Task orented vs. the big picture?

CoffeeRTC, BSN, RN · Oct 23, 2008

This is your first nursing job. I'm going to say that it is normal to try to focus at the task at hand. All of those tasks to add up to the big picture. Once a shift or more, try to take a few minutes and ask yourself those questions and "look at the big picture" If you look at the total pt aka..big picture, you will be able to prioritize those little tasks.

Nursing is so much paper work it does take away from the hands on care.

Sorry, LOL about the "getting them to sleep" part. I work 3-11 and some 11-7s and yes....it does feel that way but hey...if they are sleeping well, they will recover better.

GrumpyRN63, ADN, RN · Oct 24, 2008

Getting them to sleep is a priority (not just for you!!) pt's main complaint to days is that they couldn't sleep d/t interuptions from the nurses, noise etc. Sleep is very important to the pts healing, recovery, response to anxiety, pain, you name it. You are still fairly new, and there is a LOT to organize and get done, sounds like your doing great. Try just spending a couple of more minutes chatting with your patients. If your there on a PM its a little easier. I try to sit on the edge of the bed and spend just a few minutes. It really makes a big difference, the patient really feels listened to and cared for , and will make you feel more involved/connected . BTW, days will not make you feel more like a "real nurse", More crap on days with administration, doctors, discharging and admissions, blech !!!Will that make you feel more like a real nurse ??? Don't think so! You can do a lot of nursing and teaching on the nite shift. I always felt more like a nurse at noc, just because I felt I had more time 2/2 less ancillary crap to do.

NeoNurseTX, RN · Oct 24, 2008

You're new (me, tooish!) and you start out task-oriented. Once these things become second nature, you'll start to see the big picture. Novice to expert.

mama_d, BSN, RN · Oct 24, 2008

we are constantly harped on about completing our admission databases, dvt screening, advance directive forms, bed alarms on, skin assessments completed, charts complete, reading our strips, filling out the census, checking our new mars, completing the next day's flowsheets, preparing paperwork for next day's procedures, reading our weekly communication memo, filling our surveys, etc.

try looking at it this way...it may seem like what you're doing is all "tasks" as opposed to actual nursing. realistically, though, much of this is addressing the big picture insofar as it's contributing to ensuring optimal outcomes for the patients. we may complain about all of the paperwork to do, but things like dvt protocols help ensure that they don't happen, flu/pneumovax screenings help to ensure that our most vulnerable populations are protected and help prevent hospitalizations, mar checks ensure that allergies are correct and prevent errors, advance directive forms help us to make sure that patient wishes are followed and resources are allocated correctly in the event of a code, etc.

RNperdiem, RN · Oct 24, 2008

Tasks are the main part of our job that fills the days and nights.

I make a point after my first head to toe assessment of a patient to think up one thing to help move the patient to better health.

For example: A patient has been on 2L nasal cannula oxygen for days now, does he really still need it, or shall I try him on room air?

Or: I see Mr. X is off the ventilator, how about getting him out of bed today(might need an order for that) and teaching him about coughing and deep breathing?

Moving a patient forward often takes many small steps rather than the very thorough care plans you learned in school.

mcknis · Oct 24, 2008

I feel many a time all I do is tasks, tasks, and yet more tasks. I am there in the same boat as you guys are. I feel bad for my pts because I can't give them the care that they deserve and overlook things soemtimes, because another pt thinks they need you more than someone else. I had a pt get mad at me yesterday at work because in my 12hrs I only saw the pt 3 times (assessment, meds at 1000 and med at 1800). I have learned how much I trust my assistants to pick up on things. I had another lady yesterday who (according to assessment and VS) things were fairly stable, any abnormality the MD was aware of, but after I gave report yesterday evening I heard the RN say, "Her sats are in the 80's on 2L and her BP is 80/40." I ended up staying over my shift (off the clock) until I knew she was in ICU and safe. I felt so bad because I was stuck with another pt doing tasks, and not spending good quality nursing time with this pt like I needed to! Argh...

jjjoy, LPN · Oct 24, 2008

I think nursing education may have overcompensated in an attempt to emphasize that nursing isn't *just* completing tasks. There's the societal assumption that nurses "just follow orders" and educators want their students to also understand the why of what they are doing, to be proactive, not just reactive and to think independently and critically and not to always just blindly accept what they are told. That's good, but it tends to overlook the fact that the bulk responsibility of many nursing jobs is getting a laundry list of tasks done for each patient. Each nurse isn't expected to come up with a unique plan of care for each patient they have each shift. They ARE expected understand the plan of care and to adjust it if need be, but the bulk of time and energy is spent carrying out the tasks of the plan of care.

Some schools practically demonize a task-oriented approach to nursing. They coach students to both step back to appreciate the big picture and to dig deep to explore the dimensions of the patient's nursing issues. Students spend a good deal of time and energy writing long, detailed care plans. Which can lead to a feeling of bait-and-switch when the new grad starts working and they find that getting tasks done seems to be the main objective. And the only way that they can even make a dent in what needs to be done is to be task-oriented. Yet according to their education, being task-oriented isn't good nursing practice. It can feel like an ethical dilemma for a newbie.

Melinurse · Oct 24, 2008

You're new (me, tooish!) and you start out task-oriented. Once these things become second nature, you'll start to see the big picture. Novice to expert.

My preceptor kept telling me the same thing. I feel the same way as the OP and I can't wait till I get to the point it is not all " task oriented ". My preceptor says it usually takes new nurses a year or two to be truely " comfortable " and not so task oriented in their role. ( at least it always made me feel better hearing that ) Hope it helps.

NeoNurseTX, RN · Oct 24, 2008

My preceptor kept telling me the same thing. I feel the same way as the OP and I can't wait till I get to the point it is not all " task oriented ". My preceptor says it usually takes new nurses a year or two to be truely " comfortable " and not so task oriented in their role. ( at least it always made me feel better hearing that ) Hope it helps.

I've been pretty much comfortable w/ my job after 6 months. I still have a ton of questions but it seems even the seasoned nurses ask others about things they are unsure of.

However..I just took a job at a way more critical NICU so I have a LOT to learn knowledge-wise AND new people/unit/procedures-wise!

Melinurse · Oct 24, 2008

I've only been off orientation for 2 weeks. I am fairly comfortable, but once in a while still have a question or two. I still feel that I am mostly doing just tasky things.

Surgical_RN08 · Oct 25, 2008

i just recently had my eval after getting off of orientation and my manager said it is quiet "normal" to be task-oriented at first as a new nurse. she also says as time goes on the critical thinking we spent so much time stressing in school will start kicking in more than task-task-task. only time will tell.