New nurse staying way past 9:30 pm on day shift

First off, 9 med/Surg patients is insane! Are you including admits or do you have 9 patients at 1 time? I don't know if I could do 9 patients.

Secondly, when does your shift end? Are you staying 3-5 hours after a shift? I could see management having issues with this as you would be working 9-15 hours longer than planned. I'm not being mean, just worried. Are the other nurses staying late, too?

Being new is hard. I'm guessing you are on day shift by your mentions of rounding with the providers. Is there any way you could go to nights where it is a little quieter (although the belief that patients sleep at night is a myth!)? This might allow you to get a better grasp on time management. The downside is you may have more patients.

Are your co-workers busy all day, too, or could you ask them for help? I struggle with asking my co-workers for help because I feel like I should be able to be super nurse and do it all myself, but that's not reality.

Do you have computers in the room? Charting in the room can help speed up charting (you aren't getting interrupted by co-workers, doctors, etc.) and can help with some of the things you feel like you forgot to chart later on. You can walk out of the room knowing you have taken care of the charting for that patient.

Do you have a mentor? Is there a new grad program? Anyone you can talk to? I would consider talking to my manager to see if I could have a little more orientation or do night shifts, if possible.

Whatever you do, don't take meds out for multiple patients! That is just asking for a med error. I am imagining scanning a patient for their nightly insulin and then mixing up the syringes! Our Novolog sticker come up as Novolog, but don't fill in the dose (because of the sliding scale). It would be SO easy to mix them up!

Having feeding tubes is always going to slow the process down. Some of my co-workers will give multiple meds at once through the tube. I don't because I don't want to be the one who clogs the tube!

I was reading along just fine, and came to an abrupt stop when I got to the part about 9 patients. Nine! I thought I had it tough with 6 patients and aides of variable quality.

You are doing the best you can in a difficult situation. All I can add is delegate to your aides whenever possible, make good use of your charge nurse, try not to over-chart and take care of your health.

I also recommend that you look at this job as a short-term gig. Staying long-term in conditions like that will destroy your love for nursing. My current hospital staffs med-surg nurses with 5 patients, has good working conditions and loves to hire for nights.

With 9 patients, you are really nothing more than an expensive pill pusher. You aren't going to have time to think - and that's dangerous.

This job will kill you physically and emotionally. Unless the acuity is more rehab than med surg, I can't even comprehend how one would manage 9 patients.

Is turnover high? Are there no jobs in your area? How many patients per nursing assistant? The only tip I have for you is get out.

Nine patients?! That's insane. Reading that made me thankful for California ratios. I am one month into my first RN job and I pull meds for all of my patients at the beginning of my shift and place them in the med room. Each patient has a cassette and I put them in there. When I pass a group of meds at a particular time I pull all of the patients meds, separate them by patient into a med cup and place a piece of tape over them and write the patient's room number on the tape. The hospital I work at uses an electronic scanning system so that is another safeguard in place to prevent med errors when I pull meds for more than one patient. Insulins I draw individually, and I don't know if I would change that.

Nine patients?! That's insane. Reading that made me thankful for California ratios. I am one month into my first RN job and I pull meds for all of my patients at the beginning of my shift and place them in the med room. Each patient has a cassette and I put them in there. When I pass a group of meds at a particular time I pull all of the patients meds, separate them by patient into a med cup and place a piece of tape over them and write the patient's room number on the tape. The hospital I work at uses an electronic scanning system so that is another safeguard in place to prevent med errors when I pull meds for more than one patient. Insulins I draw individually, and I don't know if I would change that.

Do not encourage the practice of pulling meds all at the beginning of the shift and storing them. Do not encourage pulling meds on more than one patient. Both practices increase likelihood of a med error. Also depending on your EMR and electronic drug dispenser it may set a "due" time based on when drugs are pulled from the dispenser.

Nine patients?

It would require adopting a special kind of don't-give-a-crap defense mechanism in order to deal with that.

Of course you pass meds one by one. Others in your environment may do it differently because ^.

In ideal circumstances it takes an eager new grad a lot of mental and emotional work to self-critique and continuously improve so s/he can move toward eventual expertise. That is an expected challenge that is difficult enough at baseline. Usually forward progress is encouraged through the successful mastering of previous challenges and there is some satisfaction involved. It's kind of sad to think of any nurse trying to master this situation, let alone a new grad.

Some people feel good about themselves by looking at these as "trial-by-fire" situations that are a challenge to master - - - but what about the patients??? If I could be convinced that you could succeed (and feel good about it) without cutting major/critical corners, I might have some practical advice. Instead, this just seems like a sad situation to think of a new grad striving and being so eager here because experience would suggest this won't end well, either in emotional health ways or in more tangible ways.

I'm sorry. TBH, for the sake of your health and your career I will only advise putting out other apps ASAP.

^^ Everything JKL33 said.

I would have some advice for 5-6 patients. But 9? Omg, honey NO. You sound like you're doing an amazing job in keeping wth safe practices. Don't cut corners. And get out those apps pronto.

Find somebody with an identical assignment who does an excellent job.

Copy that nurse.