Always Drowning? Try these tips

It’s hard being a new nurse and feel like you’re always drowning. You’re being inundated with new information, being told to do things differently than you learned in nursing school, and generally at times just feeling overwhelmed.

Time management is often the culprit.  And that’s something you just aren’t taught.  While there’s no magic solution to time management in nursing, organizing your day will greatly improve your ability to stay sane in the ever-changing environment and not feel like you’re always drowning. Here’s a look at a strategy to re-organize your day.

Triage

It doesn’t only apply to Emergency Nursing.  Triage-in my opinion- begins any time you assume care of more than one patient. You triage these patients when receiving report. Let’s say your assignment consists of:

• Chest Pain rule out ACS:   Patient is self-care. He’s observation status on Telemetry in a Normal Sinus Rhythm.  Has had no complaints of pain/discomfort since admit.  He’s only awaiting lab results.
• Anemia: Self care patient.  Type and Screen has been ordered for a transfusion of 2 units PRBC’s.  The blood isn’t ready and his labs are not critical.
• Quad admitted with sacral wound: Total care patient. Turned and reposition 1 hour prior to your shift.  He’s getting antibiotics and dressing changes BID.  Note: This patient has a butt wound and is a quad; it would be best if you have the off going nurse turn the patient with you during report so that you can get a quick assessment of his butt area.  There’s no telling when you will have help to do it later.
• UTI: Patient has dementia. Is a high fall risk. He continues to attempt to leave the bed and there’s a bed alarm in place.
• CHF exacerbation:  Vitals are stable.  He’s on Telemetry in A-Fib.  He’s getting Lasix, daily weights, strict intake and output, and has an order for chest x-ray today.

With what you know, who will you see first?

Me? I’d go with the UTI first.  All others are stable with no immediate needs but this guy, he’s a high fall risk and obviously wants out of the bed.  Second, I’d see the CHF Exacerbation. He has a chest x-ray scheduled for some time during the day. As well, he’s a patient whom could possibly have a bad outcome so it’s best to get a baseline now.  Third and Fourth, the Anemia patient, then the Chest Pain.  No specific reason here as they are equally waiting around.  Lastly, the wound.  This patient will take the majority of your time.  Starting with that first patient, what’s next?

Assess

The second step in not drowning and our most important phase of the the Nursing Process: Assess those patients. Grab your vitals machine and get vitals while you assess the patients. It only makes sense to obtain your own vital signs as you will have the results in real time, not having to wait for them to be put in the EMR by the nursing assistant. This allows you to intervene immediately if necessary.

Complete a head to toe at that moment and document it right then. Also complete and review of current orders.  It’s at this point where you will be able to determine if there are any further interventions you need to take before moving onto the next patient. For instance, your patient has an x-ray scheduled; now may be the time to also go ahead and give the patient his meds before moving to the next.  This allows you to complete the first priorities for the patient to avoid getting behind on him later.

Let your patient know right then of any new orders, tests, or plans and explain you will return shortly for his medication pass. After that move onto the next patient, rinse and repeat. Once you get to the last patient, that total care patient, you do everything for that patient: vitals, assess, order review, turn/position, hygiene (if necessary), then medications.

Cycle back

The hard part is over with.  Everyone is assessed, your assessment documentation is completed, and their immediate needs are addressed.  You can now start back with that first patient to complete your medication administration. And that should be a breeze because you’re not drowning yet.

Smooth Sailing

Now that you’ve conquered the immediate rush, you can now move on to those other tasks such as dressing changes, getting the patient up to chair, care plan updates, ambulation, baths and linen changes, so on and so forth. From this point on you should be smooth sailing, ready for any turbulence that comes your way in the form of admissions, transfers, foley insertions, etc. The goal of my strategy is to first complete those tasks that normally get us behind up front so we are better able to stay afloat and above water for the rest of the shift. It may take some time to get this method down but once that light bulb clicks and you’ve got it, it will never fail you. You wont feel like you’re always drowning.