Staying organized on Tele

RN_BSN09, RN · Feb 27, 2013

Hey ~ My first job as a new grad was also in telemetry! First off, I would make your own nursing "Brain". I put everything I needed to know on my Brain: pt history, times meds were due, labs were due, assessments, etc. I used it throughout the shift to check things off, and also for recording shift report. In addition, come up with some sort of "routine" (which is hard to keep sometimes when things happen during the shift that throw it off), but it will help. Everyone's different as to what works for them. I always would go to each room first, introduce myself, and do their assessment. Then I would focus on 2100 meds. Then I would start to chart my assessments. Some nurses liked to say hi to everyone first, then do assessments, then meds. Other nurses would assess then chart immediately, then meds. It's a "routine" that works for you... because there is so much to be done in so little time, it helps. Sometimes during the middle of the shift, if I felt overwhelmed, I would pause, look at my "brain" sheet, and think "What needs to be done right now?" Sometimes you feel like you are drowning in tasks, but if you step back for a minute, you will find that some items can wait... so Prioritize, prioritize! You will get the hang of it, it just takes some time to get comfortable.

turnforthenurse, MSN, NP · Feb 27, 2013

Hello and welcome!

I agree with finding a "routine" that works for you. Everyone is different. I also agree with getting a good brain sheet! If you search brain sheets here on AN you will find a lot of examples...you can use those or take a look at them for inspiration and make your own sheet. What is your nurse-to-patient ratio on your floor? I work on a progressive care unit and ours is 1:4.

I get report and then go into the room with the off-going nurse. I say hi and introduce myself and this also gives me an opportunity to do a quick eyeball assessment of the patient. I then tell them I am going to finish getting report and I will be back to see them. This also helps me determine who needs to be seen first.

Depending on who is giving me report, I will go into the patient's chart and look up the most recent lab values, eyeballing everything but I especially pay attention to the patient's H&H, WBCs, electrolytes, BUN/Cr, BNP, PT/PTT/INR & troponins/cardiac enzymes and anything that may be really out of whack. I look up any test results (CXR, MRI, CT, etc). I look up allergies if they weren't given to me in report (usually they are except for the ones with the huge grocery list of allergies, I just tell the off-going nurse I will look them up in the computer). Then I quickly look at the meds I will be giving during my sheet. On my brain sheet I have all of the times listed in a row (19 20 21 22 23 00, etc...) and if I have meds due at a certain time, I will circle that time (so if I have meds due at 2100, I will circle 2100 on my sheet). This entire process of looking up information usually takes me about 10-15 minutes.

I think make my rounds, do my assessments, pull my meds and start my med pass. If patients have meds at 20, 21 and 22, and there are no contraindications, I give them all at around 2100. I cluster things as much as possible. You will eventually learn how to manage your time and develop a routine that works for you.

I also like to note that I always arrive to work EARLY - around 1830-1835. I find that arriving earlier instead of at 1845-1850 gives me extra time to get situation and look things up and gives me a head start on the shift.

RN_BSN09, RN · Feb 27, 2013

I think make my rounds, do my assessments, pull my meds and start my med pass. If patients have meds at 20, 21 and 22, and there are no contraindications, I give them all at around 2100. I cluster things as much as possible. You will eventually learn how to manage your time and develop a routine that works for you.
I also like to note that I always arrive to work EARLY - around 1830-1835. I find that arriving earlier instead of at 1845-1850 gives me extra time to get situation and look things up and gives me a head start on the shift.

Totally Agree! :)

CyclingMurse · Feb 28, 2013

Our nurse to patient ratio is also 1:4, it can be 1:6 on nights however.

Thanks to both of you for the replies! Gave me a very good insight! Very helpful! :)

andi.w · Mar 1, 2013

I also started as a new grad on a tele unit. It took me several months to find a routine that made me most proficient. One thing that I did at first was make a Sort of "check sheet/graph." I listed my pt room numbers horizontally and then tasks such as initial assessment, 2000 meds, I&Os, 2300 vitals, etc. horizontally and placed a check when I had completed each. This kind of helped me to stay on track and saved me time from stopping and going "Ok who did I miss for this particular thing..." It seems silly, but when you have 5-6 Pts and limited time to complete everything, it really did seem to help.

I think the most important thing is just try to relax and take your time. Mistakes happen when you rush. One thing that I finally had to come to terms with as a new grad was that being a few minutes late passing meds or getting vital signs was not the end of the world. Nursing definitely requires flexibility.

Nurse_ · Mar 1, 2013

Essentials would be to have your own "brain". Be adapt in core measure protocols such as ACS and CHF. Learn about cardiac enzymes, electrolytes and H&H.

Always check with your monitor tech for your patient's current rhythms and if it changed at all during the shift. Review your patient's rhythm before and after the shift just to be clear that there's no dysrhythmias that was left unreported.

turnforthenurse, MSN, NP · Mar 2, 2013

Essentials would be to have your own "brain". Be adapt in core measure protocols such as ACS and CHF. Learn about cardiac enzymes, electrolytes and H&H.
Always check with your monitor tech for your patient's current rhythms and if it changed at all during the shift. Review your patient's rhythm before and after the shift just to be clear that there's no dysrhythmias that was left unreported.

I agree with this. Always check and periodically check your patient's rhythm on the monitor and note any changes. We have monitor techs but that doesn't mean they always watch the monitor...half the time they are just clicking the monitor to silence the alarms :no:

Jenni811, RN · Mar 8, 2013

Um I don't know how other hospitals do it. But clearly we cannot be watching our monitors 24/7 when we have 6 patients. Sure we have them at nurses station and in rooms. But what if Joe blow goes into afib and I'm with Jane doe for 30 minutes? Anyway, you get my point. We are required to document rhythms every 4 hours. We have a tech that watches rhythms 24/7 and notifies us with changes/questions etc. We r all really good about helping.

RN_BSN09, RN · Mar 8, 2013

Um I don't know how other hospitals do it. But clearly we cannot be watching our monitors 24/7 when we have 6 patients. Sure we have them at nurses station and in rooms. But what if Joe blow goes into afib and I'm with Jane doe for 30 minutes? Anyway, you get my point. We are required to document rhythms every 4 hours. We have a tech that watches rhythms 24/7 and notifies us with changes/questions etc. We r all really good about helping.

That was exactly how my floor was. The tech would call if there was any change, and send us the strip. But we definitely would check the rhythms when we could.