How do you get everything done on time??

Anne36, LPN · Dec 21, 2012

Sometimes I dont get everything done. I had one night last week when I didnt even touch either of my treatment books for the first time, it was also a night when I had to send someone out to the hospital. I dont know what the people who staff and manage these nursing homes are thinking. The Nurse is responsible for everything under the Sun, including answering personal phone calls. No supervisor on staff , unless its M-F 9-5. If they really cared about the residents they would lower the Nurse to patient ratio to something reasonable. As it is, the only thing there is time for is the basics, passing meds, doing treatments, some charting if everything goes smoothly. How often does everything goes smoothly? Even on the best days, there are residents under foot, digging in the trash, falling down, etc. Im still a new Nurse and am already trying to think of what else I can do for a living where I can make the same money. Do you think I could make $20 an hour waiting tables because its looking right now.

HouTx, BSN, MSN, EdD · Dec 21, 2012

You will never get EVERYTHING done within the scope of a single shift. There is normally a continuous barrage of new tasks to accomplish - some can be anticipated, but most of them cannot. Trying to manage all of these along with having to respond to changes in your patient's condition - throw in a couple of discharges and a new admission or two - - - YIKES. Just too many variables to deal with, even with the most talented super-nurse multi-tasker.

Re-think your goal in terms of priorities.

Urgent: drop everything and do it immediately - must be done to protect the patient and keep him/her safe. Ex: sudden change in patient condition, Critical lab values, etc.

High Priority: do it within the next hour or so or by the specific deadline; STAT orders, diet changes for next meal, scheduled meds, timed lab tests, etc.

Medium Priority: Routine tasks & "do it within the next four hours" stuff - - pre-op teaching, return call to family,

Low Priority: Should be done this shift, but nothing bad will happen to the patient if it has to be given to the next shift -- advanced DC planning,

Start categorizing your work in terms of priorities. You may need to keep a written list with different symbols or columns to sort out what goes where. I worked with one particularly imaginative new grad who had his own technique for this... he visualized a color for each task.. Red flashing for Urgent, Red solid for High, Yellow for Medium & Green for Low. It worked for him.

For instance - when you get a new admit, quickly read (always do this yourself) through the admission orders and sort out what needs to be done in terms of priorities.... in order to slot these in, you may have to 'bump' some other tasks that were lower priority. If you find that you are unable to de-prioritize anything, call your charge nurse/supervisor for assistance. It's OK!!! When you explain to the oncoming nurse - exactly why you had to hand off some things - you'll be able to do so in a logical and reasonable way.

Nurse Kyles, BSN, RN · Dec 22, 2012

Anne & Lacey, it sounds like you work in LTC?? I felt the same way for the 2 months that I lasted in LTC. At the 2 month mark, I was completely burned out, and wanted to quit nursing. I would seek employment in a hospital. It is much easier, and there is much more support for us new nurses in a hospital. There are a few hard days, but I don't get out super late every day of the week like I did in LTC. I wish you all the best!

LaceyRN12 · Dec 26, 2012

Thank you, everyone. Nurses have told me that it'll be a little easier to prioritize and manage my time when I get more experience. The whole atmosphere is just so brand new. I highlight and color code to try to organize more. It's just overwhelming.

SwansonRN · Jan 1, 2013

I struggle with this, too, because there's nothing worse than signing off to a nurse and having to give them a list of the things you didn't get to do. Even though nursing IS a 24 hour job, it's always tough to feel like you didn't get everything you wanted to get done. I make my list first thing in the morning, go through the orders, go through the med chart. Then after I'm assessing the patient I add more things if needed, like pt #1 could use another IV or pt #2 dressings are due to be changed. I try really hard to finish as much as I can of that list before rounds, because I know I'll have another heap of things to add to the list after that. Then I always make sure go through everything a few hours before the shift ends to make sure I addressed everything I could. I try to be nice to my next nurses and make sure that the room is neat and clean, the patient's electrolytes are repleted, they have spare bags of whatever drips the patients have, and to make sure that all the orders are appropriate/renewed. But sometimes I just can't...the other day I got an order for a foley change, urine labs, blood labs, and a new med all on 1 patient at 6pm when my shift ends at 7. Now I know that some super nurses can get that all done in an hour, but not this newbie! Super stressful :/ I think you just have to do the best you can, make sure the patient is safe, and then just let it go.

chinacatRN · Jan 2, 2013

I know EXACTLY how you feel. I worked in LTC for almost 2 years before burning out - I'm not a burn out as a nurse but the only way I will go back to LTC is if my life depends on it.

My school required we get our LPN before we could move on to the RN program. I wanted a nursing job after I got my LPN but the only places in my area (small town) that hire LPNs are clinics and LTC. A clinic would be nice but the hours would NOT work with RN school. So I ended up at LTC. And you will NEVER ever get everything done.

First of all, day shift is the worst and lab days and Fridays and end of month are the worst of the worst. Lab days you get tons of new orders based on labs that need processed and processing orders is a lengthy process. Fridays the docs seem to all try to fax everything back in before the weekend - at least where I worked they did. So that means more orders. And end of month seems to be when a lot of docs will show up last minute to do rounds and you have to cater to their every whim.

Anyway, if it helps, maybe you should switch to nights? Nights are much less hectic than days. Yeah, you'll have residents who won't stay in bed or will experience change of status, but you won't have faxes (unless there's some left that the poor day nurse couldn't finish) and you won't have much family or any docs showing up. I've worked both 6pm-6am and 6am-6pm shifts in LTC and the night shift was BY FAR the easiest. I would have stayed night shift if my husband hadn't gotten a different job. So, if you can't work at a hospital quite yet (are you LPN or RN?) then I would suggest switching to nights, if possible.

I also agree with pp about prioritizing. And I don't know about your state laws and facilty policies, but some facilities allow CNAs/CMAs to apply certain treatments such as creams, powders, lotions, etc.

If you can get a job at a hospital or clinic, do so. Even dialysis or wound center...any place that has better staffing. LTC facilities are known for their horrible staffing. Even the BEST facilities have staffing issues.

I work for a temp agency and last night I was sent to the worst LTC facility I've ever been to. The care provided was great and the place was nice but staffing was a nightmare and there was too much put on the nurse. I was only supposed to work 2-10 and ended up being there until midnight to complete paperwork. I had to pass supper meds for all 50 residents, complete assessments on 5 residents and hot chart on 12 residents, plus do all the treaments and HS meds as well. It took me 4 hours to pass supper meds. I will never work the 2-10 shift there again. Also the nurse was responsible for checking all door alarms, personal alarms (bed alarms, pressure alarms, floor alarms, etc), and passing HS snacks. Seriously? Needless to say, snacks did not get done - my 2 diabetics had blood sugars on the 200 range and everyone else was zonked by 1930...not to mention I did not have time to pass snacks. I had to fill out an incident report on a fall and on a skin tear as well. And then these facilities wonder why they have all these issues. The administrators are getting paid $$$$ while the care of the residents goes to you-know-where. And it puts the staff at risk for injury and the nurses at risk for losing their licenses.

AnonRNC · Jan 2, 2013

HouTx hit the nail on the head: PRIORITIZE. The most important tasks must be done. The rest can be passed on, which you may not like, but that's how it is.