How do you learn to manage it all?

[CoffeePVCs]

I'm on day shift and most of the time it goes something like this...

Just finished getting report and am trying to set up my binder for the day, map out med times (look for early meds and 730 glucose checks) and a transporter comes to find me for a that I wasn't told about in report.

Stop what I'm doing, look at the chart, ID the armband with transporter, grab a set of vitals on pt and do a focused assessment before letting them leave the floor.

Get back to getting my paperwork in order. Secretary pages me to tell me a patient is requesting pain meds.

Go to pt room assess pain, no pain meds on MAR, page MD for orders.

Start doing vitals and assessments, MD calls back. Stop to get orders. Go reassess pain pt and give meds.

Finish vitals and assessments, do early meds. Med missing from machines, call pharmacy to get med tubed.

Pt comes back from procedure, get them settled in.

Secretary calls and says another pt is having chest pain.

Stop to assess that situation, spend 15-20 minutes checking BP, giving subl nitro, getting that situation under control. Secretary calls while in room and says another pt is wondering when they get their AM meds. Can't leave chest pain pt at this point. Chest pain pt has new IV meds ordered and IV goes bad with flush, charge nurse kindly steps in to attempt IV after I had two failed attempts. Deal with that situation, chest pain relieved, MD on unit and sees pt.

Resume giving AM meds. Transporter finds me to send another pt down for test. Another pt having pain. Medicine missing still not sent from pharmacy. Call them again.

I can stop there because any nurse knows what I am getting at... everytime I step into a room I ask about pain, I ask about food and water, do you need help with anything, is your IV feeling ok?

I ask a million questions to try to cover bases so the pt doesn't have to call me.

I just feel so torn in fifty directions and wish I could tackle it all. I can't leave a chest pain pt, I can't leave a pt getting blood for the first 15 minutes without a doubt.

I'm slowly, slowly, starting to realize I can't be in 5 rooms at once and on the phone with the MD and talking to transporter or pharmacy.

Is this the new grad blues, how do you find your inner peace in the middle of chaos? What's the advice or kind words you've been told you can pass on?

[HouTx, BSN, MSN, EdD]

Take a deep breath.

You're in exactly the same place as everyone that has gone before you.... it just takes time to improve your competency/confidence. Nursing is just the same as other complex skills. For instance, new drivers are functioning on a 'task-oriented' basis: Adjust mirror, fasten seatbelt, insert key, turn key, check mirror, put on turn signal. . . etc. By the time you have been driving for a while, you just jump into the care and 'off you go'. As time goes on, your increasing expertise will allow you to blend focus on larger and larger 'patterns' of patient care rather than trying to remember all of the teeny tiny details.

Sorry for mixing metaphors, but right now, you are moving along - navigating around one tree at a time. Eventually, you'll develop a 'mental model' of patient care will be more like looking at the forest as a whole... with a built-in GPS that guides you to the right pathways toward the expected outcomes. You'll immediately recognize when something is out of the ordinary & shift your focus to deal with that issue. Unfortunately, there really aren't any shortcuts. Building expertise will take time and experience.

Hang in there - it gets better. But promise me that, in the years to come, you'll try to remember how this feels when you are the 'expert' dealing with new grads.

[sbostonRN]

No advice, just hugs. I am in the same situation. I worked for a year at a SNF with 20 patients on a rehab floor. A month ago I made the move to a rehab hospital with an average pt load of 5. Thought everything would be smooooooth sailing. Uh, not so much. Even right now I only have 2 pts with my preceptor and I feel like I'm drowning every day. I can't wait for the day when I actually feel like a competent nurse.

[anotherone, BSN, RN]

No advice . sounds where I work. Night shift is slightly better so I went to night shift.