Transitioning into critical care is tough. Whether you're coming from the floor, are a new grad, or even from intermediate care, it can be quite difficult acclimating yourself to a point where you are an efficient and safe care provider. Here are some time management tips for you critical care newbies out there.
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After I get report on my two patients, I print and interpret my telemetry strips and verify their alarms on the monitor. I then decide which one is less stable (or more labor intensive if they are both stable) and start there.
At 0730, I complete a full assessment, turn, mouth care, check my drips for appropriate concentrations and rates, check lines that need to be changed, tuck and fluff them. Then I hop on my EMR and check out all of my active orders. I chart my assessment, vitals, and work lists, and give my 0800 meds. I order more drips, if needed. I check what's going on for the day by looking at any radiology/special procedures/tests scheduled and then peek at the latest MD note. Then I talk with the patient and family and let them know what's up for the day.
Side note: Families of patients in critical care are naturally very emotional and concerned. I always make sure to over communicate with them about plans for the day. This establishes a professional relationship and allows you to assert your nursey authority. You're running their care for the day; you're in charge. If you are confident and professional, it puts them at ease and makes them feel safe with you. They need to trust you. If you give them any reason to doubt you as a caregiver, they will be stressed to the max all day. Stay confident! Even if you're not sure about something, be confident in your communication. Provide a structured plan for the day. The more structure, routine, and communication you can provide these patients + families, the better everyone's day will be.
Usually, by this time it's around 0750 or 0800. I then grab my 0800 + 0900 meds for my next patient and repeat the above process with them. After this, it's usually 0830. I then grab my 0900 meds for my first patient and administer those.
If that's done efficiently, I'm done around 0915-0930 with all meds, charting, and care. Being done this early allows you some cushion time for when physicians round, ask you a bunch of questions, and enter new orders. After that, I'll check on my other staff members and see if they need anything. If one of my patients needs a bath, I'll grab my tech and knock that out. And if no one really needs anything, I grab a snack!
At 1000, I go to my second patient's room and do a 1000 neuro assessment and chart it. I'll give any 1000 + 1100 meds and change any IV or enteral tubing due or start new IV's/change central line dressings that are due. I'll grab my tech and we'll do their 1000 turn. Then I'll go back to my first patient, do their 1000 neuro exam, their 1000 + 1100 meds, turn, and change lines/IV's at that time.
Theoretically, I'm completely charted and caught up by no later than 1030.
It's important in critical care to constantly be caught up. You never know who is going to deteriorate or code and that can change in seconds. You also never know what may be coming through the door at any time.
Critical care time management is very different from the floor. I've worked in both areas and it was a huge learning curve for me at the beginning. But once I became efficient at managing my time, I was more aware and able to catch things before they became a bigger issue because I wasn't so worried about how far behind I was.
Something to always ask yourself when trying to figure out what to do first is who is more stable?
Things may seem like an emergency to everyone, but you have to use your critical thinking skills to know who truly needs you more this very second. Everyone will need you all at once sometimes, but you really have to think about who cannot stand to wait.
So remember to stop. Breathe. And think. Who is more stable?
