Must learn to love the chaos!!!!

[Virgo_RN, BSN, RN]

So I think part of my problem is that I keep wanting to plan out my entire shift from start to finish. For instance, I will have all my assessments done and charted by five. I will do this dressing change at five thirty, hang that antibiotic by six, etc. I want to get all my meds passed and charted on time. This rarely works out. I work on a chaotic floor, where you never know from shift to shift exactly what you're going to be dealing with. I have to learn how to be more flexible, organizing my time in smaller chunks, and basically learn not only how to cope with the chaos, but embrace it.

Perhaps there are personality types that are more suited to this type of environment. I like to do things in an orderly fashion, in a sequence, in a way that flows logically from one thing to the next.

I can't work that way on my floor most of the time. I get there, and the demands begin immediately. Often I am getting requests for labs and treatments for patients that I have not even received report on yet. Family members are asking me questions that I don't know the answer to. I very rarely have any time at the beginning of my shift to look up the patients H&P, labs, meds, treatments, but instead, must immediately spring into action and stay in that mode for the entire eight hours I am there. I am always charting assessments at the end of my shift. The only thing that I am able to chart promptly is medications. Everything else gets noted on my brain sheet and entered sometime during my last hour on the floor.

This is one of the reasons why nurses from other units hate floating to our floor. They are used to a more organized environment, where there is more routine. It's really difficult to have a routine on my floor.

Some people thrive on this type of fast paced environment, but for me, it is taking some conscious effort to make myself be more flexible and willing to go with the flow without getting annoyed. I find myself getting crabby when I get pulled in a different direction, or when my flow gets interrupted. I *hate* when my phone rings when I'm elbow deep in poop in an isolation room, or even just reading through a chart trying to organize my thoughts. Okay, I'll admit it, I just hate it when my phone rings. Except when it's a doc returning my call, or some other expected phone call.

And yet, I don't want to work on any other floor. I like my co-workers and the type of patient population we see. I like cardiac nursing. I don't want to do medical, med/surg, neuro, oncology, ED, ICU, or anything else. This is where I want to be.

Does this sound familiar to anyone else?

[imanedrn]

So I think part of my problem is that I keep wanting to plan out my entire shift from start to finish. For instance, I will have all my assessments done and charted by five. I will do this dressing change at five thirty, hang that antibiotic by six, etc. I want to get all my meds passed and charted on time. This rarely works out. I work on a chaotic floor, where you never know from shift to shift exactly what you're going to be dealing with. I have to learn how to be more flexible, organizing my time in smaller chunks, and basically learn not only how to cope with the chaos, but embrace it.

Perhaps there are personality types that are more suited to this type of environment. I like to do things in an orderly fashion, in a sequence, in a way that flows logically from one thing to the next.

I can't work that way on my floor most of the time. I get there, and the demands begin immediately. Often I am getting requests for labs and treatments for patients that I have not even received report on yet. Family members are asking me questions that I don't know the answer to. I very rarely have any time at the beginning of my shift to look up the patients H&P, labs, meds, treatments, but instead, must immediately spring into action and stay in that mode for the entire eight hours I am there. I am always charting assessments at the end of my shift. The only thing that I am able to chart promptly is medications. Everything else gets noted on my brain sheet and entered sometime during my last hour on the floor.

This is one of the reasons why nurses from other units hate floating to our floor. They are used to a more organized environment, where there is more routine. It's really difficult to have a routine on my floor.

Some people thrive on this type of fast paced environment, but for me, it is taking some conscious effort to make myself be more flexible and willing to go with the flow without getting annoyed. I find myself getting crabby when I get pulled in a different direction, or when my flow gets interrupted. I *hate* when my phone rings when I'm elbow deep in poop in an isolation room, or even just reading through a chart trying to organize my thoughts. Okay, I'll admit it, I just hate it when my phone rings. Except when it's a doc returning my call, or some other expected phone call.

And yet, I don't want to work on any other floor. I like my co-workers and the type of patient population we see. I like cardiac nursing. I don't want to do medical, med/surg, neuro, oncology, ED, ICU, or anything else. This is where I want to be.

Does this sound familiar to anyone else?

I know exactly how you feel! While precepting, I had so much trouble with time management that all I wanted to do was get a formal system down that I could follow to the minute! After being on my own, I realized that was completely unrealistic! Depending on the acuity of my patients and how many 0900 meds I have to pass, this determines whether or not my charting will begin sooner or later.

The orders that come in throughout the day dictate the flow of the day also. If I only have a few, then they're nice and easy to keep up on. This means I get to spend more time with my patients. More orders (for labs, procedures, or meds) means I have to spend more time watching for those orders, which means I have less time to spend with my patients.

I'm like you in that I prefer the orderly fashion. I have severe GAD and the fact that I have little control of the flow of my day makes it worse.

I realized that I enjoy my job, and I'll never be able to make IT suit ME, so (as you said) I have to be more flexible to suit the needs of my work environment.

My anxiety never gets better, so I just have to deal with it

[NsgChica]

OOO yes. It is very difficult to manage your time. I have the same problem with control. I want to make sure everything runs smoove.

[UM Review RN, ASN, RN]

Yep, same here Nancy. Exactly.

[jemommyRN]

I'm glad you posted this because I was thinking this exact same thing earlier. I wanted to plan out my day to the tee. But, that would only create more anxiety for me so I will come up with another plan.

[Virgo_RN, BSN, RN]

Well, things did seem to go a bit better tonight once I resigned myself to the fact that I was just going to have to go with the flow and chart in fragmented form, and that my assessments would not be charted until the end of my shift. I just didn't worry about it, and I didn't bite anyone's head off tonight!

On the other hand, I did forget to check and see if the CNAs charted I&Os, and I forgot to put in my IV intakes.

[canoehead, BSN, RN]

Nancy, although I am totally sympathetic, I have to laugh. You might think that with so many time sensitive treatments life would be more predictable. The minute you think you're ahead and decide to help someone wash their hair, or do some extra teaching the evil nursing spirits will see and give you an admit or a crashing patient. That's why we never mention the Q word, and nobody can pull order supper out without it getting cold. I've been in nursing forever, and there is not a thing you can do to avoid it, just do as much ahead of time as possible.

I am certain that I have literally avoided codes because I planned ahead and got all the emergency equipment in the room, and had the time to do some teaching about what to expect with patients and families. Keep those evil nursing demons at bay.

[Imafloat, BSN, RN]

I am the same way and it took me over a year to get over the fact that things weren't going to go orderly for me every day at work. I would have 3 8:00 feeds and basically ruin my whole day because I got so worked up in my head that I was already starting the day behind. One of the more experienced nurses told me that that is what they mean by prioritizing, things have eventually gotten better. It doesn't help that I am uber anal about things. Before I walk out the door at night, after giving report, I go to every bedside and look over my charting and MAR one more time.

[jjjoy, LPN]

I One of the more experienced nurses told me that that is what they mean by prioritizing, things have eventually gotten better.

It would be nice if more folks explicitly acknowledged this. When instructors emphasize the need to prioritize over and over, it often sounds like if you do it just right, then you'll be able to get everything done. They don't often mention that this means that you may NEVER get to some of the lower items on your list if other priorities come in higher.

When as a newbie, colleagues and managers warn that you need to be able to get everything done and that you could've done this or that differently, it sounds again, as if the newbie were just organized enough and prioritized well enough that they'd be able to get it all done in a timely manner.

So when the newbie tries day and after day and still ends up doing things late and leaving things unfinished, they may start to conclude that they just must not have what it takes to be a good nurse... when it reality, it may be that they are doing very well prioritizing and with time management given their level of experience.

[imanedrn]

Well, things did seem to go a bit better tonight once I resigned myself to the fact that I was just going to have to go with the flow and chart in fragmented form, and that my assessments would not be charted until the end of my shift. I just didn't worry about it, and I didn't bite anyone's head off tonight.

I did the same thing yesterday! I had sooo much to do before lunch. I'm normally able to get my charting done after my AM meds & assessments, but I had NO time at all yesterday. I was totally anxious about this, but I went to lunch anyway, knowing that if I didn't go then, I wouldn't be able to later. (Good thing I did when I did or else I wouldn't have gone until 1500!) In any case, to my surprise, I actually got everything done on time and left earlier than I have in over a month!

I've noticed that, sometimes, the more pressure I put on myself, I don't necessarily perform any better. I just end up overwhelming myself more. I'm my own biggest critic. Giving myself some slack does wonders!

[jjjoy, LPN]

Thanks for sharing!! That's great to hear!!

[nursemike, ASN, RN]

Very interesting thread. I guess I do subscribe to some nursing superstitions. My phone always rings when I'm sterile, or gowned up for isolation. I don't dare turn my phone off beforehand, because that's just begging for a code. If I remember, I lay it where I can see the caller ID to decide whether I need to answer or can call back. I don't really believe in the curse of the Q-word, but I rarely use it, since so many of my coworkers do believe it.

I think prioritizing may come naturally to me, though, since I'm a lifelong procrastinator. My whole world is divided into what has to be done right now, and what can be put off until later. Mind you, I am not advocating this as a perfect, or even viable, system. I usually spend the first four hours of my shift falling behind, and the last eight catching up. Or the last nine. Not often, but sometimes, ten. Okay, my system sucks. Still, it's a proven fact that staying too far ahead of the game is just asking for more work.

One piece of advice I can share, however, is never, ever, even in jest, never, ever tell your NM that charting isn't so odious when you're getting time-and-a-half. Just don't do it. Ever. I'm not kidding.