Sound familiar?
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.
The ultimate resource for new graduate nurses
My passion is supporting and encouraging new graduate nurses with honest and practical information. I built this course over years… talked to many nursing leaders, physicians, advanced practice providers, preceptors, and new grads to find out the specific and often unspoken needs… read the research… looked closely at different residency programs… tested material and fine-tuned it. I know what new grads feel and need. I’ve been there myself and I’ve continued to see class after class of newbies have the exact same struggles and needs.
This course isn’t just about surviving orientation – it’s about thriving. I want to maximize your time at work and teach you how to mentally disconnect from the bedside and cultivate healthy boundaries so you can enjoy your life at home. After all, you’ve worked this hard to become a nurse – you should be able to put in your time at work, improve each shift, and come home to enjoy the rest of your life. However, that does not come intuitively, and I want to teach this practice to you.
To get instant access to over 70 modules, 11 hours of audio and 9 hours of video, text, downloads, and so much more in the FreshRN® New Nurse Master Class, click here.
Even more resources
- 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
Anatomy of a Super Nurse: The Ultimate Guide to Becoming Nursey
Nurse Life: A Snarky Adult Coloring Book: A Unique & Funny Antistress Coloring Gift for Nurse Practitioners, Nursing Students & Registered Nurses … Stress Relief & Mindful Meditation)Nurse Burnout: Combating Stress in NursingNurse Coloring Book: Snarky, Funny Adult Coloring Gift for Registered Nurses, Nurse Practitioners & Nursing Students – Relaxation, Stress Relief and Mood Lifting (Thank You Gifts)
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Thank you so much for this! I just started my first job as an RN 2 weeks ago. I was beginning to wonder when that glorious day would come that I would feel capable of actually handling things on my own. This helped. It’s nice to be reminded that it’s all a part of the process, that it gets better. Nice to know that feeling overwhelmed is normal and that it doesn’t mean I chose the wrong career. I’ll get it. Day by day, week by week, month by month… and year by year. I am capable. I am competent. I can do this! THANK YOU, FreshRN ❤
So glad this was helpful! I hope the days are getting better!
I just linked over to this blog post from facebook, I needed this today. I’m a new nurse on a PICU and you described perfectly my love for my unit but the dread I feel going to work. What I have the hardest time dealing with is the person who says you “haven’t done hygiene care (insert small issue here) on your new admit” (that we just stabilized and got settled) ignoring all the priorities that were addressed and I feel defeated.
That is SUCH A HEADACHE!!! Gah. I felt like that too, even into my career. Unfortunately, there are nurses who care about the little tasks more than the big picture.. who can’t see that while hygiene wasn’t done, you got them intubated and their BP under control. It can be so hard to feel defeated after a long shift and getting a response like that. Those people can’t see the priorities, they just care about tasks, which is a bad sign. I started having to detach myself from those people and giving their words very little power in my mind. I started to only care if the nurses I respected and who knew what was the priority were like “hey you forgot to do ______” – then I’d allow myself to feel defeated. And whenever someone who was nit-picking would say, “So you didn’t do oral hygiene on your unstable admission?” I would confidently says “Nope!” I hope this helps!!!
Hi, i enjoyed reading this blog, I can relate to it a lot as far as prioritizing and time management. I graduated in January of 2016 but didnt start working until December of 2016 in a telemetry unit with only 6 weeks of orientation (not a new grad program). My preceptor was not the greatest to teach me the details and the most important things to know. Everyday I feel scared and dread going to work because im afraid of something happening and not knowing what to do. The biggest problem I have is time management, as much as I try to get better at it, it always fails me and cant never leave work on time. I feel that I am always so focused in trying to stay on top of my game to avoid falling behind instead of paying attention to the most important things which is reading new diagnostic results or digging more into the patients H&P in order to connect the pieces and understand things better about my patients. I also feel pressured in learning/knowing everything because we get sent to ICU within 6 months of employment. All these things have me thinking, and at times I feel Im better off quitting my job to avoid making mistakes and losing my license.
Your not alone… I know exactly where your coming from.
I have been in neuro ICU as a new grad RN myself for three months now. Everyday I dread going to work and use to have panic attacks before work. As soon as I build the confidence that I’m doing good, I get knocked down by a critique from my preceptor. Last shift I felt like I finally “got it” than when next shift came on they noticed a change In baseline that I didn’t and I had to rush my patient off to surgery (an hour after my shift ended). Being a new grad SUCKS and in the ICU in a level 1 trauma it seems there really never is an “easy day.” I’ve had to anxiety meds to help me cope and it barely helps.. I’m praying for the day I finally do “get it” and my days go smoother
I am so happy I found this post and completely agree with the comments above: it’s been hard. I just keep thinking that after a few more months things will suddenly click and I won’t feel like I’m under water. I’m a new grad on a progressive unit and while orientation left me with a bit of confidence, I’m currently second guessing EVERYTHING. Every car ride home my mind is racing trying to think if I forgot anything or if I could’ve done something better. The ride to work is picturing the worst case scenarios that may lay ahead. Really, I just want my peers to trust that I can do the job and won’t think of me as THAT new nurse. It’s reassuring to know that others are having similar experiences, we all have to start somewhere I guess!
It’s really too bad that we all feel like this. I have a great team behind me, that I really love and I know they will always help when I need it. But so many times I don’t even know WHEN or HOW to ask for help. Things seem to come by so fast I can’t even grasp WHAT I need to do for someone. Especially doctors and when someone calls from outside the unit. They speak and use acronyms that I have never heard of. As someone coming from completely outside of the healthcare field into nursing it is incredibly intimidating and frankly terrifying at times. I want to be safe for my patients and do the very best job that I can, and sometimes I’m just not sure what that means. I’m determined to do this well, and posts like this with comments from others going through the same thing buoys my confidence and reinforces that we are ALL new and can only expect so much from ourselves, and all those little extra tasks and distractions are sometimes just that…extras that we do once the core interventions are done. Thanks for the blog and to everyone that comments. Together we can conquer this!
Thank you so much for posting this! Basically your description in the first paragraph is totally how I have been feeling as a New Grad in the ICU. I’m almost 8 months in now, and the anxiety has been subsiding but is still there.
I also recently switched to day shift, which is a whole new beast so these time management tips are very helpful. I’m really praying that I reach the day I want to be going to work in the morning, but I’m not quite there yet. So grateful to hear others feel this way and these feelings are normal.
I really needed to read this today. I’m a new grad on a very busy GI PCU and am constantly feeling incompetent in my job. It’s as if I’ve been dropped off I a foreign country and barely speak the language! Time management is hard for me as well and it feels like it’s going to take forever before my confidence in this improves. Thank you so much for encouragement that it will get better!
No problem – I am glad it was encouraging! I’ve got some podcasts that touch on confidence building (FreshRN.com/podcast). I also have a guide for new nurses on impostor syndrome. By addressing that, we can really dig into building our confidence with a firm foundation and healthy motivators for growth. It’s a freebie at: https://kleber-media-llc.ck.page/527888297e