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Nursing time management for when you’re totally overwhelmed

Shutterstock | wavebreakmedia
Shutterstock | wavebreakmedia

Nursing is nothing short of stressful—even on a pretty good day. So when a truly apocalyptic shift rears its ugly head, you simply can’t help but be keenly aware of the nearest escape route at all times, even if you have loads of experience weathering the storm. 

Our best advice? Hang in there.

Of course, keeping calm is much easier said than done. So much so, you may be the slightest bit annoyed with us for even suggesting that it’s a valid option. Luckily, we have Kati Kleber (aka Nurse Eye Roll) to back us up on this one, with six time-management tactics she uses to keep her head above water when a maelstrom strikes.

 

It never fails. You start your day with the best intentions. You started your assessments and meds on time (woo hoo!), and then all of a sudden three doctors round at once and expect you to implement their orders immediately. One patient needs to pee, one needs pain meds, lab is on the phone with an alert lab value, a family member is on the phone waiting for an update and the STAT med you called for an hour ago hasn’t shown up yet.

Good Lord. What do you do now?

While this may seem extreme, it’s kind of not because all day you will be prioritizing and reprioritizing. When you think you have your next two hours figured out, something inevitably comes up. The key is being able to reprioritize in an instant.

I will tell you what I do when I find myself suddenly so overwhelmed that I don’t even know what to do next.

timemanagement

First: Stop and take three deep breaths. Collect yourself. Don’t just go—you need a plan to maximize your time.

Second: Think about which patient is the LEAST stable and address them first. Please keep in mind this is not always the one complaining the loudest. While one patient may be extremely upset that it’s taken 45 minutes to get their 4 mg IV morphine, your other patient who just had a graft placed with a blood pressure of 192/91 is your priority.

Third: What can you delegate? If a patient needs to pee and a CNA is available—delegate. If a patient needs pain medication and you know another nurse is caught up, ask if they can give the med for you. Nursing is a TEAM sport. We all are taking care of the entire unit together. That means when you’re caught up, you’re helping others who are behind. Trying to do everything on your own when others are caught up is a disservice to yourself and your patients. You will be running ragged and your patients’ needs will take forever to get addressed. Working together as a team is an essential part of a well-functioning and safe nursing unit. I know it can be hard to ask others to help you, but please do. Most are more than willing to help.

Fourth: What can you do simultaneously? If a family member is on the phone wanting an update, but you also need to see what meds you can give another patient, look that up while you’re on the phone. Whenever I’m on the phone and anticipating being on hold, I always get by a computer and chart or look things up simultaneously. Consolidating tasks, trips, phone calls, etc., is essential. When you see a patient, always ask if there’s anything else they need before you leave. It’s incredibility inefficient to be with a patient and try to leave immediately without asking if they need anything first, because they will inevitably put on their call light seven minutes later for something you could have addressed while you were in the room.

Fifth: Remember that charting is now the last priority. If you do have a second, chart the random/difficult-to-remember thing, but this matters the least right now. Always chart your medications in real time, but charting assessments can wait when you’re that far behind. Make notes if you need to, but if you’re running from an unstable patient to a new admit to a screaming discharge, charting is going to wait.

Sixth: Apologize to patients and families for being late with things. Never respond with excuses—they don’t help the situation (and honestly they can make it worse). Sincerely provide a heartfelt apology even if it was not your fault. Knowing that you are truly sorry for taking so long to get their pain medication (even though you were hanging blood, rounding with an upset physician and giving an antihypertensive med for a patient with a BP of 238/104) really means a lot to people. Additionally, apologizing immediately can smooth things over before they get rough. Having a grumpy patient or family can make the shift pretty tough.

  • Example of what NOT to say: “Sorry it’s taken so long for me to get here. We’re so short-staffed today it’s not even funny!”
    • Why this is no bueno: Technically you’re apologizing, but you’re also telling them there’s not enough staff there to quickly address call lights. While that may be true, it will make your patient and their family uneasy and nervous, which won’t help your situation…it will only make it worse.
  • Example of what to say: “I’m really sorry it took a while for me to get your medication. How have you been feeling? Is there anything I can get for you while I’m here?”
    • Why this is better: You apologize and acknowledge their concern/frustration immediately and quickly center everything on how they are feeling and their needs.

I know it’s really frustrating to be short-staffed and drowning all day. I’ve definitely been there and it’s pretty overwhelming, even for experienced nurses. However, it’s not the patient’s fault that three nurses called out and we couldn’t get the CNAs we needed, so just apologizing to them is the best approach. That frustration and need should be directed toward management, staffing or whoever would be appropriate in your facility—not the patient, even if they’re really upset.

Even though I’ve been a nurse for five years, I still have to remind myself of the above things. Sometimes I get overwhelmed and can’t figure out what to do next and have to remind myself to stop and go through the steps. Occasionally, I have to talk to a coworker: “Okay, I’m really overwhelmed and I’m not sure what to do next right now….” Just talking through it out loud to someone else helps me focus and figure out my priorities.

What do you do when you’re really overwhelmed? What time-management tips and tricks do you have for nurses who are just starting out?

To read more, visit NurseEyeRoll.com.

Nursey-123x18511Becoming Nursey: From Code Blues to Code Browns, How to Take Care of Your Patients and Yourself talks about how to realistically live as a nurse, both at home and at the bedside…with a little humor and some shenanigans along the way. Get ready: It’s about to get real, real nursey. You can get your own copy at NurseEyeRoll.com, Amazon or Goodreads (ebook).

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4 Responses to Nursing time management for when you’re totally overwhelmed

  1. perrywinkle

    one of my favorite signs that I saw many years ago said, “Be like the duck, calm on the surface but paddle like hell underneath!” Prioritizing is not easy when several critical judgements have to be made at the same time. Stop for a minute, take a few breaths, clear your head and charge right in ,somehow instinctively knowing what comes first. Whine later.

  2. cliff reed

    I’ve been thee. Hard to do.

  3. krizzy10

    I always remember being out to dinner and waiting over 20 minutes for someone to greet us after they sat us. Then after the food was delivered nobody checked with us for over 15 minutes and there were problems with the orders. I could see that they were busy, but when the waitress came over and told us about the problems they were having with staffing and in the kitchen I really understood why it doesn’t pay to make excuses. Though they are true, it matters very little when you are on the receiving end of poor service. A sincere apology would have gone over better. I liken this to nursing. It helps me keep my crazy shifts in perspective for the patients. Apologize sincerely and keep going, no excuses.

  4. TyGuyRN

    I’m all for talking it through with another nurse when I’ve got too much to do. Sometimes taking that extra minute to put it all outside your mangled brain provides some clarity as to how to prioritize. This also gives the other nurse an opportunity to offer help if they can, or at least collaborate care – oh hey, it’s dinner time and you both have pt’s that need insulin coverage? plan to go draw them up together in 10 minutes (helpful if your facility requires insulin double checks). I have even talked things through with a trusted CNA just so I can hear it all out loud, tends to seem less daunting afterwards.

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