Hi, I am a preceptor for a new nurse and she has excellent assessment skills, is very intelligent, but just can't get time management skills down. We have only left on time once, and have worked together I think 10-11 shifts now; other than that one time we leave anywhere from 30minutes-over 2hrs late, and if that's the case when she is still orienting/has a preceptor to help out, I dread to see what will happen to her when she is off orientation. I'm not sure how to teach her this skill; and I only have a few shifts left with her; have tried giving her different sheets to make notes on/organize her shift, etc, tell her how I do things; but it's just not helping. It seems to be the charting that gets her the farthest behind, and I don't know how I can help her get faster with it; or when she gets a new admission. She is frustrated as well and keeps asking me what she should do differently. I don't know what else to tell her, or what I should do differently as her preceptor- I really feel that I have failed her. It wouldn't bother me so much if I felt she just didn't care, but she does and I think she is going to be a really great nurse, if she can overcome this hurdle. I really want her to succeed. Thanks for any advice/suggestions.
OP, it seems that there's only so much you or the new nurse can do at this point. It sounds like maybe she needs a slower pace or lighter workload to build up to handling a full-load of patients both efficiently and safely. Unfortunately, that may not be an option at your facility. Unfortunately, there aren't many opportunities at all out there for a newbie to more slowly build up to a fully-functioning floor nurse. A student has 2+ years of nursing schools to study meds, diseases, nursing care plans, psychsoc issues, etc. Then they have 2-3 months to go from the 10% that nursing students do on clinical day to the 110% that floor nurses do.
I do think it's a shame that some grads who might make great nurses if they just had a chance to build their skills more gradually instead are let go after just 8 or 12 weeks because they're not up to speed yet, don't have sharp clinical judgement yet, and can't keep all the balls juggling that experienced nurses often still have to work hard at.
For a new nurse, just about every aspect of their job may be almost completely new to them... dealing with physicians, starting IVs, finding supplies, making the call on clinical situations, doing focused assessments, caring for more than 2 patients, seeing a patient go bad, etc. While some newbies may take to it like a duck to water, I don't think it's something we should expect new grads to pick up in just a few weeks along with all of the other new info, skills, people that the newbie is dealing with.
I agree with you, jjjoy. I was also someone who took a while to get used to the expectations of being a nurse. I wish that she could have more time, but I think this is the limit that they are going to give her. Do you think there is anything else I can do to help her be ready to be on her own.
I don't know....maybe, acute care nursing isn't her thing? Not everyone is cut out to work in an acute care setting.
Time management isn't really something you can teach. After a while(and it sounds like this gal has had 'a while') you either get it or you don't. It sounds to me like she aint never gonna get it unless she's got someone directing her every move during a shift.
I think 3 months is a good orientation length for a new grad. Yet, this girl, really isn't a new grad, is she.
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I've worked with RN's who get an admission and it just throws them for a loop, they're staying after their shift to finish charting. They are ALWAYS like this! Always on overtime to finish up while everyone else has left.
i've been an rn for just over a year and still get my butt kicked. my orientation didn't go so well...my preceptor would turn me lose on my own sometimes for 2 hours without ever touching base. yes, this was my own fault for not speaking up. a good preceptor goes a long way in helping you to grasp what takes priority at this moment and what can wait. following 6 weeks of orientation at a teaching hospital in our system, i returned to my home hospital and busy med-surg floor. the first night at my hospital i was given an 8 patient assignment on the 7p-7a shift. i was in total shock the entire shift and was told by my charge nurse in so many words."this is the normal assignment" for all the nurses on this floor on this shift (it was pretty much sink or swim) i didn't think i would make it a week, but my time management skills began to improve after a few months. i concur with the sentiment that you can't really teach time management skills. find out what works for you and make tweaks when necessary.sounds to me like you're a good preceptor. maybe acute care just isn't her bag......just my
I'm a new grad and I often have a lot of trouble with time management as well, I think we all do. I just recently went off orientation (about two weeks) and when I have six patients I'm pretty overwhelmed but even just having one less makes things a lot easier. Maybe management would be able to let her go with a lighter load for a couple months so she can get used to things? Maybe if her stress level is reduced she can actually focus!
The nurses I see on my floor that are least stressed and always done with their charting and med passes first are the ones who come in early and pull their meds and write down labs and stuff before they get report! I try to come 15 mins early but I am thinking of starting to come more like 45 mins early so I can do this too.
I am glad she has a preceptor that cares! My preceptors were all wonderful and still help me plenty, and I don't think I would have made it 3 months without them. I hope things get better for both of you! It sounds like she needs a little confidence as well and having a successful day with less patients might help with that, it certainly does for me!
I used to come in that early...like 30 minutes...then the DON was there and told us that we were not allowed to do anything related to work without punching in...something about the EEOC...just be careful with that also. I generally get to work 15 minutes early...and I don't pull meds, I just get my papers and write out the tops of my report sheets so I don't need to waste a lot of time. Meds usually have to be after report. We have a computer charting system, so I generally look up my meds after report and then write them on a sheet of paper...that way I don't have to take my whole computer to the med station.
I have read a few times in this post that time management can't be taught.
Anything can be taught (heck if Pavlo's dogs can learn to salivate at a bell, then I can learn effective TM) and learned a person sees it as important enough.
I think many new nurses (myself included, I'm a new grad and waiting for my start date with a medical unit I've been hired on) want to be able to prove themselves with their knowledge, their newly honed skills and the empathy they have for caring for patients - afterall, caring is why most of us become nurses. In a nutshell, we want to be able to do it all but this is unrealistic in todays culture of care. As with all things learned, it comes with time, experience and most importantly persistence.
When someone decides that time management is an important goal, we need to turn the nursing process on ourselves. What is our assessment on our TM - where can we cut down wasted seconds, double charting, and can we do the nice to dos later or even leave these things for the next shift? Next we have to make a plan - I'm going to focus on getting my morning assessments and charting done before first break for 1/2 my patient load. I'm going to utilize my resources and delgate what is appropriate. Then impliment your plan! Tell your plan to someone else to help make yourself accountable! Then evaluate at the end of the day/week/month etc. Did my plan help me with my TM? By how much? How can I improve it further? If you continue using your nursing process you will eventually LEARN and ingrain 'interventions' for time management.
Other nurses, like Cathy, who in an earlier post outlined some great uses of time (i.e. asking assessment questions during patient transport) can become champions of TM by sharing their interventions to help out other nurses on the floor. Time management like all the other nursing skills we've learned in school IS possible. Just don't give up :)
jjjoy, LPN
2,801 Posts
OP, it seems that there's only so much you or the new nurse can do at this point. It sounds like maybe she needs a slower pace or lighter workload to build up to handling a full-load of patients both efficiently and safely. Unfortunately, that may not be an option at your facility. Unfortunately, there aren't many opportunities at all out there for a newbie to more slowly build up to a fully-functioning floor nurse. A student has 2+ years of nursing schools to study meds, diseases, nursing care plans, psychsoc issues, etc. Then they have 2-3 months to go from the 10% that nursing students do on clinical day to the 110% that floor nurses do.
I do think it's a shame that some grads who might make great nurses if they just had a chance to build their skills more gradually instead are let go after just 8 or 12 weeks because they're not up to speed yet, don't have sharp clinical judgement yet, and can't keep all the balls juggling that experienced nurses often still have to work hard at.
For a new nurse, just about every aspect of their job may be almost completely new to them... dealing with physicians, starting IVs, finding supplies, making the call on clinical situations, doing focused assessments, caring for more than 2 patients, seeing a patient go bad, etc. While some newbies may take to it like a duck to water, I don't think it's something we should expect new grads to pick up in just a few weeks along with all of the other new info, skills, people that the newbie is dealing with.