How to deal with difficult assignment?

franciscangypsy · Feb 27, 2010

In whatever way you can.

I've been on my own as a nurse on a med tele floor since December and can't get more than 6 patients on nights (yet). Most nurses get 7. I try to break down the night into tasks and staying organized. Sticky notes are my friends. :-D

Most important for me has been finding my own coping mechanism. I stop by Church right before shift and put a sticky note on my computer to remind to stop, take a deep breath, and give it to God. It doesn't make EVERYTHING better, but it helps me to cope.

And I ask questions and help when I need to. Because it's not good for the patients if I'm overwhelmed, right?

Just what helps me. I hope you find what will work for you!

jennanurse15 · Feb 27, 2010

wow, curious what state you live in. We only give nurses 5 patients on night shifts. When I have 4 patients on eves, which I believe to be plenty. I started making info sheets for each patient. I would ask, what do I need to know about for each patient to do a good job and make a form like worksheet for yourself , so when you find the info on the chart, right it on your worksheet for each patient. Info to have on the sheet would be: name, room number, Dr., DX, patient story, how did they end up in the hospital? then what IVs, drips drains, vitals etc. Then each time you walk into that patients room, you can flip to your worksheet and for me it helped a lot. c ya

franciscangypsy · Feb 27, 2010

in other words, good old SBAR -- Situation, Background, Assessment, Recommendations!

SBAR saves my rearend every night, lol!

lifetimern · Feb 27, 2010

I hope your experience improves beause your first year as a nurse, in many ways, defines the kind of nurse you will be throughout your career.

Honestly, seven patients at night isn't that bad. I have to wonder, however, if your colleagues are taking advantage of you. If you notice when you come on shift that you have three contact isolation patients when your co-workers only have one, you need to say something and strongly request that they change the assignment. Are admissions being fairly divided among the staff? If they are not, you must tell the charge nurse that it is Nurse Suzie Q's turn to pick up a patient instead of updating her Facebook status.

Don't get me wrong, I am not advocating you adopt a bad attitude or stop being a team player, but if you don't demand fair treatment, there are some nurses out there that will roll right over you! To add insult to injury, they will be the same nurses who will complain that you aren't pulling your weight.

Also, I wonder if you are delegating tasks as efficiently as possible. Perhaps, the nurses you mention that are goofing off are more effective delegators. I have found that ineffective or infrequent delegation is a common reason novice nurses fall behind. Additionally, I always encourage new nurses I precept to group activties - try to do everything you need to before you leave the room and go the next patient - and be proactive - if an IV is at 50cc, hang a new one instead of waiting for the pump to alarm.

I hope some of these suggestions help. Good luck!

Straydandelion · Feb 27, 2010

Wow, where is this place, things must have changed drastically yet I always thought it was a good night if I was charge and we had three nurses on the floor. A bad night was splitting the floor 16-17 patients with the help of a NA. I would say the most helpful thing to do is prioritize, what is immediately important, what can wait and like another poster mentioned..delegation.

BluegrassRN · Feb 27, 2010

Just a view from the other side...

While it is possible that your coworkers are not getting such a difficult assignment, I think it's unlikely. I, however, work with a nurse who *always* has the worst assignment. So she says. I'm so sick of hearing about it. She can't see farther than her own patients, has no idea what the rest of us are doing, and complains often about how the day shift charge nurses always give her the worst assignment. She occasionally tries to switch patients, and we used to accommodate her, but not anymore. She's played that card one too many times, when she has not had any worse of an assignment than the rest of us.

By all means, advocate for yourself, and ask for help when you need it. But do not become THAT nurse.

lerabelle · Feb 27, 2010

I must agree with BlurgrassRN. Although you are a new nurse, it will seem that you always have the worst team of patients. The hospital when I worked, the nurses at night sometimes had up to 10 patients depending on staffing. And there was always that "one" nurse who always complained on her assignment. I know things seems discouraging and you feel you are getting the short end of the stick right now but you must remember, every nurse you work with were in your shoes at some point in their career.

I always have a problem with delegating because I am the type of person who wants things done right the first time. It is hard to do. But you MUST do it. Delegate, delegate, delegate. If you are behind, ask for help. That is what your charge nurse is there for, plus your co-workers should be helping you and not playing on the computer! Once you get a pattern down you will have no problems. One person posted something about having a info sheet on every patient, like your report sheet. Keep it with you so that you know what is going on with your patients. Write down the med times at the start of the shift on that sheet. Little things like that will help.

Good luck and you will be a fine nurse. Don't give up and ask for help!

franciscangypsy · Mar 3, 2010

had a horrible night to begin three nightshifts in a row. Two isolations (one which was C-Diff and constantly pooping), one pt who thought that I was her waitress and wanted coke and food every hour on the hour (and also had wound care), a pt who wanted to be DNR (but the family was having difficulty with the decision) and moaned and begged to be allowed to leave and to die all night, and one of the isolations (DNR, no sternum) kept desatting and having a change in LOC and apparently had needed to go to unit before b/c of resp acidosis. I only had a team of 5 pts and I felt swamped. If it hadn't been for my coworkers, I never would have even gotten my trending done.

Got the two DNR ladies back the next night and one of them this past night. Just felt swamped and by night three I felt like a horrible nurse with no capacity for empathy. It's been the worse series of nights I've worked and I kept wondering why the day charge decided to give this team to a new nurse when she KNEW it was a terrible team -- and even said so when she gave it to me.

Never working three nights in a row again, that's for sure. Coping with my load this time was hard enough; I need to retain some sort of pt empathy.

Just ranting. Exhausted. I really do love my job and my patients. I just felt a little swamped and not as much in control as I could have been. I guess that comes with experience. My coworkers must go crazy when working with me; I'm of the philosophy that my pride isn't worth crap in nursing -- if I don't know something, I bug the nearest nurse (who doesn't look TOO crazy busy). After all, my patient's well-being could depend on that one thing I don't know and am too proud to ask about.

Any suggestions for coping, esp. with dying patients? I had a hard time with that. With not knowing what to say and with coming to terms that I had done all I could within the DNR order -- even when one of my patients (the one desatting) died on dayshift.