hi, all! after i get my 5 id/med/surg pt assignment and reports, i'm already behind. once everything hits the fan at 8am, it may be 1pm before some of my pts get their 8am qd meds. i'm trying my best to set priorities, but giving pain meds, hanging iv antibiotics/antivirals, blood products and transferring everyone here and there for tests (we usually don't have a unit sec), and doing tech work (we don't have enough), and still everything seems to snowball. when 6pm rolls around, i totally start to freak out, knowing how much documentation and work still needs to be done. i've made up an hour-by-hour organizational sheet for each pt, which i keep in a binder, with a different tab for each pt, but i can never catch up. any thoughts on how to keep things running calmly and smoothly? thanks in advance!
In many facilities the aides do the morning vitals and chart them to be ready for the nurse who is doing meds. That way the only vitals the nurse needs to repeat are the ones with specific parameters with them. Or the vitals which were out of the norm. It helps to speed up process in the morning.
Yeah but what morning hour are talking about? Like 5 am?I noticed that during my rotation the nurses obtain their vital signs from 5 or 6 am hour for the 7 am morning report.If you ask me that is unsafe especially with BP,it does not hurt to take BP of your patient 10 minutes before you about to administer the med...And anyway the vital signs can change within minutes and sometimes there isnt enough ancillary staff.
2 patients? wow. Are you a new grad on orientation? I would be happy with even 5! With 2, I dont understand how there could be any possible way to get behind. Our BP meds are usually scheduled 1 hour after vitals are taken and I dont retake them, I dont have time to retake a bp on every patient receiving a bp med, no way. If I need one retaken, I ask my CNA to do it. I have too much responsibility and too much to do so I delegate when needed. Delegating was hard for me to do in the beginning.
Yeah but what morning hour are talking about? Like 5 am?I noticed that during my rotation the nurses obtain their vital signs from 5 or 6 am hour for the 7 am morning report.If you ask me that is unsafe especially with BP,it does not hurt to take BP of your patient 10 minutes before you about to administer the med...And anyway the vital signs can change within minutes and sometimes there isnt enough ancillary staff.
You assume that all hospitals operate like those you're experiencing in nursing school. My hospital, and I'm sure it's not the only one, has each shift take VS for that shift...therefore the VS I'm reviewing are at most 30 minutes old. Something to think about: how many people do you imagine take their own BPs at home before every dose of BP medication??
Unless it's a newly prescribed med (therefore reaction to the med isn't known) or one that can have an adverse effect on HR or BP or there's something going on that can affect BP or HR you don't have to take VS immediately before administration. Also, I think we can safely assume these aren't very high acuity patients we're talking about if the OP has 5 patients.
2 patients? wow. Are you a new grad on orientation? I would be happy with even 5! With 2, I dont understand how there could be any possible way to get behind. Our BP meds are usually scheduled 1 hour after vitals are taken and I dont retake them, I dont have time to retake a bp on every patient receiving a bp med, no way. If I need one retaken, I ask my CNA to do it. I have too much responsibility and too much to do so I delegate when needed. Delegating was hard for me to do in the beginning.
I'm a forth semester student and that is why I only have two patients,I cant take full load while being in nursing school,I think that would be unsafe as my instructor has at least 6 students under her wings and she cant be there with me all the time...to clarify why I'm behind doing my work for two patients,well days,patients stability of the health status cannot be predicted from day to day,I'm on tele floor and the CNA dont help me (since I'm just a nursing students) I have to take vital signs of my two patients (cant rely on 5 am vital signs),do total assessment,pass usually six or 7 meds fo each of my cardiac patients,do the total care,check if they are going to any therapies,then monitor I/O since this is tele floor,in the mean time do frequent rounds for safety,IV running or Hep lock status,chart,monitor patients (in case the complain about chest pain,palpilations,fatigue),do patient teaching before discharge (cant use regular razor,since most of them are on aspirin or anticoagulants,but nobody told them that,and they use regular razors in the hospital!),and I'm descrbing a good day,any questions of why am exhausted,oh and I forgot to mentioned other patients requests who are not assigned to me (please fluf my pillow,could you save this food for me,can you bring me water,can you talk to me)
i would give anything for a 5 pt. assignment! i work on a neuro/ortho/spine/med/surg floor from 7p-7a. on average i get at least an 8 pt. assignment (lately it's been 9 pts) on a 32 bed floor while sharing 2 pct's between 3rn's and 1 lpn.
btw, i work for one of the largest healthcare providers on the west coast of florida in the tampa area.in my hospital, i was told in so many words that only recently, nurses were commonly given 11 pts and i would have to find what works best for me because the nurse/pt. ratio's weren't going to change. "uh oh, what have i got myself into this time?":cry:
i hear your frustration rt. i am a new rn (8 mos) and still having a hard time getting my "gameplan" together. even the best gameplans often fail:wink2:. dont despair rt, you will eventually formulate a gameplan that will work for you in most situations. here's a brief gameplan that works for me:
1. arrive 20 mins prior to receiving report...get cardex's for your assignment.
2. quick chart scan...current orders, mars, docs progress notes, imaging and lab results. i take no more than 2 mins at each chart max.
3. after getting report, hitting every room briefly with an introduction, quick visual scan of the pt. (fluids, dressings, drains, pca's, cpm's etc.)
4. pull all my meds, giving a quick 5 min assessmnt of my pt. after passing his/her meds.
5. chart my assessments.
as you know by now, this is all subject to change at any given moment as conditions warrant ( like getting 3 admits the first 1.5 hrs of your shift:banghead:.
as a side note, i'm not sure how much longer i can last at this pace. with the economy the way it is, i feel like i'm trapped with few options. maybe i can write my senators and congressman and request a bailout:idea: anyways...just my
The hardest part about the day shift on med surg in the morning is dealing with interruptions and getting back on track.
Breakfast trays, patients needing to go to the bathroom, phone calls, early visitors with questions, doctors with questions are all important and can really get you behind in assessments and meds.
A fairly uncomplicated set of patients would have me charting my final assessment by 1000.
I learned to just keeping slogging through and eventually by afternoon I would get caught up and the pace would slow down.
The hardest part about the day shift on med surg in the morning is dealing with interruptions and getting back on track.
Breakfast trays, patients needing to go to the bathroom, phone calls, early visitors with questions, doctors with questions are all important and can really get you behind in assessments and meds.
A fairly uncomplicated set of patients would have me charting my final assessment by 1000.
I learned to just keeping slogging through and eventually by afternoon I would get caught up and the pace would slow down.
Amen! And how about those family phone calls asking how the patient's night went when you haven't even *seen* the patient yet and it's your first day having them??
dear god, im in my last semester of nursing school for my ADN, and I couldn't even imagine 8 patients, ESPECIALLY without CNAs or other assisting staff members for the RNs.
Props to you floor nurses. I'm most LIKELY going into a Med/Surg unit when I graduate to get the "floor nurse" experience and skill base, then hopefully going into ICU as soon as I can afterwords while I go to my RN-BSN
To all you experienced and hardened nurses here, thanks for sharing your "gameplans" and experiences to us newer and future nurses! It means a lot.
I'd love a five patient assignment, but then again I work in a completely different area.
I do evenings in sub-acute rehab (which gets more and more acute by the day) and can have up to 8 patients. I always take care of the same 4 semi-private rooms. Right now, I have 6 pts (but I'm expecting admissions of course..) This is my routine on a typical day, when no one is having a major crisis, and there are no admissions.
3pm-Get report & do narc count. Stock up my med cart for the evening if it needs stocking (fresh water, pudding/applesauce if I have any crushes, cups, gloves, etc.)
3:15-3:45ish: Quick rounds to make sure everyone is ok and has no immediate needs. Then make out the tech assignment sheet with who needs temps, blood sugars, special weight bearing restrictions, precautions, any stool/urine specs needed, etc. Then the other nurses & I will give report to the techs.
3:45: Start 4pm med pass & assessments. Typically our assessments are focused (CSM/PP, edema, incision, etc for orthos, LS, o2 sats etc for resp, IV site checks, etc) Everyone gets at least one set of vitals q shift (by me, our techs don't take vitals except temps), and since I get to know them well due to their long stay, I take 4pm vitals on anyone I know doesn't have a BP med due later in the shift. If they are a new admission, or have BP/HR/02 sat issues, I check them more frequently.
4:30-4:45pm--Get my 4pm blood sugars from the techs, give any insulins while they are on their way to the dining room for dinner.
4:45-5:45pm--Catch up on any new orders, labs that are left over from day shift & need to be reported to the MD/NP, try to write some notes or sign off some treatments.
5:45pm-Start my 6pm meds (which are typically just Coumadins, occasionally a lidoderm patch to remove or a BP med to give) and document meal percentages. Then if it's not crazy I try to take my break.
7pm--Catch up on some notes/treatments, get everything ready for the 8pm med pass, which I usually start between 7:15 & 7:30 (we have an hour either way) because I combine in any dressing changes, etc that need to be done.
8:45-9pm--Finish the 8pm med pass, wipe down the med cart, take out trash, etc. Finish up on some documentation.
9:30-10:15pm-Do last rounds, give 10pm meds, make sure everyone's pain is ok and that I'm not leaving any pressing issues for the next shift. Then finish up documentation and report off.
However, I still never seem to get out on time. Maybe because "good days" like the one I've described above are few and far between LOL.
lovehospital
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Yeah but what morning hour are talking about? Like 5 am?I noticed that during my rotation the nurses obtain their vital signs from 5 or 6 am hour for the 7 am morning report.If you ask me that is unsafe especially with BP,it does not hurt to take BP of your patient 10 minutes before you about to administer the med...And anyway the vital signs can change within minutes and sometimes there isnt enough ancillary staff.