How is it possible to be in 5 places at the same time? - page 2
We get out of report at 0730. Diabetics patients need finger sticks and coverage. People on Prevacid and Prilosec et al get those. Four patients. VS and initial assessments are supposed to be... Read More
Oct 11, '07Every shift has different stresses. At my hospital evening shift tends to be the admit/discharge shift - I have seen nurses start with 5 patients, discharge 3 and admit 3 by the end - talk about hectic. Even with a float to help out, it doesn't make it very easy.
I like 12 hr, any shift day or night because even though it is hectic at the start, by midday or midnight you are usually caught up and can plan the rest of the shift.
As for getting everything done by 0800, at some hospitals I worked at the night shift RN took BS at 0630 which was covered by dayshift during meal pass. I don't know what MAR you use, but ours is electronic so it is easy to look up what meds need to be given quickly and pull those for my first run through, then while giving the meds I can quickly assess my patients (charting might have to wait a bit though).
Also as a (primarily) night shift RN, I used to give the 0730 meds before I left to help out (sometime I would lump those 0800 ones in with them).
Hope this helps,
Oct 11, '07The way I look at it...somethings gotta give. You can manage your time all you want, but sometimes it is impossible to be in 5 different places at once.
Delegate what you can. I'm in a different world (LTC) but some days it it nearly impossible. I have 12 accuchecks with coverage etc. before dinner, new admits that need orders, meds for a total of 26 pts, labs to get orders on from the docs. Yeah...I have 2 hrs to do this, but throw a staffing issue or family complaint it the mix and you have fun. What I do to prioritize....check the new admits, look over orders, call the doc for them (if they have labs out...it is a bonus that I can get them and the admit taken care of) accu checks etc on the diabetics and give the meds I need to before dinner...the rest get meds when the stuff of the top is done. Pain meds and IV pushes are done immediately.
Look at the list of tasks, prioritze and delegate what you can.
Oct 11, '07I work 12h nocs. My time management is as follows: spend 4 hours getting behind, then 8 hours catching up. Hey, I'm not saying it's ideal, but it works for me...sometimes.
I can see a lot of advantages to dayshift r/t life outside the hospital, but I'm a big fan of nights. Most of our crew are permanent nights, and they're just a lot more laid back. I just love a lot of the nurses I only see in report, but some seem in dire need of a chill pill. Not bad people--just wound awfully tight.
As I noted somewhere else, I rarely have time to think about time management. What I do have is legs and feet and a back who tell me when I'm doing something wrong. Nothing like running from room to room, looking for Kardexes, to teach you--eventually--to keep track of your Kardexes.
I do come in a little early, off the clock, to look at my Kardexes and make a little bit of a plan for the shift, and it helps, even though things rarely go as planned. I've also concluded that a big part of time management is figuring out what can slide and what can be fudged, and what has to be done right now. A co-worker recently told me that I talk like I'm the laziest nurse in the world, but every time she sees me, I'm busy. She's right on both counts-- I am the laziest nurse in the world, and it does keep me busy.
Oct 11, '07nursemike, i just adore you.
i've never allowed a male nurse/md in my life.
and by golly, i think you may be a first.
i can see why you'd make your pts feel safe.
Oct 11, '07Triage is not just a word that ER/EMS folks can use. You can triage your patients, their treatments, their requests, their families' requests, on and on.
Basically, it means evaluating what is most important-get report, get OUT of report (don't sit and talk), get those vitals and fingersticks done at the same time you are in the room with the diabetics, and then give the GI meds. If the pt doesn't get the GI med until after he begins eating, so be it. Nothing bad will happen. BUT, the MDs need the vitals, and you need the blood sugars so you can give the diabetics their insulin. Some days will be better than others, and some days are purely insane. You've been given several good suggestions here. Take a deep breath, and go for it!
Oct 11, '07Quote from oldiebutgoodieThey realize but do nothing to solve the problem.Just like "body mechanics". However, finally hospitals are starting to realize that no matter how your body mechanics are, you will still get hurt transferring a 300 lb patient to the chair without help.
True story. I get a call that my admission will be coming up after shift change - the patient weighes 550 lbs and is unresponsive. The nursing supervisor tells us that it took at least 6-8 people to move the patient safely.
So why the H#$% does she pull our tech, leaving us w/just two nurses on the floor? Not to mention, why do the transporters haul butt off the floor as soon as they wheel the patient into the room?
Oct 11, '07Today was a good day.
I made my OWN sheet, not the generic report sheet the others use. Every patient gets a whole page - like the Kardex - and I put an hourly schedule for them on it, with spaces for what I needed to collect and assess. It worked well.
I think a big part of my issue is that I'm being precepted - followed everywhere, not allowed to do almost anything without her there - and her ways are NOT my ways. What is efficient for her screws up my entire train of thought. Hence, by own brain sheets. And she's a super preceptor - patient and thorough. I just really want a little room to breathe, Ah, well, a few more weeks and I get off this day shift. Man, I hate this early rising stuff.
Thanks, all, for your insights and help.
Oct 11, '07So glad to hear you had a good day. I hope and expect you'll have many more. It's hard work, sure, but that's okay, 'cause we're tough.
Leslie, I adore you, too--but haven't we gotten in trouble over this, before?
Oct 11, '07Quote from nursemikehave we gotten in trouble before?
Leslie, I adore you, too--but haven't we gotten in trouble over this, before?
thanks for the memory (???)
Oct 11, '07Quote from SuesquatchI could no longer handle it and at age 52 I had to say "I give up". I did want to make a suggestion. When I did work the floor the diabetic pt's finger sticks were done by the night shift. We did the insulin. VS were done by the techs. Lab results printed off at 7:00 and put in our boxes. Prevacid, Prilosec etc were scheduled for 6 am. As far as doing 6 complete assessments by 8:00 am...forget it...it's not happening!We get out of report at 0730. Diabetics patients need finger sticks and coverage. People on Prevacid and Prilosec et al get those. Four patients. VS and initial assessments are supposed to be done by 0800, when the docs show up. Labs are to be checked before 0800 meds.
If I hear another person utter the tired phrase "time management" i'm going to scream.
How is this done?
Oct 11, '07I'm on nights and I don't often volunteer extra work for my shift. However, my tele job had some things going that the OP's night shift could take note of.
1- nights did the AM blood sugar checks. Not the coverage, just the check, so you know how much insulin you're going to need with breakfast.
2- nights did the 7 am meds such as prevacid and prilosec. There were a few others routinely done at 0700, like synthroid. At 0600 I'd grab the glucometer and the prevacids and my MAR's and run to each of mine's rooms, doing fingersticks and handing out their AM meds. If I was feeling really froggy there's a chance I could have my closing note done on 'em (paper charting) before I left the room.
3- report ideally should include the am lab results. If they are not available, so be it, but labs are drawn in the 5-6 am range in order to have the darn things ready for dayshift, not just to wake people up.
No I don't suggest that you walk in and demand those things all at once. But the bug could be put in the right people's ear, for sure.