Time Management Strategies

  1. ok, so i'm a new nurse in the er. i am in my 5th week after finishing a 12 wk emergency nurse internship program which consisted of classroom time and clinicals. yesterday, my preceptor and i met with our nurse educator. the good news was that she told me she is hearing good things about me (phew)! she asked me where i felt i was in my training. i told her i felt my weakness was time management. my preceptor agreed, telling her that i am very smart, that i have good judgment, and that i am very focused, however, sometimes i focus too much on my more critical patients and spend too little time with my other patients (although i kind of feel if you're not acute, you can wait--i'll glance at you and make sure you're pwd, and then i'm more worried about the guy who can die within the next 5 minutes). i guess part of the reason is that i prefer the more challenging cases as opposed to the otherwise healthy 20 yr olds who have the sniffles yet feel that merits a trip to the er, but i know they come with the deal too. anyhow, my nurse educator asked me to come up with a document listing some strategies to improve my time management skills. i have no clue--if i knew, i would do them! do any of you more experienced nurses have some strategies i could use? i did a search through the threads, but i'm looking for more specific strategies. what makes it worse is that we're one of those hospitals with a 30 minute promise (which i dislike, because i think it encourages non-emergent patients to come to the er), so i always feel rushed, rushed, rushed. the good news is that my preceptor said no one expected me to be as fast as a more experienced nurse. she says it will come with time and experience. also, i don't know if this will affect the advice you have, but i work the night shift.

    i think one thing i could suggest is that my preceptor stop trying to assist me with my assignments. she should supervise, review my charts, but otherwise back off unless i am absolutely drowning. although she doesn't say it, i know she gets impatient because i am not as fast as the others so she jumps in, but if the patients are not critical and we don't have a waiting room full of people or ambulances backed up (we're a relatively small er, so we do have our down time), she should just let me do things at my own pace because it's the only way i'll learn to become faster--practice. what do you think?

    (and please, no offense, but no lectures about me needing med-surg experience first. i know a lot of nurses feel that way, but it just motivates me to work harder to prove them wrong. the reality is that i'm here and i'm not going anywhere. i know it's not the same thing, but i was a tech in the same er prior to becoming a nurse, so i am familiar with the pace. all i need is some help to get up to speed and i would really appreciate any advice that you have. thank you so much!!)
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    About cousx2

    Joined: Feb '07; Posts: 32; Likes: 10
    Specialty: ER


  3. by   classicdame
    You just have not had enough time to get in the groove. Continue to compare your methods to other nurses. Learn by asking. One of these days you will learn how to anticipate things and prevent infringements on your time from others. Your job now is to absorb. Give yourself a break.
  4. by   KckStrt
    I did do a med/surg job for about 6 months prior to entering the ED last month and I can't say it really helped me. I am happy I had the time there and learned what I did, but I am not a believer of that's the only way in to the ED or any specialty field, neither is the hospital I work at. There are benefits to everything... so who knows really.

    I think I am learning to transfer my time management skills:
    *Like staying focused on the task at hand and knowing that I need to finish up and move on.
    *Limiting my time in each room, med/surg we could spend a little longer with them.
    *Keeping the pt focused on the "chief complaint" when taking history.
    *I am trying to be a little less focused on being so organized, I used to give my meds by 9, assess and chart by 11, feed by 1230, and so on... not so in the ED. It's OK for me to know where I am going and where I have been, but I need to be aware that I may have to move onto something else very quickly.
    *Charting as soon as I give a med or finish any task, med/surg no one else was gonna give my meds or start that line.

    I hope this is some help, I am brand new in the ED too, and I guess I am writing this more to get it out in front of me so I can see it.

    Good luck....
  5. by   AmyBRN
    I have a little over a year experience in a PICU near me, and at times I to feel like I'm running around like a chicken with out its head. I'm organized, and I go with the flow, but alot of times I am 'slower', basically my time management skills are so-so. However, I have to say that with my experience so far, I have definetly had an improvement in my time management skills. Basically with time, your time management skills will improve. I know the ER is not the same as the ICU, ie, you will always have different patients, but at the end of the night, or before my next shift, in the car, I try and think about what happened throughout my shift, where I had any problems, if any, and what can I do differently next time. And as another nurse said, document write away, you never know when your patient is going to move to a unit, or get discharged to make way for the next one. Get the documenting done as soon as you can. One of my fellow nurses once said, as we were sitting at a desk writing our notes, after shift I might add, is "isn't it funny the one thing we can't delegate, documentation, is the one thing that we always put off." Don't put it off, unless there is a real emergency going on, which hopefully someone is there documenting.

    Oh and might I add I too have not had any med/surg experience before the PICU, and I don't regret it one bit.
  6. by   santhony44
    When you have the opportunity, try paying attention to how your preceptor and other experienced nurses get things done. Also, if there are other experienced staff members you trust, ask for specific things they may have noticed that you can do more efficiently. Sometimes more experienced staff notice things they may be hesitant to mention unless asked.

    You are right that it does take some experience to get better with your time management. Some of that comes as things become more automatic- you have your routine for how to do certain things in your head and don't have to stop and think as often. You'll be more sure of where things are, and you may learn to anticipate what will be needed with and for the patients.

    And give yourself some time!!
  7. by   Mommy TeleRN
    Well I can't tell you about ED having never worked there..but I was struggling with time management big time when I got off orientation. I did find having to "go it on my own" I greatly have improved. With my preceptor around I spent a lot of time running things past her, discussing options, discussing pt conditions, and trying to work more to her way of doing things (she is awesome, but her much more experienced brain processes things much differently than mine) I have to do things in steps and organized, she could go from thing to thing and keep it all straight in her mind.
    I feel I have greatly improved .. of course there is still a lot of room for improvement. As long as I have my standard load I'm fine. If they bump up my pt load then I might get behind.

    I think you'll find your way over time. Sometimes you do have to prioritize what can wait and what can't. Some shifts you just can't do every little detail you would like..sometimes you can't spend as much time talking to patients, etc. Some shifts you can. It's all constant reprioritization!
  8. by   mom2michael
    I like to save myself steps.

    If I know a person coming back to the room needs a gown, I stop by the room and I get a gown snapped, on the bed, along with an appropriate cover (blanket or sheet). If the person has an eye issue, I make sure the eye tray is in the room and on the way to the room, I make sure the patient has had visual acuities. If the person has a lac, I make sure our wound/lac tray along with all the appropriate supplies are in the room and ready for cleaning and/or suturing when the doctor is ready. If the patient needs an IV, I almost always stop by the blanket warmer (if they don't have a fever) and I grab a blanket to give them. If a patient is going to get meds at D/C, I pull everything and have everything done and written and ready to go when I walk in the door to D/C them.

    As far as non critical patients as I walk by their rooms I peek in. I tell them....we are starting to get some of your labs back, we are waiting on X lab and it *usually* takes an extra 30 mins or so (we have computerized charting along with a board that we can see at one glance what is still pending). Or X-ray will be here soon to get you. I try to come prepared when I stop by there too. If it's 20 degrees outside, I bring a warm blanket with me which helps ward off the nastiness.

    It comes with time, it really does. I worked in an ER now for 3 years (all during NS and 1+ year as an RN) so I knew the flow but the flow was so different when I became an RN. It does get easier though, I promise!!!
  9. by   trudlebug
    I am just finishing up my 12 week orientation. I can already see where I have made improvements in time management. I started making notes on copies of the triage sheet for each pt. and keeping them on a clip board at my computer to remind me of meds/labs/tests etc. that need to be done or followed up (ie. pain control and so on), and making sure I do a quick chart check frequently (q30min or less) to make sure no new orders have been written.

    My main preceptor was much less hands on, and would just watch/review from the sidelines and step in with suggestions or would review my work with helpful critique. It has been a wonderful learning experience. Also, there were a few days in the last 4 weeks or so that we were short staffed, so I handled a "light" assignment alone (the sniffles, sprains et. al) and that really helped, too.

    Remember, the first 6 months or so as a nurse (in any dept) there is a huge learning curve! I did work med/surg/tele prior to ED, and it took me about that much time to transition to really feeling like a nurse. (NOTE: I don't think that it should be a requirement to work med/surg first, it's just what I did.)
  10. by   biker momma
    Our ED just starting "rounding". As I understand the concept it was started on the floors in hospitals. The idea is that a RN or CNA "rounds" on the patient every hour. We assess and document the 4 P's (pain, position, potty, and progress). We attend to the patient's needs at this time and explain to them we will be back in an hour, if they need us sooner we tell them to use the call light. At first we thought this was pretty stupid - after all we already were in and out of their rooms frequently. But we've found that by communicating our care plan, addressing their needs and letting the patient know what the plan of care was it eliminated alot of call lights, patients knew what was happening and what to expect and we had higher patient satisfaction. We try and alternate RN/CNA so one of us charts this every hour. It doesn't mean that if a patient needs lots of care they don't get it but it keeps all our patients better informed.
  11. by   homesteadlite
    Dear cousx2:
    It's nearly a year later. I read your articulate posting about your thoughts on time management needing improvement several weeks into your ER preceptorship.
    I am researching time management strategies and would like to know, please, if you could tell me what tips you would have for a 'newbie' asking the same question now that you did in January - i.e. how do I do things faster, more thoroughly, more independently, more confidently - on my own?
    What mantra's do seasoned nurses use or what now-deeply-entrenched rules of thumb do they adhere to? I thought I would write you privately, but perhaps others would appreciate hearing from you too, in retrospect. Thanks very much!
    Last edit by homesteadlite on Dec 7, '08 : Reason: clarification on time
  12. by   canoehead
    Each time I do a check on the patient after the initial assessment I let them know what we are waiting for next, a med to work, a doc to round, or tests to come back. I ask if they are too hot/cold, or if they would like a drink (if they can). I comment on their vitals "look much better," and make sure they have the call light. Then they are usually happy and comfortable for another hour or so, or until something changes. Families just look more settled and calm when they know what to wach for next, and it's even better if you can say the labs will take xx minutes, and the doc has 2 more people to see before you, one of them may take 30-40 minutes.

    Then you have nights when you feel like a pinball in the machine. When I got experienced enough to do tasks and talk at the same time it was a huge plus, really cut time off my assessment work, and increased patient comfort. After 20 years though I still can't chat during the sticking part of the IV, I have to sit and concentrate, but a good preparation doubles my chances of getting the vein.

    As a new person you need to get used to how much time you need to do things, and then fit in what you can. If an ambulance is 5 min out I know I can probably place an easy IV, draw the blood, and push a pain med before they get in. As a new person you'd need more time, and less pressure to be successful. So your guy waiting for an IV might wait 30 min extra, and mine is a little better with labs back. That DOES NOT make you a bad nurse, it makes you new, and you keep that in mind to keep your confidence up.

    If you have a preceptor following you around use your delegation skills. Let them (tell them) give the po med, get a pt up for a pee, or whatever, and say "while you do that I'll draw up this antibiotic and prime the line" or "I'll try the first IV stick on this guy, and would you come in when you're done in case I need help?" So you are showing skills as far as multitasking, teamwork, initiative, and all that. I'd be extremely pleased with an orientee that could do that, because it's so easy to just get tunnel vision for the task in front of you, and forget about resources around you.
  13. by   Student0ntheRise

    Currently I'm a Nursing Student and I feel that you begin learning Time Management when you start Nursing School. Even though I'm only in my first semester I really need to learn how to balance school life and personal life. After awhile you learn techniques that really help you use your time effectively. Because you are still new at this that it just takes time for you to understand how everything flows. Using to-do list really helps and don't be shy to ask for help because it's a team effort and your goal is to treat those patients who come in for whatever illness they have. I know you priortize certain patients because of their urgency but using great customer service will really go a long way. Well, I wish you the best of luck with your Nursing Career. And Have Fun with it.
  14. by   LLLLiiiFFEsaveer
    Quote from KckStrt
    I did do a med/surg job for about 6 months prior to entering the ED last month and I can't say it really helped me. I am happy I had the time there and learned what I did, but I am not a believer of that's the only way in to the ED or any specialty field, neither is the hospital I work at. There are benefits to everything... so who knows really.


    Five on it