Need help

NursingGirl0726 · Feb 27, 2014

I like having a checklist to hold me accountable for the tasks that are needing to be accomplished. Lots of nurses that you will follow will have different methods of keeping track. As a student you will have different tasks and need to find something that works for you.

It can be as simple as having a piece of computer paper folded into sections (1 section per patient) and writing down the tasks you need to do and the times they need to be done. Then cross or check them off as you go. This helps me visualize.

You also need to be able to determine importance of tasks for each individual patient. If you need to do a bath, give pain medications, and do a dressing change for example you would give the pain medications first so that when you move them to bathe them it doesn't hurt them. I would do the dressing change last because it decreases the changes of spreading bacteria to the area. You have to think about patient comfort and efficiency. How many patients do you have?

Nolli · Feb 27, 2014

Ah, it is easy to become overwhelmed. Sometimes the key to time management and prioritization is planning ahead. The first day I had to manage multiple patients I felt like everything went wrong and I was late for passing meds, break, and barely made post conference on time. I looked at what went wrong and what went right that day and used hindsight to my advantage. I anticipated the possibility of there being a problem rather than being reactionary and dealing with it on the fly.

Questions to ask yourself:

Who needs the most help?

ex: Complete care, OOB assist, or ambulatory

ex: tachypnea vs low BP

*hint* always go with ABCs and prioritize the unstable or unpredictable outcome above the stable or predictable

How do you handle multiple tasks AND multiple patients who all want the same thing?

One at a time; you are after all only one person. Allow them to participate in their care to the level they are able to. If you have multiple patients who need assistance bathing or toileting ask them when they would prefer to bathe and block the time out and tell them you'll do it at x time if they are ok with that. You can combine your assessment with it. Bathing exposes all areas at some point and is an excellent way to connect with and assess your patient.

If multiple people need to be toileted and need assistance to do so, but are not at risk for falling I will help them to the commode or toilet and give them a call bell if it'll be a few minutes and instruct them to not try to get up, but push the button when they are finished and I will assist them back to bed.

The less trips back and forth gives you more breathing room. Going into the room for something else? Bring a change of linens and supplies for hygiene when you introduce yourself or do vitals etc. Planning ahead means you won't be running for it later. Cluster tasks where appropriate. If meds are scheduled around vitals see if you can do an assessment, vitals, and meds in one trip.

Check meds ahead of schedule if possible. If they are not on the floor it allows you to call pharmacy and get them on the floor and still give them on time. Also check med compatibility esp IV. One patient had 2 meds both scheduled for the same time. One was a 4 hr infusion, the other a 30 min. Solution? We ran the 30 min first, flushed and then ran the 4 hr infusion.

What did I do right?

Praise yourself and be proud of what you excelled at. Try to identify what positive actions you took so that you can repeat them.

What can I do better?

Making mistakes is part of learning. The first step is admitting it went bad, but not allowing yourself to despair. Channel that energy into doing better. Identify where things seemed to go off the tracks. What was the main issue? What actions did you take before, during and after that time? How would you do it over again if you were able to (be specific in what actions you would take)? What preventative measures can you take to avoid dealing with the situation in the future?

I hope that helps a little.

Esme12, ASN, BSN, RN · Feb 27, 2014

You need brain sheets....organization is key...here are a few.

FinalGraduateShiftReport.doc

DAY SHEET 2 doc.doc

Love2camp · Feb 27, 2014

Awesome Esme. Thank you for sharing.

Babylonne · Feb 28, 2014

Thank you JordanStaggs! I spoke with my school liaison person who helped me to improve my worksheet, that will help.

A question: in the situation you described, would you ever do the dressing before the bath?

Babylonne · Feb 28, 2014

Hi Nolli,

Thanks so much!

Esme12, ASN, BSN, RN · Feb 28, 2014

Babylonne said:

Thank you JordanStaggs! I spoke with my school liaison person who helped me to improve my worksheet, that will help.
A question: in the situation you described, would you ever do the dressing before the bath?

no I wouldn't take the chance of making the bandage wet then having to change it again. Bath first drsg after.

Babylonne · Mar 3, 2014

I printed your sheets, your critical thinking flow sheet looks especially helpful. Thank you! Do you teach?

Babylonne · Mar 3, 2014

Oh makes sense. Thanks!

Esme12, ASN, BSN, RN · Mar 3, 2014

Babylonne said:

I printed your sheets, your critical thinking flow sheet looks especially helpful. Thank you! Do you teach?

I do...well at least I used to. I am no longer "qualified" as I do not have a masters and with 2 children in college in the next year (and other reasons). My education will be on stand-by. I tutor the students who come here.

LoriRNCM, ADN, ASN, RN · Mar 3, 2014

Esme to the rescue.... again! Saved your medsurg doc.... awesomeness.