Staying late after change of shift, what am I doing wrong?

[Jon Rodriguez, BSN, RN]

I’m about to complete my first year as a BSN graduate and as an RN. I currently work at a PCU/Tele unit in a stroke/chest pain center. We see patients with medium to high acuity, our usual staffing ratios are 5 patients per nurse, and 3 CNAs for the unit. On a typical day I’ll get to work around 6:45am see my assignment and start checking on the patients to plan my day, then I get report. By the time we finish report it’s about 7:45, I take a few more minutes to write down vitals, labs, and meds I will be giving my patients. I pull meds and start my med pass. During my med pass I do assessments on my patients. At 10am we meet with case management to discuss discharge plans for patients. Usually by this time I would be done with meds, but lately I’ve been having to go back to finish off the last patient or so. That’s on a perfect day, there’s always the constant phone calls directed to our cells, rounding with physicians, and speaking with patients and family in the rooms.

My concern is that I feel like I spend all morning actively doing something. I don’t have time to chart my patient assessments. I have to try to get my discharges out by noon while preparing for the next round of meds. And that’s also if lab doesn’t call me that they need me to draw blood on one of my patients because they can’t get a good stick, or a confused fall risk patient on anticoags is trying to get out of bed.

In short, I get through the day getting tasks done, helping patients, answering calls, call bells, etc. When I least expect it it’s already change of shift. I give report, then I have to stay an extra 45-60 minutes to chart my assessments, document the days events in the emr or as nursing narratives. 

What's your advice on how to get my charting done sooner so I don’t have to keep staying late? Management isn’t on my case about my times, but I end up feeling exhausted every night, and then I have to do it all over again the next day.

All advice is appreciated! Thank you!

[LovingLife123]

How long is it taking you to assess and pass meds on each patient?  5 patients on PCU is a lot, to begin with, but it seems like that’s not changing.  Soooooo, unfortunately, you have to find ways to cut some corners here and there.

I’m not talking about anything that affects patient care, but you’ve literally have to be in and out of a room with very little time for chit chat.  I know your patients provably want to talk a little, but you have to keep it to a minimum.  And while that sucks, you’ve got to be fast to honestly save your sanity.  I’d take an hour for those med passes and assessments to give you time to chart, OR, id chart my assessment quickly while I’m in the room with the patient so I can spend a couple of minutes with them.  It’s easy to chart and talk, but you have to pick your poison here.  Things have to be clustered as much as possible.  I will literally chart an entire assessment while finding out my patients life story.  And that comes with time.

[RNperdiem, RN]

I force myself to chart at least something on each patient before I move on to the next one. For example, I will make sure I do my vitals page in EPIC, the I&Os, and do the first few sections of the full assessment with the ideas of completing the rest a bit later.

Sometimes you will have a chatty patient. Save them for last in assessment unless there is a reason to see them earlier. Less chatty patients allow for a more efficient assessment and it is good to have some charting at least done before moving on to the rooms you will be staying in for a longer time.

Some tasks I like to put off until I have all the patients seen, assessed, charting mostly done and morning meds given. Once that milestone has been reached, that is when I will worry about less critical tasks like changing IV tubing.

Best of luck to you. In your kind of work environment, interruptions and having your interruptions interrupted makes finding a work flow difficult at baseline. 

[Davey Do]

12 hours ago, LovingLife123 said:

unfortunately, you have to find ways to cut some corners here and there.

That which is not absolutely necessary can wait.

1 hour ago, RNperdiem said:

I force myself to chart at least something on each patient before I move on to the next one.

Progress not perfection.

Good advice!

[HiddenAngels]

So after your rounds you usually have one more med pass correct? If that’s the case, get that done and then start your assessments. At least one or two.  Your afternoon med pass and evening med pass if they’re anything like mine aren’t hardly as bad as the morning so try to squeeze those last two  in mid morning early afternoon. 5 patients on day. I’m giving you your flowers. Yea that’s aggressive.  I admit I would probably have to stay extra too considering the new admissions and discharges.  Not to mention the patients you have to transport  to ct X-ray yourself because of their condition some of the time.

Hang in there. ?

[Been there,done that, ASN, RN]

  You are getting in early and working for free. If you have to pull your own meds.. you are now doing  doing the work of pharmacy... and losing the pharmacy check. No nurse has time for a meeting at 10 am. Let case management figure it out for themselves, they can read a chart and talk to the provider all by themself.
Your workload is outrageous. Having to stay over to chart.. is a given

[HiddenAngels]

13 hours ago, Been there,done that said:

  You are getting in early and working for free. If you have to pull your own meds.. you are now doing  doing the work of pharmacy... and losing the pharmacy check. No nurse has time for a meeting at 10 am. Let case management figure it out for themselves, they can read a chart and talk to the provider all by themself.
Your workload is outrageous. Having to stay over to chart.. is a given

Oh my goodness BTDT I wish you were on a committee where I am.  YESSSS we don't have time to stop what we're doing to go over and do rounds with the physicians and CM, it's terrible sometimes.  I wish we could say "walk with me", while we're working and charting...

[Jon Rodriguez, BSN, RN]

On 8/20/2022 at 2:20 AM, Been there,done that said:

  You are getting in early and working for free. If you have to pull your own meds.. you are now doing  doing the work of pharmacy... and losing the pharmacy check. No nurse has time for a meeting at 10 am. Let case management figure it out for themselves, they can read a chart and talk to the provider all by themself.
Your workload is outrageous. Having to stay over to chart.. is a given

OMG I thought all facilities have Tempo, that’s the 10am meeting. Literally all nurses have to stop what they’re doing and report/discuss with case management, charge nurse, and the unit director what is pending for the patient, procedures, tests, results, and what the discharge plan is. I’ve gotten good at rushing through this in 5 minutes or so, but still it sucks to be interrupted for this. Since we have this discussion early, then charge nurse who to hit with transfers and admissions. Then they’re pushing us to discharge and/or transfer when we still don’t even know the patient. Any delay or interruption and all of a sudden we have a 6th patient before we can move the other patient.