the first head to toe assessment. The reason for this is the patient should at least be assessed upon arriving to the floor. A lot can happen in 30 minutes and then things get hairy. But the rest of the admit can wait for the oncoming shift. You've assessed that patient so you at least know what's going on with them. Most facilities have a time frame that the admit has to be completed, when I was in acute care it was 24 hours. Yes, the oncoming shift may complain about it, but remind them that the patient just arrived and at least everyone else is clean and medicated at the start of their shift. Good luck, you'll get the hang of it!
I work in a critical care area and spend maybe 30 minutes a shift charting combined on my 3 patients. Not to toot my own horn too much, but I think my charting is usually pretty thorough and accurate, too. Now, this has cut back dramatically since I was a new grad now that I've gotten used to the flow of the check boxes. But something is up that it's taking you 4 hours to chart on 7 patients. Is it possible you are over charting? How is charting set up in your EMR? Is is free text? Check boxes? Charting by exception? Does your hospital have especially lengthy charting requirements compared to what you saw at clinical sites elsewhere? Are the computers unreliable and that's slowing you down? Are you so tired you're unable to fully pay attention to your charting? Please don't tell me you're continuing to provide direct patient care after your scheduled hours and you've given report. Even with 7 patients you don't have some down time between, say, midnight and 3 am?
Specializes in Care Coordination, MDS, med-surg, Peds.
Sorry, but this is terrible terrible advice. It is against the law to do this. One concern is: What if you trip and fall while sneaking to the back room? worker's Comp? NOPE you were off the clock. What if you are seen by a Doc who asks you to help, would you refuse because you are charting off the clock? Nope? Yep? and if you did help out and something goes wrong.. who is at gonna get in major trouble---YOU for being off the clock and working. NOT GOOD not good idea at all!!!!!!!!!!!!!!
My guess is you are overcharting. There is a such thing as being TOO thorough. Ask your manager if there are any workshops in your facility on time management.... maybe that can help? You do just have to get into a routine. We are a very busy surgical floor as well, with high patient turnover.... and I can promise you if I stay past 8am it's because someone tried to die at shift change.
I feel your pain & I was a seasoned nurse. Keeping it real - I really want to say something positive to ya. I think it all depends on the unit you are on as to the support you get. I too, experienced what you experienced & there just wasn't much teamwork. My unit/shift had only 1-2 CNA's that would actually do their job & wanted to work with you. I rarely got off on time and I too got in trouble about time management. As to positive comments, it is really hard for me to come up with some because I haven't figured it out yet. Another RN who was frustrated. I say that now because I was one of the "seasoned nurses" they got rid of after working at a hospital for 25-30+ years. I will say a prayer for you & I feel your pain. [PS - there are some nurses/cna's who leave on time because they aren't doing there job like they should, even if they are experienced or not] Hang in there & I hope it gets better for you & you can find some help.
I understand completely your need to make sure your patients are taken care of. As far as the Tech's go. Is may be the way you are stating that needs to be done. For example people will say Do you Mind doing this or that. Instead of saying Mr. Jones in 153 needs a blanket. Each person should know their job title and duties. As far as the Nurses who report off to you. If they are leaving medication's not given to a patient then your manager may need to know that. I would mention it to the that Nurse first, if their was a legitimate reason or a 1 time incident then I would keep quiet. Patient's missing prescribed medication can be serious. Talk with the seasoned Nurses and be willing to learn from them. Also your Tech's can help you a lot. Should you find yourself having a problem getting out of there on time, you will need to talk with your Manager and ask for help. Patient care should come first and if they are not willing to acknowledge that you are trying to do your best, you may need to look for a job somewhere else.
I'm also a new grad nurse and have been on my own for two months now. A few pieces of advice:
1. Use your shift change report time wisely if you are continually finding things not done from the previous shift. We do shift report in front of a computer and actually look at the med list, lab results, and vitals on each patient. If you have to do it bedside, take the computer with you. If there are meds not given, I ask why. Sometimes there's a valid reason to delay a med. If there are labs that should have been addressed (ie replacing electrolytes, calling docs) and that hasn't been done, again I ask why. We also look at orders and if there are orders that haven't been completed (ie labs that haven't been drawn, etc), then again I ask why. Sometimes I tell the previous shift not to worry and I'll take care of doing something that hasn't been completed (such as if they've had a particularly strenuous shift or it was a simple oversight). Sometimes I ask them to please do that before they leave. Sometimes there's a valid patient-based reason that something needs to be postponed and will now be occurring on my shift.
2. Chart as you go. There are millions of little moments throughout the shift where you are standing around for a few minutes. Patient is toileting and you can't leave, you're waiting for a doc to call back, you're trying to get Zosyn to reconstitute, you're waiting for a blood pressure to take, whatever. Chart during those moments, even the times as short as the blood pressure taking! It's amazing how much you can fit into your day that way. Learn the keyboard shortcuts to make charting as fast as possible. I almost always have all of my charting caught up to within an hour. It has been a lifesaver when patients have suddenly gone critical and had to transfer to ICU. I've had one shift when I stayed 1.5 hrs over - and that was because three patients were all experiencing serious nursing-intensive complications at the same time and the oncoming nurse and I were both doing active bedside care between the three patients for those 1.5 hours. I was incredibly glad that my charting was all caught up throughout the day when that happened.
3. Be the example of teamwork and inspire it in others. There are shifts that are easier than others. Make use of those shifts to build up your unit karma. Starting in orientation, I have made a point of staying busy 95% of the time, even on my slower shifts. When my patients don't need anything, I am helping other nurses. And I never ask "Do you need anything?" because this is a female-dominated profession and the answer to that question is almost always "no". I say "you look busy, give me something to do to help." and 99% of the time, the nurse pauses to actually think of what they can give me to do. Or I offer something specific like "do any of your other patients need meds?" or "can I go get you anything from the supply room?". This has a much higher success rate in actually being allowed to help. I also do this with the techs. Because my charting is almost always caught up, I have time to tell a tech I'll answer this particular call light or I'll take that pt to the bathroom. And again, female-dominated profession, so I say something like "Oh, I can get this, I know you are busy." to make sure that they know I'm being helpful and that it's not that I think they are incompetent. Building this helpfulness karma has paid off when I've been swamped. There are still some nurses and support staff who are just lazy and should be fired, but that's everywhere. In general, though, I have experienced teamwork and I know that a large part of it is that I am viewed as a helpful part of the team and not another new grad who is taking up everyone's time and energy. I've had nurses tell me as much.
4. For your specific situation as described: Use your charge nurse. Given what you have said in subsequent comments, this amount of going over is not a normal occurrence for you, so I am assuming that this patient assignment was just extra nuts. You need to tell the charge nurse this kind of thing. Assignments can be split up or shifted around for the next shift to redistribute patients appropriately based on care needs and acuity. It's a simple as going to the charge nurse (which would have been the day shift charge by the time you were leaving) and giving the most pertinent facts and stating that this patient assignment needs to be split up for your next shift or if nothing else that you need a different assignment because this one requires a more experienced nurse. Nursing is not a good fit for martyrs or isolationists. The nurse who works three 16-hr shifts because she tries to do everything herself is just putting the patients at risk of serious harm. It doesn't make you a hero, it makes you extra tired and more likely to make a serious mistake that could kill someone. Nursing is shift work for a reason - if everything can't be done, then you prioritize and leave some things undone. If you don't have the ability to handle a particular assignment, ask for an assignment change for the safety of the patients. Making nursing assignments based on nursing competencies is evidence-based practice because not doing so hurts patients.
I too love nursing and trust me, it does not always get better. The best thing you can do for yourself is to know that you were thorough and your patient is better because of you. Also, sometimes we just have to hand off so work for the next nurse to do. It is difficult but try to chart as you go. I too had a hard time getting everything on time and sometimes on nights we would get up to 9 patients. Our patients were 24 hour seizure monitoring, fresh strokes, plus overflow med-surg. On our floor we sometimes had 2 PCAs but usually only 1. Hang in there and talke with your supervisor and show her you want to learn better time management. It is a challenge, but then we are nurses and that is our job. Pioritize. You will be fine and in a year will look back and wonder how far you have come. Here are lots of hugs. OOOOOOOOOOOOOOOOOOOOOOOOO
Dear Newbie, you will "get it." You had a really rough shift, and you're new. You probably have a paper "brain" of your notes from report, right? Re-design it, at home, and for yourself. I had to re-design mine many times over 40 years of nursing. I usually listed my IV fluids right next to the patient's name or initials and room number. And during your shift, relax unless there's an "ABC" emergency (Airway, Breathing, Circulation). If someone is breathing, not bleeding, not seizing, not losing circulation to a body part, then they are not your priority. The patient who wants a coke can wait for the tech. You are secure in what's important for your patients. Go get 'em, nurse!
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..
Dear RNnewbie2014. For starters you are new and have not developed a system yet. Secondly, there will be nurses that will leave things for you do when it was up to them to complete. They are taking an advantage of that (believe me) but it is expected of you to complete everything before the oncoming shift. (Good luck with that one when you have a million things to do). And if you don't do something, they are on you like vultures. So believe me I really do know your pain because I was put in the same shoes. One day I had a discharge which the nurse manager took care of fore me, an admission which I was not aware of, a patient where a change is status took place and was sent to the hospital, another patient change rooms and came to my side. He asked me about new orders for pain medication which I checked but could not get back to him right away, an upset family member, meds to pass, medicate patients with pain meds before they went to therapy and demanding patients. This was all in on the same shift. I didn't eat lunch til late. I was happy for the shift to end. BUT I had to sit down and chart. Trust me, I was there for hours. What ticked me off the most is when my relief asked me to flush an IV when the supervisor was on the next unit but did not want to come over. I was behind as it is and she had the nerve to ask me to do another task because it was convienient and the nursing nursing supervisor would not have to come. I said "NO". Trust me I got in trouble for the overtime. Things were happening-how in the world am I supposed to leave on time after a day like that. Sure they helped me but I was trying to stay afloat. Yeah I was crying inside. Yeah I feel your pain. Really I do. Sometimes it's hard to get organized and stay organized, I get the same crap with the CNAs.
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..
Everyone aclimates at their own rate. Yeah she thinks you should but she is forgetting she was once there too.
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
Be careful because when you tech see this they will expect you to do it all the time so they don't even think of answering the bells
I get the same crap with the CNAs.
NurseSpeedy, ADN, LPN, RN
1,599 Posts
Being a new nurse in a hospital environment is hard. The biggest this is developing a routine that works for you and knowing how and when to delegate. You will have techs that will give you an attitude and try to see what they can get away with. You will also have ones that are totally awesome. Now, since your having trouble getting everything done the next statement is going to sound crazy but once you get a routine going, its not, I promise. Show the techs that you are willing to help them out too, it will go a long way and they will be more apt to help dig you out of a hole the next time you need them. Utilize your hospital educator and see if there's shortcuts in your computer system that maybe you didn't pick up on in orientation. I worked agency for HCA when they just started using computerized charting. I was doing the head to toe several page form on my patient every time an assessment was needed because they were every four hours for that floor. The agency never told me about the nice little button that would take my first assessment and then just chart any changes...a staff nurse did about a year later...I could have kissed her (but didn't) and club the agency computer instructor (but didn't). Needless to say, charting got one heck of a lot less time consuming. My routine was always to assess everyone first, then medicate those in pain, and then depending on the time either chart then meds or start charting/pass meds/finish charting. After that I dove into care. Sure, incidents will come up like the hell day that you had the past three days, but hopefully with a routine you won't be stuck very late or very often. The hospitals will forgive OT here and there, but what they were pointing out was what they were seeing as a pattern, and if it was four hours even once a week, that's around 16 OT hours a month and it adds up when it comes to budget and you will see your patient ratio's get worse to compensate for that budget loss. Also, as another poster stated, nursing is 24/7...if an admit roles down the hall 30 minutes before shift change. I would suggest settling the patient into the room and doing the first head to toe assessment. The reason for this is the patient should at least be assessed upon arriving to the floor. A lot can happen in 30 minutes and then things get hairy. But the rest of the admit can wait for the oncoming shift. You've assessed that patient so you at least know what's going on with them. Most facilities have a time frame that the admit has to be completed, when I was in acute care it was 24 hours. Yes, the oncoming shift may complain about it, but remind them that the patient just arrived and at least everyone else is clean and medicated at the start of their shift. Good luck, you'll get the hang of it!