Nursing/tech work -- ever feel like you can't keep up?

[eventualeventer]

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I just got back from a busy shift at work, and I was wondering if anyone else ever feels at their job like they have trouble keeping up -- getting treatments done on time along with everything else that has to get done, and not feeling like you're scrambling to have everything ready to go by the time the next shift gets there.

I was dealing with three mare/foal pairs in isolation. Two of the foals still had diarrhea and were on fluids, periodic blood draws, IV meds, and lots of oral meds with the mares getting milked out q2h. The third was getting vitals/oral meds (and the mare getting vitals) every three hours. Isolation is a big black hole as far as time management: besides treatments, you have to keep the stalls cleaned and bedded, do vitals on the mares and keep the mares fed, clean and dry poopy foal butts, and scrub the diarrhea stains off the walls, and you have to gown up before going in each stall. I was doing OK at the beginning of the shift, but the 9's, 10's, and 11's all blended in together and I got behind, with the 11's not really getting done until 11:45 (turnover is supposed to be at 11:30). I think what happened is that I should have started 9's at 8:30 or so (we are allowed to start up to an hour early with treatments). I didn't because I was asked to run some bloodwork for a colic that had just arrived (we had three arrive in rapid succession and several on fluids in the main barn, keeping the other girl busy), and then I took ten minutes to wolf down some dinner.

I am very meticulous in my work and I know that my patients all get high quality care. I am attentive in my physical exams, butts and stalls get cleaned thoroughly, and I am very careful not to make mistakes with medications. I think sometimes it would pay to fly through things a bit more, but it goes against my nursing instincts, for lack of a better way to put it. Tonight's was a fairly high patient load in terms of number of treatments but I volunteered to take all three because I know there are times when it's busy and I have to do this much to keep up.

I talked to my supervisor (who doesn't actually work on the same shift as me) a few weeks ago and she gave me some tips, such as starting treatments as early as possible and trying to have a rhythm, doing patients in the same order each hour. I think one of the problems is that during the school year I only work one shift a week (it's a really long drive), and winter and early spring were very slow. It just seems like there's always stupid little stuff that slows me down, like shuffling in and out of the gate (the foals are kept behind gates to keep the mare from getting tangled in the fluid lines) with the muck tub during stall cleaning, or when I have to wait for the other girl to come help me take blood because the foal is flailing around too much for me.

I'm not really sure if I'm looking for ideas or just a place to vent. You small animal people are probably laughing at me because you have to deal with more patients on a daily basis, but it seems that everything is just more labor-intensive with horses. Anyway, thanks for listening . . . 🙄

 

[sumstorm]

Even is SA, if there are a handful of intensive cases, it is easy to get behind!

Also, it is FAR HARDER to work 1 or even 2 shifts a week and maintain skill sets than it is working 3+/wk. To me, it means each shift involves a 'learning curve' of sorts. It also means you are often behind in little aspects of the practice such as how various staff are doing, changes in patients, changes in long term cases, etc...and so you tend to be loaded with all that info at one time, which takes time and decreases processing.

I honestly don't know about labor-intensive. Larger areas to clean vs a parvo dog...but not compared to a prized brahma.

Hope it gets better. Also, something that helps is knowing what your duty priorities are. Are you the only one who can do bw for colic? Is it a primary responsibility, or does it need to fall to another tech so that you can handle your priorities? A lot of vet clinics use a free-for-all model of staffing, which can increase inefficiency and jeopardize care. There is a difference between helping other areas catch up when you have completed your duties and interupting your duties to help other areas (and sometimes it is a judgement call!)

 

[Angelo84]

One thing that helps me is to draw up all the meds for that hour at once for all of my patients it cuts down on the backtracking. Then I can just go down the line. The system we have here is that orders are done by time x. So we start 10pm treatments at 9 so that all the treatments are done by 9. RR, HR, EcG monitoring are done on the hour. All the patients are on the same type of schedule so walks, quant pumps, and such done at specific times. Meds, food etc done at another time. So "odd" hours end up having less treatments and you can do the little things then.

Good luck.

 

[ImaJerseyGirl]

You hit the nail on the head! I think its all rhythm and being in the loop with things. I usually work full time hours during the summer (not so much this year) and once you're doing the same routine everyday, it just comes naturally, no need to stop and ask yourself what step comes next because you've already thought of it. It's just adds smoothness to the flow of the day. Getting started on earlier on treatments is good. Try setting a timer by each stall. I put timers up at cages for post blood samples, injections, feedings, etc.
During last semester I took off so much, once I was out for three weeks! Now I come in and feel totally disoriented. So much changes as far as patients and staff meetings, it's hard to keep up and a lot to deal with in one day. You have to wait for someone to help hold for a blood draw... takes time and disrupts flow. Then yes, you get the dog that chews through the IV line overnight or the bloodmachine spits out the slides and you have to start alllll over. It happens. I know how you feel. Having supportive coworkers helps sometimes. You just have to do the best you can and know you are doing the best for the patient.
As a horse owner and stablehand for many years, it seems like things with horses take longer than they should!

 

[jglovicz]

I completely know what you are talking about. I worked at a small equine clinic and I was the ICU tech a few days per week. I think the hardest part was that one day there would be a post-op colic from a week ago that needs 2 or 3 checks at night...the next night we would have a treatments every hour and a full house. I would definitely say that the winters were slow...then spring would come, horses would be turned out and would come in with newly-discovered barbed wire around the legs. If it rains in pours right? It's good to vent/discuss it because sometimes it does feel like it is so much. I worked when I was a full time undergrad and my shifts were 5pm-8am so, while it didn't happen too often that I didn't get some sleep, there were other times when I came home and laid down before heading to class. What is important is that even when you have had a long day, you can sleep it off, wake up and still want to do it 🙂. One frustration I had was that in the winter I could go up to 2 weeks without being called in... (except on weekends) so it was kind of hard to plan out my schedule, then, of course we would have a full house 🙂. Good luck, and get some sleep!

 

[eventualeventer]

Thanks for the support.

ImAJerseyGirl, I like the idea of a timer to help stay on track. Maybe the thought of the timer going off will help me move a bit faster, too. Another thought I had last night was taking a few minutes at the beginning of the shift to write down when I'm going to do what.

Sumstorm, the other tech was starting the bloodwork but had to go hang fluids, so she asked me to take over. Generally, the nurses are asked to run bloodwork but it is ultimately the responsibility of the on-call doctors to find someone to run it, and they usually have at least one tech helping them with the work-up. I should have told her to leave the bloodwork for whenever someone (whether it was us or the on-call people) had time.

I've asked for more hours this summer, and I'm getting closer to 2-3 shifts per week on average, but the budget is tight and there are other people asking for more hours since it is summer, so I'm unlikely to get as many as I'd really like.

 

[sumstorm]

The entire routine thing means a lot. I went from working 5-6 days a week to 2x a week, then to once a week, and now I just do relief work. The 1-2 days a week was the worst. I was expected to keep up with the flow, but wasn't in a routine, and at the same time, I never knew what had changed (ie the vet put in a 'no euth of new clients no matter what circumstance' policy, but I only heard about it after I scheduled a possible euth appointment) or everyone else would know something was on back order but I didn't. Once I went to relief work, there is an understanding that I can't know this stuff, so I get less duties per shift, and no one assumes what I can or can't do.

 

[StillDreaming]

oh i've been there and had those shifts where you just feel like you are always behind. Our protocols are pretty close to yours (in relation to when meds need to be done, etc.) but our supervisors know that sometimes we may not fall exactly on schedule. For me, i do my treatments in a timely fashion, and then worry about cleaning, etc when i have time. We are supposed to pick stalls and such throughout the shifts, and i do so when i first get there (mostly so i can monitor patients passing manure at a reasonable rate, etc), and then only do so when i have time throughout the rest of the shift...

Don't even get me started on foals, i've had some experience working our ICU and such with them, but for the most part when i'm there i'm working the colics/opthos/surgery patients or emergencies... but when i do work foals, they seem to take so much longer because you've got 2 patients for 1 stall, and the little things seem to be very intensive (i guess that's why they are in ICU lol) and take forever!

Our doctors are pretty understanding, and if i'm working an emergency and the rest of the hospital is falling behind, they will usually let me leave to help the treatment tech for a few mins if there is downtime with the emergency (i.e. waiting for clin path results, fluids to bolus, etc.) It just depends on the doctor, the patient, and what students are comfortable with doing.

I guess my point is that this is not uncommon. there will always be times that there is just too much to do in the time you have to do it. My way of handling this to ensure that i don't mess up is to just take it one thing at a time. I will speed up a little obviously, but not to a point i'm not checking for correct meds, or correct doses, etc.

 

[alliecat44]

Ditto to StillDreaming on the "treatments first, cleaning second" idea. I admit that I have no equine medical experience (yay for next year!), but in my SA world, sometimes I'd be dealing with 20+ patients on an overnight with only one other nurse, cases coming in the door for the DVM, etc etc.

What I used to do in those extreme times are DEFINITELY do patients in the same order every time--that way nobody gets missed, and each individual's treatments are approximately an hour apart. I'd go through and give meds/do blood draws/etc, and then look at the clock--if I had time, I'd go back and clean the animals that needed it. If not, I'd start on the next hour's treatments right then and hopefully get done with enough time for the cleaning rears, etc. In other words, I'd do all the "important"/medical stuff first, then go back for the sanitation/upkeep stuff (including feeding and even walking dogs if they're on maintenance fluids and not acting antsy).

The exceptions to this are those patients whose eliminations you're monitoring VERY closely and/or patients who are so dirty that it really is unhealthy for them to sit even ten minutes more.

Good luck! Part of the fun of ER/ICU work. 🙂

 

[eventualeventer]

Alliecat, I love intense cases, it's just getting back in the swing of it!

I feel like I'm doing better this week. I worked Sunday overnight and again last night -- it really does help when you already know the patients! -- and managed to get done on time both shifts. I was more aggressive about getting started early, and I think I'm starting to shave some time off of the average time spent in each stall in iso. Sunday night, I made one mistake of giving loperamide a couple hours early -- there were a bunch of oral meds on the cart outside the stall and I didn't double-check carefully enough to make sure that they were all being given at that time -- but it was not a big deal (phew!). I also was a bit firmer about asking/telling? the intern to finish getting the emergency (diarrhea baby #4) settled in while I attended to the other patients, and I gently insisted that the resident help me get blood off of another baby while the opportunity was there (baby was down). I did also leave some butt washing for day shift since there was no way I could fit it in with the more important treatments.

I appreciate all the input!

 

[aretoo]

foals are awesome 🙂 But SOOOOO busy!! We also had 4 this week (though it wasn't just me doing them, lol).

Where I work it seems like we have a much lower staff😛atient ratio, which is good when we are busy but also means we are more likely to be sitting around when it's quiet...though sometimes we (students) or the techs will go home early at night if there's really nothing to do.

We have a somewhat similar schedule...most treatments happen at 8s and 2s...sometimes stuff at 12s and 6s etc, but mostly it's just walkbys between 8s and 2s.

Tips I've learned from the awesome techs I've worked with:
- Making a list of what needs to happen when at the beginning of the shift is helpful.
- Where I work, the day shift makes up all of the meds for the night shift, also helpful (since pharmacy, where drugs are *supposed* to come from, isn't open at night - obviously we have access but it's easier to avoid it)
- In iso stalls I try to have everything ready that I will need in the stall so I don't have to walk around the anteroom too much when I'm gowned and booted - i.e. all meds, bum cleaning stuff, foal feeding supplies, whatever - then I just have to reach out the door and grab it all

Sounds like fun though - I love my summer job very very very much!!