Need some encouragement:Stretched thin

[KMC-RN-BSN-710]

I am a newer nurse and have been employed since August last year. I was hired on as a RN on a 64 bed unit med-surge unit. Med surge is not the field I wanted to go into, but because of the economy I took the job and I am really learning alot. However I need some advice/encouragement. I feel when I am at work I am stretched so thin. I recently moved from 8hour PM's to 12 hour days because I thought I would have more time for my patients and get away from the task oriented nursing. I feel like when I am at work I am merely getting tasks done, I become agitated when family members ask me to talk so many times during the day, and it is not that I do not want to talk and comfort them or answer their questions but when they are calling multiple times per day when I just spoke with them, I do not have the time to go back 20 minutes later. I became a nurse because I truly want to make a difference in the lives of the individuals that I serve. I have complained about not being able to find enough time for patients and it frustrates me, but I feel like co-workers just brush it off they say that is how it is and to not let it get to me. I want my co-workers to like me but it is hard to not complain about things on certain days. Some days I will have a 2 discharges 2 admissions and a transfer all in 1 shift, on top of all my other duties as a nurse. We have a charge nurse but they are not always available to help and I feel when we ask for help they are not as open as I would like them to or they do not have the time. Often I feel overwhelmed and drained and to top it off I have co-workers who tell on other co-workers if they are not able to get all their work done or they forget to do something. I am not talking about something that could hurt a patient but things that I didn't even do like a missed page on a printed mar, that is copied by night shift or not having an antibiotic hung before shift is over because it was not available. I am still new and I feel some of the other nurses eat their young and there are some cliques that are evident. I am not complaining about having a job I am greatful. I just want to know how other nurses deal with the constant stress of nursing, go home and still are able to sleep without worrying about whether you made a mistake. I go home worrying about making a mistake because I am so busy I do not always get the time to be as thorough as I would like and I cannot always double check. I feel sometimes it is unsafe with 6 patients. When we have 5 it is ok, but we are getting the same number of patients on days and pm's as they are getting at night. During the day we have doctors, families, tests, orders, and heavy med passes. I am not saying they are not busy at nights, because I know they are but. How can I stay happy at my job, have energy to go above and beyond and still be safe and get out of work on time. I want to give the best to my patients but lately I have been dreading to go to work. Positive encouragement only please!

Kristen:nurse:

[classicdame, MSN, EdD]

welcome to nursing. That is what it is like in hospitals. You are stretched thin. You might ask more seasoned nurses how they manage time and prioritize.

[RNAM1965]

Yes, take the advice of the previous poster, and see if you can learn from some of the other nurses who seem to have good time management. Things get better with time and experience. I used to feel the same way for at least my first year in nursing. The other day at work alot of us were talking about this, and we all felt overwhelmed and nervous going to work for at LEAST the first year after nursing school. It's a complex job and you don't become a safe AND efficient nurse overnight; it can take years to become "expert" in your area. I work with some nurses who it took at least a couple of years before they were really good at delegating effectively and using all their resources, and knowing what has to wait and what cannot. That being said, even the best nurses will have a rough shift from time to time. I promise even if you had less patient load, there would still be days where you would seem stretched thin. I

Just take a deep breath, prioritize, ask for help when you can, and see if there are some tips and tricks to help organize shift in the beginning, etc. Everyone has their own way of managing their time and you will find yours.

Good Luck!!

[Tankweti]

Not that this is much help from another new nurse, but I feel the same way you do. I (finally) got a job in a nursing home where I am responsible for 20 patients at a shot. I am grateful that it is not 40, as that is what most nursing homes do. I am still experimenting with trying to get everthing done in a safe fashion over an 8 hour shift, which is what we have. I leave there literally bathed in sweat every night from running hither and yon. There are times I feel like I am going to pass out. We get a half hour lunch supposedly but there is never time to take it as something always interrupts that takes priority (like a resident falling). There are many nights where I go without drinking anything for the entire shift. I have now taken to putting a drink for myself on my med cart so I can at least keep hydrated. I have two big med passes to do, treatments, and of course documenting and documenting and more documenting. Not to mention if I get an admission which has scads of paperwork. There are times, especially lately, where I feel like I want to give up and walk out and never come back (not in the middle of a shift, of course, as that is patient abandonment).

But, if I did that, where would I go? It sounds to me like the same scenario exists in hospitals. Even though you may have 5 patients, they are probably generally not as stable as 20 nursing home residents, not to mention the fact that you get alot more admissions, discharges, transfers, etc.

So, there is no perfect world in nursing. I guess we just have to "suck it up" and figure out how to deal with it, as it is no better any place else.

Good luck to you.

[Genista, BSN, RN]

Kristen-

I've been a nurse 12 years and I could have written your post. Time management tips may be helpful, but the truth is we are all spread thin. Med/surg isn't my dream job either. I often dread going into work, because the pace is so hectic and it feels like I never have enough resources/time. I am glad to have a great job, but looking into other nursing areas that may be a better fit for me than floor nursing. I hope you can find some peace in your current situation, or perhaps an eye for something better to come your way! I wish I had a more encouraging answer. I just wanted to share that you are not alone, and that even the more experienced RNs struggle with getting it all done. Hang in there. :-)

Edited to add: Not sure what state you live in, but in my home state there are lower nurse patient ratios in certain specialties. Something to consider if you float to other units. I often find my load a little lighter on the units with less patients (not always, though...depends on acuity). Good luck!

[gettingbsn2msn, MSN, RN]

I do not like floor nursing. I have put on 30-40 pounds in 3 years. I have aged 10 years. My husband and I no longer get along. I could go on and on. I am finishing my masters because I have already got over a year in. I do not like the person that nursing is making me become. I looked around at my nursing cohorts the other night. We all look horrible. Everyone is telling me to get on Lexapro. I used to look good.

[canesdukegirl, BSN, RN]

Hey OP!

It sounds like you are feeling unsupported and overwhelmed at work. You have been a nurse long enough now to know how to avoid the pitfalls. Now you must learn how to hone your time management skills.

When you go into a pt's room for the first time, introduce yourself, tell the pt what you will be doing, and what kind of schedule they can expect for the day. Ask the before you leave the room what you can do for them, and what kind of timeline they can expect. If you set boundaries from the get-go, they understand and comprehend what to expect. This is the biggest reason why pt's hit the call bell relentlessly. They just want to know what to expect. Example:

"Good Morning Ms. X. My name is Katie and I will be taking care of you from now until 7 pm. Your doctor has ordered VS every 8 hours, so either I or one of the nursing aides will be doing that for you. I know that you aren't feeling well, so we will try to make these visits as short as possible in order to let you rest. Breakfast will be around 0730, lunch will be from 11-1pm, and dinner will be from 4-7 pm. I will be coming into your room to give you medication that your doctor wants you to have. If you are in any pain at all, I ask that you hit your call light and let me know when your pain level gets to 3-4. (At this point, go into pain management education.) A nursing assistant will come to give you a bath or assist you if you prefer to do it yourself. We will also want to change your bed linens. If you have family members that want to visit you, you are welcome to have them, but please know that I am wanting you to rest as much as possible, so limit your visitors if you can. If your family members want to help you with things, please call me first so that I can give them instructions on what would be most helpful to you. (Here is where I do some family teaching. Families are in the horrible position of feeling helpless. If you can give them even the smallest task to do, they will feel as if they are contributing to their loved one's care, and will find satisfaction in that. Have you ever been to a gathering where you want to offer to help with something and are turned down? Your anxiety goes up, because you would feel better if you could help with SOMETHING. Families feel the same anxiety.) The doctors round very early, and usually don't come back to round until late afternoon. I will inform you as to any changes that you might have in your schedule and will let you know if the doctors change your orders. There is always someone here in the unit that will answer your questions. I will be back to see you when I give you your morning medications and your afternoon medications. If you should need something in the interim, just press your call light."

This (LONG) introduction sets boundaries for your pt. It lets them know what kind of schedule YOU are on (without really stating it), and also eases their fears that they will be taken care of. The most difficult thing for a pt is the fear of the unknown. If you state clearly what their schedule will be for the day, they will not hound you on the call bell all the time for little things. They just want to be assured that they have not been forgotten. If you allay those fears from the beginning, they will be self sufficient for the most part.

This mechanism will garner you amazing results. You will be able to plan your day and prioritize your care. Remember that the pts are scared. If you can somehow communicate to them that you are not far away, (you are their security blanket) they will be assured to some extent, and you can get the rest of your tasks done.

Don't forget to delegate. This is key in time management. If you can state concisely what your goals are for the day to your nursing assistants, they will know what their expectations are. On the whole, people tend to respond better to cut and dried directions rather than innuendo. When you deliver your expectations, give them a high five, a fist bump, a wink...whatever it takes to let them know that they are part of the team. If you can dissipate the "us v. them" mentality of RNs and CNAs, you will have bridged a gap that will become invaluable to you. A pack of M&Ms or an unexpected coffee waiting for your CNA will do wonders for you...and they will realize that you really do appreciate them.

I hope this helps to some degree. We have all been in your place. These are some of the things that I have found that worked for me.

[nurse.sandi]

Hi. I could have written that post, too. Several friendly advice from a nurse who worked a heavy fast paced dayshift stepdown unit. First, if you feel that stressed out see your Dr. and talk to him/her about your mental status. It is ok to talk to him about it. Check and see if your company offers a mental health phone line that you can call and get help. Never tell anyone you will be back in a few minutes, even if you have every intention of coming back. My best bet is most likely you will not. Excuse yourself politely from family members by saying simply saying I have to go. No explanations needed. If you have family members that are overbearing check and see if your facility has a public relations employee who helps the families think they are getting what they need. Make sure you take your breaks, even if it means sitting in the bathroom for a few minutes and destress which ever way..prayer, meditation, etc. Laugh a lot. Find ways to bring humor and self esteem to your break room. Hang baby pics up or have a dog board where everyone hangs pics of thier fav. pet, light reading nothing too serious. Take a mental break and drink a glass of water. I gained weight from that kind of stress no matter if I was dieting or not. Listen to whatever type of music you like in your car on your ride to and from work and sing real loud. Blog on here...Keep us posted and good luck.

[mama_d, BSN, RN]

Canesdukegirl had some great advice for you.

I would add on to make a visual sweep of the room and pt to figure out what will need to be taken care off with your next trip in...allergy bracelet on? New bag of fluids? Fall risk sign on door? Towels in bathroom?

I've found that taking a few extra minutes to make sure that the pt is settled and the room is set up properly at the beginning of the shift saves a lot of time by the end of the shift!

And lastly, you've been at it for less than a year. It's normal to still feel overwhelmed. Instead of focusing on all the "wrongs", try focusing on the "rights"...even the smallest accomplishments will eventually add up, and eventually you'll have a routine established that allows you to feel that you've had a good day.

[atlantasedeno]

I just finished my first day on the floor. I felt like crying. I spent almost the entire time passing meds and kept getting lost. When a patient has to tell you you're missing one of their pills and go back to check the mar and see that they are right, that's such a horrible feeling. I felt like a failure today. I don't know how these nurses do it. Patients bugging you all the time, their families.. Its hard! I want to treat my patients really well too, but I feel so pressed for time. I really hope I can make it too. I just think if they can do it, so can I. I just need to manage my time better I guess. I hope I don't gain 30 pounds!! Ahh that would be horrible!

[mama_d, BSN, RN]

Atlanta -- hang in there!

Having a pt remind you about a pill you didn't bring in is pretty minor...as long as they end up with all their meds at about the right time, in the right doses, no harm no foul. Remember that it takes at least a year in general to be comfortable; some take less, some take more, it's a ballpark figure.

[Bea1128]

I could have written this post as well. I graduated in December. I also have 6 patients. I'm glad this was posted as I fell less alone. I thought maybe there was something wrong with me. It's good to know this is the way it is and that eventually I'll get used to it. And I suppose I'll survive the stress of it all. Thanks for all the good advice.