Time Management for the Not So New Grad

  1. 4
    I know it's been asked many times before "how can I time manage better as a new grad?". However, I have been off orientation for 6 months and have addressed by my supervisor about my frequent overtimes. (Sometimes it's 15 minutes, sometimes it's an hour). It is hard for me, because I'm not sure what I'm doing wrong.

    I work nights, and this is definitely a down fall, because at least at my hospital:

    1. We have no attendings. I must call and wake up my doctor if I need anything.
    2. Our pharmacy closes at midnight, so if it's not pre-made, I have to mix it.
    3. We write down all of our vitals onto a 24-hour flowsheet, which can be tedious.
    4. We have no CNAs or lift teams, so I am dependent on other nurses or my charge to help me turn, move up in bed, or give baths if they're not busy.
    - This is especially bad if I get stuck on a shift with either a lot of crictical and busy
    patients, or when I (as happens frequently on night shifts) have lazy nurses or
    charges who don't feel obligated to help me - lest they fall behind or don't get to go
    on 2-3 smoke breaks.
    5. As I've heard with most places, there is a lot of tension between day and night nurses. Though it's assumed that day shifts are busy, when our unit has had 3 critical admits and we're putting in orders for one another and calling codes, I still get flack for not having done a bath, or labeling all of my lines.

    The day shift nurses have immediate access to supervisors, which means if they have a complaint, then they get told immediately, where as night shift nurses have to fill out online complaints that are more hassle than helpful.

    While all the night ICCU nurses face the same difficulties, I am getting more overtime than almost anybody else. Granted, I am one of two new grads and nights, and the other new-grad and I do not work together very much, but I need help.

    Advice? Strategies? Methods? Any words of wisdom is appreciated. I'm just 6 months in and should be so much better by now!
    TimeFlies, JennyandPups, bebbercorn, and 1 other like this.
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  3. 14 Comments so far...

  4. 8
    Quote from stephanie.felder5
    While all the night ICCU nurses face the same difficulties, I am getting more overtime than almost anybody else. Granted, I am one of two new grads and nights, and the other new-grad and I do not work together very much, but I need help.

    Advice? Strategies? Methods? Any words of wisdom is appreciated. I'm just 6 months in and should be so much better by now!
    First ....6 months in and you aren't drowning? I give you a standing ovation!
    The second is.....not every single task needs to be P-E-R-F-E-C-T.

    It has to be perfect ...but not P-E-R-F-E-C-T....

    In the the long these are the kind of ICU's that I prefer.....It drives me NUTS to be incessantly badgered by residents, interns, med students, and fellows. They also usually do the procedural things like IV's and NGT's PA line removals etc. The kind of ICCU you explain was the way I worked in my favourite ICCU of all time and became very quick and independent.

    That you are new and having to stay late doesn't surprise me......even experienced ICU nurses have issues getting out on time.

    It is a tough environment to be a new grad and "get it all done". The expectation of days and nights doing the baths because nights has "so much down time" REALLY annoys me when nights has far less ancillary personnel to accomplish tasks like orders, admits, and paperwork......for the night crew has no secretary to assist in the order entry or runners to get specimens to lab. Historically...the day and night crew do seem to have "issues" and the night crew is considered "quiet" with a ton of "down time". For the most part I have never seen all the down time claimed by days.

    Yes nights has less noise and "chaos" for there are less people around to cause it. Night crews (eventually) end up being very close for they depend heavily on each other. There is no ancillary personnel, management, physicians, PT/OT, and visitors to cause unnecessary noise and havoc that plagues the day crew.

    For the most part the patient that was busy/critical on days....is the same on nights in a critical care unit for there is not a real day/night routine change. It the same monitors, same drips, same patients that are on days....just less bodies to care for them. But we are supposed to have all this spare time for extra tasks.....

    The curse of the night crew is that the world assumes that while they are sleeping were a sitting around doing nothing......it is something that has annoyed me my entire career. They also assume because they wait til 11am that they can call you because they "waited" for you to get some sleep they are being gratuitous and kind.

    Really? How nice of you to allow me 3 hours of "sleep".
    If you go to bed at 9pm are you still sleeping at 11pm????
    Well SO AM I at 11AM...grrrrrrrr!!!!

    You will get faster and better as time goes on. What I used to do in my initial prep for the night I would gather all my "stuff" to be ready for the night. All my drips and tubing I would spike ASAP and label ready to hang. Everything I could possible need I gathered in a flurry at the beginning of the shift on the list I would make at during my initial assessment. I used a wash basin and gathered tubings, drsgs, labels, tubings etc to ready myself for the night ahead of me.

    I made up a check list for myself at the beginning of every shift of the things I needed to do and checked them off as I went along....I would then give report with that list in plain sight so that they could see in plain view...In was busy all night.

    I don't know if you have a good brain sheet....I used them A LOT at first.....here are a few.

    mtpmedsurg.doc
    1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc
    ICU report sheet.doc‎

    Until you get the hang of it and develop your own rhythm.....don't expect a break. I very seldom took them especially at first and I made sure I didn't dwell on what the other staff were doing or how many breaks they took for I knew my patients were getting the BEST care I could give....and may be in all likely hood much better care than those who sat around all shift.

    I would place a bath blanket under patients after their baths if I couldn't get any help...I htink the day shift could change some linen. Many times I would change the linen whenever I had help then protect the bed with a bath blanket so that when I bathed my patient all I had to do was remove the blanket. It took me a while to not feel bad but there were nights that all I could do was a pit and private bath with good oral care because really.....where had they been all day? I knew they were not out there sweating and rolling in the mud.

    It will come to you in time.....they say the first year is the hardest. I say the first 15 months is when you are in critical care.

    I wish you the best!
    Last edit by Esme12 on Mar 9, '13
    mondee619, JennyandPups, qaqueen, and 5 others like this.
  5. 0
    How can a hospital not have a 24 hour pharmacy? I never heard of such a thing. Is this normal?
  6. 0
    Brandon,

    I've never worked at a hospital WITH a 24 hour pharmacy. There's a pyxis, and an overnight pharmacy, but not a room with medications and a pharmacist - they're on call, but about 45 minutes away.
  7. 0
    Quote from BrandonLPN
    How can a hospital not have a 24 hour pharmacy? I never heard of such a thing. Is this normal?
    The pharmacy at my hospital works 7a-7p M-F and they go home at 12p on the weekend. We usually mix our own meds if it's a new order or the patient came in after pharmacy hours. We have a contract with an off site pharmacy to handle after hour admits or issues that night shift might have. Occasionally we have to call and wake our pharmacist up because it's something the off site pharmacy can't deal with. Our hospital is small..but it would sure be nice to have a 24 hour pharmacy on site! Especially when you get a new admit with 4 or 5 stat antibiotics that need to be mixed! I wonder if I could use pharmacy tech in addition to my nursing degree on a resume?
  8. 0
    Huh, well vie only worked in pretty big hospitals, so I figured all hospitals had on site pharmacy 24/7.

    Even the nursing home I work at has an in house pharmacy Mon thru Sat 9a-5p, but I guess this is rare for LTC.
  9. 4
    Time management...

    Prioritize your patients.
    - Check your labs... if it's a critical lab, do it in the beginning of the shift so that you don't have to wake anyone up. If you are receiving a patient from ER, make sure they get the appropriate orders before admitting them to the unit. Be assertive! They'll tell you that you can do it but it's different when they have the doctor in the unit and you don't.

    - Check VS. If you don't already have one, make sure to get a small bag or tray where you can put your saline flushes, stickers, pens, etc. Do all the labeling of tubes after you're done with your VS and assessment. This saves you time going back and forth and you don't have to remember it anymore. I usually also carry a small trash bag for IVs I need to change, I collect them then trash them later in the appropriate bins.

    - Give your meds... cluster if you have to. If you have (3) IVPB sched at 2100. Start at 2030, 2100 then give the longest duration (like zosyn) last.

    - Baths can wait, do them an hour before shift change. Anything not critical like that can be delayed or postponed. Don't feel bad not doing it or endorsing it to the other nurse.

    Remember:
    Do all your calls during the first two hours of shift
    Bring supplies with you when you do your initial assessments
    Check your medications and cluster things you can
    Buddy up with a nurse for turning and other things
    Do all other tasks when you have time
    Don't be scared to endorse it to the incoming nurse.... It's not just your job. It's both you and the AM nurse's jobs.
    JennyandPups, maydaysvp, Natural510, and 1 other like this.
  10. 0
    Yeah, like Brandon the idea of pharmacy hours kinda threw me (as did the old-school concepts of paper charting, smoke breaks, and no hospitalist on site).
    The advice is great for this (hopefully) future ICU nurse. Keep it coming!
  11. 0
    Quote from BrandonLPN
    How can a hospital not have a 24 hour pharmacy? I never heard of such a thing. Is this normal?
    We recently switched over to a 24-hour pharmacy and it has been a Godsend. Before, if the pharmacy didn't send up any medications prior to closing, the supervisor had to fetch them for us...or make our gtts. A more simple gtt was made by ourselves on the floor. In ICU, they got accustomed to making all of their drips, including pressors. If we have to speak with a pharmacist, there was a 24-hour number we could call, but it was a remote location.

    Now that we have a 24-hour pharmacy, I cannot imagine life without it, lol.

    As for time management, you will get there. I agree with clustering activities. With abx scheduled at the same time, start the ones that run in a shorter amount of time (such as Zosyn) first and save the ones that take longer to run (Levaquin, Flagyl, Vanc, etc) last. If you have meds due at 20, 21 and 22 and there are no contraindications, give them all at the same time.

    And although bathing is important, it is not a priority. Nursing is a 24-hour job and if you cannot get a bath done on your shift then oh well, the next nurse will just have to deal with it.

    Do you have open visitation in ICU or strict hours? I have found that family members are usually eager to help with the care of their loved one so if I cannot find anyone to help me do a bath and I have the time, they are usually the ones who help me.

    Sent from my iPhone using allnurses.com
  12. 1
    Quote from Nurse_
    Time management...

    Prioritize your patients.
    - Check your labs... if it's a critical lab, do it in the beginning of the shift so that you don't have to wake anyone up. If you are receiving a patient from ER, make sure they get the appropriate orders before admitting them to the unit. Be assertive! They'll tell you that you can do it but it's different when they have the doctor in the unit and you don't.

    - Check VS. If you don't already have one, make sure to get a small bag or tray where you can put your saline flushes, stickers, pens, etc. Do all the labeling of tubes after you're done with your VS and assessment. This saves you time going back and forth and you don't have to remember it anymore. I usually also carry a small trash bag for IVs I need to change, I collect them then trash them later in the appropriate bins.

    - Give your meds... cluster if you have to. If you have (3) IVPB sched at 2100. Start at 2030, 2100 then give the longest duration (like zosyn) last.

    - Baths can wait, do them an hour before shift change. Anything not critical like that can be delayed or postponed. Don't feel bad not doing it or endorsing it to the other nurse.

    Remember:
    Do all your calls during the first two hours of shift
    Bring supplies with you when you do your initial assessments
    Check your medications and cluster things you can
    Buddy up with a nurse for turning and other things
    Do all other tasks when you have time
    Don't be scared to endorse it to the incoming nurse.... It's not just your job. It's both you and the AM nurse's jobs.
    ^LOVE this!!!
    JennyandPups likes this.


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