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5 reasons you always “end up last”

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Every nurse has gone home at the end of a shift and had the thought: Another day without a moment to think about food or the bathroom! We sacrifice our personal needs for the needs of others each and every day. We’re the first to admit it. We put ourselves last when caring for our patients. Sooner or later, enough is enough.

Here are five big things that can eat up your time during a shift—and what you can do about it to stay on an even keel.

1. Budget cuts. Healthcare facilities may have fewer support staff due to budget cuts and people less willing to do menial jobs. Finding people who want to do direct patient care is difficult, which leaves nurses doing more. Many nurses work short-staffed and are expected to perform jobs that would normally be completed by a nursing assistant or housekeeping. Toileting a patient when your own bladder is full can be an experience in self-discipline. Many times nurses chuckle over the need for personal Foley catheters and caffeine drips as they run from patient to patient.

Solution: Try to do tasks in groups. Pass fresh water to all of your patients prior to passing medications. Once meal trays are passed, eat and use the restroom; most patients are busy eating and requests are few. You can restock gloves and necessary medical supplies when patients are at physical therapy, having procedures, sleeping or visiting with family.

2. Hourly rounds. This has become a common policy in many healthcare settings. Nurses are expected to enter a patient’s room hourly and ask the patient if she has needs or wants. The nurse is expected to fulfill each request and then move on to the next patient. Doing hourly patient checks is supposed to allow the nurse to have more free time and prevent patient falls, unless the nurse has a large patient assignment. No policy is foolproof.

Solution: Ask the CNA to round on your patients so you can document, take a break or run an errand. If a patient needs medication, the CNA can relay the message to you once you’re available. Nurses continue to have less time for meals and breaks with or without hourly rounding. If you get a break and leave the unit, keep your ear out for those dreaded overhead pages. Remember your patients come first!

3. Administering medications. In the hospital setting, the days when one person administered medications to the entire unit are gone. Each nurse is responsible for her patients’ medications. Entering a patient’s room with a cup full of pills and hearing him say his pain medication isn’t working, he needs a drink or needs to use the bathroom can cause a nurse to get behind.

Solution: Ask your patient what medications work for him at home and notify the attending physician for medication changes (within reason, of course—we’ve all had patients who exaggerate what they take at home). Try to be sensitive to the needs of your patients, but don’t let them manipulate you. Try repositioning the patient or use heat or ice therapies. When your patient needs to use the restroom during medication times, ask if it’s critical; if not, call your CNA and move on to your next patient.

4. Cleaning up after coworkers. Following a nurse who leaves food trays from various meals along with wet towels and linens can be frustrating. It’s hard to clean up after someone else. Nurses are supposed to keep patients’ rooms clean and clutter-free. There are times when garbage cans are overflowing and housekeeping can’t be found. Cleaning your patients’ room can make you late in completing necessary tasks, which may include your break.

Solution: Take a linen cart and bin with you when you begin your rounds on your patients, and replace clean linens and remove dirty linens at the same time. Straighten beds and tidy bedside tables. This time with your patient can give you a chance to do patient assessments on alertness, orientation, recent memory and shortness of breath without your patient ever knowing it. Bring an empty push cart on your next rounding and remove trays and anything else that’s been left in the room. Garbage cans? Wait for the patient to call for the bathroom. You can empty the trash after placing your patient on the toilet.

5. Documentation. Last, but most important, is patient documentation. Documentation is easier due to electronic medical records. Well, that’s what the IT companies would like us to believe. Documentation continues to keep us from doing the things we’d like to do, like go home on time. There’s no way to cut corners when we document on our patients. Documentation is a legal document that can be used in a court of law. Do your best and don’t rush.

Solution: Work on documentation when your patients are sleeping or visiting with friends and family. Mealtime—yours’ and your patients’—can also be used as a time for documentation. Remember, if you work while you eat and don’t take a “real” dinner break, you should be paid for your time. If it’s a busy shift, keep notes on your patients’ changes and do your documentation after your shift ends. Punch out after you finish documenting, not before you start.

Nurses will never have time to put themselves first until they punch out at the end of the shift. Reward yourself frequently during your free time and continue to do your best for yourself and your patients. Create balance in everything you do.

What are your solutions for staying “on top of it”?

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Candace Finch, BSN, RN

Candace Finch, BSN, RN is an orthopedic and bariatric nurse. Candace began her nursing career after the age of 40 and recently completed her BSN from Empire State College Distance Learning. She is a firm believer that it is never too late to reinvent yourself. As a mother of two children with Type 1 Diabetes, she has learned that whatever God gives you can be used to benefits others. She enjoys quiet time with her husband and family, reading non-fiction books, listening to contemporary Christian music and traveling with her daughter to Disney World.
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