Will I ever get the hang of this?

ML504 said:

Should I fully have the hang of it by now?

In my opinion you are finally just past the point where many of the basics shouldn't be as overwhelming, such as doing an assessment and documenting it, or doing an admission or safely administering medications without as many questions or calling a provider for a patient concern, etc., etc. There are still a lot of growth going on and now that the basics aren't as troublesome you can move on an focus on other things. Prioritization in particular is a longer learning curve and in some respects is worked and reworked throughout one's career as tips and tricks are learned and routines honed and knowledge base grows. 

Where do you think you are struggling? What kinds of things are you doing beyond the 12 hour shift? Charting?

Add more detail and we can help troubleshoot.

It's usually charting. I am so focused on getting tasks done that I do the bulk of it at the end of the shift. Prioritization is improving but I feel I still fall into the trap of doing the first thing that pops up, usually changing my schedule completely. Charting is what makes it go especially long though. 

Well it's good that you've identified a need to improve in certain areas. I think now's the time to stop yourself every time you are about to run to a next task without charting what you just did--stop just long enough to ask yourself if that next thing is truly so urgent that you essentially can't finish the task at hand. If you start to be more mindful about this I'm pretty sure you will be able to identify that a number of "next tasks" aren't so urgent that you need to leave your current task unfinished.

Please understand that hospital staffing is such that everything feels like an urgency and the day turns into racing from here to there for many nurses, not just newer nurses. Essentially this is by the design of administration. You can't let it become your problem. Your job is to prioritize prudently, and that *is* going to mean being more discerning about what is truly, actually urgent and what isn't. I will forewarn you that this isn't going to feel good, since we've been taught that everything we do is so utterly crucial in one way or another--a patient should never have to wait [for xyz--pain medication, toileting, water refills, whatever], everything we are responsible for is to be done on time (example medication administration), doctors don't want to wait, family members need things too, lab results are back, a new admission is coming....and on and on and ON.  But we live in reality, and reality is that one person cannot do all that is on a single RN's plate each day, without making some smart/safe compromises and good prioritization.

Elsewhere on the forums we are discussing a tragic situation where a patient was killed by a medication error. The situational background of that error was that there was a patient waiting for anxiety medication so that they could get a very non-urgent PET scan before being discharged home, and if the patient didn't get the med the PET scan would have to be delayed. Well, that would surely be unfortunate--but not nearly as unfortunate as being dead. My point is that not everything in the hospital is urgent, and even some things that are important on some level or another are not ALL *equally* urgent. MANY things in the hospital that can make us feel like they must be done in hair-on-fire mode are simply not that urgent. Period.

You are going to figure out which is which when you stop yourself and ask that question: Is the next thing so very, very urgent that I cannot properly finish the task I am currently doing (including documentation).

Get the hang of the chaos on med/surg??? I once read a nurse's response to a patient's question: PATIENT: When will it stop hurting? NURSE: When the pain goes away.

Sometimes the pain (chaos) doesn't go away; we just learn to cope, go with the flow, role with the punches. Med/surg is one of those areas where we learn something new everyday and role with the punches. No matter how organized you think you are, either a patient(s) with his or her demands, or the charge with an unfair assignment throws a wrench in it.

Even when you are prepared, that change-of-shift admission screws up everything. It only takes one situation to screw up an entire 12-hour shift. And sometimes, experienced nurses go through the exact same thing that newer nurses do...the entire unit is drowning. You just tread water until it's time to go, ensuring that nobody receives harm on your watch.