Doing too much for your patients?

[Virgo_RN, BSN, RN]

I'm beginning to feel that one of the reasons I struggle so hard to get my documentation done is that I am doing too much for my patients. For example, I did not get two of my systems assessments charted until after my shift had ended and I had given report. While I was charting my assessments, patients and family members kept coming to me with requests, because I was at the nurses station (lesson learned, if I have to stay late to chart, go hide somewhere where I won't be disturbed!).

Anyway; it seems that often I spend a lot more time getting warm blankets, doing linen changes, bringing snacks, etc., than I should be. I know the aides are busy, but frequently when a patient or family member has a request, since I am right there, I just do it. The thing is, I have three other patients whose meds are getting passed late because I took the time to do these things that can be delegated.

My charge nurse wanted report, so I told her I'd be right there after giving two medications. I went into the patient's room, and could not give the PO med because the patient had slid down to the end of their bed and could not sit up to swallow pills. I poked my head out and asked the aide who was there (not the aide assigned to this patient, who I saw maybe once the entire shift) to assist me to boost the patient. We went to boost and discovered the patient's linens were soaked, so we did a linen change and cleaned up the patient. Now, this patient was a turn Q2 and incontinent, and that info was clearly posted on the grease board, plus aides on our floor give each other report, so I know the aide assigned to this patient had the info even if I never had an opportunity to directly delegate (because I could never find her when I needed her).

While another nurse was at her meal break, I was covering her patients. A light came on, and I was busy so I waited for the aide to get it. The aide never came, and in fact, nobody was getting the light, so I interrupted what I was doing to go answer the light. The patient's family member had put it on because the patient had been incontinent and needed a gown and linen change and needed a brief put on. He told me (very politely) that I was the third person that he had told. I went to find the aide to assist me, and could not find her. I asked another aide, and it turns out that the aide (same one who was assigned the above patient) had gone on a meal break but had not told me. So I asked this one to help, and we did the linen and gown change and put the brief on the patient. In the meantime, I'm falling further and further behind.

Last example; I'm in the room to give a medication, and the family member shows me a small wet spot on the top sheet and the patient's gown. Since I'm there, I'll help. But the linen closet is empty, so I have to go down the hall to the linen room to get a new top sheet and gown, then go back to the patient's room to change them. I would have felt like a jerk to track down an aide to do this since I was right there, but at the same time, the few minutes this is taking me is a few more minutes that I'm falling behind.

I ended up staying a half hour late charting assessments that I had done at the beginning of my shift. I know I need to prioritize better, but I have a hard time prioritizing charting over direct patient care, and leaving patients uncomfortable until the aide can get to them, and tracking down the aide to do something that I can do since I'm right there. Plus, it seems that any time I sit down at a computer to chart, I am continually interrupted by requests from patients and their family members. They come out into the hall and ask the first person they see (me) for what it is that they need, instead of putting on the call light.

Anyone else find themselves in this situation?

[Blee O'Myacin, BSN, RN]

I'm beginning to feel that one of the reasons I struggle so hard to get my documentation done is that I am doing too much for my patients. For example, I did not get two of my systems assessments charted until after my shift had ended and I had given report. While I was charting my assessments, patients and family members kept coming to me with requests, because I was at the nurses station (lesson learned, if I have to stay late to chart, go hide somewhere where I won't be disturbed!).

Anyway; it seems that often I spend a lot more time getting warm blankets, doing linen changes, bringing snacks, etc., than I should be. I know the aides are busy, but frequently when a patient or family member has a request, since I am right there, I just do it. The thing is, I have three other patients whose meds are getting passed late because I took the time to do these things that can be delegated.

My charge nurse wanted report, so I told her I'd be right there after giving two medications. I went into the patient's room, and could not give the PO med because the patient had slid down to the end of their bed and could not sit up to swallow pills. I poked my head out and asked the aide who was there (not the aide assigned to this patient, who I saw maybe once the entire shift) to assist me to boost the patient. We went to boost and discovered the patient's linens were soaked, so we did a linen change and cleaned up the patient. Now, this patient was a turn Q2 and incontinent, and that info was clearly posted on the grease board, plus aides on our floor give each other report, so I know the aide assigned to this patient had the info even if I never had an opportunity to directly delegate (because I could never find her when I needed her).

While another nurse was at her meal break, I was covering her patients. A light came on, and I was busy so I waited for the aide to get it. The aide never came, and in fact, nobody was getting the light, so I interrupted what I was doing to go answer the light. The patient's family member had put it on because the patient had been incontinent and needed a gown and linen change and needed a brief put on. He told me (very politely) that I was the third person that he had told. I went to find the aide to assist me, and could not find her. I asked another aide, and it turns out that the aide (same one who was assigned the above patient) had gone on a meal break but had not told me. So I asked this one to help, and we did the linen and gown change and put the brief on the patient. In the meantime, I'm falling further and further behind.

Last example; I'm in the room to give a medication, and the family member shows me a small wet spot on the top sheet and the patient's gown. Since I'm there, I'll help. But the linen closet is empty, so I have to go down the hall to the linen room to get a new top sheet and gown, then go back to the patient's room to change them. I would have felt like a jerk to track down an aide to do this since I was right there, but at the same time, the few minutes this is taking me is a few more minutes that I'm falling behind.

I ended up staying a half hour late charting assessments that I had done at the beginning of my shift. I know I need to prioritize better, but I have a hard time prioritizing charting over direct patient care, and leaving patients uncomfortable until the aide can get to them, and tracking down the aide to do something that I can do since I'm right there. Plus, it seems that any time I sit down at a computer to chart, I am continually interrupted by requests from patients and their family members. They come out into the hall and ask the first person they see (me) for what it is that they need, instead of putting on the call light.

Anyone else find themselves in this situation?

Whoa. You are doing way too much at once. If the patient is not in an unsafe situation, you need to delegate - find the aide assigned to you and state your needs. Since you are doing all of this yourself, the aide is undoubtedly busy with other patients, but yours need to be a priority as well. Med passes, report and charting at the expense of your leaving on time, should not wait because a patient has a spot of something wet on a gown and top sheet. That is something that can wait. Even a towel as a barrier between the patient and the wetness would have sufficed until you were able to get back to the patient.

I'm certainly not an advocate for leaving a mess for another co-worker, but you can't spend your shift doing what you are doing and expect to complete your job. To the patient's family member who politely told you that you were the third person he asked, apologize, and put it on your mental (or written) list. I once worked with a nurse who used sticky notes with her tasks and she'd rearrange them on a sheet of paper according to priority. She had her med passes and meal breaks in there too.

Being overly helpful can bite you in the behind sometimes. Even if you have to page the aide to room xxx, then do it. If the patient is a one person assist, find the assistance and go on to your next fire to put out.

I've had days like the one you've described, but I strive to make it the exception and not the rule. Good luck!

Blee

[missouriman]

I feel the same way.... we are supposed to be a team... yeh right.

I am going to let it hang out here...

you bet you are doing to much.... I was an aid while going to nursing school and if a nurse made a suggestion to you ... you got it done.. now.. it takes more time to explain to the aid why... then it takes you to do it..

we are way over worked for the care that, even I as a nurse would expect for a loved one.

I am a man, I have a kind face so I have been told.. I am always getting stopped, asked, because I look like a nice person... to care for other nurses patients...

yet if I try to get help.. I get that, well if you can't handle it, I will try to find some one to help you... right in front of the family...

I Know just where you are coming from...

I am about to snap and am so glad that I found this thread...

family comes out all upset that you are 5 min over the 2 hour turning..... I want to say. ( where were you for the last 6 months while their butt was rotting off)..

or.....why didn't you care for the last 5 years while they drank them selves silly...

aggggggggggggggggg going to stop for now..

but you and I and all nurses have lost control over the number of patients that we care for, the aids. our support has gone the way of no child left behind.

nurses are getting BSN's and don't know much.... I expect an aid that has never been to any school to know more then some nurses I am seeing today.

got me started

[Dolce, RN]

Nursing is so heavy and time consuming that we hardly have enough time to take care of our own patients, let alone those assigned to other nurses and CNAs. If another nurse's patient has a request for a simple thing like a blanket, water, crackers, etc then I will gladly get it for them. However, if you are already running behind you cannot spend all your time caring for other people's patients. I tell the patient/family that I will tell their nurse/CNA their requests. Nursing is a team sport, but if you are a new grad and are not getting your charting done/assessments completed/meds passed you really need to make time management your priority. When you have that down then you can work on the teamwork part of nursing. The fact of the matter is you cannot be in 8 places at once. There is only one of you and you can only do so much. Try to prioritize the needs of your patients and others patients. If it is not a priority you need to get your own tasks completed first so that you can get out of work on time.

[pagandeva2000, LPN]

This is hard, because I have been on both sides of the fence, was an aide, and am now an LPN. It does tear my apart to see a person soaked with urine and covered with feces. I also know that many times, the aide is caring for someone else in the same position. I have meds to pass. This could be me, my husband, son, or any loved one that I really care for. I work in a clinic, but did 6 weeks of med-surg orientation because I was a new grad last year. While oriented as a nurse, patients would ring their call bells for the bedpan, changes, many other things. At that time, because my priorities were to learn my position as a NURSE, I had to get someone else, and there was no guarentee that the patient would get assistance in a timely manner. However, at that time, I had to realize that I had to function safely as a nurse. I was still learning the medications, how to hang an IV, etc...and I had no choice. I don't know what to say, really. But, try and do the quick things, and complete YOUR work. As unfortunate as it is, you can help the aide with her work, but she cannot legally help you with yours.

[Becca608]

I'm beginning to feel that one of the reasons I struggle so hard to get my documentation done is that I am doing too much for my patients. For example, I did not get two of my systems assessments charted until after my shift had ended and I had given report. While I was charting my assessments, patients and family members kept coming to me with requests, because I was at the nurses station (lesson learned, if I have to stay late to chart, go hide somewhere where I won't be disturbed!).

Anyway; it seems that often I spend a lot more time getting warm blankets, doing linen changes, bringing snacks, etc., than I should be. I know the aides are busy, but frequently when a patient or family member has a request, since I am right there, I just do it. The thing is, I have three other patients whose meds are getting passed late because I took the time to do these things that can be delegated.

My charge nurse wanted report, so I told her I'd be right there after giving two medications. I went into the patient's room, and could not give the PO med because the patient had slid down to the end of their bed and could not sit up to swallow pills. I poked my head out and asked the aide who was there (not the aide assigned to this patient, who I saw maybe once the entire shift) to assist me to boost the patient. We went to boost and discovered the patient's linens were soaked, so we did a linen change and cleaned up the patient. Now, this patient was a turn Q2 and incontinent, and that info was clearly posted on the grease board, plus aides on our floor give each other report, so I know the aide assigned to this patient had the info even if I never had an opportunity to directly delegate (because I could never find her when I needed her).

While another nurse was at her meal break, I was covering her patients. A light came on, and I was busy so I waited for the aide to get it. The aide never came, and in fact, nobody was getting the light, so I interrupted what I was doing to go answer the light. The patient's family member had put it on because the patient had been incontinent and needed a gown and linen change and needed a brief put on. He told me (very politely) that I was the third person that he had told. I went to find the aide to assist me, and could not find her. I asked another aide, and it turns out that the aide (same one who was assigned the above patient) had gone on a meal break but had not told me. So I asked this one to help, and we did the linen and gown change and put the brief on the patient. In the meantime, I'm falling further and further behind.

Last example; I'm in the room to give a medication, and the family member shows me a small wet spot on the top sheet and the patient's gown. Since I'm there, I'll help. But the linen closet is empty, so I have to go down the hall to the linen room to get a new top sheet and gown, then go back to the patient's room to change them. I would have felt like a jerk to track down an aide to do this since I was right there, but at the same time, the few minutes this is taking me is a few more minutes that I'm falling behind.

I ended up staying a half hour late charting assessments that I had done at the beginning of my shift. I know I need to prioritize better, but I have a hard time prioritizing charting over direct patient care, and leaving patients uncomfortable until the aide can get to them, and tracking down the aide to do something that I can do since I'm right there. Plus, it seems that any time I sit down at a computer to chart, I am continually interrupted by requests from patients and their family members. They come out into the hall and ask the first person they see (me) for what it is that they need, instead of putting on the call light.

Anyone else find themselves in this situation?

I'm in my last semester now and prioritizing/time management are already things that I am concerned about. Sure, we are learning team nursing, but I wish they would spend more time TEACHING prioritizing and time management to us in the clinical area rather than just PREACHING to us about it when we fall short.

[ktwlpn, LPN]

While I was charting my assessments, patients and family members kept coming to me with requests, because I was at the nurses station (lesson learned, if I have to stay late to chart, go hide somewhere where I won't be disturbed!).

Good luck-it takes time to learn how to prioritize and how to say "no"..What is it with everyone coming to the nurse's station for stuff? I hate that-It sounds like "Night of the Living Dead"....."NEEED EXTRAAA BLANKETSSSS"

[leslie :-D]

we all have different priorities.

most requests, i can let slide when in a time crunch.

but i absolutely cannot and will not, let a patient remain in a saturated and soiled diaper.

to me, that is right up there w/the need for a med or o2.

if i discovered 10 pts that were soaked/soiled, i would make it a point to ensure they were cleansed and changed.

i think it all depends on not whose job it is, but what are your minimum standards in being able to sleep at noc.

leslie

[locolorenzo22, BSN, RN]

I wish that more nurses were like you...to a point. When you've got 5-6 patients with meds, nursing needs, etc.....please, please, go ahead and do those...If they need a blanket, soda, etc....let me know, I'll be happy to go get that for you when I can....

However, any aide worth their weight will be turning those patients when they can, checking at LEAST every 1.5 hrs for wetness, problems, etc...especially if I'm done with all my major tasks for the shift. I don't expect a nurse to be doing those checks.....

HOWEVER, if you are in a room and a patient needs a bedpan, needs to go to the bathroom, is wet, had a obviously smelly BM....DO NOT come find me to "let me know"....TAKE care of it! You are there to care just as much as me...

You are doing way too much, but set limits, don't start NOT doing anything.....

Good luck on changing things a little...

[Virgo_RN, BSN, RN]

I was lucky enough tonight to be working with an aide with a team attitude. She was proactive, anticipating patient needs, and responsive, answering call lights and assisting patients with their requests. Instead of waiting for me to ask her to do things, she would ask me if I needed her to do X,Y, or Z. What a difference that made!

My patients weren't as heavy tonight either. That made a big difference too.

[UM Review RN, ASN, RN]

I was lucky enough tonight to be working with an aide with a team attitude. She was proactive, anticipating patient needs, and responsive, answering call lights and assisting patients with their requests. Instead of waiting for me to ask her to do things, she would ask me if I needed her to do X,Y, or Z. What a difference that made!

My patients weren't as heavy tonight either. That made a big difference too.

Yes, I have the same problem. Truthfully, it's easier to just change the person rather than try to track down the aide and wonder all night if the patient was changed. Some just don't care. I know which ones I'll find wandering the halls trying to look busy and which ones I can count on.

Some techs really won't do it if you don't tell them to directly. Others are self-directed and know what to do before you do.

I make sure that at the beginning of the shift, I write the tech's cell phone number down and make sure that she has mine. If I call her and tell her what needs to be done for a patient and it still doesn't get done, I'll eventually get exasperated enough to mention it to the Charge Nurse.

I've had to suggest or support a write-up of only a couple of techs who simply didn't want to do their job.

I went home and I slept better knowing that the patient got changed and the work got done, even if it made me late to do it.

[Tait, MSN, RN]

Personally I would put my foot down on the aide to aide reporting.

I fully support aides offering to inform other aides for the next shift, however there are little nuiances (watch BP if pt gets up to walk, empty foley frequently pt is on lasix tonight) that I like to get directly to my aides, and they appreciate it.

I use a little half sheet chart I designed and I incorporate the normal things they need to know (activity, diet, VSS/Accuchecks) and then I add little details such as a turn schedule etc.

I usually give it to them and then point out a few things. This cuts some time on giving a full report, they can look it over when they have a second, instead of when I have a second.

I believe delegating like this not only covers your butt legally, but also creates a bridge between aide and nurse, making them more responsive when you call for help in a room, and most times more respectful between them and yourself.

Teamwork is really a key to nursing, and knowing when to say I can't get that right now, but we will take care of you.

Tait