How do you structure your day?

SarHat17, ASN, RN · Oct 26, 2020

Deep breath! You will get through it! This is a VERY stressful and crazy time, and you are NEW and finding your rhythm. Don't be too hard on yourself, although I know that may sound hollow right now. I'm not sure exactly the specifics of your situation, but maybe this will help you and others.

Here's what I do. (I work on an Intermediate/Telemetry unit/CVRU with 3-4 patients per shift.)

I get to my unit on time and am ready for report when the shift starts. Our hospital has nursing handoff sheets for each patient printed out for the shift, so I have my papers and am ready. I have a "grid" I write on the papers to keep report of body systems/assessment to stay organized during report/my shift. I eat breakfast before coming into work; I don't have time available to stop for breakfast during my shift in the morning.

We aren't doing bedside report at the moment (that is coming) and I pop in to say hello to all the patients/make sure they are OK if the off-going RN and I haven't already done that during report. If there aren't immediate needs, I grab a computer and review orders/hx/most recent notes and write down my med lists. I then detour to the telemetry monitor and run a strip on everyone. (I've waited before to do that later in the shift, and had Drs ask about the rhythm and I don't have a specific answer ?‍♀️.)

Then I grab meds on the first patient and start with assessment/med pass on them, then work my way down the list.

-- Very sick/critical patients get seen first. Hard-Stop. Particularly if I feel like my report kind of indicates the patient is sicker than the previous RN thought, or important things were not addressed, etc. (This doesn't happen often, but it does happen.) I've had a gut feeling a few times like that, and sometimes my gut is right. (Pulses not checked on foot during previous shift post-femoral procedure; any drains set for suction/chest tubes; my first impression of patient in report and then on assessment is "stroke," but night RN didn't see it that way.)

-- ISO patients don't necessarily get bumped to the end of my list, but I make a point to be proactive about bringing in meds/supplies, and I do explain to them that I am doing assessment and med pass, and address any needs while I'm there, but then can come back after seeing the other patients.

-- With chatty patients, I consider whether I have a lot of meds/lengthy assessment to do. That affects when I see them.

-- I know I need my cath/other procedure patients ready and all pre-procedure prep completed fairly early in the shift.

-- If you put wound care/dressing changes off until later in the shift (unless they are going to procedure/Dr coming to assess and the dressing will be coming off, etc) the task will inexplicably take twice as long, and something always comes up to delay it. (LOL, I have learned that the hard way.)

-- I used to (and am actively trying to do so again) chart at least my head-to-toe in the room during med pass. If I get as much charting as reasonably possible done right there and then, well, it's like the dressing changes- it seems to take longer doing it on the back end.

-- I make a point to round throughout the day on my patients, address needs, etc; if there's time for me to stop and scroll social media (as I have seen some coworkers), then there are likely tasks that need to be done. (I don't run around like a crazy-person, but I will clean extra IV pumps/poles and restock, that type of thing.)

You WILL find a rhythm. Ask others/watch others on your unit and see what they are doing. I have very rarely had a patient argue/complain when I explain that I need to see/pass meds/give pain medication down the hall and then will be back; in fact, I think it almost helps them (in certain situations of course) remember that others are here as patients also, and doesn't it feel better when your nurse can bring pain medication in a timely manner if that makes sense. ?‍♀️ Hang in there! We need you and appreciate all the hard work you've done to get to where you are!!

RNperdiem, RN · Oct 26, 2020

Excellent advice from the previous poster. I will add, jot down notes of things to do that come up during the shift that need to be dealt with. Trying to keep it all straight in your head is taxing. With four patients you have to learn to deal with repeated interruptions to any plan you make and get back on track. I found this to be the biggest challenge of med-surg.

Sorry you are going through all this, being new is stressful enough. My next point is self-care. To give so much to your work, I hope you leave a little room to take care of yourself. Make yourself a priority. A good night/day sleep, proper nutrition, some fresh air now and then, someone you can talk to, and some fun stuff/hobbies goes a long way to staying sane.

baloo656 · Oct 28, 2020

Thanks guys. After a day of letting the situation sink in, I think I’m seeing it in a slightly better light. I’m still nervous about my first shift back and how it’ll look to others that I’m back with a preceptor, but I have to do what I have to do. Deep breath, suck it up, let go of any ego, and try to heed your advice on how to find my groove.

kkbb, MSN, RN · Oct 28, 2020

My orientation was a week or two longer than the other new grads on my unit. When I finally got off orientation, I lasted about 4 weeks before it became clear I wasn't ready. I work nights and was put back onto orientation during days so that the manager and unit trainer would be around more for me. To the unit, it looked like I was training to move to days (at the time there was a long list of night shifters wanting to go to days). Needless to say, people were upset that I got to switch to days. It was hard to have to repeatedly assure people I was not going to days, and that I was back on orientation and then would go back to nights. I felt like a failure. I knew that everyone was judging me. But, the reality was, no one treated me any different. They were supportive. And I learned.

I will not lie, it took a while to feel like I moved past being the questionable new nurse (not sure how much was in my head vs what everyone really thought). But now I know I am a stronger nurse for everything. It took time, but now I am a preceptor, and other nurses that I respect actually ask for my thoughts on things. I still get excited when people ask me for help.