priorities and time management
- 0Feb 16, '13 by amzyRNI'm starting orientation on a fast paced tele unit soon. I have 6 months experience is a slow paced critical access hospital. I was wondering if anyone could send me a copy of a good "brain" sheet. With priorities, I know it's abcs, and assessing the sickest patient first. My routine would be (hypothetically): get report, maybe check labs real quick and orders and a quick skim of anything I missed in report on the computer, check most recent VS if I didn't get them in report (aids do vitals where I will be), write them down on my sheet. maybe make a quick task list on my sheet. Then I'd do rounds checking my sickest pt. first, if all is well, start AM med pass and do a focused assessment when I do the med pass, I pass meds on my sickest pt. first and give them critical meds first in case one of my other pt's starts to crash and I have to go deal with it. Finish med pass, then chart on my pt's and check orders and any new labs and deal with any changes. I know this is kinda dumb, but am I prioritizing my duties correctly or are there things I'm missing. Anyway, I will get 8 weeks orientation, maybe 10 but I want to be off orientation as quickly as possible.
- 1Feb 16, '13 by turnforthenurseRNUse the search function as you will find there are a lot of users here who have posted their brain sheets.
We have computer charting where I work, so we always do report with that. Afterwards, we usually go to the room so I can say hi and introduce myself and then I tell the patient that I will be back after I finish my report. This allows me to do a quick eyeball of the patient and if the patient has any drips or dressings or things that I need to verify with the off-going RN, this allows me the opportunity to do so, too. After verbal report, I go back to the computer and check labs if they weren't mentioned (mostly paying attention to H&H, WBCs, electrolytes, BNP, creatinine and cardiac enzymes, but I eyeball everything, too), check for new orders, check the patient's histories/allergies (because they aren't always given to me in report and if a patient has a laundry list of allergies, I just tell them I'll look in the computer, they don't have to name off every single one) and meds for my shift. I also do a quick check of their vitals to see what they have been trending during the past 12 hours, though usually the off-going RN will alert me to the trends (but again, not always!).
And yes, CNAs do our vitals, too, but remember that you are ultimately responsible for them. If I get into the room before my CNA at the start of the shift (which I usually do), I will just check the vitals myself. It's easier for me that way. All of our patients are on monitors, but remember, if something is out of whack on the monitor, CHECK THE PATIENT, not the monitor. You'll learn that things like CPT will cause crazy v-tach with a "HR" in the 200's but that's what the monitor is telling you. Again, check the patient.
If I have tasks that need to be done, I just make a box next to each task on my sheet so that I can check things off as I go. For example, if I have a patient with an NGT or PEG and I need to check residuals Q4H, I will make boxes with 20, 00 and 04 and check them off as I go. If I have to flush a tube with tap water every so often per MD orders, I will make note of that. If a patient needs a urine or stool, I will make note of that and will highlight it on my sheet, too.
You will eventually learn what works best for you and establish a routine. And do not try to get of orientation as quickly as possible, make sure you are 100% ready. It is crucial for new grads to have a long, thorough orientation.
- 2Feb 21, '13 by andi.wIt's good that you have a mental plan for how to begin. I work both CVICU and tele, and my "routine" is different for each. Everyone has a routine that works best for them. It took me a while to figure out how I could be most efficient. I too do a quick "eyeball" of everyone when I first start. At my facility, you are supposed to complete all initial shift assessments within one hour, which as you can imagine, does not always happen in quite that time frame. We also do our own vitals. I start by doing vitals on my sickest patients first. I usually do vitals and a focused assessment to begin with, depending on the acuity of the patient. Halfway through my first rounds, if I'm "on time" with getting everyone checked over, I begin doing full assessments and passing meds. Also, if a pt has meds due that affect HR or BP, I try to pass their meds when I do vitals to avoid giving the med a while after the vitals were taken and/or having to retake vitals. I think the best advice I can give is to relax and be flexible! When I first started working tele, I stressed over all meds not being passed within the golden half hour window or all full assessment being completed within the first hour of my shift. You have to take your time and work at a pace that suits you. Mistakes happen when you rush, and you will become faster and more efficient as time goes on!