Floor Nurses... How do you organize your day, and survive?

[Ashimaly]

I have been working as an RN for 1 year a brand new very small hospital. This is a Rural hospital, and our Medical floor has 10 beds. We staff 2 RN's and once CNA. Management says we should be able to hand a 5 to 1 ratio no problem. I can tell you that when this happens, I do not get any breaks, and I often feel like I am not giving my patients the care they deserve... I know all of the RN's I work with feel the same way, and it has become a very popular topic to complain about at work. Our argument is that they want us to build this great reputation, and start taking sicker patients... well we want to feel safe doing that. My Manager (who does not work the floor EVER), says we need to become better organized, because other hospitals do a 5 to 1 ratio just fine. (Keep in mind, we are the only support staff we have. There is an ER, but they are having the same problem, no respitory therapy, nothing...) So for you nurses that do have a high ratio, how do you do it? We do 12 hours shifts. I start my day by doing all my physical assessments, I try to keep it basic overall, and then focus on the reason they are with us. Then I try to chart. (We are all paper charting still, and we have to chart multiple things in multiple places.) Then I start my morning med pass and am usually done with in two hours. Then its lunch, which usually consist of taking off Dr orders and discharging or admitting. Then there is another med pass and dinner. That's usually how it goes as long as NOTHING goes wrong. Any tips is very much appreciated. If I need to be able to take 5 patients, then that's fine, I want to learn how to do it well.

[Morainey, BSN, RN]

Here's what I do. Granted I work an 8 hour day, but still:

0700-0730: Get report.

* Take a few minutes to organize yourself. Who needs to be seen first? Who has the most pressing need? What can be delegated to the CNA?

* Write down your patient's labs and vital signs before you assess them. This should give you a hint of what to be aware of (low/high BP and pulses, high/low electrolytes, low H&H, etc., are all very useful things to consider during your general head to toe assessment).

0800-0930: Assess your patients and give them their morning meds while you are in the room with them. This means, do your head to toe assessment, and then medicate them as ordered. Bring the meds in with you to save a trip. Make note of what needs to get done for your patients, on my floor, home meds are a biggie. I write a note to myself, with a check box.

0930-10ish: Chart my assessments, write notes, call docs. Yes you will probably get interrupted.

Whenever you get done with charting: Round on your patients. If someone's getting discharged, I see them first and go over everything with them.

Followed by: lunchtime! (hopefully your docs don't come in at 11 and then write all new orders timed to start at 1200!) and then round on everyone again. You mentioned a second med pass - I suppose it depends on the facility when they bulk most of their meds together, ours are at 0900 and 2100. We usually have TID meds, Coumadin at 1600, etc.

There will be many interruptions - patients going for tests, patients who want to leave OMG RIGHT NOW at 0800, people who need frequent toileting or on isolation or try to climb out of bed or admissions - but you gotta go with the flow.

TLDR; Combine your med pass and assessment.

[hiddencatRN, BSN, RN]

I work 7p-7a. I get report and start assessments/8p meds at 7:30. Chart as I go if I can, otherwise assess with med pass then chart. Unless there are urgent or unexpected things to take care of my initial assessments and charting is usually done by 9. Then I organize my shift around rounding and tallying I/Os and additional meds (we can have them all spread out which is a mixed bag). I make a checklist on my brain sheet by time for any action I need to complete ( meds, treatments, vitals if we don't have a CNA, etc). 5:1 is our standard ratio but occasionally we'll have patients requiring a 3:1 ratio (my floor doubles as cardiac stepdown and oncology overflow and those patients get the better ratio).

I think tightening up your med pass and thinking about what actions you can combine will help with your workflow.