A VERY frustrated nurse

EwaAnn · Feb 26, 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.

You're not alone:yes:

EwaAnn · Feb 26, 2015

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.

Hey Babydolltoo:

It's good to hear from you because even the experienced ones can go thru the same as the newbies.

meeche26 · Feb 26, 2015

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

I total feel your pain, I have not even graduated, yet. But just from working in the hospitals, I have seen a lot of why you re talking about.

Twinmom06, ASN, APN · Feb 26, 2015

I'm not sure what version of EPIC you're using but with ours once the care plans are populated, we do a daily clinical evaluation goal and then close out the care plans at discharge. If a new diagnosis comes up (such as isolation) we then add the care plan.

As far as time management goes, cluster your care. If you have 2000 and 2200 meds do them all at once. It doesn't matter if the 2200 heparin shot is given at 2000 or vice versa. Right now I'm on days (orientation) and you bet that 1000 Lovenox is given at 8 - ain't nobody have time for 2 trips. One thing they taught us in school is that med dosing is for the doctors convenience. You can bet that pt's don't say "oh its 0800 time for this med, oh its 0900 time for this med" - they just swallow them in a heap at breakfast with a cup of coffee! Daily meds are ok to give on YOUR schedule.

as for charting, I make it a priority. I see all my patients, assess them and then sit down and give myself a half hour or 45 minutes to chart the daily assessment. After that its just hourly rounding charting.

I'm nearly 2 years out and I rarely leave late (unless its late report or an RRT happens at shift change). It does get better - I promise.

nurse4ever08 · Feb 26, 2015

If you know you need a bp for meds, take the machine with you and the meds. Round with purpose. Chart as you go. Chart by exception not long drawn out notes. You can do a paragraph note at the end. Do bedside report with day shift. Ask questions then not worry about was or was not done. Patients asking for frequent snacks? Take it in on your rounds.

blondy2061h, MSN, RN · Feb 26, 2015

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!!!!!!!!!!!!!!

Also, charting off the clock is a HIPAA violation, because it's illegal to access electronic charts of people you're not actively assigned to care for.

blondy2061h, MSN, RN · Feb 26, 2015

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.

Is this a second career for you? You are wise beyond your experience.

blondy2061h, MSN, RN · Feb 26, 2015

As far as time management goes, cluster your care. If you have 2000 and 2200 meds do them all at once. It doesn't matter if the 2200 heparin shot is given at 2000 or vice versa. Right now I'm on days (orientation) and you bet that 1000 Lovenox is given at 8 - ain't nobody have time for 2 trips. One thing they taught us in school is that med dosing is for the doctors convenience. You can bet that pt's don't say "oh its 0800 time for this med, oh its 0900 time for this med" - they just swallow them in a heap at breakfast with a cup of coffee! Daily meds are ok to give on YOUR schedule.

This could be a huge no-no in some places. Our Lovenox is given later in the day so if the physician/PA/NP comes in at 0900 and decides they need a CVL placement/bronch/egd/colonoscopy/Bone marrow biopsy/LP/picc removal/et al it's not too late to hold it for the day.

Twinmom06, ASN, APN · Feb 26, 2015

I was using that as an example...our Lovenox is scheduled for 1000 - and orders are placed by 6 am to hold if necessary. Ok so lets not use Lovenox...we'll use an antibiotic. scheduled for 0900 and you're in at 8 to give PO meds - hang it anyway!

RNnewbie2014 · Feb 27, 2015

Well, the past 5 days I have gotten out a 0830. I felt a like I've done a little better. I am seeing a lady in the hospital about time management and she will be helping me. She thinks I may have ADD because a lot of nurses who have ADD have a hard time with time management. I was caught up pretty good until 0530 when I go to give a patient medications and boom the messed is totally messed up from urine. Not that I care but I had to go get the linens and all that jazz and it took 30 minutes to do it all. The patient was 90 years old. We only have 1 tech now and they only do vital signs and accu checks when they have to take all 33 patients vitals.. So I didn't get done passing meds until 0700. I saved the PEG tube for last. I feel like its the morning meds that get in a bind more than the night time meds. And trust me I do get a lot of my VS if they aren't done by 2030. I like to start on my medicines early if at all possible and of course like 95% of my patients are on BP medicines. I do cluster my care a lot.. One thing I have never given is a lovenox shot early.... I mean if its due at 2300 sure give it at 2200 but I don't give it at 2000. Didn't know that was okay? These patients were pretty good but the weeks before I had some serious doozy patients.. I had a major complainer the past two shifts. Dilaudid q 2 and lap chole with hernia repair. Wanted their soup heated up, wanted a wheel chair, wanted this and that and everything else.. Lol Oh and now see big drama happened.. That 90 year old pt had wet the gown.. Well I had a patient that needed blood so I delegated that task to my tech. I told the tech hey can you please get the pt in la la la a new gown. She said okay.. Well at shift change the family come out there freaking out bc the patient has urinated on themselves (pt wears briefs for incontinence) and saying omg what happened.. My so so said they needed a gown and yall never brought one.. Then the day shift PCC asked me about it and I said i told the tech to get the pt a gown and the pcc was like did you follow up with it? and said no.. and she said you should have.. Anyway now that tech heard about it and was gotten on to about not doing what she was supposed to because she said that she thought the patient only wanted a gown.... I probably should have been more clear but I guess if a 90 year old wants a new gown I don't feel like you flop it down in the room and hope she sees it when she needs it.. Anyway now I look like the bad guy because it looks like I was trying to get her in trouble when my PCC asked about it.. Working with women ga!! My tech is 29 and I am 24 and sometimes I wonder if its an age thing. I ask her questions about BPs and she's like if its critical I am going to let you know.. But I also care if their borderline hypotensive before giving them a BP medication. I don't think they take me seriously

EwaAnn · Feb 27, 2015

Well, the past 5 days I have gotten out a 0830. I felt a like I've done a little better. I am seeing a lady in the hospital about time management and she will be helping me. She thinks I may have ADD because a lot of nurses who have ADD have a hard time with time management. I was caught up pretty good until 0530 when I go to give a patient medications and boom the messed is totally messed up from urine. Not that I care but I had to go get the linens and all that jazz and it took 30 minutes to do it all. The patient was 90 years old. We only have 1 tech now and they only do vital signs and accu checks when they have to take all 33 patients vitals.. So I didn't get done passing meds until 0700. I saved the PEG tube for last. I feel like its the morning meds that get in a bind more than the night time meds. And trust me I do get a lot of my VS if they aren't done by 2030. I like to start on my medicines early if at all possible and of course like 95% of my patients are on BP medicines. I do cluster my care a lot.. One thing I have never given is a lovenox shot early.... I mean if its due at 2300 sure give it at 2200 but I don't give it at 2000. Didn't know that was okay? These patients were pretty good but the weeks before I had some serious doozy patients.. I had a major complainer the past two shifts. Dilaudid q 2 and lap chole with hernia repair. Wanted their soup heated up, wanted a wheel chair, wanted this and that and everything else.. Lol Oh and now see big drama happened.. That 90 year old pt had wet the gown.. Well I had a patient that needed blood so I delegated that task to my tech. I told the tech hey can you please get the pt in la la la a new gown. She said okay.. Well at shift change the family come out there freaking out bc the patient has urinated on themselves (pt wears briefs for incontinence) and saying omg what happened.. My so so said they needed a gown and yall never brought one.. Then the day shift PCC asked me about it and I said i told the tech to get the pt a gown and the pcc was like did you follow up with it? and said no.. and she said you should have.. Anyway now that tech heard about it and was gotten on to about not doing what she was supposed to because she said that she thought the patient only wanted a gown.... I probably should have been more clear but I guess if a 90 year old wants a new gown I don't feel like you flop it down in the room and hope she sees it when she needs it.. Anyway now I look like the bad guy because it looks like I was trying to get her in trouble when my PCC asked about it.. Working with women ga!! My tech is 29 and I am 24 and sometimes I wonder if its an age thing. I ask her questions about BPs and she's like if its critical I am going to let you know.. But I also care if their borderline hypotensive before giving them a BP medication. I don't think they take me seriously

Sometimes it makes me wonder how and what these techs think. They too can ask questions if they are not sure about something. I mean if these techs are mothers how do they think at home? do they forget how to think when they get to work?

RNnewbie2014 · Feb 28, 2015

I guess in my opinion, I think our specific techs are viewing their job as a task oriented job. I am not saying it isn't but I feel like they don't understand how imperative it is for vital signs to put in in at timely manner or the purpose for outputs to be documented.. They may appear as just tasks to them, but they are evidence of patient well-being.. Especially a JP drain or a new colostomy. If my vital signs aren't in by 2015, I start doing them on my own. I am still going to continue to work on myself every day. I have faith that I will get better. Who knows where I will be in 2 years with time management. Hopefully, in a good place lol I don't plan on being med-surg for too long at least I don't think. I haven't decided. It's hard to think about going from somewhere like that to labor and delivery where the mechanisms of thinking are totally different.