What to do when there is too much to do...

Nurses General Nursing

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I am a new grad RN on a telemetry floor, prior LPN experience x 7 years, which has made my transition into an RN role somewhat easier. I feel 60% decent about going on my own but I am still stumped about how to complete everything in a 12 hour shift when multiple things pop up at once.

For example, a patient needed a transfusion before a procedure the other day. Patient was a difficult stick, IV fell out, and that took up a good chunk of time just getting a new line. Add in having to monitor the patient the first 15 minutes of the transfusion then the multiple re-checks, it took my preceptor and I off the floor into the patients room for an hour.

This was in the middle of a med pass and vital check for the 4 other patients. I ended up leaving my preceptor in the transfusing patient's room to address the other patient's needs.

Where I am looking for advice is how in the heck would I have managed that if I were on my own?! My meds would have been well over an hour late and my patients would have had no nurse. That is just one scenario obviously but I often leave my shifts thinking, "If I would have been on my own, I literally would have drowned".

Obviously you can ask other nurses for help but they, plus our charge, have 5 patients each so they are often too busy. Our PCA's are 1:20, sometimes more, so they have little spare time as well.

I am really nervous about being able to handle things that "pop up" and take a lengthy amount of time and still be able to wrap things up and get things done for the next shift. I don't want to be the nurse that the next shift's nurses hate to follow.

Any advice would be super appreciated.

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Prioritize and reprioritize is all you can do. What kind of work did you do as an LPN?

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Honestly, there will be days where no matter what you do, you will just be behind because of situations you just can't predict. You've identified asking for help as a strategy. I don't know if your charge nurse has an assignment but ours doesn't so she's always a good resource if we are falling behind. Things will come quicker as you get more experience as being an Rn and with Rn tasks, so that will help. I write down times and interventions on my cheat sheet so worst case scenario I can stay late and just document (we have the paper system). If possible, if I can predict that I'll need to be in a patient's room for a period of time, I will check on my other patients and do all my tasks (meds/vs) before going in the room. It sounds like you didn't have that option in this case, but it's something to keep in mind. You will have days where you will want to cry because you have so much to do but also know you don't have time to cry. If your workload feels unsafe, talk to the charge, especially if the acuity of a patient is changing. Best of luck!

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Specializes in ICU, ER, NURSING EDUCATION.

@SOURLEMONRN: PRIORITIZE AND REPRIORITIZE. Couldn't have said it better!

You will find ways to manage and stay ahead of the eight ball so that when the unexpected happens, you have some wiggle room.

You will learn to multitask and shift gears like nobody's business in time...But for now, not speed, SAFETY FIRST!

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Prioritize and reprioritize is all you can do. What kind of work did you do as an LPN?

Mostly occupational health and urgent care with a little LTC thrown in there.

While I am used to a high patient volume, I do not have much experience with unstable patients. I think that's throwing off my game as well, I recognize when someone goes south but I also think things that were emergent in the urgent care world aren't as much in the acute setting...still getting used to that part.

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Honestly, there will be days where no matter what you do, you will just be behind because of situations you just can't predict. You've identified asking for help as a strategy. I don't know if your charge nurse has an assignment but ours doesn't so she's always a good resource if we are falling behind. Things will come quicker as you get more experience as being an Rn and with Rn tasks, so that will help. I write down times and interventions on my cheat sheet so worst case scenario I can stay late and just document (we have the paper system). If possible, if I can predict that I'll need to be in a patient's room for a period of time, I will check on my other patients and do all my tasks (meds/vs) before going in the room. It sounds like you didn't have that option in this case, but it's something to keep in mind. You will have days where you will want to cry because you have so much to do but also know you don't have time to cry. If your workload feels unsafe, talk to the charge, especially if the acuity of a patient is changing. Best of luck!

We do have a charge but they too take 5 patients so I am not sure how they quite manage a full patient load + charge tasks. Thank you for your tips, I think the predicting how long I may be in a patient's room will help me prioritize more efficiently.

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@SOURLEMONRN: PRIORITIZE AND REPRIORITIZE. Couldn't have said it better!

You will find ways to manage and stay ahead of the eight ball so that when the unexpected happens, you have some wiggle room.

You will learn to multitask and shift gears like nobody's business in time...But for now, not speed, SAFETY FIRST!

I sure hope so! Yes, I am big on safety. I made a medication error in my first 6 months as an LPN years ago so I think I am being perhaps overly cautious now since your more apt to make mistakes in a new environment. I suspect this slowing me down as well but I don't want to ever make that kind error again.

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Specializes in Hospice.
We do have a charge but they too take 5 patients so I am not sure how they quite manage a full patient load + charge tasks. Thank you for your tips, I think the predicting how long I may be in a patient's room will help me prioritize more efficiently.

I used to be charge with the same amount of patients as the other nurses, as charge you are continually assessing the needs of your patients as well as the needs of your staff. A good charge nurse can redirect other staff members as appropriate, they may call a bed huddle so everyone is aware of what is going on with the entire floor, they may delegate tasks to other nurses or perform the task themself.

When you are in over your head you must let the charge nurse know, it is his or her job to keep the ship sailing. Granted, their may be a time when the charge nurse is unable to help, and then that is when you prioritize and reprioritize and make the best of a bad situation.

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Get done what matters the most..

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Specializes in CrItical Care, Street Medicine/PHM, School nurse.

I know all too well what you experienced. I'm on my 7th week in orientation as a GN. This past week I had 3 patients that were mostly stable. My preceptor had to leave the floor and said he wouldn't be gone for more than an hour. Well in that hour one of my patients became hypoglycemic (40); he was NPO for a procedure that was supposed to be done earlier that day but had been delayed (also needed a blood transfusion before procedure). He was so edematous that he was starting to blister. When I went to push D5W, I lost both IV sites. He asymptomatic so that was good. While this was going on, the tech came to tell me that my other patient across the room "was acting wierd" and his sats were in the low 80's (despite being on 6 L of O2 NC). That patient was 1 day s/p chest tube removal due to empyema. Ok, so I called my charge to start this IV while I adressed the issue across the hall. Put my other patient on a nonrebreather because of his stats and the AMS, called the MD, ordered an ABG and a CT scan. By the time CT came to get my patient, my preceptor had returned and my other patient now had 2 IV's and a BS of 85. While I felt that I was drowning, I LEARNED A LOT THAT DAY. Especially prioritizing.

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Specializes in Tele, ICU, Staff Development.

You can only do one thing at a time. As a nurse, you must constantly decide which ONE thing you are going to do NOW.

Deciding to do A means you are deciding to not do B.

So the key is to have a decision-making rationale that you can speak to if need be. Is it a safety concern? Is it time-sensitive?

All you can do is...the best you can do.

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If everybody is safe and stable, get the "easy" people out of the way first. If you know there's a room that you get sucked into like a vortex, "bundle" your care for that room to keep you from going in and out. If you know somebody's discharging, you have to expedite their tasks. If someone's not discharging, you have more time to get stuff done for them (provided it's routine).

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