How can I be in two places at the same time?

[sistasoul]

Hi all,

I need suggestions and/or advice. I have been a nurse for a year now on a neuro/ortho floor. Still having issues with time management. I do OK until I have an admission come in. Especially if it is after 8 pm in the evening. My shift is supposed to end at 11 PM. The other day I had an admit come up at 9 PM. At thsi time I stil had all of my 9 and 10 pm meds to give out. These meds were time consuming because one woman had multiple blood pressure meds at nine and ten and I had to take her BP and heart rate before giving her her meds. Another lady I had to give everything through her NG tube and she had a feeding due. This same woman had 2 different IV antibiotics that needed to be hung with all tubing to be changed. Another patient I had had a blood sugar fingerstick with Lantus and novolog insulins due plus PO meds. My other patient thank God had just PO remeron.

When the new admit came up at 9 PM she immediately needed a breathing treatmnet. I called respiratory and arranged that and then told this patient I would be back in to her to get her settled. I checked on her in between giving my meds out to make sure she was OK. By the time I got in to do the admit on this lady it was 10:30 PM. I The first thing she needed was the commode so I ran and got her that out of the bathroom and helped her to it. She had some cellulitis on her lower extremities and SOB so she needed some help. Then of course the oxygen tubing is not long enough so off I go running down the hall to retrieve an extender. It is true I could have called an LNA to get me an extender but by the time an LNA would have been available to get it I would have been able to get it faster myself. Then she needed pain medicine. I frantically looked through her chart for an order for pain meds. No order. So off I go to call the Doc and get something for the poor lady. By the time I gor her settled with pain med and toileting done it was 10: 45. I noticed she needed a finger stick. I proceeded with that and ended up giveing her 8 units of Novolog and 66 units of Lantus. The Lantus was what she took at home. Then she proceeded to question me as to why she needed the novolg at night and why her blood sugar was 330. I explained that the solumedrol was causing her blood sugar to rise. She did not fully understand and this took another 5 minutes to explain to her. It is now 11 PM and next shift is coming on to get their assignments. I still have the entire admit to do and to check the orders and to give her about the 10 meds she still had due. Needless to say by the time I gave report and did the admit it was close to 3AM.

I was told if the patient comes up before 10:30 PM it is my responsibility for the admit. The admit data the admit history, full assessment, ensuring orders are entered accurately and checking meds from the med rec and giving those meds that are due.

Sorry about the length of the post. I am just really frustrated and don't know how I am supposed to get all of this done while still haveing the 9 and 10 pm med pass and still get out on time. Thank God the lady had been there before and the admit history had been done. SHe had a rather lengthy medical history that would have taken an hour to go through with her and never mind that she was HOH bilaterally. Please don't mind the spelling as I am a terrible typist.

I asked my charge nurse how was I suppose to get this all done and she told me if I knew the admit was coming late to start the 9 PM med pass early. This didn't really sit well with me.

How do you all handle a situation like this? The admits are time consuming especially when it is really hard to keep the patient on tract with the questions that need to be answered.

Thanks

[cherrybreeze, ADN, RN]

Thank you for the tips. My charge nurse has to take a full assignment herself. I try not to ask her if I can help it.

I was going to mention this, as a lot of people suggested asking the charge nurse for help....where I work, too, the charge nurse has just as full of an assignment as the rest of the staff. They aren't any more likely able to help than any other nurse that's there working.

I work in a hospital, and yes, there's a 24 hour window for admission paperwork to get done. However, it never would fly to not have it done right away, and by the nurse getting the patient, unless it's right before shift change.

[sistasoul]

Medications have a 2 hour window, an hour before to an hour after they are due and can be given at any time during that period.

I had the same situation Friday, discharge at 3pm, informed at 4pm I was getting a PACU admission. By 4pm I had all charting for the day done and was working on my notes. Needed fingersticks and 5pm and 6pm meds to be given.

PACU arrived at 6pm, at that time I only had one patient who had not gotten meds. ALL documenting, including notes were done. Therefore, all I needed was to focus on the admit. However, I still didn't get out till 8pm instead of 730pm.

I have found that it is best to do everything humanly possible as early as possible to avoid getting stuck for hours with a late admit. Time management is essential to work/life balance.

Also, the charge nurse could help if it is crazy busy. However, at the end of the shift she also has alot of things to get done.

Work on your time management skills. Good Luck.

Thank your for the advice. At my facility we have a half hour leeway before and after a med is due. I usually do start passing meds at 8:30 PM but depending on the patients needs and the particular meds that are being given out it can still take 2 hrs if not longer. We all know the many directions we are pulled in as a nurse. Management seems to think this is all doable and I have been told many times "it can be done". Also, everyone else is in the same boat as me including the charge nurse.

[annaedRN, RN]

WOW! Kudos to all of you! Don't think I could (or want to) do this anymore. This confirms to me why I am in home health nursing...that way it is only one place, one person at a time. I still need to utilize time management skills and there are plenty of stressors....but only one patient at a time. Good luck to you.

[Kooky Korky, BSN, RN]

Thank your for the advice. At my facility we have a half hour leeway before and after a med is due. I usually do start passing meds at 8:30 PM but depending on the patients needs and the particular meds that are being given out it can still take 2 hrs if not longer. We all know the many directions we are pulled in as a nurse. Management seems to think this is all doable and I have been told many times "it can be done". Also, everyone else is in the same boat as me including the charge nurse.

Ah, that's the problem. You work in hell. Your bosses expect the impossible of you and you have all, apparently, bought into this.

How can a Charge Nurse also carry a full assignment? That's just not right.

[SnowStar4]

medications have a 2 hour window, an hour before to an hour after they are due and can be given at any time during that period.

this is a common misconception, at least in my hospital system in mi. people always think they have an hour before and after a med is due, so a 9pm can be given from 8-10 pm and be on time. this is not the case. it means the med can be given from 8:30 to 9:30. when this was addressed at my hospital last fall almost every nurse had it wrong! i would make sure you know what the real policy is at your hospitals (or is that a state thing?) in case anything ever goes wrong.

[sistasoul]

this is a common misconception, at least in my hospital system in mi. people always think they have an hour before and after a med is due, so a 9pm can be given from 8-10 pm and be on time. this is not the case. it means the med can be given from 8:30 to 9:30. when this was addressed at my hospital last fall almost every nurse had it wrong! i would make sure you know what the real policy is at your hospitals (or is that a state thing?) in case anything ever goes wrong.

at my hospital it is a half hour before and a half hour after. in a nursing home in my state it is 1 hr before and 1 hr after

[MERRYWIDOW46]

this is a common misconception, at least in my hospital system in mi. people always think they have an hour before and after a med is due, so a 9pm can be given from 8-10 pm and be on time. this is not the case. it means the med can be given from 8:30 to 9:30. when this was addressed at my hospital last fall almost every nurse had it wrong! i would make sure you know what the real policy is at your hospitals (or is that a state thing?) in case anything ever goes wrong.

i do know what i am talking about, this is not a misconception. in my state and facility medications can be given one hour before and one hour after the administration time.

[SnowStar4]

I DO KNOW what I am talking about, this is NOT a misconception. In my state and facility medications can be given one hour before and one hour after the administration time.

Woah, killer... That's why I said "at least in my hospital system in MI".

Chill

[gcupid]

Is it me or did I hear a time jump from 11:00 to 3am... Even if the op had started med pass an hour earlier that would mean she'd get off at 2am...right?

I'm guessing u must not have had any patient's initial assessment charted...

It may not be right but for the patients that didn't have extreme time sensitive meds maybe u should have pulled there meds by 7:30.

Ive learned that since u have an hour window that doesnt mean start preparing meds for 8 but prepare them @725 & have the drugs in the patient room by 750 so to speak.

Start with the easiest and do the hardest (peg tube, crush meds last) if possible

1rst pt whose meds aren't time sensitive: 7:25 physically get meds 7:38 be in pt room admin

2nd pt physically preparing meds 7:43 be in room admin 7:58.

3rd pt getting meds out of pyxis @ 8:20, admin in room for 8:43

4th pt preparing meds. 8:55.. In room throwing pill down throat finish @ 9:28.

Etc....its all about cheating the system without killing anyone in the process. Everybody knows that u cant pass all of the meds required by a certain time all the time especially when pharmacy never restocks, you're calling for new orders, families are calling to check on pts status, patients needing to be changed & need ice, juice, or whateva...

Unless every patient has a personal aide & a personal charge nurse, u can't delegate unless it's an emergency. You have to do everything yourself.. Start early, early, early......

since you are 3-11p While the 7-7 nurses are getting report..I'd be geting 9'o clock meds then...Well at least for half of the patient's I'm assigned.

I'm a new nurse so any nurses with expericence Let me know If Im doing this process wrong...

[canoehead, BSN, RN]

Meds aside, there is no way an admission at 9pm should result in someone staying until 3am, even if she did have to do it all herself. There are more issues here than finishing admissions, or taking more than an hour to give meds. There's no way to tell without actually being there. I haven't seen even a new grad take 4-6 hours for an admission.

[zofran]

I was going to mention this, as a lot of people suggested asking the charge nurse for help....where I work, too, the charge nurse has just as full of an assignment as the rest of the staff. They aren't any more likely able to help than any other nurse that's there working.

I work in a hospital, and yes, there's a 24 hour window for admission paperwork to get done. However, it never would fly to not have it done right away, and by the nurse getting the patient, unless it's right before shift change.

Sorry, just don't agree. "Never would fly?" It is this type of thinking that causes bad feelings between different shifts and GUILTS new/nice/gullible(sp?)/hardworking nurses into staying over.

Being able to get the admit paperwork done "right away" just may NOT be possible.

The admit may be complicated..(the ones who bring 5 family members, 20 bottles of pills, 300 dollars in cash, left their shoes in ED, are in terrible pain,are sitting in pee, have not eaten "all day," and have a HR of 180) Meanwhile, your other 4 or 5 (or more!) patients want nausea meds, need to go to the BR, and need their dry IV bags changed. Not to mention, YOU havent eaten or peed yet and your charge nurse is busy helping someone else. Oh ya, it will be about this time when the CNA will come get you and say, "The pt in 117 O2 sat is 77 on 3L and he is having chest pain. "

So ya...the parts of the admit you cant get done, CAN wait. Who cares when the pt had his last flu shot at this point? The next shift can figure it out.

To the OP. Learn to say in report....I got x,y,z done for this pt. He still needs a, b, c. And DONT let the oncoming shift make you feel bad. If you have truly been working all shift, and not sitting at the nurses station eating Bon Bons, then you have done your part and its time to GO HOME.

[Kooky Korky, BSN, RN]

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Sorry, just don't agree. "Never would fly?" It is this type of thinking that causes bad feelings between different shifts and GUILTS new/nice/gullible(sp?)/hardworking nurses into staying over.

Being able to get the admit paperwork done "right away" just may NOT be possible.

The admit may be complicated..(the ones who bring 5 family members, 20 bottles of pills, 300 dollars in cash, left their shoes in ED, are in terrible pain,are sitting in pee, have not eaten "all day," and have a HR of 180) Meanwhile, your other 4 or 5 (or more!) patients want nausea meds, need to go to the BR, and need their dry IV bags changed. Not to mention, YOU havent eaten or peed yet and your charge nurse is busy helping someone else. Oh ya, it will be about this time when the CNA will come get you and say, "The pt in 117 O2 sat is 77 on 3L and he is having chest pain. "

So ya...the parts of the admit you cant get done, CAN wait. Who cares when the pt had his last flu shot at this point? The next shift can figure it out.

To the OP. Learn to say in report....I got x,y,z done for this pt. He still needs a, b, c. And DONT let the oncoming shift make you feel bad. If you have truly been working all shift, and not sitting at the nurses station eating Bon Bons, then you have done your part and its time to GO HOME.

Flu shot, yes, and sexual history, religious and cultural issues, and all that other CRAPPOLA :mad: that we are supposed to "assess". I just don't have time to care about anything beyond the absolute life-saving basics, do you? Even comfort comes second to these. Usually anyway. Once in a blue moon, there's time to deal with it all. But you're going to be kind and nice to everybody anyway and you'll find out soon enough if there's any issue that's a barrier to treatment. The people who sit in offices and think of all this stuff for us frontline warriors to worry about - oh, it's a good idea, but there just usually is never enough time or staff to really do it or even frankly, care about some of these things. Even sitting in pee must take a back seat to chest pain, nausea, and dropping sat. Oh, and I will never pee myself, sorry. Sometimes, you just have to stop and use the john, sip some water, think, and just plain resp. Well, I meant rest but we have to resp, too, don't we?