Need advice please

[sistasoul]

Hi all,

I am badly in need of advice and suggestions. I gradusted in 2008. I worked 5 months in LTC passing meds. I finally got hired to a ortho/stroke unit in April of 2009. I received 3 weeks of training and was told to ask questions if needed. I was told that because I had experience at a LTC facility that I had experience. Working at a LTC facility is totally different as most nurses know.

I have now been on my own for 4.5 months. If it was not for the support of the nurses on my unit I would definitely not have made it this far. My dilemma is that I am still getting out of work 2-3 hrs after my shift ends. This is the only time I have to chart. I run my behind off and don't take lunches or breaks and just gulp down some graham crackers or cookies on the run. I try to do the best job I can by my patients. I enjoy my patients and being a nurse but the constant time constraints are stressing me to no end. I do not mind staying late but was already spoken too by management 6 weeks ago about overtime. If I did not have management breathing down my neck I would not care if I stayed late as I feel my patients deserve the best I can give them. Even some of the experienced nurses end up staying 2 hrs over their shift to finish but not as often as I do. Of course I understand why my manager gets on me about this and I am trying my hardest to finish on time.

I go into work with a plan for my day but it all seems to go awry very quickly. I still question almost every thing I do and ask for advice. I cannot believe how other nurses have time to sit and chat or actually chart before their shift is over. I just figure that I am too slow. My manager suggested that "I walk faster" and sit down to chart every hour for 10 minutes. I was told it should not take me longer than 10 minutes to chart on every patient. We have computerized charting and it is very tedious.

Is this normal for a new nurse to stay over 2-3 hrs every shift and what can I do about it? Any suggestions/ words of wisdom are welcomed before I run screaming from this job.

Thank you.

Heather

[athena55, BSN, RN]

Heather:

I certainly feel your pain. Went through the same thing when I started work at the VA on the telemetry/step-down unit.

Yes, we had computerized charting with the infamous "drop-down" menu, and my patient load was only 6-8 patients. So why did I always leave at around the same time (03:00) when my shift officially ended at 12 midnight? And why did the majority of my peers leave on time?

I am not saying that those RN's that left on time left behind a lot of work for the on-coming shift to complete (like starting blood or starting IV's). They didn't. So, what was my problem?

I still don't know. In fact sometimes I was so tired I would just open up the template for my notes and save it, knowing that I would come in the next day a wee bit early and finish up the notes (at the VA we had 24 hours to complete the admission notes; 12 hours to complete regular shift notes)

I am not pointing fingers at others who seem to "have time to sit and chat or actually chart before their shift is over" I don't think it is because you are "too slow" I think it is because of the type of person and nurse you are.

Is it normal for a new nurse to stay over 2-3 hours every shift? I have been a nurse for over 30 years and as I stated above, been there, done that! In fact I work in a combined Army ICU now (usually only have one sick patient) and I STILL will be sitting there, in the break room, finishing up my notes (my Army MEDCEN hasn't joined the 21st C yet and we still do paper charting) while everyone else on the night shift has gone home.

Maybe it will get better for you, maybe there are some safe, legal "short-cuts" that you can attempt.....Have you asked one or two of the other nurses - who seem to go home on time, how do they do it?

As an aside, the majority of the Vets (male) on my unit would actually ask me if I would be "their" nurse for the shift and some even requested me and my unit when they were admitted, so yes some people actually do notice you and the work/nursing that you perform. Maybe not the suits and nursing administration, but the patients, they do.

I say, embrace the type of person/professional nurse that you are.

athena

[Student2Registered]

I don't have answers because I am a brand new new grad but I still cannot wrap my mind around being able to pass all meds, complete all orders, chart, and provide emotional support to patients in the amount of time given. Literally one unexpected event sends my whole day into a tailspin...You are not alone.

[nursemike, ASN, RN]

I'm interested in this thread because I've started doing charge from time to time, and a couple of the problems I've had to deal with are new nurses in much the same situation as the OP. I've been a nurse for four whole years, so my recollection of these straits is still pretty vivid, but it's hard to recall what I did to get out of them. Student2Registered's point about one unexpected event really strikes a chord. It wasn't long ago that an IV going bad was a catastrophe. Now it's a task. On the other hand, there are still tasks that can throw a monkey wrench into an otherwise well-planned shift. Bedside procedures like lumbar punctures can throw a schedule off. Any time you crack a code cart qualitifies as at least a bit of a disaster. I've even had patients with urgently needed IVs that no one could get, and lately there have been a few very needy or very confused patients who'll do their best to eat up your whole shift. Worse, I've seen nurses with 7-or-8 times my experience dealing with similar problems. It never gets easy. But it gets better. The question is, how does it get better?

I dunno. I discussed the question with our clinical preceptor, and her advice boiled down to help and encourage the newbies. There were a few specifics that might relate to a particular nurse, but that was the gist. And I try to think of what helped me, and it's similarly vague. Well, you know, there's a lot about nursing that can't be done with a cookie-cutter, and mentoring seems to be one of those things.

So, my best advice seems to be, keep doing what you're doing. The routine chores like IVs and Foleys are just a matter of practice. By the time you've missed a hundred IVs, you'll be missing them a lot less often. I still feel a bit rushed during my 2200 med pass when just about everybody gets something, but a lot of times I start at 2130 and I'm done by 2205, so why did I feel so hurried? So, even though I know I'm a little adrenalized, I make a conscious effort to take the time I need, and if occassionally the patient getting only Pepcid and Colace doesn't get them until 2245, the main thing is that they got what they were supposed to get. 15 minutes late with Pepcid and Colace is not the sort of med error I fret about.

I work nights, and I think that can really help a new nurse find a rhythm. It's a lot easier to keep track of your patients when they're all in their beds. That doesn't mean the patient who needs their Ativan taper is never in the MRI when the time comes, but at least it's unusual.

Some of the best nurses I know get out late. Not as often, but it happens. I get out late for the same reasons: patient care first, charting later. But not as much as I used to. Some very-well organized nurses are rarely late. By a strange coincidence, they never over-chart. So I try not to write a book on each patient, but as you may have noticed, I'm verbose, so it's a challenge. A few nurses get out on time by leaving things undone. As long as you aren't one of these (and there will be times, no matter how good you are, when something has to be left for the next shift, just as it will sometimes be left for you) the rest will come, with practice. So just keep doing what you're doing. Faster, though.

[Eiano]

Yikes,

First, 3 weeks of orientation is not nearly enough. I'm surprised that's what they offered you.... and what you accepted... and that after the 3 weeks you didn't tell your NM that you needed more time on orientation.

In any event, after about 5 months, I would say just keep doing your best. It's not like you are providing unsafe care. If the management is only worried about your OT, why not swipe out at your normal swipe out time and continue charting. (In the hospital I worked at, they would basically yell at you if you ever stayed even a min, past your time and a lot of us would have to swipe out anf finish up what we could afterward).

I think time-mgmt. is a problem for all new grads. Good luck, eventually you'll get it down!!!

[sistasoul]

Thanks to all who have taken the time and replied.

I agree that 3 weeks is not enough training but where I live hospital jobs for new grads are really hard to get so I accepted the position. It took me 8 months to get into a hospital and there was no guarantee I would have been accepted into any new grad orientation program. I was so happy to get this job. I was told that since I had experience in a LTC facility that I was not considered inexperienced. It is what it is and I can only move forward and try my best.