Congratulations on your new job! You've hit the nail on the head to realize that time management is your key to surviving a very busy orthopedic floor. Your savior will be your clipboard. Keep everything organized on it religiously. Meds on top sheet, an extra sheet behind the meds for taking little notes, vital signs behind that, patient print outs behind that. Take post-op report directly on the nurses notes of the patient care record. And as much as possible (always, lol) Chart directly onto the nurses notes so that you won't always be transcribing your notes from other places (I call it double charting). Always sign off on the MARS when meds are given so you won't always be trying to remember when you gave them and document the pain level at that time. The more you can keep the information contained to the least number of places the more time you will save in the long run. Don't worry, you will find your own system. I do Orthopedic/General Surgery on 12 hour night shifts and it is pretty wild most of the time, but I wouldn't change it for the world! But the key to success is definately organization. Good luck and hang in there! It really does get better.