Advice please!

[RNurse2]

I have been working at my first job for four a little less than four months now. It's a busy med-surg floor. I had a pretty lengthy preceptorship compared to some I've seen here, but I don't think it was very good. I don't know though because I don't have anything to compare it to.

Anyway, I'm really really struggling with time management. I feel so guilty when giving off going report because I either have to leave things hanging for the next nurse to do (while I spend an extra hour or two catching up on charting) or because I don't know about things concerning my patients when asked such as particular lab work because I haven't had time to look. I have read to try brain sheets, but things change throughout the shift so much that I don't think another sheet of paperwork would be that helpful for me. We have SBAR sheets for each pt when we get report and then I have a sheet that I put notes on of things I need to remember to do or chart. Not to mention I really don't have time to try to get much organization going on because I can't come in more than 5 minutes early and my work phone is ringing with fires to put out often before I'm finished getting report.

Then there are discharges and admissions and often having to work without an aide. Then there's all the tasks that pop up for me to do that are new to me that I have to stop, track someone down and ask them to help me (they are busy too and I know they will soon be sick of it). Add to the top of that the other stuff the company mandates such as hourly rounding grids in the room etc.

I am so overwhelmed. I cry a lot. I want to be good at my job so bad but feel like a total failure! I think it may be normal but I don't know. I see my coworkers getting off on time and even having time to chit chat sometimes and I am jealous of their abilities. If what I am feeling is normal for a new grad, I think I want to be abnormal.

[itsnowornever, BSN, RN]

I am nearly 7 months in and just started feeling settled about a month ago. There are still nights when I have 3pt instead of 2, or the dreaded 2 admits at once and OMG-I-HAVE-TO-START-THE-INDUCTION-NOW!!!! When that happens I just stop. Take a moment, breathe, and do one thing at a time. Remember priorities! You will figure it out.

Posting from my phone, ease forgive my fat thumbs! :)

[itsnowornever, BSN, RN]

I am nearly 7 months in and just started feeling settled about a month ago. There are still nights when I have 3pt instead of 2, or the dreaded 2 admits at once and OMG-I-HAVE-TO-START-THE-INDUCTION-NOW!!!! When that happens I just stop. Take a moment, breathe, and do one thing at a time. Remember priorities! You will figure it out.

Posting from my phone, ease forgive my fat thumbs! :)

And might I add, I'm leaving this floor and moving to a new one, so back will come the anxiety (though I don't suspect it will be as bad since I've fought tooth and nail for this new position!)

Posting from my phone, ease forgive my fat thumbs! :)

[decembergrad2011, BSN, RN]

How many patients are you managing? What service lines are attending to your patients?

I've found that the best thing for me is to use my custom brain sheet. It highlights what's important for my patient population. We give a lot of blood products and electrolytes where I work, so I have an area to write the hemogram and bmp results. I know first thing in the morning if I need to activate standing orders for blood products or call the doctor. I would look up my labs during report if you have a computer handy - my floor regularly communicates abnormal or important labs shift to shift but I do look up the full set of labs first thing in the morning. Then I look up and write down every med for the patients in their corresponding time column on my brain. Then I will look at their pending labs and such. In about 5 min per chart, I can get a really good picture of their day. My brain is just a written guide for me, but it is the process of filling it out that is most beneficial for me.

Some random things I do to manage throughout the day: I go in with my techs to give baths or at least help turn to get a look at their skin. Gather all supplies you need for the entire day (that you know of...you can't always anticipate the orders) and place it in your work area or in their room. I will make sure I have normal saline flushes in every patient's room if I'm accessing their central line often. I make up chemo tubing all at the same time. I chart my goals/shift note anytime after 4, and try to put things in as soon as I can so its charted and not waiting for me at end of shift. I look in on my patients every 2 hours at least, but I give them space if they are basically able to complete ADLs. I go over what I'm doing with every med, dressing change, intervention throughout the day and ask the patients if they have questions at the time - it saves a lot of time from them calling out later. Delegate some things, like drink refills, to your tech.

Some days you won't get it all done on your shift, and that's ok. Nursing is a 24 hour job for a reason. Figure out what's important for the patients on your floor and focus on that.

[RNurse2]

I have 6 patients if I am in total care. Yesterday, I had 6 when I got to work. I discharged 3, and admitted two. I did have someone helping with some of the paperwork, but the tasks that go along with discharges and admits still falls on me. Not to mention, discharge paperwork has to be double checked, so I still had to do that. I can have up to 7 patients, but I have already told my manager I flat out cannot handle 7 at this time. And there are MANY days we don't have anyone to delegate to. And if we do have them, it's usually one for the whole floor, so they may have 20+ patients.

[RNurse2]

I would love to have 30 minutes when I first get there to look at stuff and write down important information, but I often have people calling me to pre-op a patient, to start an 18 gauge in the AC for another patient for their procedure and another patient needs help to the bathroom and another one wants something for nausea, before I am even finished getting report. Just being able to have a minute to breathe and take in all the information before I start my day would help. Plus pre-opping a patient and starting IV's are very big tasks for me, because it's still so new. I'm not very good with IV's and don't really know well what pre-op entails. I'm sorry to vent, I am just feeling like I am drowning.

[decembergrad2011, BSN, RN]

This sounds like an environmental issue, meaning your staff is not well-equipped to deal with shift change. You should be able to get a full report without being interrupted routinely. There are days that I hit the floor running, but I always get report first, and if a patient calls out, the outgoing nurse answers it since they know the situation better. What does your supervisor say?

[MissM.RN, BSN, RN]

hi Rnurse2! so sorry you're going through this. I think it's great that you want to be a great nurse and have set your sights on that - some nurses sadly don't. That said, agree with previous posters. Get a customized brain sheet stat. I get to work at least 15-30 mins before shift change to read up on my patients, find out what times meds are due, what has been going on, etc. If you haven't swiped your badge (ie 1900 or 0700) then don't answer those call bells. Take that time for you. Fill your pocket with flushes, alcohol swabs, IV caps, claves, etc to save you time having to go back to the cart to get supplies. Put a granola bar in the other pocket :) to take care of yourself!

Are you on a med-surg floor? if so, 1:7 nursing might be ok. 1:20 for CNA?? no way - I would talk to your union, trusted other RNs, or maybe your manager. You have got to get support with the low level tasks in order to succeed with the RN tasks. A thorough discharge or 3 checks on the new medication order are far more important than bringing an LOL to the restroom. Plus, why would your hospital want to overpay for the task, if a CNA could have done it? I hope you get the clinical support you need.

[salvadordolly]

I really don't have time to try to get much organization going on because I can't come in more than 5 minutes early and my work phone is ringing with fires to put out often before I'm finished getting report.

Sounds like your unit is poorly staffed/disorganized altogether. Get your report and get organized before your shift and do not take the phone until you are "officially" on the clock. Be firm about it. If you miss things in report, it will come back to haunt you some time.

[TnRN43]

I had to double check to see if I had actually posted this!!! I promise you, you aren't alone. I am only 8 weeks in, with 3 weeks of orientation left though. We have 7 pts also. I run the entire 12.5 hrs and hardly ever get a minute to stop and think. I suck at giving report too-I just don't know a lot of the stuff because I flat out didn't have 3 seconds to find it out! I can't imagine that in 3 weeks time I'll be any better at it either. We also have hourly rounding and our cna's have 13-14 patients a piece. Yes, I have been paged for a potty call, on the phone with a doctor, had sbar called up for a new pt, have meds for one patient in one hand and a pt standing at the desk wanting something. I have the absolute best preceptor with the patience of a saint, but sometime I just look at her and say "you are kidding, right?" when she reminds me of yet something else that I have forgotten or need to do. The turnover on this med surge unit is crazy and with good reason apparently. I have been told repeatedly-if you can work this unit, you can work anywhere. And I fully believe it! So have faith that you are not alone. Oh, and I have also typed up a custom brain sheet, but as you said-when the crap changes every 15 minutes, that stupid sheet doesn't help me a bit. I feel your frustration, trust me!

[NewbieNurse1]

As far as getting/giving report, it often takes way longer than it should (when you do a walking report) because of distractions and interruptions. I think it would be beneficial to tell the tech/CNA that you will not answer call lights etc while giving report, even though you are out on the floor. It is too important and info might be missed or left out. Make a sheet with reminders (last BMs, skin assessments, etc) or whatever is helpful for YOU! Other nurses might look at my sheets and think they are strange, but they work for me and help me stay on task. Don't be too hard on yourself, you are new and nursing is a very intense and demanding job. You will develop a routine and things will get easier!

[RNurse2]

Thanks to everyone for your encouraging words. It helps to know that I am somewhat normal.