Please, needing a little help with a couple of things

[cupid09]

Hi all, just needing some help with a couple of things. My notes, they seem to be just too inadequate, too much, too something. I really don't know what exactly to put as an opening note and we have to chart q 2 hrs. we chart by exception. It seems that I basically chart almost the same things on all 6 of my pts and that can't be right. Some say I chart too much info. I always get out late because I have to go back and chart on all my pts. I try to do as I go but that always seems to fail. It also takes me about 10 min to chart each assessment on each pt. I also have a hard time leaving unfinished orders, iv's, dressing chgs etc... that I didn't get done for the next shift to do (they get mad at me if I do leave things). My mgr says I had better start leaving on time or else!!! I just want to be able to leave with the rest of day shift. My shift if over at 7p but I don't leave till 9p or later:crying2:. How do I leave on time??

Any help and advice would be appreciated.

[UnbrokenRN09, BSN]

Here's my take on "leaving tasks" for the next shift. You are there for however many hours you're there for. What gets done gets done. Simply pass this on....if it's something pretty tedious, offer help. The oncoming nurse has no business getting mad, they are there for 12 hours too and if they don't get it all done, no biggie...they can pass it off. Night nurses are typically worse about getting mad than day nurses for whatever reason, which is silly because day shift is usually balls to the wall busy and night shift is not anything close to this. Try your best to get things done, but sometimes it is out of your control. If the MD comes at shift change and writes a bunch of orders, it should be no surprise to the next shift that it's not all done. We get to paid actually work while we're at work....big surprise!

I struggle with this too still....I feel bad when I leave tasks too. It's normal. But you have to realize there's a big difference between leaving things that should have been taken care of long before shift change and things that happened later in the shift that affected how you had to spend your time.

Charting...if it's by exception stick to that. Don't waste time charting "normal" things. My workplace charts by exception as well. It saves a lot of time. If there's nothing new that is abnormal with the patient simply chart "no change". When sometime happens, chart it, and more importantly, chart what you did about it. If you can't chart right away, jot down some notes and chart it later. You'll get faster with your assessments/charting....I now can do 4 assessments and have them all charted within 45 minutes to an hour. Charting is there to simply show what has been done to the patient, abnormal reactions to treatment, & what was done about it. No novels necessary.

[Up2nogood RN, RN]

"Progressing towards expected outcomes", is what I chart when there has been no change in pt during my shift. I don't get to use it too often though as something always arises-nausea, uncontrolled pain, high b/p, etc. We only need to chart a note in the nursing plan of care. The assessment is exception only and computerized so it takes me 5 minutes tops.

[NajRNBSN]

you should never be there more than 2hrs after a shift, you should only be there 30 minutes to an hour later on RARE occassions when you had a code or something major that shift occur. you need to write out a "brain" very detailed with each hour and all tasks due at the time. look online their are examples of brains (example: http://nurseteeny.wordpress.com/tag/nursing-brain-sheet/ ). some hospitals have them so if you dont like yours or you dont have one there then make your own on the computer, print them and make copies. in time slots you have blanks then schedule in little tasks you need to get done such as dressing changes. you also need to learn to ask for help and delegate tasks to aides, ua assistants, and even a charge nurse needs to help you get out on time.

you cannot finish everything every shift but it should not be common to leave so much left over. you will receive bad peer evals, poor patient outcomes, and staff will get sick of it.

charting by exceptions is the easiest charting. It means you only chart instances where a patient's response to care/med deviates from that expected you dont need to restate things like the age, diagnosis, etc. focus on what they are their for. Charting by exception should be a few sentences, at most. How can you be writing so much? Your patients must be deviating from the plans of care or expected outcomes.

Again look up charting types online or go buy a book that gives you examples of charting by exception. Of course a code or some major problem will take a long note. But every 2 hours your patients shouldnt have so much deviation from care/med that you need to write that much.

[cupid09]

Thank you all for responding to my post, I appreciate it. I was told by a couple of nurses that are always chilling at the NS talking, gossiping, texting, waiting on 2nd shift etc. (I envy them) that I spend too much time with pts and their care. I was told that I need to cut my time in 1/2 with them. Ex. bedbath, gown, linen chng and poop clean -2 mins tops, VS and BS-1 min tops per pt, that every morning I should be able to go thru 6 charts look up everything that I need to know on each pt - 10 mins total time tops. How is that possible??? I'm starting to think that this whole nursing thing was a huge mistake for me. I have been at this going on 5 months on my own and it is NOT getting any better, (this is not happening for me yet ) don't know if it ever will...so depressing.

Please understand that we have no teamwork, it is every man for himself. usually 1-2 techs for 40+ pts so not much delegating going on there and nurses dont help each other. We have to draw labs, do VS, BS, bedbaths,linen chg, feeding pts, clean poop, transport pt to/frm procedures....how can i incorporate all this with....caring for pts needs, chart checks, scanning orders, pulling/passing tons of meds(most times the meds are not in omnicells so they will be late due to searching hi & lo on the floor then notifying pharmacy and waiting on them to send up), paging docs, interventions, tons of paperwork, admissions/DC, charting assessments and notes q 2hrs, and responding to no less than 30 calls a day from pts, family members, MDs, depts, not to mention outgoings calls I have to make, and the list goes on. Is there any kind of order to this madness, it is total chaos for me. I just want to manage to feel good about my pt care, get my orders completed and get out on time!!!!! (Hoping one day I will be able to look back and do this )

[Becca76]

I'm wondering if maybe the night shift is a possibility. (and no, I'm not being sarcastic)!! The night shift has less distractions, less going to and from procedures, less phone calls, less new orders, etc. It may not be your first choice but it can be a nice place to develop time management, skills, etc. Just a thought! Good luck to you!!!!