Always feeling rushed/stressed!

[TexasmedicRN]

How do you approach busy shifts? All my day shifts are super busy every morning till about mid to late morning. Some taper off and I just maintain based off the assignment. While the majority I don’t get caught up (finished assess/meds/charting ) till early to late afternoon. I feel a lot of anxiety if I am not caught up or finished with the essentials. Is there any advice on mentally how to approach your day when something monkey wrenches you’re morning and it puts you behind? A lot of times there isn’t really an issue with a sick or crashing pt, I just feel very stressed when everything is not done and perfect. I had one nurse tell me to just take care of the pt and don’t worry about documentation until all your pt’s are good. Then just catch up as you can.

[yupnv80, BSN, RN]

I disagree with the nurse. If no one’s crashing, you shouldn’t leave your charting near the end of the shift. That being said, this sounds like a typical day in med/surg. I hope things will get better in the future!

[DAL2010]

I think a lot of people have felt this way before. This is how I approached my shift when I worked medical:

• Get assignment
• Label report short for each pt (or one sheet, segmented off for each pt)
• Quickly glance at lab results, timed labs due, timed meds coming up soon
• Receive report from offgoing nurse. If bedside reporting, check wounds/lines/drains/critical drips with offgoing nurse. Let pt know you are meeting all of your patients for the day and you will circle back around in the next half hour or so.
• Jot down each pt's meds in 2 columns: scheduled and PRN (when last given or next available)
• Jot down tasks due for day: line/dressing changes, drain maintenance, tests/procedures for each pt
• Circle back to each pt as promised, taking fresh water with you. Check wounds/lines/drains/drips if not done with offgoing nurse. Take vitals (or review if taken by tech). Give am meds as appropriate and update pt to day's plan and when PRNs are available. Chart in the room while doing your assessment, or, 2nd best option: place your computer just outside the room door, and chart as soon as you exit. Please do not leave charting for later 'until all your pts are good.' I've seen that go south when pts crash/code and the charting is not current with the most recent assessment. Especially if the primary nurse is off the unit, and no one knows what's going on or how the pt presented before the code.
• Prioritize your tasks and complete in order of importance to pt need (which may not align with pt want). I know Karen wanted her Lorna Doone cookies 3 minutes ago, but Jim is having difficulty breathing and chest pain because his Pleur X needs emptied.
• Cluster care for each pt. It's okay to instruct pts to think of anything they might need from you and ask you all at once, or write it down for you to address on your hourly rounds. That way you aren't bringing meds one trip, then another trip for juice, then another trip for a blanket, then another trip for ice chips, etc.
• Delegate. If you have techs, let them do their work, and ask/remind them to do their work when necessary. Coordinate with them ahead of time to plan things like wound care if you need them to help hold a patient on their side to get to a coccyx or something.
• Let your peers/charge know when you will be unavailable for a period of time. "Hey, Pt SoSo has a tube and tons of meds, I'll be in room 402 for a while. Can you watch my call lights for me?" or "I have to start blood in 410. I'll be in there until about 1030."
• Recognize that things happen: pt conditions change, you have discharges/admissions/transfers, you assist a peer in a difficult situation, etc. It's okay. Take care of the emergent need, then refer back to your report sheet and pick up where you left off.
• Try out different report sheets to find one that works best for you as you gain confidence and practice in your workflow.

[AlwaysLearning247, BSN]

I think what your coworker was telling you was to not focus on charting before patient care (I agree). Make sure your patients have their meds, treatments, etc. then chart. If a patient is crashing, I like to chart in real time. For assessments, I do charting as soon as I can after my patients are situated. You’ll find your groove, good luck!

[myoglobin, ASN, BSN, MSN]

Early in my career I used to be a "care first" nurse and then pray for my "window of opportunity" to catch up on charting between midnight and around 0300 (before morning labs, baths, and medications). Over the years after getting burned with sudden transfer, admissions, and assignment changes I became a "chart first, except when critical patient issues are present" nurse. Thus, I will see that my patients are somewhat stable, not in pain that could be medicated, and safe (not trying to get up to the bathroom while intubated for example). If those issues are present I will attend to them and then do my initial charting.