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Just not _____ enough

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by Nuked Nuked, ASN (New) New

Has 7 years experience.

Supply your own adjective.

I graduated from a challenging AS RN program in 2014. I had trouble finding employment, eventually landing at a few sub-acute/LTAC type places doing part-time work before finally landing a benefit eligible hospital job working acute inpatient geriatric psych. I worked there for nearly two years when I resigned over administration attempting to force me to float to a med-surg unit and take a patient assignment with no orientation to med-surg or the unit itself.

Shortly after, I managed to get a job on a telemetry unit (yes, irony) at a great local hospital. It was to be a big change. 12 hour shifts instead of 8s. Days instead of evenings. Med-surg w/telemetry instead of psych. I was going to participate in their "LTC to med-surg" program. It all sounded great.

Then my gf of 6 years was diagnosed with breast cancer and started chemo. Then the education person at my new hospital went out on leave for over a month. Then COVID and quarantine and we've got my gf's 10 and 13 year old sons home all day and we have to help with schoolwork. Big changes pretty much daily at the hospital. I'm not keeping up. I'm only taking 2-3 patients and it seems like one of them gets transferred to a higher level of care every single shift. This continues. Through my not pushing hard enough for help from education/admin and hospital education/admin being overwhelmed with COVID changes and issues there, we parted ways at the end of my orientation period.

I just couldn't do it. No matter what system I used or notes I took I couldn't juggle competently enough. Would always drop a ball somewhere along the way. I wasn't fast enough so I always felt rushed. While there were distractions aplenty and enough blame to go around, the simple fact is that I've struggled with multi-tasking effectively and "time management" all along. Getting organized doesn't come naturally but I can do it. I am frequently the last out the door on a shift though. So these aren't entirely new problems, it's just that the last job brought it all together and put a big bright spotlight on it.

Within a few days I'll be leaving on a travel/contract assignment because nobody is hiring nurses around me yet for anything. It'll be night shift psych, which will be somewhat new but I'm confident I can do. What I don't know is how I get better from here in a general sense professionally. I feel as though I squandered a great opportunity with that last position and I don't want that to happen again.

How do I improve my speed/"time management" or ability to multi-task? I thought it would just start to come together with time and experience, but it doesn't seem to be working out that way for me. I'm just trying to figure out my best way forward, because I feel a bit like a failed/failing nurse at this point in a certain sense because I couldn't handle med-surg. I know at some point I'll need to start considering getting a bachelor's degree, but honestly I'm starting to wonder if that degree maybe shouldn't be in nursing. Why go deeper into an area where I haven't had success?

There are a lot of questions there, sorry for that. Any advice or direction to resources that might help in any way would be appreciated. Thanks.

BSNbeDONE, ASN, BSN, LPN, RN

Specializes in Med/Surg, LTACH, LTC, Home Health. Has 35 years experience.

Have you ever considered that the problem may not be you? Unless I missed something in your post, you are the only critic here; your managers and coworkers haven’t complained about your ‘productivity’.

As the newcomer to a unit, any unit, you are probably being assigned the worst patients on the unit. It’s not right nor fair, but that happens almost daily. And now you’re about to embark on your first travel assignment?!??! Hang on to your hat, my friend!

It has been my experience over the course of many, many years as a float nurse (and recent traveler), the new kids on the block will get the worst of the assignments as charge nurses continue to look out for their friends and regular staff.

There are so many threads on this forum about that very thing. So, just continue taking care of your patients the best you can. You can complain about the assignments, but it probably won’t help. On my last assignment, I reported this to 3 different supervisors, and afterwards, my assignments got worse. So I contacted my recruiter and told them that I refused to go back. I had been keeping my agency in the loop of what was going on since day one.

Until the culture changes, the practice of unfair assignments will not. But ALWAYS strive to become more efficient because at the end of the day, it’s your patients’ lives and your livelihood at stake.

Prioritize! Very patient wants to be first but ONLY ONE actually will be. Have your talkers to “hold that thought”; patients with verbal diarrhea are usually attention drainers (they are ALWAYS the last on my list to be seen). I even take care of my total-care patients before I let those talkers unload on me. And don’t be afraid to ask your charge nurse for help. After all, he or she is the one who handpicked this assignment for you.

Good luck on the new venture!

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

3 hours ago, Nuked said:

While there were distractions aplenty and enough blame to go around, the simple fact is that I've struggled with multi-tasking effectively and "time management" all along. Getting organized doesn't come naturally but I can do it. I am frequently the last out the door on a shift though. So these aren't entirely new problems, it's just that the last job brought it all together and put a big bright spotlight on it.

The section I quoted above says a lot of value. You have identified something that you are not naturally very good at. So don't plan a career where those particular skills are critical. Most of the people who are really good at their jobs and happy with their careers are people who choose career paths that utilize their strengths -- not their weaknesses. They choose not to make their careers a constant struggle.

So what is wrong about being a psych nurse? Why not plan on being a great, successful psych nurse? If you are good able to be successful in that general field, look at different possibilities within that field -- and in related fields that emphasize similar talents and skills. Focus on what you are good at -- develop a career that emphasizes those things -- earn money and be happy.

Good luck!

Nuked, ASN

Has 7 years experience.

On 6/10/2020 at 9:15 AM, BSNbeDONE said:

[snip]

As the newcomer to a unit, any unit, you are probably being assigned the worst patients on the unit. It’s not right nor fair, but that happens almost daily. And now you’re about to embark on your first travel assignment?!??! Hang on to your hat, my friend!

[/snip]

Prioritize! Very patient wants to be first but ONLY ONE actually will be. Have your talkers to “hold that thought”; patients with verbal diarrhea are usually attention drainers (they are ALWAYS the last on my list to be seen). I even take care of my total-care patients before I let those talkers unload on me. And don’t be afraid to ask your charge nurse for help. After all, he or she is the one who handpicked this assignment for you.

Good luck on the new venture!

Psych I've been OK with. My recent adventure into med-surg was not. I was let go at the end of orientation, I wound up sending a patient to ICU the morning of the day I was let go. I understand that newbies get dumped on often, but this was more than that. Perhaps med-surg with tele was too much of a jump for me personally, who knows.

On 6/10/2020 at 11:06 AM, llg said:

The section I quoted above says a lot of value. You have identified something that you are not naturally very good at. So don't plan a career where those particular skills are critical. Most of the people who are really good at their jobs and happy with their careers are people who choose career paths that utilize their strengths -- not their weaknesses. They choose not to make their careers a constant struggle.

So what is wrong about being a psych nurse? Why not plan on being a great, successful psych nurse? If you are good able to be successful in that general field, look at different possibilities within that field -- and in related fields that emphasize similar talents and skills. Focus on what you are good at -- develop a career that emphasizes those things -- earn money and be happy.

Good luck!

Nothing "wrong" with being a psych nurse, but opportunities are not as varied or as available in that particular area. I come from working radiology (nuclear medicine), so staying organized to a certain degree has always been required for me. I also passed nursing school and was among the first in my class to take and pass my boards so I'm not totally inept, but clearly my skills are not where they need to be.

If I can't get better, then perhaps you're correct and nursing isn't for me, but I'm 41 and my brain isn't as malleable as it once was. I also don't have any extra money, so it is what it is for the time being and I need to do the best with what I have.

@Nuked,

I won't try to make excuses for you if you are significantly confident that there is a problem with you/your skill acquisition/your way of doing things.

However, I will point out that none of your so-called failures have occurred while being given the benefit of ideal or even usual circumstances. This past few months hasn't been idea or usual or anything remotely normal. So, while you may need to concentrate harder on this area of difficulty that you think you've identified, you don't truly have hard and fast evidence that you can't do this and should look for something else to do.

Pay attention to this goal of improving your time management, but don't pre-decide that you're going to struggle and ultimately fail.

One thing that is really foundational to time management in nursing is prioritization--which itself is dependent upon concise and accurate patient assessment. Keep honing all of these things toward your goal of time management. Also, pay attention to logical sequences in planning your care. Keep honing those. If you have 3 patient that need fairly simple nursing tasks completed and then a 4th patient who is more involved and will take you awhile, you take care of the 3 first--and while you're in each of their rooms you attend to their incidental needs/questions and also do a basic assessment (make sure they are stable, etc). Now they are (in theory) taken care of for awhile and you can go attend to the 4th patient. That sort of thing. I'm sure you know this and I'm not trying to tell you what you already know. I'm just mentioning some major things (prioritization and care sequence planning) that play heavily into your success at time management.

Lastly, gently direct the communications and activities that take place while you're in a patient room. You want to provide patient-centered care, but at the same time you can't afford to use your time in the room in the manner of "whichever way the wind blows you..." if that makes sense. Be there with a purpose. Right or wrong, none of us has time to let every patient inquiry become a 20-minute saga or to get off-task figuring out why someone is having trouble downloading an app to their device (for example).

TLDR: Concise assessments, prioritization, plan your care sequences, say on task when in rooms. And most of all: Believe you can do it.

Best of luck ~

Edited by JKL33

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 40 years experience.

I agree with JKL that you've been struggling under a huge load of unusual circumstances. I think psych nights will give you a much-needed breather.

The one thing about psych nights is that there usually aren't too many tasks so there can be a lot of downtime. It would be a good idea to remain self-directed and find things to do so you can stay used to being busy.

I worked psych for the first 15 years of my career and during that time felt very intimidated at the thought of working med-surg. But one day I took the plunge and managed just fine. It probably helped that I wasn't dealing with family illness and covid.

I really think you mainly need to go easier on yourself. Take the psych job; enjoy what you can about it. When it's time for the next thing I suspect you will do just fine.