Feels Like I'm Drowning... I Can't Seem to Get it!

jadelee · Mar 30, 2010

Hi,

Its been ten years since I was a grad, (and yes you are a new grad, please remember how much nurturing you need in the first year, don't feel like you should be able to do it all on day one) but reading your post makes me want to give you a big hug.

Firstly do you have a preceptor? If so have you spoken to her? Are you working enough shifts with her?

If not why not!!@..

In Australia most grads do a graduate program, where they don't work in critical care, have lesser pt loads (at least in first few months). Are you on a grad program?

If you have no preceptor, and no grad program, then I suggest on your next days off, taking care of numero uno, to recover from your stressful start and regroup.

As for tomorrow, can you come in early, and plan your day before handover? Ie find your allocation, and start to get a grip on their clinical needs (ie not the ordering of the food!),.

Can you discuss with the nursing assistant that your will be doing obs, meds etc and assess how pro active she will be about ADL's and menu ordering etc.

(which by the way don't really exist in Australia hospitals as we have lower pt ratios and therefore toileting and feeding are part of our role)

I need to re read your post so I will get back to you,

But remember, if your patients were still breathing at the end of your shift then you did well

Take care:redpinkhe

caliotter3 · Mar 30, 2010

When you get the "Oh sweetie do you mind" request, say, I have to contininue ...., let's put the call light on for the assistant. It may seem like you are passing the buck, but you are really delegating and keeping yourself on track to get your own duties done. It is fine to do assistant duties when your own duties are caught up.

tri-rn · Mar 30, 2010

I have to agree with caliotter...while I'm sure you don't want to be one of "those nurses" who don't do "CNA stuff"...you have to keep up with your RN responsibilities first.

Be sure, when you delegate, to thank the CNA you're delegating to and I would give a short explanation like "Hey thanks for helping her to the toilet! I would do it myself but I'm behind on med pass".

Hang in there :)

jadelee · Mar 30, 2010

Back again,

When I was grad I had huge time management issues, even in my 2nd year,

but the place I worked never let Nurses miss breaks, or go on breaks without the buddy nurse covering. If your buddy nurse got lunch, she should of covered for you.

However if takes skill to stop the other demands on your time.

even now I have to concentrate on finishing one thing at at time,

not saying yes to other people, (i even u used to offer to help when i hadn'f finished my work!). and i often was one to two hours late leaving)

So you need to be assertive with your patients because

they may not care about the other patients ,

or your paperwork to cover your backside,

or getting their meds and obs on time,

Menus can wait.

Toilet can be done by the AIN ( preemptively !)

Explain that just in case toileting is bad for the bladder! :)

Also learn to ignore the phone (if its badly needs to be answered its prob the co-ordinator/senior nurse of the shift phone call anyway and they will ring back)

If you are polite (ie saying I would love to ...... for you BUT I have to.... to other staff, they should accept that with grace)

To patients give them a time frame (double what you think that u will be back by),

and ignore the next bell until u have finished what u are doing,

you are prob doing better than you think, and will be better than u think day by day,

time to time to go to the loo (no one will die in that time, even if they did call a code on my pt while I was in the loo!) make it a habit know before its too late!

Also do as much as paperwork as u can while u go along, but also set aside a block of time at the end of the night. If a critical incident happened, i tried to document as soon as pt was stable to debrief, keep it fresh and ensure it wasn;t forgotten.

It is hard to see the wood for the trees, in the midst of the crazy shift, but just breathe and keep them breathing and you will get there,

It is totally worth it (even after ten years)

Best wishes

Music in My Heart · Mar 30, 2010

I'm a new grad, too, and sometimes experience what you describe - though I'm pretty good at keeping it on the outside (that is, I don't internalize the stress - I just do what I can do and solicit feedback from everybody to determine if I'm at least prioritizing well).

One concrete suggestion regarding charting: I have a piece of paper which is sectioned off into time zones -- 0600-1200 on one side and 1200-1800 on the other side, in half-hour increments. I keep it on a clipboard in a set location at the nurse's station and jot little reminders to myself of what happened when so that I don't get lost when I start trying to chart (I try to chart in real time but without a computer on which to do it, it's just toooo inefficient).

Flare, ASN, BSN · Mar 30, 2010

You need to learn how to manage your time - which is something that comes with experience - you are still a new grad - so don't be too hard on yourself.

Figure out what tasks are really binding you up. When you are passing meds, unless it is something that cannot wait, politely inform your patient that you will help with thier request once you have finished or get somebody to help them in the meantime.

It's just me, but i like to get my charting done as quickly as humanly possible into my shift. If i have to attend to something i will, but then right back to charting. This way the bulk of it is done and if my day crumbles around me, at least the charting is up to date.

I like to check my meds at the beginning of the shift and if i don't have anything pressing, i like to make sure all i need for the day is there and separate (note - not pre pour - just separate) the meds by when they will be given.

You will develop your own system, the main key though is simply to keep yourself and your patients organized.

NurseNinaFla · Mar 30, 2010

Delegate & Prioritize!..The CNA's can do the pillow fluffing,you have meds to pass,IV's to hang,charting to do etc...If it makes you feel any better though after 25yrs I still feel like I'm drowning sometimes and there are many times I do not take a half hour break and work 1-2 hours past my shift

classicdame, MSN, EdD · Mar 30, 2010

see if an Educator has any suggestions, or maybe another seasoned nurse. Could be you are not managing time to the optimum in some spots. If you find others have the same issues perhaps the group can ID the issues - like duplicate charting, not enough ancillary staff, etc. Then people can work on the issues.

sistasoul · Mar 30, 2010

I have been a nurse for a year and still cannot get out on time and have only taken a lunch once. It is really hard to delegate especially when you know the nursing assistants are running far behind also.

MassED, BSN, RN · Mar 30, 2010

I don't even know if I'm a "new grad" anymore. I graduated in August 09, finished orientation in Jan 10 ANYWAYS... I mean I don't even have the energy to type this right now thats how zapped I am. I feel like I'm drowning everyday in my own whirlwind of work. Its just so overwhelming for me and I think its just me and I just can't seem to "get it". I mean some days I've got it! But some days I come in and I'm being pulled 10 ways to Sunday and I cant seem to manage it. I've tried report sheets with boxes for times that I have to do things. I've tried writing a list of things to do from the time I come in until hand off, I've tried using a stopwatch to time myself but it seems like EVERYTIME I go into a patients room to do an assessment and pass meds, it cannot be a 5-8 minute ordeal. It ends up being a 28 minute ordeal because "oh sweetie do you mind, since you're in here I have to go to the bathroom". I don't want to be rude, go and get the nurse asst. who is going around doing their morning vitals, blood sugars, labs, etc. Ok so I help them back into bed, and because our hospital is somewhat like a hotel we have room service food delivery so food must be called in and ordered. "Can you help me call my breakfast order, I'm not sure what to get" all I want to do is pass my meds between the hours of 0900 and 1000. As if this is not enough I can't seem to get all of my assessments charted because I'm constantly being interrupted by the phones, the Nursing assistants and the patients families who all need me so desperately, I have to deal with those matters, catch up with the MD's, the PA's and the NP's as they Zip quietly in and out of pts rooms never to be seen again for the rest of the day JUST so that I'll have an update on the POC for the patient when they or their families ask ''so whats going on"? Or at least pass along to the next shift. To make matters worse this goes on nonstop and the next thing I know its 1500 and I have not charted an assessment, a careplan, I'm running around like a chicken with its neck cut off, I now have 10 patients because 1 nurse had sense enough to say I'm going to lunch. I DON'T take a lunch. I may pee, I may take a couple sips of water I am always leaving an hour maybe an hour and a half later to make sure everything is done. I work dayshift. I have 2 kids and a husband. I got home last night at 9:45 pm and guess what I have to turn around and do it again the next day. Any suggestions?

delegate to those CNA's - you NEED to do your job as well, they are there to help with those non nursing skilled job aspects. If you have time, you can address that, but you have meds to pass. Can you document edit? Document as you go, if you can, but if not, jot down a note of what time you did whatever and go back later and chart that in your computer.

As far as meals go, I don't feed my patients, so that eliminates that need.

Just kidding. How about when you enter the room in the morning, give them their meal sheet (or however you do it) when you say hello. Let them know you will be doing medications between 9am and 10am and if you can get the meal done before or after, that would be helpful. Let each patient know that, so they know what you need. Have them use a call light for toilet breaks - then those nursing assistants know when they're needed. You can't do everything, and as you well know, you have to delegate those duties that are non nursing, if you want to save your sanity. I don't spend chatty time with my patients until all work is done - you can let your patients know politely that you need to get a few things done and you'll be back, if their intention is to chat.

It sounds like your issue is more about time management than anything else. Why do you need to track down MD's/PA's/NP's? You can find what they document in the chart. That's wasting your time to track them down or wait for them, when you could be more productive with your time. What about leaving them a note in the chart if there's something you need to communicate to them? How about calling them, if you have a portable phone? Then you can continue on working without stopping.

Just a few suggestions. Oh, and take a few minutes to eat - you need that.

MassED, BSN, RN · Mar 30, 2010

I have been a nurse for a year and still cannot get out on time and have only taken a lunch once. It is really hard to delegate especially when you know the nursing assistants are running far behind also.

you are running behind on your job as well - nursing assistants have to manage their time, as well. You need to be able to delegate - they are there to work, just as you are... if you did their job, what is the point of them showing up to work? You can't do two jobs - otherwise they will take advantage and not even make the attempt to work. Been there, done that. You may not make friends, but you will gain respect. You are there to be a good nurse and that takes a team. They are not helping you out with your med passing or documentation, so make sure you are able to get your work done, then help them if you have time with the more basic nursing care.