Oh, I remember those days. I worked a unit just like yours, we got everything except hearts we joked. It takes time.
Question: 8 and 9 oclock meds? why can you not give them together or at 0830 or save yourself time that way?
In terms of assessment and vitals, I am going to say you have GOT to do that ASAP. say you leave it for later and then something changes. how do you know what the baseline is? But do assessment with med pass and vitals, get em all done together. Medication wise, you have to study the most common meds for your common patients and get those down. I found a small 1000 common medication book at barnes and noble and it was a lot quicker than the computer.
With no aide at night, I would NOT leave your patient in the bathroom, if you do and they fall, you'll quickly be found at fault if you were in doing another assessment as you weren't really "watching" for that light. when you push through assessments, make sure to let your patients know that you'll be happy to talk with them later....when you have time. but make sure you go back and talk with them soon.
with those @#$@#$ phones, if it's trival, you just have to take a hard stance if management comes down on it and say, "I am getting my medications. the Joint commission and numerous studies have shown distracted nurses make medication errors. Do we want a culture that allows that here?" and just grow a tough skin. If the patient's call about that stuff, let them know you will be there as soon as you can, but they will have to wait.
When everything has to be done "right away" and when my co-workers are often busy pushing through this beginning of shift rush as well, what can I do?
It takes time to set up a routine and get it down. I didn't feel like a good nurse for at least a year. give it time. Also, those "walkie-talkies"? they are in the hospital and they want help because it's there. That's what we get paid for. we see it all in this world.
A personal question, but were you a CNA before becoming a nurse? Aides have a lot of skills that we don't always see. perhaps asking them for some points for vitals or clustering care, etc may help. do you have a preceptor or a mentor that could help? good luck, post back and let us know how things are working out.