huge juggling act with time as the enemy

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I'm a new grad and have been on my own (life after precepting/orientation) for two weeks now. I've read many of the already posted threads under the "First Year in Nursing" category and can relate to almost everyone. I broke out in tears reading the thread that said that it was OK to cry. I've chosen to work on the telemetry floor (7a-7p) after passing the boards and going through orientation. Most days, after my shift is over and I'm ready to go home (during and after precepting), I'm uncertain that I want to come back for my next scheduled shift!! The job is so fast paced and everything is hitting me all at once. I have typed up numerous ideal scheduling on Word to help guide me (0700 to 0800 - get report, 0800 to 0830 - go see my patients etc...). I have developed a baseline on how to manage my day but there is just so much interruptions throughout the shift (PT/OT/RT wanting to see the patients, patients' request, their families request, doctors who write new orders sporadically throughout the shift and not in clear handwriting, pharmacy not delivering meds on time, patients with change of status, making sure the correct consent forms are filled before an invasive procedure, new patient admits half way through the shift or towards end of shift, and the nursing students who take the charts, it goes on and on).

Leaving late to finish charting has become a routine. Night shift thinking that you are working with them now. Even after 12 hours on the floor, I feel that I don't know the big picture on all of my patients. I can only focus on their admitting diagnosis and their current signs/symptoms. Some medications that I give, I wonder why the patient is getting after knowing what they came in for, but I know that it is safe to give after looking up the med in my PDA, so I give it. Scary, I know. If I know that doctor is personable, I'll ask him or her. But in most cases, it's not asked.

I just hope that through time, I'll be able to get the hang of it. Hopefully before I get so discouraged that I end up quitting or worse, being force to quit (you know what I mean).

Thanks for letting me vent.

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Specializes in Family.

My advice would be to ditch the time schedule! I use a sheet with a box for each pt. If they have meds or FSBS, I circle that time in red and then check it off when it's done. Tryiing to adhere to a set schedule will make you crazy. There have been some sample sheets posted on here before that may help you. Maybe try a checklist rather than a timeline that way you can see what you've accomplished when you've checked off the next thing on the list. Good luck! :)

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I'm a new grad and have been on my own (life after precepting/orientation) for two weeks now. I've read many of the already posted threads under the "First Year in Nursing" category and can relate to almost everyone. I broke out in tears reading the thread that said that it was OK to cry. I've chosen to work on the telemetry floor (7a-7p) after passing the boards and going through orientation. Most days, after my shift is over and I'm ready to go home (during and after precepting), I'm uncertain that I want to come back for my next scheduled shift!! The job is so fast paced and everything is hitting me all at once. I have typed up numerous ideal scheduling on Word to help guide me (0700 to 0800 - get report, 0800 to 0830 - go see my patients etc...). I have developed a baseline on how to manage my day but there is just so much interruptions throughout the shift (PT/OT/RT wanting to see the patients, patients' request, their families request, doctors who write new orders sporadically throughout the shift and not in clear handwriting, pharmacy not delivering meds on time, patients with change of status, making sure the correct consent forms are filled before an invasive procedure, new patient admits half way through the shift or towards end of shift, and the nursing students who take the charts, it goes on and on).

Leaving late to finish charting has become a routine. Night shift thinking that you are working with them now. Even after 12 hours on the floor, I feel that I don't know the big picture on all of my patients. I can only focus on their admitting diagnosis and their current signs/symptoms. Some medications that I give, I wonder why the patient is getting after knowing what they came in for, but I know that it is safe to give after looking up the med in my PDA, so I give it. Scary, I know. If I know that doctor is personable, I'll ask him or her. But in most cases, it's not asked.

I just hope that through time, I'll be able to get the hang of it. Hopefully before I get so discouraged that I end up quitting or worse, being force to quit (you know what I mean).

Thanks for letting me vent.

I know what you are going through...Tomorrow I go back to work (7A-7P) though I'm looking forward to it but I'm scared of the challenge that I will be facing (type of patients I will be assigned to, family members questioning evrything you do or say, doctor's orders.......the list goes on)..I only have 2 more days of orientation and yet I'm still unsure of what I'm doing...everyday I feel like a blind person taking care of these patients.....I know being a nurse you have to be flexible because most of the patients we take care of have unpredictable conditions (from being asymptomatic to being worst the next)..I can't even call myself a nurse ( I just feel like I am not one yet or at leat until I'm condifent and competent at it)..Just like you I am also hoping for the day that I will get the hang of it..I know at this time I'm still being watched by everybody at work and they will either keep me or just let me go....I take care of 8 patients with an LPN and a tech but I feel like they know more than me and this makes my confidence lower....Here I am supposed to be the RN and yet I'm clueless....Too many things to know......I really hope that my preceptor and my director will not give up on me as of yet.....I know in time I am going to be a very good NURSE!

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I'm a new grad and have been on my own (life after precepting/orientation) for two weeks now. I've read many of the already posted threads under the "First Year in Nursing" category and can relate to almost everyone. I broke out in tears reading the thread that said that it was OK to cry. I've chosen to work on the telemetry floor (7a-7p) after passing the boards and going through orientation. Most days, after my shift is over and I'm ready to go home (during and after precepting), I'm uncertain that I want to come back for my next scheduled shift!! The job is so fast paced and everything is hitting me all at once. I have typed up numerous ideal scheduling on Word to help guide me (0700 to 0800 - get report, 0800 to 0830 - go see my patients etc...). I have developed a baseline on how to manage my day but there is just so much interruptions throughout the shift (PT/OT/RT wanting to see the patients, patients' request, their families request, doctors who write new orders sporadically throughout the shift and not in clear handwriting, pharmacy not delivering meds on time, patients with change of status, making sure the correct consent forms are filled before an invasive procedure, new patient admits half way through the shift or towards end of shift, and the nursing students who take the charts, it goes on and on).

Leaving late to finish charting has become a routine. Night shift thinking that you are working with them now. Even after 12 hours on the floor, I feel that I don't know the big picture on all of my patients. I can only focus on their admitting diagnosis and their current signs/symptoms. Some medications that I give, I wonder why the patient is getting after knowing what they came in for, but I know that it is safe to give after looking up the med in my PDA, so I give it. Scary, I know. If I know that doctor is personable, I'll ask him or her. But in most cases, it's not asked.

I just hope that through time, I'll be able to get the hang of it. Hopefully before I get so discouraged that I end up quitting or worse, being force to quit (you know what I mean).

Thanks for letting me vent.

Hi I feel like I could have written your post. I have been off orientation for 3 weeks now . I work on med/tele and have six pts on days. We only have 1 cna though for a 35 pt floor so I feel I spend most days washing pts, getting ice water , and helping pts to the bathroom and trying to do meds , assessments. orders, etc....it's making me crazy. I am really trying to maintain a positive attitude . I haven't messed up at all but I also do not feel most of the time that i have a good grasp on everything that i should. Just think the next time you go to work , that there is someone else out there running around like a squirrel on speed:) Hang in there!!!

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I'm a new grad and have been on my own (life after precepting/orientation) for two weeks now. I've read many of the already posted threads under the "First Year in Nursing" category and can relate to almost everyone. I broke out in tears reading the thread that said that it was OK to cry. I've chosen to work on the telemetry floor (7a-7p) after passing the boards and going through orientation. Most days, after my shift is over and I'm ready to go home (during and after precepting), I'm uncertain that I want to come back for my next scheduled shift!! The job is so fast paced and everything is hitting me all at once. I have typed up numerous ideal scheduling on Word to help guide me (0700 to 0800 - get report, 0800 to 0830 - go see my patients etc...). I have developed a baseline on how to manage my day but there is just so much interruptions throughout the shift (PT/OT/RT wanting to see the patients, patients' request, their families request, doctors who write new orders sporadically throughout the shift and not in clear handwriting, pharmacy not delivering meds on time, patients with change of status, making sure the correct consent forms are filled before an invasive procedure, new patient admits half way through the shift or towards end of shift, and the nursing students who take the charts, it goes on and on).

Leaving late to finish charting has become a routine. Night shift thinking that you are working with them now. Even after 12 hours on the floor, I feel that I don't know the big picture on all of my patients. I can only focus on their admitting diagnosis and their current signs/symptoms. Some medications that I give, I wonder why the patient is getting after knowing what they came in for, but I know that it is safe to give after looking up the med in my PDA, so I give it. Scary, I know. If I know that doctor is personable, I'll ask him or her. But in most cases, it's not asked.

I just hope that through time, I'll be able to get the hang of it. Hopefully before I get so discouraged that I end up quitting or worse, being force to quit (you know what I mean).

Thanks for letting me vent.

I sent you a private message. We are experiencing the same feelings/experiences.

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Specializes in Case Management.

I am an experienced nurse who has been through the trenches. My biggest lesson learned was organization. I used my paper list to organize my whole day. The most important lessons to learn outside of school are organization and prioritization.

Nursing is a changing landscape from moment to moment. You could be flying through your shift passing your meds on time, keeping up with charting and taking off orders and all at once one patient will crash and send you into a tailspin and before you know it you are running around like a chicken and you are so far behind you are struggling to get back to where you were when everything was going smoothly, and you never get back to that point.

That is the curse of a nursing carreer and why the hospital is staffed with wonderful and competent nurses like yourself.

Just try to keep your sheets organized and continue to set your priorities throughout the day. Before you know it you will be one of the veterans knowing what to do in all situations and you will look back and there will be new nurses struggling just like you did. It happened for all of us.

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I am an experienced nurse who has been through the trenches. My biggest lesson learned was organization. I used my paper list to organize my whole day. The most important lessons to learn outside of school are organization and prioritization.

Nursing is a changing landscape from moment to moment. You could be flying through your shift passing your meds on time, keeping up with charting and taking off orders and all at once one patient will crash and send you into a tailspin and before you know it you are running around like a chicken and you are so far behind you are struggling to get back to where you were when everything was going smoothly, and you never get back to that point.

That is the curse of a nursing carreer and why the hospital is staffed with wonderful and competent nurses like yourself.

Just try to keep your sheets organized and continue to set your priorities throughout the day. Before you know it you will be one of the veterans knowing what to do in all situations and you will look back and there will be new nurses struggling just like you did. It happened for all of us.

I agree with you gr8trnpjt....today I started my day smooth, I was on time with my meds and charting (except for 2) until 2 o'clock strikes....one fo my patient who was receiving platelet transfusion came to my attention because she was having pain in her upper arm ( the night nurse had to out the IV access close to her armpit) upon assessment I found out the the IV inflitrated which means no platelet went in her system..so I had to call and notify the doctor and got some order for benadryl...but I was panicking the time I found out (this is my first platelet trans)..then next oatient who was a chem code only begun to have respiratory depression and the doctor was called and gave an order for narcan 1 mg IV....so gave it to the patient then 5 minutes later she begun to vomit and aspirate (oh, this patient has an NG tube)...............what a nightmare it was.....all of a sudden I felt so behind and disorganized and did not get to report until 1830...on top of this I had 2 patient transfer and had to do assements on them (one abdominal paina nd one acute ETOH)...What a day!!!!

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Specializes in NICU.

Where do I even start with my night last night? I had 3 babies (I work in NICU), 2 were stable, and one was needing to be intubated. In the hour that I was there before she got intubated, she had 3 apnea episodes, one requiring bagging to get her back. She did ok with minimal settings, and then around 2300, all hell broke loose. She was desatting severely with any handling, possibly refluxing, etc. So, I found the doc, and she wrote a list of orders as long as my arm - IV fluids, antibiotics, prevacid, lasix, CBC, blood gas, blood cx, urine cx, etc...the list goes on. Well during this time, my other 2 babies were due to be fed, and I had a hard time getting any of this done. My charge nurse fed my other two babies for me, while I worked on getting all of this started. It took 2 of us about 4 tries to get the IV. I attempted to get all of my labwork off of another stick, but got enough blood for only the CBC, so another nurse did an arterial stick and got the rest of my labs. Then came the fun of trying to cath this little baby (~1200 grams)...our efforts were largely unsuccessful, so there went that idea. Around 2 I managed to get all of this done, but still hadn't done any charting on any of these babies. Within the next hour, this baby was no longer tolerating feeds, her belly had blown up, bowel sounds were decreased...I basically spent the entire night at this one bedside, and I'm convinced now that I forgot to do something. I started on time with everyone, but soon my feeds were all off schedule because this one sick baby was requiring all of my time. This was probably the roughest night I've had since I've been an RN...I felt mostly competent, but everything took so much time. By the time I finally left (a good 30 minutes late) and got to my car, I found my eyes welling up with tears...guess the pace and stress of the night overwhelmed me more than I thought.

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the nursing students who take the charts, it goes on and on).

You cannot allow the nursing students to take the charts when you need them. They are interfering with patient care and need to back off. Get territorial.

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joli,

I am glad I'm not the only one. I have had THE WORST day! Everybody has been talking down to me like I'm a nobody. Today I verbally stated to my boyfriend that I don't like being a nurse. I hope I can make it too.

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Specializes in vascular, med surg, home health , rehab,.

Well, after 18 years of nursing, I can tell you, there will always be bad days. Sunday I left my 7a shift at 10pm. I have a few tips that help me. Report varies so much, mostly because no one has time to reasearch charts, days or nights. So I whizz through the computer, print the H&P out, recent labs, Vitals. Takes a minute, but I now have some history to go on. Because we share a tiny medroom, and one accudose, I try to get there early, pull my routine 10am meds out, so I am not wasting time waiting on the accudose. Then I hit my rooms, starting with the "worst first". I try to get at least a couple of assessments down and charted. I try to assess, do dressings, medicate and move on. If I have a "problem" pt, you know needy etc, starting with them first seems to help with the calls etc. All of this goes to hell frequently, but, you learn just to try and handle what you can as it unfolds, learn to prioritize, Mr Smith might think she needs an emema stat, but medicating everyone and at least having a look at them is more important. I feel bad that your all having such a bad time; but we have a lbeen there and no matter how experienced we all are from time to time, so give yourselves a break. It won't all be "done" when you leave, thats why there are more than one shift, don't expect to be perfect. The oncoming shift will appreciate not walking into everyone screaming for pain meds, infiltrated IV's, nothing done on OR patients and before you've finished report, OR are here for the patient. And don't forget to take the time to take breaks. It really doesn't save you any time not to; even if its a short one, get off the floor and sit, eat, regroup. Good luck and hang in there. Some days success is having them all breathing when you leave;)

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Dear All,

Thank you SO VERY MUCH for all of your responses. I worked this past weekend and was actually able to be a nurse versus a chicken with its head cut off. Of course, it was an exceptional weekend. The census was low, every nurse had 4 patients. I think I got the 4 with the lowest acuities to (1-preCABG, 1-preangiogram, 1-post septicemia/current-endocarditis, 1-CHF w/ aortic stenosis). I guess it made a difference that it was the weekend also (no administration, no patients going for invasive procedures). My coworkers and I made it fun to, we had a potluck for both weekend days. However, overall, nursing is very challenging! I can't just give up on nursing, none of us should. Being a nurse is something I truly enjoy, I find it very rewarding. However, with such a fast paced environment, it makes it more difficult to give good nursing care. Everything becomes more task oriented in a fast paced environment. Until I am able to manage my time better, I know that I will be taking many more deep breaths!

Yes, taking breaks and lunch at a decent time is something I have to work on to! I simply don't take breaks, lunch is on average taken at 3pm. I'm new, I'll learn! :lol2:

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