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How do I deal with an overwhelming assignment?

male-nurse-thinking

Image: Sam Edwards/OJO Images Collection/Getty Images

First, take a deep breath. Then another one.

Deep breathing might seem like a waste of time when you have a post-op wheeling down the hall, one patient waiting for discharge and an ER nurse on hold, ready to give you report on your new admission—not to mention your other patients who, hopefully, are holding their own. (Please let them be holding their own!)

But unless you get control of your thoughts, you’re going to spin your way through your shift without ever really knowing what to do next. You’ll lurch from one crisis to another, and then go home with your head still spinning, wondering if you truly did everything that needed to be done.

So find a quiet place and begin prioritizing. Make a list, if you’re a list person. What things absolutely, positively must be done? What has to be done now and what can wait until later?

Then think about available resources. Who can help you? Do you have a CNA assigned to you? Delegate, delegate, delegate! Is there another nurse you can ask for help? Ask! In fact, even if you think the answer is “There’s no one who can help me,” ask anyway. You may be surprised to find a colleague who is more than willing, for instance, to do some post-op vitals for you while you take report from the ER.

If you still feel overwhelmed, tell your charge nurse. Staying quiet helps no one—not you, not your patients and not the healthcare team. Express your concerns in a constructive manner, though. Flying off the handle and loudly complaining, “This is ridiculous! What do I look like, an octopus?” is probably not going to net you any additional help. (Laughter, by the way, can also help you cope with an impossible assignment.) You’d have better luck asking for help with specific tasks.

One final point: If you truly believe that your assignment is excessive and potentially endangering, it’s your responsibility to let someone know. Start with your immediate supervisor and work your way up the chain of command until someone listens.

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4 Responses to How do I deal with an overwhelming assignment?

  1. Nicole, RN

    Depending on what kind of floor/hospital/staffing situation you work on, an assignment like described above is not unusual. You must speak up before you get so far behind that it is dangerous for the patients. Also, extensive waiting times and poor customer service reflects poorly not only on you but on the hospital itself and the managers are aware of that- they will do everything they can, on most occasions, to help you care for your patients in a timely manner for the betterment of customer service, if nothing else. Obviously there will be times when short-staffing becomes a HUGE issue, but at that point the best thing to do is be honest with your patients and families- being honest with them about your workload will, in most occasions, help them to be more patient with you in their demands. And prioritizing is what nursing is all about- organize your day based on highest needs before you even begin to see your patients. If you organize, you will avoid making unnecessary trips to the med room to get supplies, etc.

  2. I work in a hospital on a Telemetry unit. There is usually only one RN and two LPN’s with one CNA for 21 patients. We do Nitro gtt’s, Cardizem gtts, lidocaine gtt’s, dopamine gtt’s, dobutamine gtt’s, amioderone gtt’s, Heparin gtt’s, almost every gtt that ICU does, with a few exceptions. The LPN’s aren’t allowed to titrate any of those gtt’s. I am usually the only RN on shift at night when I work. So, I understand the words “STRESS”! I think that this is very dangerous!! There is another hospital in our area that if a pt. is on one of these gtt’s they are in ICU, where they should be. But it wouldn’t be so bad if the floor was staffed with more nurses and all RN’s. Right now the way it is the LPN’s take 8 pt.s apeice and the RN has 5 pt’s. I have been here for 9 years and it has always been this way so I’m so used to it I just do the best I can. Are there other facilities out there that are like mine? I would like to know. Please write in and tell me about your facility and let me know. We have no union either. The admin. there says there are no nurses to hire! But they dont advertise in the paper anywhere except for travel nurses. Then most of the travel nurses dont know anything about the gtt’s unless they are ICU nurses and then they get hired for ICU not the floor. Just wondering. So, yes alot of deep breathing and praying! Just don’t deep breathe too fast!

  3. Loretta

    I would just like to comment on the posting above me by Renee. I am a night shift RN as well. I worked in a facility where 35 patients are skilled/rehab/sub-acute, and the other half are 47 LTC residents with some form of dementia. The skilled unit is very busy, we have iv’s, unstable patients, and i cant even begin to tell you the amount of paperwork and dressing i have to do. I am the only licensed personel on nights. I have 2 cna’s on the skilled unit, and 1 cmt/cna with another cna on the dementia unit. CRAZY is not even the word for it. I have gone to management and i get “we have no nurses applying” or “we have had several new grads apply, but this isnt a good fit for them”….basically no support. I’m lucky to get what absolutely has to be done, done. The poor cna’s say that there have been numerous nurses working nights there in the last 3 years, hmmmmm….maybe it’s too much? I’d like to see management do it all. Then a nurse manager has the nerve to call me during the day (while im sleeping) because I missed signing a tratment MAR for EUCERIN CREAM!!!!!!!!!!!!!!! Deep breathing isnt working for me thats for sure. I think unfortunately even though i have only been there over a month; i may be looking elsewhere. I do not feel its safe practice for my kicense nor is it fair that a patients has to wait 20-45 min to get PRN pain med when they are in tears and state a 10 out of 10 pain :=(

  4. re37622011

    So I too frequently get put as charge nurse at the last minute on a surgical floor n only work weekend night. I feel like we are the reddest headed step children of the hospital. I have voiced my concerns and fears and basically have been told I need to keep my mouth shut. What do we nurses do when faced w increasing budget cuts that put patient safety and satisfaction in major in jeopardy? I want to make changes across the board, across the nation. Does any hospital calculate acuity into their staffing grid? My fear is that a million dollar lawsuit will happen one day and we all know the nurse and charge nurse will be the sacrificial lamb. I don’t want my career ruined because the hospital gambles on most nurses sense of commitment. The stress is crazy and trying to truly talk about it seems to fall on deaf ears and makes mgmnt very tense. I don’t want to be a trouble maker but it seems every night shift has an ok ending only on the wing of an angle and a hundred prayers while the big dogs sleep. No one wants to hear about the multiple close calls and the realistic what ifs if no staffing n what if u had two simultaneous codes? We can’t have unions but we need to make legislative changes that protect patients and nurses, not the bonuses of the office folk. Any advice? Or am I just being a whiner? Please advise, I’ve only been a nurse for 5 years.