Experienced Nurses: How is your day organized?Register Today!
- by *4!#6 Sep 5, '12I am looking for an outline of how you organize your day, with times specifically, and particularly if you work in a hospital -- med/surg setting. I am new grad nurse and I want to get an idea of how you organize your day effectively.
For example, here is my current routine:
7am: Nurses pick patients and assignments
7:15am: Look up patient's information in charts and recieve report. Decide who to see first based on acuity or needs such as insulin/other high priority medications
7:45am: Pull patient A's meds, take patient A's vitals, assess Patient A
8:05am: Pull patient B's meds, take patient B's vitals, assess Patient B
and so on and so on.
However, I end up getting interrupted by phone calls, new orders, changes in patient's conditions, and other things. I remember in nursing school that we learned we should at least lay eyes on all of our patients during the first hour of our shift. I also learned it is good practice to assess a patient before giving medications. I will peak in on people I haven't gotten to see. But it makes me nervous when I get behind, and I don't know how I can pass 8am medications on four patients all within a 30 minute timeframe
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- Sep 5, '12 by batmikWe do information gathering the first 15 minutes of our shift, then report at the nurses station then a mini handoff or more like an introduction between the off going and on coming nurse for each patient. This way I know each patient is not in distress, call light within reach, bed alarm set if appropriate, drips right rate etc. I'd be uncomfortable never laying eyes on one of my patients until 50 minutes after hand off.
The best laid plans will always get goofed up but you have to start with some plan. Looks like you have a good start. I think you are right to have vitals and at least a focused assessment on each patient before passing meds. Not sure when breakfast is served but you could do your blood glucoses, vitals and focused assessment all at once then later and go back and assess what you weren't able to do on the first go round.
I say focused assessment meaning if the patient is a abdominal surgery patient. Assess mentation, abdomen, check IV site, listen to lungs. Later go back check skin, extremities etc.
- Sep 5, '12 by *4!#6You know, at another facility, I used to dislike bedside report, but now I really miss it for the reasons you mention. I like to know my patient is breathing and feel assured they are safe at the very beginning of the shift.
- Sep 5, '12 by Aurora77I work nights, so my rundown will be different. We start at 630 on both shifts. Assignments given and report through 1900 or 1915 if days has had a rough shift. Our BID med passes area at 0900 and 2100, so those are the biggies, with others interspersed through the day/night. Before I do anything (unless there's an emergency) I make a list of med times with room numbers, so I know what has to happen at what time. Ideally i track down each patient's drawer and set up my meds, but that doesn't always happen right then. Then, I start my assessments.
How I approach my assessments--I start with the new patients or fresh post ops first. Our charge nurses are great about trying to give us the same patients each night, so I'll peak at the ones I know as I pass their door and visually see if things look the same, then fully assess them later.
The only way you'll survive the craziness that is med-surg is to develop a good rapport with the CNAs and other nurses. Be a great team player, so your coworkers know they can trust you. At the start of the shift, our CNAs are required to go to each room, update the white boards, and check on the patients. While your setting up your meds, they're checking to make sure your patients are at least alive and breathing.
Also, you'll probably never get all of your big med passes done on time. The patients always need something when you're in the room, so it's just not practical. My boss wasn't too worried about the occasional excuse in our charting--usually it's a note entered "delayed with other pts.". Thankfully, our parameters have been expanded out to be an hour before and after the time. Half an hour was dictated by someone who didn't actually care for patients, I'm sure.
The biggest piece of advice I can give is to do everything you can as soon as you can. You can start passing med 30 minutes before the hour? Start at 0830 for the 0900 pass. Do all of your charting as soon as possible. You also need to develop a routine. Put your tools in the same pocket every time. Going to change a lot of dressings? Pull all of the supplies at once, organized by patient. Organize your brain sheet so if you need to see a piece of info--labs, assessment notes, pain med admin times, you can glance at the same spot on the sheet rather than hunting for that info. It sounds over organized, and a couple of my fellow nurses tease me (good naturedly), but I am the nurse who usually gets my stuff done and has time to help out my fellow nurses and CNAs. Since I have time to help them, I have that rapport I talked about earlier. That rapport is essential--if your coworkers know you'll help them, they will help you when you need it.
- Sep 5, '12 by sbostonRNI start at 6:45... I wouldn't say I'm experienced but I've been at my job for a few months and been a nurse for over a year so I feel like I have a good routine down. I generally have 6 patients and on a good day I have 5.
6:45 to 7:15... Get my things organized (Get assignment, check chart for new orders since previous day, ensure daily labs were drawn, listen to report from night shift)
7:15 to 7:30... See each of my patients. By this, I mean I go into each room, write my name and CNA's name on their white board, introduce myself and ask them if they had a good night. That way I know who needs pain meds right away, and I can make sure everyone is breathing. During this time the CNA is checking vitals and blood glucose.
7:30 to 9:30... Pass meds and do assessments on each patient according to priority. Some patients have early therapy, some patients may need their BP meds earlier due to a high BP, and some patients may need insulin or pain meds. When I go in to see the patient with their daily meds, I do my head to toe assessment.
9:30 to 11:30... wound treatments, documentation, 15 min break at some point
11:30 to 12:30... CNA rechecks blood sugars, I give insulin when meal trays are delivered. Help certain patients eat or help CNAs with blood sugars if they are too busy.
12:30 to 12:45... lunch break, usually
12:45 to 2:00... pass afternoon meds, finish up any treatments or wound care that was not done earlier
2:00 to 2:30... clear my charts and ensure that all the orders have been transcribed. Also check my med sheets to make sure I didn't miss anything
2:30 to 2:45... tape report for evening shift
2:45 to 3:15... finish up documentation. Rarely I'm out by 3:15 but if I get my documentation started early on in the shift I usually dont' stay more than an hour past the end of my shift.
- Sep 5, '12 by SaoirseRNAfter taking report I always do a quick round, lay eyes on each patient and introduce myself, and unless they have something they urgently need, I tell them I will be back later. That way I can see that nobody is distressed or having a serious problem.
Then I start my regular morning round - vitals, meds, assessment for each patient in turn.
Basically I've found that you are always going to have interruptions, but if you develop a system and stick with it, it's easier to get back on course after being pulled away.
- Sep 6, '12 by RNperdiemAll of the above plus: stock your pockets if your floor does not keep supplies in the room.
A skill to develop will be to get back on track after your interruptions have been interrupted.
Now what was I doing?
I also work days, and find if I just push through and keep charting as I go, that things start to get caught up and the pace slows down around 3pm (at least it does on a good day).
- Sep 6, '12 by *4!#6Thanks for all the tips. I like the idea of doing a quick round to introduce myself before grabbing meds and getting assessments done. On day shift CNA's do the first rounds and update boards and get vitals and BG. But evenings and night's RN's are responsible.
- Sep 6, '12 by not.done.yet6:45-7:15ish - recieve assignments, get report, do bedside handoff (introduce self, check that pumps are cleared and foley emptied), check orders, blood glucose testing with trays
7:15-9:15 - review MAR, pull meds, assessments, vital signs entry, medication administration, check orders, blood glucose testing with trays, participate in huddle, admissions/discharges as applicable
9:15-10:00 - charting, check orders, confer with MDs and case worker as applicable, sending and recieving patients from procedures, surgery, dialysis, etc, admissions/discharges as applicable
10:00 - 12:00 - patient rounds. Prep for surgery or diagnostic testing. Greet and discuss things with family members as applicable. Recieve admissions, do discharge tasks as applicable. Check orders. Get feedback from speech and physical/occupational therapy as applicable. Assist patients as applicable, hang meds, pain meds, etc etc etc, blood glucose testing with trays, perform reassessments, chart vitals
12:00-12:30ish - lunch
12:30-4:00 - wound care, dressing changes. Assist with grooming. Feeding patients as applicable. Admissions/discharges as applicable. Patient/family teaching as applicable. Sending and recieving patients to and from procedures, surgery, dialysis, etc. Meds as scheduled. Charting. Perform reassessment. Document 4:00 vitals. Change IVs, tubing, whatever. Check orders.
4:00 - 6:30 - medication pass, glucometer testing with trays, patient teaching, admissions/discharges as applicable, confer with MDs as applicable, check for orders, prep for end of shift. Chart Kardex and care plan.
6:30-6:45 - round with CNA on patients for pain, potty and personal belongings to help with smooth shift change. Prep charts for shift change. Empty pockets.
6:45-7:30ish - report, bedside handoff, say goodbye to patients, double check pockets, go home.
Pain assessment and reassessment is continuous. All times given are very very very rough estimates. It is all fluid.