Been there. Felt that. And I want to tell you that – yes… dear Lord, yes – it does get better. I also want to tell you some ways to work through this because you can do this.
Let me repeat myself.
YOU CAN DO THIS.
Take Your Thoughts Captive
When you are already overwhelmed and discouraged before you’ve even clocked in, it’s important to stop those thoughts before they take over. And they can take over your mind pretty quickly. So, before you clock in.. before you drive to work.. before you get your coffee ready.. before you put your scrubs on, remind yourself that you can do this. Continue to tell yourself this during your entire commute.
And if there are thoughts in there trying to creep in, going over all of the worst-case scenarios or trying to freak you out, actively tell those thoughts, “No – that is a lie. I can do this. I can handle this.”
This continues when you get to work and when you get report. The most important time to maintain this thought process is after you get report and are suddenly faced with 900 things to do (one needs to pee, one wants to be discharged immediately, one needs a heparin drip, and a doctor is rounding in the last room) right this very second.
Tackle Your Tasks With a Plan
Ok, what is the most important thing to do? What fires can I put out immediately? Remind yourself that you can tackle everything appropriately, just do so in chunks. Don’t think, “Oh man there’s 5 new things I need to do and I haven’t even assessed my patients yet!” While yes, that’s true.. but you can combine these new tasks with the ones that you know you must perform (assessments and charting for example).
Typically, while you’re working on completing new tasks, you can combine them with others. So if a patient has to pee and no one is available to delegate, I’ll go grab their morning meds and knock my assessment out and give meds all at the same time and chart it in the room while they’re peeing. So when I walk out of that room, I’m done for about two hours.
Remember: you are perfectly capable of dealing with all of this AND you will have an awesome day.
What Are MY Priorities?
Many people will act like absolutely everything is a priority right this very second (from therapy, to management, to the doctor, to the PA, to radiology tech, to the family member..), but you as the nurse must look at your task list and prioritize everyone’s priorities.
“Everything is a priority to everyone, I need to decide what is a priority for me right now. I am the nurse, the common denominator. I see the big picture. What needs to be done right now?”
I feel like a lot of my day is reassuring people and calming them down because things don’t happen as quickly as they want them to. It is totally okay to make people wait, when appropriate. You’re the nurse, your the one whose time is absolutely precious (not saying other people’s time is not, but you are the gatekeeper for your entire patient load and can only do one thing at a time for each of them).
Remember: you get to dictate what order you will do things.
While your patient’s mother is livid that the scheduled Colace is 10 minutes late on her 54 year old son who is being discharged today, she doesn’t know that your other patient next door just flipped into atrial fibrillation with RVR and a rate of 167.
So, for those aforementioned patients above.. you can think, “First, I’ll let the guy know that he’ll be discharged as soon as the paperwork is completed by the doc. It’s not in yet I’ll tell him to enjoy his breakfast and I’ll be back with his morning meds after breakfast. Then I’ll delegate the patient who has to pee to the CNA. Then, I’ll make sure the doc has all he needs, as I’m walking to the med room to grab the heparin bag. On my way to grab a pump, I’ll let another nurse know I need a dual sign-off and BOOM all of your fires are out.” Then you can proceed to your normal day.
At the beginning, I thought I had to do everything one everyone else’s timetable. Every time someone came to me with something they needed or wanted, I thought I had to drop everything and immediately address it. WRONG! Only you know all the things you need to get done for your entire patient load in the next 1, 2, 4, and 12 hours. You can make the call of what is now the priority (unless there is a legit drop everything emergency).
You will start to develop your “Ok I know I need to do this first” skills as well as your confidence in yourself and your patient/coworker interaction. Soon you will be able to confidently communicate, “I hear that you need _______ right now and I will address that as soon as I finish with this priority. Thank you for bringing that to my attention.” Say it with confidence.
An Example of the Beginning of My Neuro ICU Shift
(Neuro ICU meaning I typically have two critically-ill neurologically compromised patients, as do all of my other coworkers. On most days we have one CNA. My patients must be assessed neurologically at least every 2 hours, fully assessed every 4 hours, all lines needs to leveled and zero’d, turned every 2 hours, vitals as often as every 15 minutes, oral care every 2-4 hours, scheduled meds passed on time as well as monitoring to see if PRN meds are needed to maintain stable vitals, address nausea/pain/seizures, etc. There’s more we’re responsible for but this is the basics of what I expect to complete once walking in the door.)
I walk in, get report, and see all of my tubing is out of date and my Neo drip is about to run dry. Their arterial line needs to be leveled and zero’d, their BP is too high, and their ventriculostomy drain needs to be leveled and dumped. My patient needs to be turned, his mouth suctioned, he needs SCD pumps on, both need to be assessed, they have meds due, a family member is on the phone wanting an update and the neurosurgeon is rounding on my next patient.
What do I do? This seems like the perfect time to get overwhelmed. But nope – I’ve got this, guys.
I’ll have someone tell the fam member to call back in 45 min, I’m with the patient and the doctor and will give them a more detailed update shortly. That is not my priority right now. I quickly level and zero the art line and make sure the BP is accurate before I titrate my drip. I then titrate my drip accordingly and chart it. Then quickly level my ventric drain, dump, make note of amount of drainage. I touch base with the neurosurgeon on my way to get my Neo drip and his other due meds, I can’t let that run dry! I complete my neuro assessment along with the neurosurgeon of my other patient so the patient doesn’t go through it twice and it saves me time. I remember their assessment and jot down anything that might be hard to remember on my brains (AKA my report sheet). On my way back to the first patient’s room, I let the CNA know I want to turn the patient and ask him to grab SCD’s before he comes in the room. I can see if my titration of my Neo worked on my BP, if not I titrate again. I switch out my drip and when he arrives with the SCD’s, we turn the patient, I clean out his mouth, assess him, etc. I re-level my drain and art line. I then pass the meds that are due. I chart my assessments and meds and deal with all my tubing later in the day because that can wait until I’m totally caught up. Now he’s good to go until the next meds and assessment (probably about 2 hours) and will go grab meds for patient number two.
BOOM! Done, son!
It sounds like a lot, but that can be done in probably a total of 15 min or less (if my drip is in the med room, my CNA can come help, etc.). This will all become second nature to you. You’ll be completing tasks and prioritizing without even realizing it. You’ll be calming people that are making a big deal out of something that really isn’t. Like the tubing, people will say “Your tubing is out of date by 3 hours, you need to change that right now!” Um, wrong. I have a lot of other things to do that are a much higher priority like making sure both patients are okay and my drips aren’t dry. People can chill out. I got this.
And so do you.
For specific educational needs
If you’re in a specific unit and you’re struggle with various medications you give frequently spend some time on your days off going over some concise and helpful information. This makes a world of difference and helps connect the dots sooner. You can focus on practical steps at the bedside, while filling in the why at home when you have a little more time to process the information.
YouTube has tons of great free videos (Khan Academy, for one), or check out your specialty nursing organization (the American Association of Critical Care Nurses has tons of great resources for critical care), or you can check out the NRSNG Academy.
NRSNG Academy is primarily an NCLEX resource, but there is a ton of information applicable for the new nurse. The EKG, Lab Course, and MedMaster Courses are specifically what I’m thinking will be particularly helpful for the new grad. You can get all these course and more for a 7 day trial for just $1!
They go in depth on mechanism of action, nursing considerations, contraindications, and more within MedMaster. The EKG Course dives deep into each rhythm, nursing considerations, pathophysiologically and electrically what’s occurring, and more. The Lab Course does a deep dive into specifically what each lab is measuring, why it’s important, and more.
You can buy each course individually, or you can try them all with an NRSNG Academy membership.
NRSNG Academy works like a monthly fee, so once you feel like you’ve extracted the value and knowledge you need to be more successful at the bedside, you simply cancel. There is a ton of information in the entire academy that would be applicable to the newbie nurse and it would take a few months of membership to equal the cost of purchasing each individually.
- Everything You Need to Know About Nursing Time Management – NRSNG blog
- Time Management – FreshRN Podcast
- Nursing Time Management For When You’re Totally Overwhelmed – FreshRN Blog
- Nursing Time Management Scenarios – FreshRN Blog
- Ultimate List of Nurse Gear – FreshRN Blog
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