[abundantjoy07]

I'm starting out on a Medical Unit this week. I just wanted to see what everyone's routines are. How to manage tasks and time efficiently from start to end of shift.
I know that no one day is truly ever "routine" but what is your ideal shift like? How do you structure and prioritize your day?

[liljsmom02]

I take a few minutes at the beginning of my shift to prioritize. 10 minutes can save alot of time. First I check my charts against my ned sheets. At the same time I write down what time each pt has meds. Then I look at my "cheat sheet" and prioritize my pt's by diagnosis and next by med times. This way I can get the most out of time in with a pt. I will coordinate my meds with my assessments. I also try to time my dressing changes with med times towards the end of the shift. When I have even just a few minutes of down time, I chart. Sorry that was so winded. Basically, optimize your time by multitasking and staying organized.

[crossbow]

Time Management is the key. I work nights and usually we are understaffed in terms of support staff availability.

After getting report, I check all my patients (initial nursing rounds) and environment of each patient (IV access and lines, feeding tubes and foleys, diapered or not, a quick mental assessment by talking to patient and seeing how he/she responds to my verbal stimuli - usually introducing myself as the nurse for the night. Fall risk or not)

Then check the charts and reconcile what you got in report and what is in the chart. (I call it "truth or consequence" game. If the previous nurse that gave you report told you the entire story...you're well off. But if the previous nurse report is lacking....the consequence is that you will have to do the research.) Reconcile chart orders with MAR and Medication Profile of the patient in the computer. Check med cart if all patient's meds are available to you
in time for your Med pass.

Then take it from there.

A tidbit. When you have an isolation patient, before gowning up, make sure you have everything you need and you do all that needs to be done in order to avoid making another unnecessary re-entry into that room.

[abundantjoy07]

Thanks guys...great answers. Learning how others progress through the day is very helpful. Any more responses would be welcome!

[otan11]

hi abundantjoy07,
i will be starting next week in a med-surg area.i am pretty nervous.thank you for nice information...

[MedicalLPN]

I work night shift as well. I'll just give you my routine assuming that I have no admissions and no patients going critical. I start off getting at work at around 1830 get report at 1845 and head out on the floor. I pull up all my patients on the computer and look and see what time their getting their meds and how many their getting, etc. I then go to my first patient check their chart looking over the orders and skimming the H and P I go in and assess my patient, introduce myself, check their IV site, etc. I then document my assessment and move on to the next patient until I've checked all my patients charts and have assessed all my patients and documented the assessments. Depending on my patient load this takes anywhere from 1 to 1.5 hours. Usually by then is 2030 I get started with my 2000 and 2100 med pass, once those are done I again check to see if I have any 2200's or 2400's. When I'm giving out my 2200's if they're on telemetry I go ahead and get their VS (all tele pts are on q4hr VS where I work). Usually once my 2200's and 2400's are given out I go ahead and chart some more on each of my pts, answer call lights, medicate for pain, do any dressing changes that have to be done, hang IV fluids as ordered. I give out any 0200 and 0300 meds (usually IVPB antibiotics). By 0430 I begin getting the qshift VS, I/O's, nursing rounds charting, and 12 hour chart checks. Once those are done it's usually around 0500 or 0530 I start handing 0600 meds, call in any critical labs, this takes until about 0615-0630 I make one final round and prepare to give report to the dayshift nurse. Like I said this is my routine if I don't recieve any admissions, don't have any DNR's die, and don't have any pts go critical, and all of us who work Med/surg know that nights without complications are rare! lol Anyway hope this long and drawn out post is helpful!