New nurse staying way past 9:30 pm on day shift

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Hello everyone,

I am a new nurse and this past week was my first on my own and also my first 4/4. I work at a very busy med surg floor and needless to say I feel very stressed/overwhelmed being on my own.

I am so scared of making a big mistake. I usually end up giving some meds late like very late :((. Even though I try really hard it is very difficult with 9 patients. I had two patients with PEG tubes so those really made me late for meds for all the other patients. On top of that, doctors want me to round with them, management, new orders, critical lab value reports ughh just remembering it all makes me hypertensive lol. I have stayed very late until 10 pm or worsee 12 am (that day was crazy).

I absolutely LOVE my job and my patients, but it is too much. I usually end up thinking of little things that I should have documented but didnt. I stay up late documenting but even then I feel like my documentation is not very good. I am scared those four days I was on my own I made a mistake I didnt catch.

There are a lot of things I could have done better for my patients but could not since I was very busy. I don't know if I should talk to my director and ask her.

Time management with meds and documenting is my big issue. Anyone have any tips to keep up with documentation/passing meds on time/ provider notification? I also give meds one by one so I take out the mediction for one patient and then go give it, then I return to the med room take out medications for next pt. and give them. I dot he same for insulins but I am beginning to see not everyone does that. How do you all pass meds? one by one too?

Any tips/advice/suggestions are welcomed,

Sincerely,

A stressed out new nurse.

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First off, 9 med/Surg patients is insane! Are you including admits or do you have 9 patients at 1 time? I don't know if I could do 9 patients.

Secondly, when does your shift end? Are you staying 3-5 hours after a shift? I could see management having issues with this as you would be working 9-15 hours longer than planned. I'm not being mean, just worried. Are the other nurses staying late, too?

Being new is hard. I'm guessing you are on day shift by your mentions of rounding with the providers. Is there any way you could go to nights where it is a little quieter (although the belief that patients sleep at night is a myth!)? This might allow you to get a better grasp on time management. The downside is you may have more patients.

Are your co-workers busy all day, too, or could you ask them for help? I struggle with asking my co-workers for help because I feel like I should be able to be super nurse and do it all myself, but that's not reality.

Do you have computers in the room? Charting in the room can help speed up charting (you aren't getting interrupted by co-workers, doctors, etc.) and can help with some of the things you feel like you forgot to chart later on. You can walk out of the room knowing you have taken care of the charting for that patient.

Do you have a mentor? Is there a new grad program? Anyone you can talk to? I would consider talking to my manager to see if I could have a little more orientation or do night shifts, if possible.

Whatever you do, don't take meds out for multiple patients! That is just asking for a med error. I am imagining scanning a patient for their nightly insulin and then mixing up the syringes! Our Novolog sticker come up as Novolog, but don't fill in the dose (because of the sliding scale). It would be SO easy to mix them up!

Having feeding tubes is always going to slow the process down. Some of my co-workers will give multiple meds at once through the tube. I don't because I don't want to be the one who clogs the tube!

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My shift is from 7 am to 7pm. Those days, I didn't have any new admits in the day. I had the same 9 patients through the 12-hour shift. Other nurses end up leaving around 7:30- 8:30 pm. If there is a crazy day (incident report or AMAs). I have seen them stay up till 9pm.

I would actually love night shift but there are no openings in my department. It sucks because I love my patients and the work that I do but I have too many patients. I will definitely start charting in the patient's room! Thank you for your advice.

My coworkers are wonderful. I am always asking questions because there is simply too much I don't know. I feel horrible asking for help because I know I slow them down and I literally have nothing much to offer in return right now to help them haha. I will ask my coworkers how they manage their time because so far I have just seen how my preceptor used to manage her time.

Thank you for your response

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I was reading along just fine, and came to an abrupt stop when I got to the part about 9 patients. Nine! I thought I had it tough with 6 patients and aides of variable quality.

You are doing the best you can in a difficult situation. All I can add is delegate to your aides whenever possible, make good use of your charge nurse, try not to over-chart and take care of your health.

I also recommend that you look at this job as a short-term gig. Staying long-term in conditions like that will destroy your love for nursing. My current hospital staffs med-surg nurses with 5 patients, has good working conditions and loves to hire for nights.

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With 9 patients, you are really nothing more than an expensive pill pusher. You aren't going to have time to think - and that's dangerous.

This job will kill you physically and emotionally. Unless the acuity is more rehab than med surg, I can't even comprehend how one would manage 9 patients.

Is turnover high? Are there no jobs in your area? How many patients per nursing assistant? The only tip I have for you is get out.

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Nine patients?! That's insane. Reading that made me thankful for California ratios. I am one month into my first RN job and I pull meds for all of my patients at the beginning of my shift and place them in the med room. Each patient has a cassette and I put them in there. When I pass a group of meds at a particular time I pull all of the patients meds, separate them by patient into a med cup and place a piece of tape over them and write the patient's room number on the tape. The hospital I work at uses an electronic scanning system so that is another safeguard in place to prevent med errors when I pull meds for more than one patient. Insulins I draw individually, and I don't know if I would change that.

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Nine patients?! That's insane. Reading that made me thankful for California ratios. I am one month into my first RN job and I pull meds for all of my patients at the beginning of my shift and place them in the med room. Each patient has a cassette and I put them in there. When I pass a group of meds at a particular time I pull all of the patients meds, separate them by patient into a med cup and place a piece of tape over them and write the patient's room number on the tape. The hospital I work at uses an electronic scanning system so that is another safeguard in place to prevent med errors when I pull meds for more than one patient. Insulins I draw individually, and I don't know if I would change that.

Do not encourage the practice of pulling meds all at the beginning of the shift and storing them. Do not encourage pulling meds on more than one patient. Both practices increase likelihood of a med error. Also depending on your EMR and electronic drug dispenser it may set a "due" time based on when drugs are pulled from the dispenser.

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Nine patients?

It would require adopting a special kind of don't-give-a-crap defense mechanism in order to deal with that.

Of course you pass meds one by one. Others in your environment may do it differently because ^.

In ideal circumstances it takes an eager new grad a lot of mental and emotional work to self-critique and continuously improve so s/he can move toward eventual expertise. That is an expected challenge that is difficult enough at baseline. Usually forward progress is encouraged through the successful mastering of previous challenges and there is some satisfaction involved. It's kind of sad to think of any nurse trying to master this situation, let alone a new grad.

Some people feel good about themselves by looking at these as "trial-by-fire" situations that are a challenge to master - - - but what about the patients??? If I could be convinced that you could succeed (and feel good about it) without cutting major/critical corners, I might have some practical advice. Instead, this just seems like a sad situation to think of a new grad striving and being so eager here because experience would suggest this won't end well, either in emotional health ways or in more tangible ways.

I'm sorry. TBH, for the sake of your health and your career I will only advise putting out other apps ASAP.

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Specializes in ED, psych.

^^ Everything JKL33 said.

I would have some advice for 5-6 patients. But 9? Omg, honey NO. You sound like you're doing an amazing job in keeping wth safe practices. Don't cut corners. And get out those apps pronto.

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Find somebody with an identical assignment who does an excellent job.

Copy that nurse.

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RNperdiem, thank you for your response. Honestly, I woke up, read the responses and cried for a little bit. I did not realize my situation was that bad. The last thing I want to do is to hurt my patients. We are short staffed right now, and my manager says by October there will be four more nurses in my floor. So we would each get 6-7 patients. I will look into other jobs in my area, but I need to stay at least a year in my facility since I already got the bonus and signed an agreement. I do delegate to my nursing aide but they are also super busy. They get 10-15 patients

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Thank your for your response, beekee. One of my coworkers said the same thing, she felt all she did was pass meds. I do not see my job like that. I actually assessed pts and held some meds because they were inappropriate, potassium low and lasix, heart rate below 60 and digoxin, scheduled insulin and bs less than a 100. The acuity is def not rehab

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