any other nurses feel workload is too much?!

pie123 · Jan 10, 2006

seriously guys, maybe it is just me, but when i hear other nurses nonchalantly claiming to take care of 5+ med-surg type patients and it's no big deal, i am starting to freak out!!! i think even 4 pts is too many!! what's wrong with me?! maybe i don't have a goood rhythm/organization going, but i feel trying to juggle 4 pts on telemetry and numerous ivpb abx or meds, several ngtube meds and numerous doctor orders is too much!! especially on day shift
half the time by the time i get to try to do assessments, the doctors and residents are rounding with the patients, or ot/pt is working with them, and then i have delays in assessing and passing meds and it seems i dont' get time to do nursing 'care'.. i have too much charting to do and too many new orders, and sending patients to procedures..... yikes...
do you guys ever feel overwhelmed with this stuff? do u ever feel scared of losing your license due to missing something in the midst of all this running around and juggling many patients and meds?
i feel awful that some patient is begging for a backrub or for me to listen to them talk and i dont' have time!! id on't have time to pee, for chrissake :)
i think 2or 3 patients would be okay,, 4, maybe but 5 or more.. that's asking for trouble i think... especially when 2 of them are ngtube meds.. and all of them get numerous ivpiggyback meds and they are all on telemetry....not to mention watching labs and checking for new orders and adjuting heparin nomograms..... and admitting/discharging/transferring pts all day long.. how do y'all do it?!!!! and that's just basic medical 'tasks' .. not including fetching things for the pt/family..... or an unexpected turn for the worse,, or answering bells and walking pts to the bathroom or having a pt pull an iv out......
maybe i am in the wrong field....
does anyone else understand this?

Ok. EVERYTHING you just mentioned happens on my telemetry unit on a daily basis. I am a new grad about to be off orientation. I work dayshift. In my opinion, everyday is a mess, but TODAY was really pitiful. Nurses on my unit get 4 patients each. The capacity on our floor is 20, and there is one CNA for 15-20 patients. I have yet to leave work feeling good about the care that I have given. Today my preceptor and I had 3 of 4 pretty high acuity patients. We spent literally all morning with this patient: putting her on Dopamine, among MANY other orders for her. She passed away later in the afternoon. Then at 6 pm, I get another admission; one patient needs blood, and guess what time it's ready...a little after 6pm. So now I have a patient to admit and assess, and chart all of that; I have blood to give; I have a few new meds to give (the doctor came in and wrote new orders); one patient's son wants me to come in the room and explain to him why his mother is "Breathing through her mouth, when she's getting oxygen through her nose"; I still have charting to finish on the patient who passed away, and I have to finish I&O's for EVERYONE. I actually wasn't able to even START my computer charting today until something after 3pm. My preceptor helped me out a lot today. I felt really bad for that. She said that today was the busiest day that she and I have had together. I agree. On top of these things, I was also trying to juggle what felt like hundreds of other things. Not a fun day. On the way home, I decided to stop at McDonald's for a little stress eating. Great :stone

DutchgirlRN, ASN, RN · Jan 10, 2006

seriously guys, maybe it is just me, but when i hear other nurses nonchalantly claiming to take care of 5+ med-surg type patients and it's no big deal, i am starting to freak out!!! i think even 4 pts is too many!! what's wrong with me?! maybe i don't have a goood rhythm/organization going, but i feel trying to juggle 4 pts on telemetry and numerous ivpb abx or meds, several ngtube meds and numerous doctor orders is too much!! especially on day shift

I've been a nurse for 30 years and if I say so myself I am very organized. I have a hard time taking care of 5+ patients. Well, taking care of them the way I would like to. There's just no time for bedside nursing. The acuity of the patients has gotten so high over the years, we now have patients on the floor who 10 years ago would have been in the unit with a 2:1 patient ratio. What is so sad is that many patients do not appreciate how hard we work and the family members are becoming ruder and more demanding by the day. I transferred to home health and am loving it. I eat when I'm hungry, I pee when I need to go, I listen to my CD's while my driving, there's no beeper in my pocket and no overhead paging going on. I LOVE IT! So far (2 mo) I've only run into one ungrateful type patient. The rest have been so gracious and so thankful. What a difference it makes!

pie123 · Jan 10, 2006

I've been a nurse for 30 years and if I say so myself I am very organized. I have a hard time taking care of 5+ patients. Well, taking care of them the way I would like to. There's just no time for bedside nursing. The acuity of the patients has gotten so high over the years, we now have patients on the floor who 10 years ago would have been in the unit with a 2:1 patient ratio. What is so sad is that many patients do not appreciate how hard we work and the family members are becoming ruder and more demanding by the day. I transferred to home health and am loving it. I eat when I'm hungry, I pee when I need to go, I listen to my CD's while my driving, there's no beeper in my pocket and no overhead paging going on. I LOVE IT! So far (2 mo) I've only run into one ungrateful type patient. The rest have been so gracious and so thankful. What a difference it makes!

Ok, so how long should a new grad like myself stick around dealing with the these things? I keep telling myself that I am new, give it time, etc. I'm just not sure I want to give it time. I enjoy being a nurse, but I do not enjoy not being able to provide the kind of care that I want to provide. My friend left the bedside 8 months after getting into it. She spent 5 months in an ICU, but 3 of that was orientation. Then she spent 3 months on a Postpartum unit, where she also took care of OBGYN patients. She has found a job working in a clinic that she really loves.

DutchgirlRN, ASN, RN · Jan 10, 2006

Ok, so how long should a new grad like myself stick around dealing with the these things? I keep telling myself that I am new, give it time, etc. I'm just not sure I want to give it time. I enjoy being a nurse, but I do not enjoy not being able to provide the kind of care that I want to provide. My friend left the bedside 8 months after getting into it (this includes her 3 month orientation period, so she really was on her own for 5 months). She has found a job that she really loves. I have yet to find my niche. But I know that the area that I am in is not it.

Smart girl pie 123. Try to find your niche!

pie123 · Jan 10, 2006

Smart girl pie 123. Try to find your niche!

I am planning to stay for one year. Maybe in the morning I will wake up and one year will already have passed :chuckle. How awesome would that be...

grinnurse, RN · Jan 11, 2006

Hi Pie-

Med/Surge can be tricky, tiring, and wild at times with all the stuff that you mentioned that go on during a "regular" day. I have now been working M/S for 7 months with a 6 week preceptorship and please believe me when I say those feelings do get better with time. Everything improves with time. Things from NS will begin to make sense, you'll figure out how to get your time managemnet down and your confidence will increase.

If someone would have told me that in 7 months I would feel the way I do about knowing what I was doing I would have had to laugh!! I too would go home at night wishing for that "magical 1st year" to just pass me by!! Eventually, 4-5 pts will seem like nothing!! When I started on M/S I didn't really think that it would be my "niche", I was just doing it to move to another unit like ER but now, you couldn't pull me away from it. Now when the senior nurses compliment me I say thanks instead of degrading myself in my mind. I have yet to have the "picture pergect" day where I can do all the things that I wish I could for my pts, but you have to remember in NS you had an excellent supervisor that made sure you had all the help that you needed, supplies at your fingertips, and Doctors that didn't have the "Holier than Thou" attitude to deal with.

M/S may not end up being your "Niche" but it can lead to so many other great opportunities I hope that you won't give up!!

Best Wishes

pie123 · Jan 11, 2006

Hi Pie-
Med/Surge can be tricky, tiring, and wild at times with all the stuff that you mentioned that go on during a "regular" day. I have now been working M/S for 7 months with a 6 week preceptorship and please believe me when I say those feelings do get better with time. Everything improves with time. Things from NS will begin to make sense, you'll figure out how to get your time managemnet down and your confidence will increase.
If someone would have told me that in 7 months I would feel the way I do about knowing what I was doing I would have had to laugh!! I too would go home at night wishing for that "magical 1st year" to just pass me by!! Eventually, 4-5 pts will seem like nothing!! When I started on M/S I didn't really think that it would be my "niche", I was just doing it to move to another unit like ER but now, you couldn't pull me away from it. Now when the senior nurses compliment me I say thanks instead of degrading myself in my mind. I have yet to have the "picture pergect" day where I can do all the things that I wish I could for my pts, but you have to remember in NS you had an excellent supervisor that made sure you had all the help that you needed, supplies at your fingertips, and Doctors that didn't have the "Holier than Thou" attitude to deal with.
M/S may not end up being your "Niche" but it can lead to so many other great opportunities I hope that you won't give up!!
Best Wishes

WOW! Thank you so much for that post. I am going to have to print off all of these positive posts because when I'm right in the thick of going nuts at work, I certainly cannot remember ONE positive thing. Today was another day from hell for my preceptor and I. The charge nurse was going nuts with trying to get pts transferred/discharged. One nurse had FOUR admissions. She would get rid of one, and get another. Personally, I think that's kind of crappy, but I guess it happens. I do know that she has had words with the charge nurse, and since then she's gotten a great deal of tough assignments.

Anyway, no more rambling. Thanks for your post. Take care.

Daytonite, BSN, RN · Jan 11, 2006

That's telemetry. You really jumped into the fire when you accepted a position on a telemetry unit. Please tell me you have CNAs or LPNs to help you out with patient care because 5+ patients is too much for one person alone on the dayshift without any other back up personnel helping out.

Organization is everything. You need to sit down and develop a "To Do" list of things you absolutely must accomplish each day by the end of your shift. I used to keep a list on my clipboard and write it out on the back of my report sheet every single day. As I finished things I crossed them off. The thing about time management in a busy environment like a nursing unit (especially a stepdown) is that it is very easy to get sidetracked and spend a lot more time doing insignificant tasks rather than the major ones you really need to get done. This is why it helps to have the written list to refer to. Like, "now where was I?" and continue working down your list. Multi-tasking is really necessary and as you learn and become more proficient with the admission forms and daily assessment check off list, you start to incorporate looking for that data whenever you are in contact with a patient. Saves time. I know that while I'm helping to transfer a patient from a guerney to their bed during admission I am already eyeballing whatever I can see of their body and sometimes already asking questions that I know are on the admission assessment sheet I am going to have to fill out. Saves time. I will sometimes put a little grid below my ToDo list with my patients names down the left side and the hours of the shift across the top. I put check marks in the boxes for the times medications, especially IV piggybacks, are due for each patient. That way I don't have to keep going through every one of the MARs multiple times over my shift to figure out who need meds right now. If I see that an IV bag is going to have to be hung during my watch, I get the next bag up on the IV pole so it's there and ready to be spiked when I need it. If you have CNA help you need to delegate basic nursing care to them, you have to. My big fault always was putting off charting. I would often do for the patients first and foremost and end up having to finish up charting at the end of the shift. I just planned on it and would take one or two charts into the break or report room and work on them where I could relax after the next shift was out of report and the narcotic keys passed on.

Is your report sheet a tool that YOU can work with? That also need to be something that you are constantly streamlining to make your shift go smoothly.

I won't beat a dead horse to death. I've made my opinion about new grads working on stepdown units quite well known on this forum. I worked on a stepdown for 5 years and know quite well how busy they are and the kind of patients you get. I can only say that organization is everything and developing a mastery of all the various procedures you do on a regular basis will help you out immensely. Unfortunately, it takes time to develop mastery. Your only choice, really, is to just stick it out and continually work to improve yourself.

cherricka · Jan 11, 2006

I was an LPN before I became an RN for several years, and that included working as a charge nurse responsible for 40 patients at one time. When I went to go work at the hospital after getting my RN, I thought-hey what's 5 patients when I use to take care of 40? Needless to say, over one year, my 5 pts. turned into 10 in one day. I got the heck out of dodge.

I love nursing, but almost once a week, I would come home crying, and it would take me two days to recover from a 12 hour shift.

I don't regret working in a hospital, I needed it , and was lucky enough to work with wonderful nurses and preceptors.

I now work in home care, and for a small cut in pay, I gained peace, knowledge, and the satisfaction of really being the nurse I always wanted to be.

Yesterday, I got a call from my supervisor, telling me that a patient called her up to say what a great job I was doing in their home. Now you don't get to hear that often in the hospital!

Hang in there. I won't kid you, and say it will get better. But after one year of med/surg (or tele) , most employers will hire you for different positions.

By the way, here is my one hint to stay organized at the hospital. I use to carry a binder with me everywhere- Each page was dedicated to each patient (or you could use 1/2 page). In the right sided margin, I had 12 boxes, one for each hour. If something happend in that hour, or if I gave prn meds, emptied a foley, did some teaching (yeah right), I would jot it down, that way when I charted, it would make sense, and be chronological. It had Pt's name, room, Dr., Dx, tests, labs, last IV insertion and night report.

Daytonite, BSN, RN · Jan 11, 2006

By the way, here is my one hint to stay organized at the hospital. I use to carry a binder with me everywhere- Each page was dedicated to each patient (or you could use 1/2 page). In the right sided margin, I had 12 boxes, one for each hour. If something happend in that hour, or if I gave prn meds, emptied a foley, did some teaching (yeah right), I would jot it down, that way when I charted, it would make sense, and be chronological. It had Pt's name, room, Dr., Dx, tests, labs, last IV insertion and night report.

That is an awesome tip! I never in a million years would have come up with that. Good job!

Long Term Care Columnist / Guide · Jan 11, 2006

I feel your pain, folks.........it's why I got out of med/surg myself, just a few weeks ago. I figure I've got 20 years minimum before I can retire, and I was using myself up waaaay too quickly running that floor 4 days a week. As the 11 o'clock person I got the crappiest assignments---mostly new admissions and post-ops, with all the paperwork, frequent vitals, dealing with the families, new orders and so on. Then at 3 PM I'd pick up more patients, discharge one or two, then have to take still more admissions........it was hell.

I fought it, of course; but when you fight, you get a reputation as a whiner and then you get some assistant department manager breathing down your neck and giving you even harder assignments, like all the heavy care patients at the farthest end of the hall, probably in the hope of breaking you so you'll quit. Which I did (and do you know, I've run into that ADM several times since then, and she's never even looked me in the eye) because the fight was all whipped out of me, and I was getting sick or hurt every time I turned around.

I wish I knew what it would take to fix this crazy system so that nurses can give patients the care they need and deserve without killing themselves......probably nothing short of a nationwide walkout would do it, and even then there's enough 'scabs' in the business that the effectiveness of such a walkout would be blunted. It's all about the $$, anyway, and that's why we won't have decent staff-to-patient ratios until big money gets out of the healthcare business. And we all know when THAT will happen........~sigh~