PleeeeZ help me with organization - vent

military girl · May 23, 2005

I know exactly what you mean. I am in the military now, but when I was a civilian(up until January of this year), I could never seem to get out on time. The facility where I worked, we could have up to 13 patients apiece, and with meds and charting and all those other little things that seem to crop up(low blood sugars, falls, etc), it made for some hectic days.

Just ask for help. I am new to med/surg and military nursing and believe me, I will be asking or help.

Okay I have been a RN {0n 3-11 shift}for a year now and I am still unable to get out of work on time. I usually work 1hr overtime. Other people are usually able to leave on time. What am I doing wrong?? I have an average of 7-8 pts with a CNA assistance. I start out my day with assessments which I am never able to complete them without countless interruptions. I may get 3 of the 7 done and fit the others in the shift when I can. Today I had one discharge to complete and a transfer to another unit at the beginning of my shift. It took me until 6:30 to finish all paper work while I am doing this I am passing meds. Oh I forgot the new admit at the beginning of the shift that I had to complete. At 7pm I picked up 3 new patients, this gives me a grand total of 7 which 2 are complete care. One patient fresh cardiac cath who needed a foley insertion. I do not know what to do but I think this is horrible. I have a problem with the next shift who will get very angry if you leave anything . I try to do the best I can but these people are relentless and talk about me anyway. I noticed everyone talks about everyone so I take this with a grain of salt. I very seldom take a break. Oh, guess who was charge nurse today.
We use preprinted kardexes where I write all of my information, but I find that it is too many papers to carry with you. I tried condensing on a single sheet of paper, but i need to transfer this information to the kardexes anyway ,which we use for report (too much writing). Sorry for the long vent.

meownsmile, BSN, RN · May 23, 2005

Are you working acute care with 8-13 patients and no LPN? You are the only one passing meds and doing assessments, charting, discharges, admissions, new surgicals?,making calls, taking calls, and still having to assist your CNA with baths and dailys, and do enotes at the end of the shift? No one nurse should have to do total patient care on more than 6 patients and even that is risky.

Get the heck out. Total patient care on that many patients is a hazardous work environment and is totally out of line. Your patients deserve better, so dont let it be you that has to give second rate care in that situation. I think id be outta there.

starcandy · May 23, 2005

Are you working acute care with 8-13 patients and no LPN? You are the only one passing meds and doing assessments, charting, discharges, admissions, new surgicals?,making calls, taking calls, and still having to assist your CNA with baths and dailys, and do enotes at the end of the shift? No one nurse should have to do total patient care on more than 6 patients and even that is risky.

Yes I am required to do all these chores teamed up with a CNA. I have an average of 7-8 pts daily. I leave work hoping I did not forget anything. I am looking for a new job, but I am wondering if it is like this everywhere. I need a compact sheet with my pts dx, diet, abnormal vs, lab values. I work on a nephrology floor where I am always having abnormal vs issues. If anyone have help it would be greatly appreciated.

meownsmile, BSN, RN · May 24, 2005

Well as far as i know it is NOT like that everywhere. We carry large teams on my med/surg/ortho floor but if we have more than about 5-6 patients we have LPNs to help with meds, dressings, and pull up help for the CNA if they need. Needless to say we usually have LPN's because our normal team size is about 8-13 for 1RN, 1LPN, 1CNA.

Good luck,, i hope you find a new job soon.

RRT/RN · May 24, 2005

Just curious about a few things. Have you talked to your nurse manager about this problem you are having? Where are your co-workers while you are struggling? Are you delegating?

I had a hard time with the delegation until I learned what our techs can actually do. Sure, I'm going to have them put the Foley or take out a saline lock

if it gives me a few minutes to do an assessment or even for me to take my lunch. I just make it a point not to abuse the techs. I don't ask them to do things just because it is something I don't feel like doing. Every day I learn just how important the whole delegation thing is to getting things done. I can't and shouldn't be expected to do everything for everybody.

SheRN1 · May 30, 2005

Okay I have been a RN {0n 3-11 shift}for a year now and I am still unable to get out of work on time. I usually work 1hr overtime. Other people are usually able to leave on time. What am I doing wrong?? I have an average of 7-8 pts with a CNA assistance. I start out my day with assessments which I am never able to complete them without countless interruptions. I may get 3 of the 7 done and fit the others in the shift when I can. Today I had one discharge to complete and a transfer to another unit at the beginning of my shift. It took me until 6:30 to finish all paper work while I am doing this I am passing meds. Oh I forgot the new admit at the beginning of the shift that I had to complete. At 7pm I picked up 3 new patients, this gives me a grand total of 7 which 2 are complete care. One patient fresh cardiac cath who needed a foley insertion. I do not know what to do but I think this is horrible. I have a problem with the next shift who will get very angry if you leave anything . I try to do the best I can but these people are relentless and talk about me anyway. I noticed everyone talks about everyone so I take this with a grain of salt. I very seldom take a break. Oh, guess who was charge nurse today.
We use preprinted kardexes where I write all of my information, but I find that it is too many papers to carry with you. I tried condensing on a single sheet of paper, but i need to transfer this information to the kardexes anyway ,which we use for report (too much writing). Sorry for the long vent.

I know exactly how you feel, I started in med-surg as a new grad and worked there for 3 years. It takes a while to get organized and focused especially with 7-8 patients. You need to focus and do what is most important. Which is patient assessments. You always need to know what is going on with the patient. Also grasp the concept of delegation to the patient care associates. Above all you need to realize that nursing is a 24 hour process. If certain tasks just cant get done on your shift, then the next RN needs to get it done. Believe me I am talking from experience. Always complete your documentation no matter what.

Be patient you get there.

starcandy · May 31, 2005

I know exactly how you feel, I started in med-surg as a new grad and worked there for 3 years. It takes a while to get organized and focused especially with 7-8 patients. You need to focus and do what is most important. Which is patient assessments. You always need to know what is going on with the patient. Also grasp the concept of delegation to the patient care associates. Above all you need to realize that nursing is a 24 hour process. If certain tasks just cant get done on your shift, then the next RN needs to get it done. Believe me I am talking from experience. Always complete your documentation no matter what.
Be patient you get there.

Thank you, I am really trying. I know I need to improve on delegation. There are times when the shift is so hectic, I am doing patient assessments very late and this is wrong. The first hour should be dedicated to assessments only but the countless interruptions I receive is horrible. If you leave outstanding work you run the risk of the next shift making derogatory comments. But there are times when it can't be helped. I realize this is job where you have to develop thick skin. I find multitasking difficult sometimes.

mydesygn · May 31, 2005

Okay I have been a RN {0n 3-11 shift}for a year now and I am still unable to get out of work on time. I usually work 1hr overtime. Other people are usually able to leave on time. What am I doing wrong?? I have an average of 7-8 pts with a CNA assistance. I start out my day with assessments which I am never able to complete them without countless interruptions. I may get 3 of the 7 done and fit the others in the shift when I can. Today I had one discharge to complete and a transfer to another unit at the beginning of my shift. It took me until 6:30 to finish all paper work while I am doing this I am passing meds. Oh I forgot the new admit at the beginning of the shift that I had to complete. At 7pm I picked up 3 new patients, this gives me a grand total of 7 which 2 are complete care. One patient fresh cardiac cath who needed a foley insertion. I do not know what to do but I think this is horrible. I have a problem with the next shift who will get very angry if you leave anything . I try to do the best I can but these people are relentless and talk about me anyway. I noticed everyone talks about everyone so I take this with a grain of salt. I very seldom take a break. Oh, guess who was charge nurse today.
We use preprinted kardexes where I write all of my information, but I find that it is too many papers to carry with you. I tried condensing on a single sheet of paper, but i need to transfer this information to the kardexes anyway ,which we use for report (too much writing). Sorry for the long vent.

You are working 3-11, one of the busiest shifts. Unfortunately, you come in at a time when you have to hit the floor running. Day shift have the luxury of somewhat organizing their morning while patients are still asleep and nights will have a slowing down point after 1 am. You have no "lull" point. I have worked 3-11, most days it is difficult near impossible to get out at a reasonable time. You have to become super-structured. What worked best for me is to not set foot in a patient room until I had organized my meds that were due in the next 3 for all my patients. My assessment and medication administration were always on the first visit. I kept seperate notebook for each patient in which I placed their flowsheet and MAR. This helped me to document as I went along as well as organize meds. Also, remember (and remind the next shift) nursing care is care, that's why we are here 24 hours. It is absolutely unreasonable to expect you to accomplish every task in the time allotted. I know it's hard but learn to stop feeling guilty about "leaving" tasks. Trust me they will manage.

barefootlady, ADN, RN · May 31, 2005

You have to learn to delegate, to make certain things a priority, and to not feel guilty if "something" goes to the next shift. It takes awhile to get it together, just keep doing a competent job, it will come.

1Tulip · May 31, 2005

I'm wondering what kind of report you get at the beginning of shift. If it's any good, you should be able to anticipate (many of ) the issues you're going to be facing.

i.e., Mrs. X in room 23 had a bit of (fill in the blank) problem today and since she's on (insert drug name here) we drew some stat labs. The electrolytes haven't come back yet but are pending. With Mr. Y in room 24 we did such and such. It didn't work because of blah, blah, blah, but we're waiting for a call from Dr. Smart for orders. Mr. Z's coma in 25 is unchanged and Dr. Neuro is coming in this evening for a conference with the family. The mother and daughter have been here all day. etc. etc.

If you've been off for a while or any of these patients are otherwise new to you, you ask for clarification and a bit of background until you get the general picture.

You ought to be writing down (on a single piece of paper) the high-points and issues that are falling to you to handle in the next 8 hours. You mention running around with several cards and sheets in hand or in pocket... I don't think this is a good idea. You should be able to condense the critical info. Of course the report doesn't absolve you of rounding and making your own priority list, but it should give you a road map (for those patients) for your shift.

When you say you never finish your initial assessments, I wonder if you are trying to be totally, thoroughly comprehensive. In spite of what they taught you in nursing school...you can't know everything (and with 8 patients you can know even less!) But you need to know what the priority assessments are that you need to make for that patient. I think it takes 6 months or a year on the job to get confident in your ability to know what you need to know (now!) and what can wait till later.

Just random thoughts for what it's worth.