“Here are some very useful advises written by Kati Kleber, RN, BSN.”
It isn’t uncommon, as a new graduate nurse, to begin each day feeling not quite in the groove of things. Then, to end each day feeling so very far outside of the groove, you wouldn’t even recognize “calm and collected” if it whacked you upside the face with a stethoscope.
First and foremost—breathe. In the words of Kati Kleber: YOU CAN DO THIS.
Now that we have that settled, read on to discover how Kati Kleber, aka Nurse Eye Roll, shifted gears from utterly overwhelmed to “People can chill out. I got this.” Our hunch is that you can, too.
So you’ve just started your new job as a new graduate nurse. You have a great preceptor, you like your unit and your manager seems pretty cool. But you dread going to work. You get report and you’re already an hour behind. You’re already overwhelmed. There are so many things to do right this second that you shut down. You can’t do this. It’s too much. You struggle through each day, just trying to get to the end of the shift. You are elated for days off. You dread going back. Is this really what you signed up for? Will this EVER end?
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
Okay, what is the most important thing to do? What fires can you put out immediately? Remind yourself that you can tackle everything appropriately, just do so in chunks. Don’t think, “Oh man, there are five new things I need to do and I haven’t even assessed my patients yet!” While yes, that’s true, 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, the doctor, the PA, the radiology tech, 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, you’re 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 in 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, 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 my fires are out.” Then you can proceed to your normal day.
At the beginning, I thought I had to do everything on 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 one, two, four 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 “Okay, I know I need to do this first” skills as well as your confidence in yourself and your patient/coworker interactions. 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 two hours, fully assessed every four hours, all lines need to be leveled and zeroed, turned every two hours, vitals as often as every 15 minutes, oral care every two to four 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 these are 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 zeroed, 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 got this, guys.
I’ll have someone tell the fam member to call back in 45 minutes; 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 I 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 SCDs before he comes into 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 SCDs, 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 two hours) and I 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 minutes 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 who 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 three 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.