How to Deal with the Chaos of Med/Surg

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I'm a new grad nurse and I started on my unit this past August. I've been off of orientation since mid October. On my unit there's a 4:1 patient ratio and I work the 3-11 shift.

Since I've gotten off orientation I'm really struggling. I find it so difficult to focus on what needs to be done and get anything accomplished because I feel like I'm constantly pulled in a million directions at once during my entire shift. Literally from the minute I start my shift to the minute I'm done, I feel like all I do is run around like crazy as one thing after another comes up. I know we are supposed to be prioritizing and planning what needs to be done during our shift blah blah, but I never feel like my plans to accomplish tasks actually work.

For example, I'll decide...I'm going to go see pt in 203 and take in all his meds, do my assessment, change his fluids, reposition him, assess for pain, and then get out. Well it just so happens this pt is in isolation and while I'm in there a doc calls to speak about another pt (who I haven't even seen yet) and now I have to leave this pt and talk to the doc. So then I get off the phone with the doc and then the NA comes and tell me pt in 204 has a BG of 70 and the pt in 205 is in pain and wants meds...and so on. This is what I deal with almost every shift and it drives me crazy. Throw at least 1-2 admissions/discharges into the mix and I think you get the picture.

Does anyone else feel like this? How do you deal with the constant chaos and everyone needing you? I just feel like I'm pulled in a million directions constantly. It makes it so challenging for me to focus on anything I'm doing and sometimes I have to stop and think, ok wait which pt is this again, what was I doing before? I'm so scared I'm going to make a mistake (like with meds or treatments) because as soon as I'm focused, it seems another issue comes up like the previous scenario.

I'm beginning to think med/surg nursing isn't for me. Maybe I would do better in an ICU where the ratio is 1:2 max and I can focus better on those pts?

Anyone else feeling like this or have any suggestions? Thanks!

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Umm this is THE norm on med-surg units with ratios as high as 1:7.. I would KILL for 1:4..

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Unfortunately, I agree with the previous post. I was also surprised to hear that you have an NA, which along with the low ratio is rare on my MS unit. I am always feeling like I am drowning and looking for ways to improve my time management, so I will be watching the replies as well. Good luck!

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Specializes in Home Health/PD.

Some days will be better than others. Do the best you can. Try to cluster care as much as possible. Say rm 205 needs pain Meds? Md called on 204? See what md wants (I hate to put md needs over pain but they called first.) and call them back. See 205 and get pain Meds, go ahead and do assessment and other Meds while your in there giving pain Meds. A blood sugar of 70 is above our hypoglycemia protocol so I wouldn't worry about that at my facility unless pt has symptoms. What I'm trying to get across is, fight fires as they come and roll with the punches. Try to cluster care as much as possible while your in the room. Hope that helps!

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Rachelrn89 I must say you are not the only one that feels that way & it's common to feel that way, however you do have to roll wit the punches, and just do the best you can while you're there. Your time mgmt will get better and prioritizing will also. I worked night shift on med-surg unit as I am a new grad and on nights it's a lil slower and you have time to gather thoughts mgmt and prioritize but I start days next week and I'm very nervous about that because it is busy and you have a lot more going on,but I already have a made up mind to do much best and that's it! And I'm sticking to it! Hope you have experienced nurses who may help you with suggestions on how to prioritize and use gd time mgmt, because I can say that I do have a lot of nurses that I can go to who will be willing to help me out with questions & that really does make a difference! Gd luck to you!

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I still feel like that someday and I have been at it for almost 2 years! I bunch everything! When I go see my patients I bring their meds anything else they might need and also do all of my charting at the bedside. Bedside charting (if available), saves a lot of time from trying to catch up later on in the day! Which is sometimes hard if you have a very busy day! :)

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Specializes in Med/Surg,Cardiac.

1:4 sounds great! Still it is easy to get overwhelmed and fall behind. Are you delegating appropriately? I found that to be hard but it's all about teamwork. Ask the aid to take the low bs a snack. Cluster care when possible. You're only one person and can only do what you can do. Prioritize and things will improve =)

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

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Thanks for the support everyone :) Rolling with the punches is something I definitely need to work on and I'm finding that out. I just get flustered/stressed really easy when things unexpectedly come up and then I can't think straight which just makes me more stressed. Luckily I do have very supportive and experienced nurses that I work with who help me out tremendously and are willing to help my whenever I need it. EatmysoxRN, I do try to delegate as often as possible, but I could probably delegate more. Sometimes I just want to do everything (which I think is part of my problem), but you're right I am only one person and I can't do everything alone. Thanks for all the advice!

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I must say I'm very jealous of your only 4 patients! Imagine doing that with 6-8 regularly! First of all, it DOES get easier with more practice! You get more efficient at charting, juggling, multi-tasking, etc. Second, always prioritize what's the most important thing you need to be doing right that minute. If you have a bs of 70, dr calling, pain med requested, and regular meds due then you know a bs of 70 isn't critical-have the aide take them a snack. Take the dr's call, give the pain med, then do your regular med, have aide re-check bs if that's your hospital's protocol, etc. I use sticky notes and start writing all requests I get from other people-pt's needing pain med, new orders due, etc so as I'm working my way through assessments/meds I can stop and take care of urgent issues/stat orders or take care of the issues as I go through my round of pts. Try not to get flustered and remember as long as everyone is alive it's ok. You're only one person so you can't be in 6 different places at once. If you feel you're really getting behind ask for help. Like others said it's good to group your tasks together which it sounds like you have been and charting at the bedside if possible does help because whenever I'm sitting at the nurses's station charting everyone acts like I'm taking a break (even though I'm charting) so I constantly get interrupted by family members, other nurses that want to talk or need help moving a pt, etc. Also, I've found the more time I can spend in a pt's room the less needy the pt's seem to be and are on their call light less because they feel less neglected even if I'm not actually doing anything for them at that moment. Just having that company helps and it's also nice to have their chart pulled up so when they ask about labs/tests I can check for them. I think one of the hardest things in med-surg to learn is to just go with the flow and not get bent out of shape because you don't have something done. It took me about six months to really feel efficient and there are still days I'm a step behind all day long but I no longer freak out about it. Good luck and hang in there!

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Nurse ABC, thank you so much for all of your advice! I cannot imagine having 6-8 patients on top of what I already have...I have so much respect for the nurses who can juggle that many patients and still manage to get everything accomplished while I'm struggling with 4. As for bedside charting, that sounds like a great idea. We do not have computers in our patient rooms but we do have the moveable laptops (COWS--apparently we're not allowed to call them that anymore?) in the hallways that I could easily wheel in and do charting...except for the patients in isolation (which is basically everyone right now b/c of the flu hah!). I will definitely try this, because what you said is so true about people thinking we are taking a break when we're at the nurses station when we're actually doing one of the most important things...charting! (If it wasn't documented it wasn't done *cringe*). Thanks again! I love hearing what other nurses do to make life easier throughout their shift. I learn so much by taking advice from other nurses, as I have yet to find what "works" for me.

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I work in the u.k..and when i worked in stroke i would look after 12 patients a shift..often at night i would have 21 patients and i would be the only trained member of staff with 2 care assistants..it is hard work juggling your workload but it does get better in time..do u have other staff to help with you patients?

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You'll get there with practice! I used to feel overwhelmed when I was a new grad but you get into your own routine and you will learn to manage your time more effectively as the months go on. But remember that even experienced and the most efficient nurses can have a hopelessly stressful day and can fall behind- it often depends on the type of patients (and family members) your dealing with.

Good luck

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