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

[gcupid]

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.

Some people are born naturally with the gift of time management. I can tell by reading your post that you possess it.

How? You state that there is no way an admission at 9pm should result in someone staying until 3am. You are looking only at the admission. I know I'm not the only nurse on here thinking of all the things that could stop you from getting things done in a timely matter. It's not jus an admit to us but the admit on top of qthing else that must be done.

You are thinking of it as an individual task. You are able to prioritize and make yourself sit down & finish a task..

Where as I would be gotta do this then come back & sit down for 6min, gotta do that...come back & sit down for 5min, gotta do this....The op maybe running around like a chicken with its head cut off. Beyond SOB, bleeding out, and Chest pain qthing else has to wait in your eyes.

I dont care if patient needs bedpan right away...pt is jus going to have to get changed later. (its not life or death)

I dont care if a family member is holding to speak to you...He/She will jus have to call back or ask the unit secretary to write the number down until I can call myself & give an update on how the patient is doing...

When u develop that "I'm sorry but they will have to wait attitude" you will get it. It is stressful being pulled in so many directions...

I always thought of it as if it were me or my family member, I wouldn't want them waiting but what about the possibly unstable new admit who could be going down hill b/c ur taking forever to get the assessment out of the way. And if its paper work that's draining all the time, be selfish. You have things u need to tend to when u get off of work. What if you have to come back to work the next day? Being tired can cause an error that may not benefit the same patient ur doing all these unnecessary things for to be convient for them @ this time...

[RNforLongTime]

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.

It doesn't fly at my hospital either. If you got an admit at 9pm, you better have it done before 3rd shift. It's not right to dump it onto the next shift UNLESS there were extenuating circumstances like a code or a crashing pt. The unwritten rule at my facility is that if you get an admission less than an hour before the end of your shift, THEN you can pass it on to the next shift.

I started my shift at 7pm one night and the nurse I was relieving informed me that her admission, which arrived to the unit at 2:30 PM was not complete! She did not do the admission history and assessment, didn't do careplans. Oh was I MAD! I told her that it was unacceptable to leave an admission that came 4.5hrs before my shift started. She said well the supervisor told me I could leave it for you. Um no...the patient was admitted on your shift..it is YOUR responsibility to complete the admission assessment!! This is my coworker who is chronically late every shift by 10 minutes..never gets written up for it...shoulda been fired a long time ago for lateness.

Usually you know about an hour before an admit comes from the ER..another unit...whatever..sometimes it's less if the pt is crashing(I work in ICU)...that's when you need to decide that at 8pm, you'll start to pass your 9pm meds.(so you'll be ready for the new admission)..If you are a floor nurse and have 5-10 pt's there's no way you can pass the bedtime meds in an hour.

SO glad I'm not a floor nurse anymore.

OP-I applaud you for not leaving the admission stuff to the next shift.

[canoehead, BSN, RN]

How? You state that there is no way an admission at 9pm should result in someone staying until 3am. You are looking only at the admission. I know I'm not the only nurse on here thinking of all the things that could stop you from getting things done in a timely matter. It's not just an admit to us but the admit on top of qthing else that must be done.

You have a good point, but even if it was the night from hell she finishes her shift at 11p. Then report and finishing other charting til midnight, or one. Then she can do just the admission, and it takes 3-4 hours?

You can bet there was more than the admission papers not done, and probably she wasn't even aware of half of it. That's why the oncoming nurse was annoyed I'll bet, maybe not the admission, but the total chaos. When I get a report that leaves me with hours of work unfinished I get that some days your brain stops working, it's been so stressful. I'll take it and sort it out, but I might ask you to finish up some of the brainless paperwork (like an admission sheet), and I'll take it from there. I don't mean stay til 3am- I mean take it to a quiet place and fill out the assessment, and sign some stuff so it looks like the patient was received by someone and then sign it over. No one is going to be happy if the chart looks like the guy sat for hours without a nurse, and I know I'm not getting anywhere near him for at least an hour or more.

I'm afraid this nurse has more problems than just this one bad shift, and her coworkers are going to start "eating" her if she can't focus well enough to complete a task. Nursing is a bucking bronco some nights but you have to balance going with the flow and hanging on to finish one thing before you start another.

[canoehead, BSN, RN]

The OP hasn't been back. I just want to add that on one of those days I generally pitch the charting part of my job and stick with patient care-minimal notes on scrap paper. Then when I report off I've got enough between my brain and my fake notes to manage. I tell the oncoming nurse it's been a day from heck, and that I'm going in room xxx with one chart at a time if she needs me. She'll probably come back with questions for you as she starts going through her work. Sit with the charts in a quiet place to finish your notes, and make a list of things you didn't get done/issues for the next nurse and paperclip it to the front of the chart. then once you are done you've got something she can work from.

If you're still too scattered hand the lists off. If you feel like you're OK call the doc from that quiet spot yourself, and you'll tick off half your lists. Write the orders, then let the other nurse know you finished off what you could. Docs also respond well when you call and say "I've made a list on a few of your patients." They know you've prepared and saved them a few minutes later on, and are usually pretty patient.

On my worst days, so long as I actually leave to do the charting, I'll finish with at most 30minutes charting on each patient-which is a lot when you're talking 5 patients, but still better than it could have been. If I sit at the desk to chart I'm still listening to the chaos, answering questions that the new nurse can take care of, and just generally can't think, and it'll take twice that time.