Inability to multi-task is killing me on my acute rotation

[GOTTHATPMA]

---

Members don't see this ad.

Self-explanatory. I got good marks at the mid-term, but then I was given more responsibility with patient treats (basically, walk in the door and do it while she watches) and now I'm not doing well. I'm anxious, which she sees and the patient sees.

I get anxious because I suck at multi-tasking, and as anyone who's worked in acute care knows, you have to be able to multi-task really well during an eval. I've talked to my CI about it, and she is sympathetic, but she doesn't really have any tips for me. She also said if I can't multitask well I can't really be a PT. I disagree, from my observations and experiences in pediatrics, wound care, TMJ, and vestibular rehab. Anyone got any thoughts? I have been trying to go the old, "fake it 'til you make it" route, which works for about a minute into the eval, at which point I have to multi-task and my brain starts to fry.

 

[bnwj89]

Can you be more specific about what you have have to multi-task with that creates problems?

 

[GOTTHATPMA]

Sure! Here are the things I have to do at some point:

1.I have to ask the usual questions - what was your previous level of function, did you walk with a walker before you got here, etc.
2. I have to manage the patient's body/bed - lines and tubes, a 2nd gown for the patient's back, disconnecting SCD/Av, etc.
3. I have to manage the room - Prep a bedside chair, set a chair alarm if I think I'll need it, get the food tray out of the way, etc.
4. I have to test/assess the pt.'s strength, ROM, sensation, balance
5. I have to mobilize the patient, and manage the physical environment/lines while doing so (could include IV pole, NG tube, O2, Foley, PEG tube, dragging a chair behind me with my foot, etc.)
6. I have to assess the patient's mobility and give them appropriate cues/support during that mobility
7. I have to respond to unforseen circumstances, and quickly change the treatment if necessary - could include sitting the patient down, putting on a pulse-ox, changing the assist level given, restraining the patient, pulling up a diaper, etc.
8. If I'm mobilizing as a team, I have to communicate with the Tech/OT/PT/RN/family member
9. I have to make mental notes of what happened during the eval and what kind of verbal responses the patient gave to my questions. I used to take notes with a pen and paper during the session, but I do not have time. I do it at the end now.

Of course, I cannot do those things one at a time or the session would take forever. At any given moment, I am engaging in at least 2 tasks.

 

[Azimuthal]

Sounds more like a confidence issue rather than a multi-tasking issue. More than half the items you listed are procedural and could be done while obtaining the subjective, they are procedural in that you shouldn't be on to the next task without having performed the other. Have you tried speaking to your CI about running mock scenarios with you? Or running through what you will do with the patient with your CI before entering the patient's room?

 

[NewTestament]

She also said if I can't multitask well I can't really be a PT..

So is her advice to drop out now and find another career that doesn't require multitasking? What job doesn't require multitasking? I understand your frustration, but your ability to multitask will improve.

 

[jblil]

I agree with Azi, I don't think it's a multi-tasking issue. I just finished an acute rotation a few days ago and had to do all the items you mentioned in your post (ask pt questions, manage room/bed, prep chair, etc). At first, I thought of making a list with checkboxes for each task and go through them in order, with each patient. Turned out I didn't have to because I found the flow to be pretty natural. You said "I cannot do those things one at a time or the session would take forever." Personally, I find that most of the tasks are better handled serially, and they don't really take that long: for ex., disconnecting SCDs + getting the tray out of the way would take less than 60 secs.

If I were you, I'd design my own personal flow to be used with the patients. For instance,
1. Always bring a 2nd gown and hospital socks into the room, in case the patient doesn't have them so you don't have to run out and get them;
2. Ask the usual questions while you're disconnecting the SCDs and testing the patient's strength (if you insist on multi-tasking; I'd do those tasks serially);
3. Manage the IV lines and cath;
4. etc
Then use the exact same process for every patient; uniformity breeds efficiency, and I'm sure you'll eventually find ways to improve it or shave off a few seconds here and there.

Good luck, and keep us posted.

 

[GOTTHATPMA]

Sounds more like a confidence issue rather than a multi-tasking issue. More than half the items you listed are procedural and could be done while obtaining the subjective, they are procedural in that you shouldn't be on to the next task without having performed the other. Have you tried speaking to your CI about running mock scenarios with you? Or running through what you will do with the patient with your CI before entering the patient's room?

I think the two feed off each other. I came in knowing that I have always been a "slow and steady wins the race" type guy, and I like to do things one at a time. Too much distraction throws me, which is why often one of the very first things I do when I enter a patient's room is to mute the TV. I'm also pretty physically clumsy, which has gotten better but can be a safety issue during gait training. As for working with the CI on mock scenarios, I can bring it up. On Monday, we plan to do the first eval with her treating and me observing. Previously, I was to learn by being an extra set of hands while she performed the eval. Which, in retrospect, doesn't make that much sense. If my goal is to be able to treat patients without help in the room, it would make more sense for me to strictly observe.

And the tricky part of an eval is that you can never know for sure what you're going to do with a patient once you get in the room. I always come in with a plan, but there is a big "think-on-your-toes" component. I am feeling more confident with that, though.

So is her advice to drop out now and find another career that doesn't require multitasking? What job doesn't require multitasking? I understand your frustration, but your ability to multitask will improve.

I don't know. She seemed kind of pessimistic.

I agree with Azi, I don't think it's a multi-tasking issue. I just finished an acute rotation a few days ago and had to do all the items you mentioned in your post (ask pt questions, manage room/bed, prep chair, etc). At first, I thought of making a list with checkboxes for each task and go through them in order, with each patient. Turned out I didn't have to because I found the flow to be pretty natural. You said "I cannot do those things one at a time or the session would take forever." Personally, I find that most of the tasks are better handled serially, and they don't really take that long: for ex., disconnecting SCDs + getting the tray out of the way would take less than 60 secs.

If I were you, I'd design my own personal flow to be used with the patients. For instance,
1. Always bring a 2nd gown and hospital socks into the room, in case the patient doesn't have them so you don't have to run out and get them;
2. Ask the usual questions while you're disconnecting the SCDs and testing the patient's strength (if you insist on multi-tasking; I'd do those tasks serially);
3. Manage the IV lines and cath;
4. etc
Then use the exact same process for every patient; uniformity breeds efficiency, and I'm sure you'll eventually find ways to improve it or shave off a few seconds here and there.

Good luck, and keep us posted.

Thanks!

1. Already do, plus a gait belt, bedsheet, and draw sheet
2. Good idea!
3. Makes sense, along with room management.

I know one of the things my CI brought up was that I tended to kind of just bounce from task to task and the patient can't really tell what's going on. So a more even flow would make sense.

 

[markelmarcel]

I think managing lines/tubes/drains can definitely be hard... But, like others have said, you need to come up with a plan and then stick to it for every person. As far as your "plan before you go in" my CI during my acute rotation would make me give THREE plans of action... What my initial plan would be and then 2-3 back up plans... For some patients that were more complicated I had up to 5 different ideas before I even walked in the door. That way, I wouldn't freak out when my first plan failed; I had already considered what else I would do.

I think it's key to move everything out of the way while you are speaking to the patient once you go in and introduce yourself. I had a clipboard and I would have all my questions written out at the top (eventually I didn't need all my questions up at the top as I got used to the flow) and I would go through each one, jotting down just enough words to make sense to me later when I went to write my note up in the department.

If tag-teaming with an OT/whoever, we would decide beforehand who was going to take the lead for which pieces. Everything was planned out PRIOR to entering the room. That way, there were no awkward pauses and everyone was clear on what their role was once in the patient's room.

Acute care was a rough rotation for me at first, but by the end I was amazed at how smoothly I was able to do everything! Stick it out, you've got it inside, just work on your planning before walking into the room and you may see a huge difference!

 

[GOTTHATPMA]

Time to do more evals tomorrow. I've narrowed the entire Eval form down to 5 key questions

1. Who are you?
2. Why are you in the hospital?
3. Where did you come from before you came in, and where do you plan to go when you leave? This includes subsets like house vs. apartment, can lead to questions about stairs or curbs.
4. How were you getting around? This leads to questions about assistive devices.
5. Have you had any falls? This relates to question 5.

After that, it's remembering to test sensation, ROM, strength, and vitals if necessary.

 

[GOTTHATPMA]

I did an eval and a re-eval/co-treat today. I was calmer, more patient-focused. I had been so anxious, fidgety, and just discombobulated that my CI had straight up told me that there was a good chance I would get the ax today. And instead she told me that I'm doing better, and we're going to continue onward. Thanks to all who chimed in! Any other tips would be appreciated.

 

[jblil]

Good job!

I always engage in small talk with the patients as I work with them, it tends to put them more at ease.

 

[GOTTHATPMA]

jblil I do that, too. I try to find out something about the patient as an individual and go with that.