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Balancing safety and time management for a new nurse

Nurses   (8,743 Views 10 Comments)
by Fiveten Fiveten (New Member) New Member

Fiveten works as a RN.

989 Visitors; 7 Posts

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Hello all!

I am a brand new nurse. I just completed my orientation. I work on an inpatient surgical unit. We get ortho patients, other surgical patients, and medical patients as well.

I am overwhelmed by the struggle to balance safety and time management. I come on shift at 7, have to

do my own vitals (aides are not allowed to do them on my floor), get my assessments done, and pass 8 and 9 o'clock meds within my first few hours. We have a great link to MicroMedex to look up meds, but I can't seem to find the time when everything has to be done in those first few hours. I try to be familiar with the meds that are passed most often on my unit, but the medications for the medical patients are overwhelming, especially one patient with TPN through a medi-port with a PCA and other medications piggybacked into it.

I am trying to learn to be proactive; clustering care and learning to push through assessments when a patient want to share personal stories or things irrelevant to their current hospitalization. More often than not, we have no aide at night. I can't say no when when a patient has to go to the bathroom when I came in to do their assessment. I can get them to the bathroom, have them pull the call cord when done, and try to get partway through another patient's assessment in the meantime.

We have phones that our patients can call directly and we are tracked on how often we answer call lights, etc. I am afraid to ignore a patient call as it could be important, but I am often in the med room when I get a call that a patient can't get their TV remote to work or something as trivial (although I know it is important to the patient and customer satisfaction percentages).

When everything has to be done "right away" and when my co-workers are often busy pushing through this beginning of shift rush as well, what can I do?

Also, how can I encourage patients to be more self-sufficient? I don't mind helping a fall-risk patient to the bathroom, but patients who could care for themselves at home a week ago are suddenly "unable" to adjust their own pillows. I came into nursing because I wanted to help people. I am quickly starting to feel that often times I am not.

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canesdukegirl has 14 years experience and works as a OR nursing.

2 Likes; 8 Articles; 36,784 Visitors; 2,543 Posts

It is so easy to feel overwhelmed as a new grad. I can definitely empathize with you! It sounds like you are doing all of the right things by learning the most administered meds on your floor, clustering your care and knowing how to continue your assessments when pt's want to chat. It is mind boggling.

I think that a lot of your frustration stems from not having an NA work on your floor. It sounds like you are being called away to a pt room when you are trying to get meds ready. Being interrupted when you are trying to get your meds ready is in itself, frustrating at best.

I found that the best "defense", if you will, is a good offense. When you start your assessment for a pt, go over some of the things that they can do independently. Show them how to do it, and then ask them to perform the task you are teaching. I have noticed that some patients are very receptive to positive reinforcement...they WANT to be engaged in their own recovery and by giving them some control (performing tasks independently that you taught them), they begin to adopt the mindset of a can-do attitude. Cheer them on, encourage them to do more as tolerated.

I love that you are implementing self-sufficiency in your patients. That alone means that you are focused on the recovery and the mental well being of your patients. This is evidence that you ARE helping people:)

Please do not be so hard on yourself. We all have days when we feel that none of our interventions helped. We can easily get overwhelmed with the sheer running around putting out fire after fire. It seems that sometimes we are never going to catch up. You feel that you are flying by the seat of your pants, and all you want to do is to ensure that you are giving safe and effective care for your patients. The bottom line is that we can only do so much...and thank goodness that we can rely on our co-workers to help out when they can.

Fiveten, know that things will become easier as you gain more experience. It seems overwhelming now because IT IS. I would be willing to bet that in a year's time, you will have your routine down pat and will get into a groove. Go to your NM for advice when you feel that your frustration is climbing (do this before your frustration becomes "crisis mode" for you). They can offer pointers and perhaps even offer classes that you can attend (like time management for nurses) to make your days easier.

Hang in there! You sound like you are doing all of the right things. I am cheering for you!

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1,619 Visitors; 38 Posts

I agree with canesdukegirl. Hang in there; it truly does get better. You are on the learning curve and going about it all the right ways.

Just a couple of thoughts. I'm not sure if you are prioritizing before you jump out of the gates. On your time off, if you dont have your own worksheet (organization tool) create one. This will keep you on track and in time you will not need it. Here are a few things to keep in mind when you are prioritizing. Before you jump out of report and start sprinting down the hall, glance at who gets meds at what time, make mental note of those that have antibiotics or set times such as Q6H; Those TID are important to give at 2100, but are not going to hurt if they are a little late (prioritize). Before you go to your first room have that first patient's medications with you. When you are called to another room, do that person's assessment as you are helping them to the bathroom (pulses when applying slippers; Lungs when you help them dangle (better assessment listening posteriorly), assess pain, glance at incision after or as getting to destination to see if it is oozing and jot down on your worksheet what supplies you will need to bring with you (ie...gauze, scissors, tape, look to see if they have ice and stuff for HS care) when coming back with there meds/pain pills. If you are responsible for HS care also; could put the stuff on BS table, take canesdukegirl advice, do teaching/encouragement (which you will need to chart per shift anyways) and let them know you are doing your medication pass, and will return ASAP.

But most importantly, continue what you are doing by looking things up and learning as you go. This will make you a stronger nurse, and is the right way to practice. SAFETY first. GREAT JOB :)

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619 Visitors; 3 Posts

Being a new nurse is a nightmare, isn't it? It definitely gets better, much better. I went from non-stop job-related anxiety for over al year to feeling like a relaxed diva.

My tips are: safety first, I quickly eyeball all of my patients, forget about a full-initial assessment, if I see someone who is in a less than safe situation I proactively make it safe for them. Put everything they need around them, including the phone. If an IV is running, I check it and the site (takes 3 seconds). If they are sleeping I make sure they are not breathing too quickly (an easy sign of distress - don't do the full minute count, a rapid breathing rate should be obvious).

Do this before vitals - it doesn't matter if one patient's bp is slightly high if another one of your patients is about to fall and hit his or her head. (I have seen that turn deadly). Bathroom time does take up time, if they can wait 5 minutes take that time to eyeball all of your patients quickly and then help them. If they are in distress help them right away.

If a patient is comfortable, safe and occupied (on the phone or into a TV show), skip over that patient and assess them when you have more time.

If all of your patients are safe, make sure your meds are all there, a very quick check, call pharmacy for all missing meds. Then do vitals and start your assessments. By the time you pass your meds hopefully pharmacy has come through.

That's my advice. You really have to adjust your thinking and realize you can't do everything, just make sure you do the important things and walk into patient's rooms with a calm attitude and speak with a soft voice. Nothing makes people more nervous than a nervous nurse. Good luck, you picked a great field, for some reason nursing school skips over the most important nursing skill, time managment.

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BrookeeLou_RN works as a disabled RN.

14,538 Visitors; 734 Posts

Encouraging patients to participate in their care is one thing, but just because they were a walkie-talkie a week ago does not mean they do not deserve your time and attention. Obviously if they are now inpatient something must have changed. Just keep in mind without the patients you have no job. :twocents:

That said...you are new at this.. give yourself a break.. it takes time to get all the ducks in a row every day, and some days the best of nurses have overwhelming feats to accomplish. Try to get up a plan to follow every day,, sure you will be diverted all the time but at least you can then go back to your plan to keep your self focused. Nursing is alot harder than any school program ever lets on...just keep improving every day and you will be surprised when you start to feel more confident. You are a Work in progress. :)

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locolorenzo22 works as a ortho neuro detox nurse, new tele nurse.

1 Article; 11,767 Visitors; 2,396 Posts

Oh, I remember those days. I worked a unit just like yours, we got everything except hearts we joked. It takes time.

Question: 8 and 9 oclock meds? why can you not give them together or at 0830 or save yourself time that way?

In terms of assessment and vitals, I am going to say you have GOT to do that ASAP. say you leave it for later and then something changes. how do you know what the baseline is? But do assessment with med pass and vitals, get em all done together. Medication wise, you have to study the most common meds for your common patients and get those down. I found a small 1000 common medication book at barnes and noble and it was a lot quicker than the computer.

With no aide at night, I would NOT leave your patient in the bathroom, if you do and they fall, you'll quickly be found at fault if you were in doing another assessment as you weren't really "watching" for that light. when you push through assessments, make sure to let your patients know that you'll be happy to talk with them later....when you have time. but make sure you go back and talk with them soon.

with those @#$@#$ phones, if it's trival, you just have to take a hard stance if management comes down on it and say, "I am getting my medications. the Joint commission and numerous studies have shown distracted nurses make medication errors. Do we want a culture that allows that here?" and just grow a tough skin. If the patient's call about that stuff, let them know you will be there as soon as you can, but they will have to wait.

When everything has to be done "right away" and when my co-workers are often busy pushing through this beginning of shift rush as well, what can I do?

It takes time to set up a routine and get it down. I didn't feel like a good nurse for at least a year. give it time. Also, those "walkie-talkies"? they are in the hospital and they want help because it's there. That's what we get paid for. we see it all in this world.

A personal question, but were you a CNA before becoming a nurse? Aides have a lot of skills that we don't always see. perhaps asking them for some points for vitals or clustering care, etc may help. do you have a preceptor or a mentor that could help? good luck, post back and let us know how things are working out.

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Fiveten works as a RN.

989 Visitors; 7 Posts

Thanks to all for your advice! I really do want to help my patients get better. It's frustrating with those phones. Would you beleive I had a patient who wanted me to call the nursing supervisor at 1 a.m. so we could figure out how to hook up his video game system?!?!?!?! I'm sorry, but my other patients need things that I can provide.

I suppose it's going to just take time. I'm always having to call another nurse to show me how to do something, etc. One day at a time, I gues..

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9,106 Visitors; 672 Posts

You could very well work on my unit from the sounds of it. Although we NEVER have aids on nights. Everyone has a different groove and I'm sure you will find yours eventually although it does take time. In the meantime, try different things. We do bedside report so that is when I "eyeball" my pts with the offgoing shift. Pt's room a mess, they are in pain, need more water, or IV bag about to run out? It's time to hold the other shift accountable and ask them to take care of A, B & C before they leave. If the IV bag will run out at some point during the night and they need to be on IV fluids I make a note and bring it with my first med pass. I also ask the patient how their pain is. If its a 8/10 or something and they will be due for pain meds around my first med pass I clarify that I will go ahead and bring them at that time. I write my name/phone number on the white board and tell them to call me if they need something urgently otherwise I will be back after I see my other pts. Pts that are ambulatory I ensure that they know they are able to get up and walk to the bathroom, especially if they have not been up yet, especially lap appys, lap choles, hernia repairs, plastics etc which will likely go home within 24 hours. Our facility has a policy for rounding every 1 hour between 6am-10pm and every 2 hours at night. I find doing this effectively on my pts eliminates call lights. I would say the majority of nights I work my patients do not call at all. When I go in to assess them I let them know when they are next due for pain meds, when their next antibiotic is, if they are going for a procedure what time it is and what the prep will include for them. If they are a frequent toileter I make sure to tell them I will be back in about two hours, if you need to go before then let me know, but know I will be back to check on you at xxxx (time).

Best of luck for you.

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1,212 Visitors; 33 Posts

Time management is tough, but practice makes perfect. After I first started out as a RN I would get to work 30 minutes early. I would go over my patients' charts and their meds. I would do this before even taking report. It helped alot.

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325 Visitors; 1 Post

Great to know that time management just takes, well, time to master. It certainly can be overwhelming! I am a new grad nurse on a busy surgical floor and feel just like fiveten described!

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