feeling totally overwhelmed!!

mangopeach · Oct 12, 2012

I'm a new grad working in psych and I can totally relate to your post. Some days I feel completely overwhelmed and find myself staying an 1hr or more to finish up tasks that should have been completed on my shift. I work the 3-11p shift and it tends to be the busiest shift. Lots of admissions and discharges. A lot of the docs round on that shift so lots of orders and we are still paper charting so transcribing orders, getting them to pharmacy. Each shift is also required to do a chart check. I love my job, I love my patients and I am happy I chose psych but sometimes I feel completely defeated and wondering how I can improve on managing my time to get everything done by the end of my shift. Most days I don't even take my break for fear of getting further behind.

Hang in there, I hope things get better for both of us! I don't have any advice, since I am pretty much in the same boat but just wanted you to know I understand how you feel.

K.P.A. · Oct 12, 2012

I recommend rounding as soon as possible after coming on shift so you know what you'll be dealing with. Ask patients how they are feeling and if they need anything. I suspect there is some sort of patient assessment flow sheet you need to complete on each shift and this gives you the information to start it. Know your patient concerns and can get them taken care of early in the shift. Part of therapy is providing structure. Let the patients know that you have some other work to do and will be doing rounds again, give them a specific time, and stick to it. You're modeling. Next, do your chart checks. You don't want someone missing evening meds because an order was missed. You will also want to note any lab orders so you can let the 11-7 shift know which patients will be going to the lab and will be NPO. Give your tech(s) as much autonomy as you can. This takes a while if you are new. Structure your staff activities but also give them as much autonomy as you can. Don't get discouraged. It will take many months to develop an efficient and enjoyable structure for your shift. You eventually want as much of your shift as possible to be therapeutic, and pro-active, without turning yourself into an autocrat. As for staying late to finish work. Prioritize your work so that you complete everything that can't be done by the next shift. Hand the rest off in report.

sleepdeprived1 · Oct 13, 2012

Thanks for the advice! You are right when you say part of therapy is providing structure..i think what you mean is setting firm limits on the unit? Like with patients loitering the nurses station half the night sucking up my time especially the borderlines...and I don't want to come off as being a _____. This is something that I need to work on being more firm and setting more limits. But I have seen an improvement in myself since I first started I guess it's normal to feel like this at times, and I am sure this won't be the last.

MangoPeach, so your facility does paper charting too? Ours is a combination of paper/computer charting. Yeah I have heard that 2nd is the busiest shift but I think all shifts have their times being super busy..working on nights isnt too bad except for when there are "issues" and barely any staff at night and I am only nurse for entire unit with one tech and have psychotic/agitated patients who need prn or IM meds and/or patients awake on unit requesting snacks, sleep meds,pain meds,anxiety meds, and I have 2+admissions. But its also comforting to see an experienced psych nurse struggle with same workload so no your not alone.

MissPiggy · Oct 21, 2012

It CAN get overwhelming at times but you have to learn to prioritize your duties. If you have a good tech you can delegate a lot of things to that person which frees you up to do more of the RN-only tasks that need to be done. As far as the pesty pts. sucking up all your time, maybe set a limit that they can only come to within 3 or 4 feet of the nurses' desk. If they come up repeatedly with different requests, limit them to one hourly request, meaning that if they have 3 or 4 things that they want, they have to request it all at one time or else wait til the next hour, etc. and start a list of requests if need be. If they are sill bugging, maybe they need a prn for sleep? If you offer it they may realize that insomnia really IS their issue. Also, if you have a good relationship with the day shift you may be able to work something out, like if you do the safety check maybe they'd be willing to do the rest, etc. etc. Hang in there, it is the most fun job you can have, IMHO.

MedChica · Oct 24, 2012

So, lately I have been feeling completely overwhelmed at work! This is my first nursing job after nursing school and have been working mental health nights for about 5 months. 3 or so have been on my own. It was always my dream to work mental health and I really enjoy the field, but as of lately I feel that it has been getting harder and harder to get my entire job duties completed on time and lately need to stay after work to finish the bare minimum necessary. I also find I am needing to leave things undone for other shifts. This really stresses me out too since I feel I am not doing well if I dont get everything done. I know I am told that night shift is easier and so is mental health, but with night shift I have alot of extra duties that I am expected to get done-one example of this is to go through all the patients medications in chart and print out paper copies of all meds,and verify current meds for day are correct. Last night I had 15 patients but then I got two admissions. The only other employee was a psych tech on that unit. How is this even safe? Plus the patients who cannot sleep, up all night asking for meds,food. I feel that my charting and my entire job is being done crappy because I do not have enough time to complete it and I am always the only nurse on my unit at night-just last week we had several codes and behavioral issues that required my time...I was hoping this week would be better but maybe it is me..I just want to cry because I feel I cannot keep up, I take two 5 minute breaks to go to bathroom and get something to drink but feel that is even too long when I cant get my work done. Anyone else have this issue with psych nursing? Also do you have problems with patients up half or all the night with numerous requests for snacks,fluids, prns. I just want a good night!

At night? They sleep.

Thank God. Half of them raise so much hell during the day, of course, they're tired. Hell-raising is tiring work. LOL

I do understand. I mentioned something like this in another thread tonight.

Breaking up fights. Trying to keep the wanderers out of the rooms. Trying to 'bring down' excitable, ranting residents. Running to stop people who can't walk from ambulating and falling. Took me 30 minutes to convince a resident to take her meds. I even bribed her with a diet Coke, because none of us want to have to hold her down and give her a shot. Sometimes, it's necessary when she's refusing like this. You can't redirect her, most of the time. With each refusal, she just gets more and more 'off' until she flips out and we have to send her off to get her stabilized. She doesn't understand, but it's important that she take her medication. I'm not just talking about her narcs and antipsychs, either. I'm talking about her heart meds, vitamin supplements and INSULIN, as well.

Her feet are as big as a tree-trunks, right now. She has hypothyroidism. She's also, as previously mentioned, a diabetic... with no 'awareness'. It's kind of scary. She can have a b/s of 400 and exhibit no visible s/s.

So, after 30 minutes, I ended up getting her to take her Ativan. Success! Not much. Just 1 mg. Afterwards, I was able to convince her to take some of her meds (lasix, metformin, cholesterol and HTN meds) and the depakote.

We had a new admit who was completely unmedicated with no meds on her. She'd been removed from a prior facility for trying to kill her roommate. So, we rec'v her and she's making a dash for the door every 10 minutes. Then...we had to put on 1x1 because she threatened suicide. We had 2 residents calling the police and the F/D on us. All of which amounts to more paperwork.

That was my weekend!

You deal with all of this in addition to their medical issues. Let's just say that my nerves were completely shot by Sunday evening. LL I could not wait to go home. None of us could! LOL

My job is fun, but when I've a bad day? It's a really bad day.

In what world is mental health 'easy'?

Sometimes, I leave work feeling completely drained from some of those personalities that we have in there. And I understand the attention seeking sort. I have a lady who followed me all over the place in her w/c last sunday. Crying and whining (no, seriously, it's a whine. she whines. i'm not being mean) behind me for meds, pain pills, 'look at my feet. I've an infection'. 'someone snuck into my room and raped me 2 minutes ago'. 'I'm pregnant'. This is a 68 year old woman.

With her, I really have to step back and check my responses and attitude...because she's just THAT annoying. I'm just being honest.

She annoys the hell out of everyone but she latches onto me because I'm not as dismissive, I'd say. I figure that she can't help it.

It's not her. It's her illness.

I don't want my care compromised by my reactions to her.

Then we had a lady who is borderline and bipolar disorder'd and she was on that call-light every 10 minutes. The aides (god bless em) handled her. She's really a sweet woman. She's just very 'excitable' and melodramatic. LOL

But once I read her chart? I began to understand.

I'm working on my boundary setting, however. I'm happy to say that my skin has thickened to a great extent, which allows me to handle the residents in a more therapeutic fashion.

sleepdeprived1 · Oct 25, 2012

Medchica:

It sounds like you've definately had your share of "challenging" days, and yeah for the most part patients do sleep at night but it all depends on the group for the current week. Sometimes be a good group other times not so much. I find it almost unsafe at times to be on the unit alone with only 1 tech many times and if I am working a certain unit -it is by itself-seperated from other units/floors. So when the tech takes a break if chaos breaks out it would just be me (if she were still on break) ...kinda gets me a bit worried. Yes I can call other staff to come and assist might be a minute or two..I feel like I am slowly making progress on being more time efficient as well. It's almost as if I was having a mid-year new nurse crisis doubting myself and my abilities...it is nice to hear from other RN's and their experiences. Safe to say it is getting better, but I know there will always be nights that I get completely overwhelmed and that nursing isn't ever predictable..just alot of time management....

Miss Piggy:

Yes prns for sleep are great except when they DONT work and the patient stays up all night....prioritize is definately something I have been working on.