Scrambling to keep my head above water

[patientsb4politics]

I stepped down from a leadership position earlier this year and returned to bedside. The med-surg/ tele floor that I work on has a 6:1 ratio with the charge nurse taking 2 patients. I am struggling with time management of course but find it almost impossible to get help from my co-workers cause they are just as busy. As a result occasionally something gets missed or passed on to the next shift (it goes both ways, they pass things back, too). Even though our leadership knows how crazy our floor is, EVERY thing get pointed out whether it's a late med or a routine lab that got passed on. I am finding it hard to feel confident and maintain a positive outlook. How do find a way to get a grip on time management and not feel like I am always swimming against the current?

P.S. I have been an RN for 8 years and was in leadership 4 of those years.

[Ruby Vee, BSN]

Essentially, you have a new job. The term "stepping down from a leadership position" implies that the job you now have is a lesser job, and that perhaps you thought you had already mastered it. But leadership is a different focus, requires different skills and is only peripherally related to the skills you need to be successful at the bedside.

You don't say how long you've been in your new position, but we tell new grads that it takes a year to become competent. I've observed that it takes 6 months to a year to become competent when switching specialties. You're somewhere between the two -- you have bedside experience, but not recent bedside experience. You don't say whether your previous jobs were Med/Surg or Neuro or L & D . . . . Regardless, you've just changed specialties in a major way. You need time to adjust to the difference in role, to organize your thinking around the immediate needs of patient care rather than the future needs of next year's budget.

Time management requires a good "brain sheet". Identify someone who seems to have a good handle on time management or a good brain sheet and pick their brains. When asking for help, make sure you're asking the right person. If Sally sucks at IVs, don't ask her to help with yours . . . ask Polly, who is a whiz at IVs. While she's helping, ask for tips. If Meredith has louse time management skills, she's probably not going to be able to help you with turns, lifts, etc. unless you volunteer to "help clean up Mrs. P if you'll help me get Mr. Q up into the chair."

As you become more used the routines, the policies and protocols and the usual medications, it will get easier.

[pmabraham, BSN, RN]

Is the 6:1 ratio with charge taking 2 patients on day shift, evening shift or night shift?

[patientsb4politics]

Day shift, we do 7a-7p.

[pmabraham, BSN, RN]

Thank you for sharing the shift. I work on a busy cardiac-telemetry unit rotating between day and evening shifts. The day is 7-3 or 7-3 (we have the choice for 8's or 12's) and evening is 3-11. Both shifts are typically 5:1 ratio. The hardest of the two shifts for time management is day shift. 20 to 30 unplanned phone calls per hour make it difficult especially when they occur during the 8-10 AM medication pass. Also, we have patients going off for procedures, and coming back at various times. If for any reason we are under our ratio (i.e., 4:1), we have to be on guard for an admission or transfer. It is common to have one to three discharges, and then within short order one to three admissions.

What helps me keep my head above water are the following things:

* Regular use of brain sheets - meds and treatments due when, up to date lab values (along with checks if they were passed on, etc.)

* Being vigilant to ask myself what should I be doing now? Free time? Maybe pre-pull non-countable meds and put them in the patient's bin for the next med pass. Maybe it's reviewing patient notes to see when a discharge might take place. Maybe it's updating documentation/charting.

Thank you.