Last night was my first shift with my own patient load.

In our new grad program we spend our first week doing the corporate, OHS, manual handling etc orientation, we then spend a day on ward orientation, then we have 5 days as a supernumery, buddied up with a preceptor with increasing responsibility.

Anyway last night was my first shift without that, and it did not go well to say the least.

And it's not like I sat around talking, I didn't get a chance to sit down at all. I felt like I was always rushing around trying to get stuff done, but I was always behind. Other RN's were asking me have I done this or that (trying to help me) and I was always saying no not yet, then they would remind me that I needed to get it done. (which I was aware of believe me)

I'm strugging to keep up.

I feel like I don't get time to actually talk to my patients. It's so frustrating and it's really getting me down. The other new grads seem to be coping, why is it just me?

I felt like crying last night, it was horrible.

My first night out of orientation on my own was the worst night of my life. The family of a patient that I admitted even told my manager the next day that she didn't anymore new nurses. It was that bad.

I am almost a year and a half in and I have people tell me all of the time I seem like I have it together. Like many of us on here, you will most definitely have more than your fair share of breakdowns and insecurities. This is a hard job. A lot of people do not realize how hard it really is. Believe me when they say it takes you a year to get your groove -- they are right. I feel like it took me exactly a year to the week. I still have my ba-aaaaddd nights but nurses who have been around for 50 years have the same exact days. You just get over them a lot easier with time. I still have my insecurities from time to time but I have gotten a lot better and trust me if I can do it YOU CAN TOO.

Also my preceptor taught me something VERY important -- to hit the *delete* button when you go home. I used to go home thinking about every single patient I had and what all I did and what did I do wrong and blah blah blah. Nowadays if you ask me who I took care of the night before I couldn't even tell you half the time. In a good way -- it's REALLY nice and you will come to it.

Keep up your chin!

I've been in your position before, wondering how other nurses made it look so easy... until I got to know them better and found out they were feeling the exact same way I was! Its a tough job, cut yourself some slack, and good luck!

Michelle, I think every new nurse goes through what you're feeling right now. I remember driving to work one day and realizing that for the first time, I was not afraid to go to work. I'd been a nurse for a year.

When you're new, most of what you see is brand new to you. Sure, you've learned the theory and you've seen a lot of stuff already, but in nursing there is so much to learn that if you ever get to the point where you think you know it all, you'd better quit. I've been a nurse for quite a while, but I learn something new every day.

Your stress level will go down as you gain experience. Your time management skills will improve. New nurses sometimes complain (jokingly) to me that by nine p.m. (I work 12 hour nights) I've done all my assessments, given all my meds, and done all my charting, while THEY haven't even had time to glance at their patients yet. This is basically true, even when things are very busy, but of course there are nights when I can't seem to get caught up.

Here's some practical advice:

After you get report, take a few minutes to work out a game plan. This means setting priorities. Some things must be done RIGHT NOW, but those are rare. There are certain things that have to be done at a specific time (meds, lab draws, etc.). Other things have to be done during your shift, but not at a specific time (this includes charting). Other things fall into the category of things you'd like to get done, if you have time.

Your game plan will consist of ways to get as much done in the shortest time possible. This doesn't mean racing to and fro; it means being efficient. I do my assessments around 8 o'clock p.m., and I work in an ICU/telemetry unit, so I have up to four patients. If a patient has an 8 p.m. med, I'll bring that med with me when I go to do the assessment. I do all of my assessments without stopping to chart. If there is something I might forget when I do go to chart (such as a patient's breath sounds, or how many liters of O2 they're on) I jot a note to myself.

I usually save my sickest patient for last. If I know it will be a while before I get to that sickest patient, I'll go in that room first, introduce myself to patient and/or family, take a quick look around to see how the patient is doing, and explain that I'll be back soon to do my assessment. This way I know what the situation is, the patient/family know they are not being neglected, and I'll have more time to spend with that patient when I come back to him.

If I have meds due at nine and ten for the same patient, I plan to give all of them at nine thirty, although of course this is not a hard-and-fast rule. I try to spend a chunk of time doing everything I need to do with each patient, instead of running back and forth between rooms. I anticipate what I'll need to do with each patient, and be sure to bring any necessary supplies with me.

I've learned that it's very helpful to involve the patient in my plan, and adjust my plan to the patient's needs. If my patient has a PRN sleeping pill ordered, I'll ask if and when they prefer to take it. I'll explain ahead of time that we check vital signs at midnight and four, and we draw labs around four. This way the patient knows what to expect. I also work with the nurses' aide so we're both on the same schedule. When she goes in to do vital signs, I go with her to do my assessment, give any meds that are due, draw labs, etc. so the patient isn't constantly disturbed.

Every time I do a task that will need to be charted, I jot down a note. "2330 20g IV" or "0145 dilaudid 2" or whatever, just enough to remind me what I did and when so when I go to chart, everything I've done for each patient is right there.

If I have to draw labs at a certain time AND the patient needs his IV site rotated, I'll plan to start a new IV when those labs are due and draw the blood off the new IV. The patient gets one stick instead of two, and I accomplish two things at once.

I loosely schedule "charting time". This is a time where I know I'm caught up on the task part of my job: my patients are stable and comfortable, my IV fluids are not about to run dry, etc. If the night is very busy, it may be late in the shift before I have time to chart, but since I've been jotting down notes all along on each patient, it doesn't take very long.

When other nurses are available to help you, take advantage of it! One of the most difficult things for a new nurse to learn is how to delegate. Don't get angry when you see another nurse sitting at the desk with nothing to do while you're drowning. Ask that nurse to start your IV, give a patient some morphine, check a blood sugar, whatever you need done. Thank that nurse for helping you. And when you get caught up, ask your co-workers what you can do to help them.

Ask your fellow nurses for advice. Observe them to see how it is that they manage to get so much done in so little time. Nurses are clever people, and most of us are more than willing to teach you our tricks.

You will get into the swing of things, and when that happens, you'll gradually find yourself having more time to enjoy the best part of nursing: talking to your patients and being able to truly make a difference in their lives. You'll get there!

Of course you're overwhelmed! You're doing something very new, and very involved, and nursing is hard work. REALLY hard sometimes. One of the things that I did, from the very beginning, was to pick my shift apart on the 1 hour ride home from work. I'd analyze what I did well, what could have been better, and what I should never do again. And I'd come up with ideas to try and improve the way I worked, be more efficient, etc. It helped me a lot.

Just keep breathing, and keep working. Try to stay as levelheaded as possible. It will get better, bit by bit.

Meanwhile, HollyHobby is spot on.

Best wishes, and happy thoughts to you!

HollyHobby,

Great post! I find myself doing many of the same things you mentioned as time management strategies.

Keep in mind, you are one person, and nursing is a 24 hour job. I feel great when I can get everything done, and leave nothing for the next shift. But, this is not always possible. I have 20 months on the job, and I had a really horrible night recently. The nurse I gave report to kept asking me if I had done this, done that, what about this, what about that. And I kept having to say no, I didn't do this, no I didn't do that, I don't know about this or that, didn't have time to research. (This particular nurse is notoriously hard to give report to.) Anyway, I felt REALLY bad and like a failure, but I had not sat down all night. It wasn't like I was shooting the breeze at the nurses station all night. So, when I came back the next night, the nurse looked frazzled, and said "no wonder you had such a bad night....that group was hard!" So, then I felt much better that she understood what I went through.

When I get on shift, I try to always do my chart checks first so that if anything didn't get done during the day, I can make sure it gets done during my shift. Or, if any meds were D/C or added and not noted on the MAR, I can make sure I am giving what I am supposed to. When I go to see my patients, I at least go look in on the most unstable patient first so that I can make sure everything is OK, even if I don't do a full assessment at that time. I try to get at least a couple full assessments done before I start meds. Then, I will do the rest of my assessments as I am passing meds. I try to chart my assessment at that time, but I dont usually write my note at that time.

Like HollyHobby mentioned, I will ask the patient when they want their sleeping pill. With their 2100 meds? Or at some other time, or just wait until they call? Also, I try to address pain issues at this time as well. Do they want me to bring in pain meds every 4 hours and wake them up, or wait until they call? I try to time pain meds so that I have something I can give in the morning, and in some patients just go ahead and bring in a pain med at the same time as morning meds. That way, I don't get called in the middle of shift report. I find these things keep the patients happy and make less hassle for me.

If I have worked several days in a row and most of my patients are the same, I will go see the patient I haven't had before first so that I can make sure they are stable. Then, I organize my time by the following principles:

1. Things I MUST DO during my shift (meds, charting, dressing changes, change tube feeding bags)

2. Things I SHOULD DO during my shift (I should change that IV that expires in the morning, I should clean the room)

3. Things I WOULD LIKE TO DO during my shift (I would really like to give that total care man a shave)

Keep plugging along. It will get better.

When I'm with a new nurse who's feeling overwhelmed, I always remind her: do the ABC's. Do your patients have airway, breathing, and circulation? Good!

Next comes meds, since you have a limited time frame to give them. Bundle up your care. You can give meds, do an assessment, and provide poofy care at the same time. Hint: when going in to give meds, chances are the water glass is empty, so bring a glass of ice water with you. And the glucometer, and the thermometer.

Use the chit-chat time as your neuro assessment. Do you know where you are? Why did you come to the hospital? What year is it? Steer the conversation away from counting how many grandchildren your patient has, and what year she got married, and the personal downcomings of her daughter in law. While grandma is talking, nod and smile and make appropriate comments while you feel her pulses, measure her edema, and flush her IV.

The best way to test your ventilated patient's reflexes is by giving oral care. (What happens when I shove this thing down your throat?)

Before the end of your shift, check on your patients once more to be sure no one is lying in poo, they have water and fluffed pillows, box of kleenex, IV bags are full, etc. This will minimize interruptions during report.

Be aware that even unconscious patients can somehow sense shift change, which causes them to poop. It is a reflex.