Me again... What is your approach to prioritizing and organizing your day?

live4today, RN · Aug 13, 2003

Hello redwinggirlie

Depending on what kind of unit you work on, I would think the most important tasks to get out of the way first would be checking the patients charts for new orders, checking the labs to see if you have to report any abnormal values, and checking the patients med sheets to see what meds are due, and what supplies you will need to give them. After doing this, check the vital signs of each of your patients to ensure they are within normal limits. If not, call the abnormal values to the doc to see if there are additional meds or treatments required to stabilize the patients vital signs, etc.

Assess your patients after doing all of the above. Now this list sounds perfect in black and white and on "paper"...

The REALITY of nursing is call lights go off, patients crash or yell they are in pain and want their pain med NOW, docs call, the unit clerks are constantly ringing the dang phone nurses must carry around with them all shift, and shift managers are screaming about acuities being entered, the board being updated, and the nurse educator is reminding everyone about the competencies that must be addressed by a certain date.

Now, we move from what the unit staff is requiring of you to what the patient's family members are requiring of you. Then there is transport calling or in your face to take a patient on your list somewhere, or dietary, or physical therapy, or respiratory, or.......... Get my drift! :rolleyes:

In lieu of all the drama that occurs during a shift's work, it is EXTREMELY important for a nurse to block out all "noise" and FOCUS, FOCUS, FOCUS on providing the safest care possible to the patients assigned for that shift. The only way this can be done is to STAY in control of your assignment. It's up to YOU to remind those demanding your attention that there is only ONE you, and unfortunately....like at a doctor's office...only ONE patient at a time can receive your full attention, therefore the others will have to wait their turn. DON'T LOSE SIGHT OF THIS VERY IMPORTANT INFORMATION EITHER because your license depends on it! :kiss

kimmicoobug · Aug 13, 2003

I am a new nurse too and currently in OB, although I have been told I will be placed in the float pool...that is another story, though. In OB, here is what I do.

Since it is a small unit, we know when the doctors are coming and going. So, after getting report if the OB doc is in, I check orders (although I may not necessarily take them off right then and there--still trying to work on that with my time management). Then I go prepare 0800 meds, check in with each patient to see if they are still breathing, get fresh ice water for patients. Then I start with first patient and work my way down the line with vitals, assessments, and charting. If there is one patient that is more acute than the others, I start with them. It probably takes me until 0830 to get all of this done. But it seems things always go hairy after a seemingly smooth start to my day. And that is the part where I need to work on time management.

redwinggirlie · Aug 13, 2003

Thanks, you're both right about things getting demanding. I'll use your advice to maintain control and above all, keeping safe practice. Any more tips from anyone will be most welcome.

KailuaNurse · Aug 13, 2003

Congradulations on your RN!!!

The way that I priortize my day is after report, i turn my paper over that I have been making notes on and make a grid for each hour. Then I write down what needs to be done in what hour (e.g CS, change and turn etc.) After this I check the MAR and write down in each hour block where meds go. This way I can just glance at my paper when things get busy of what has to be done for that hour.

After that is done I check the VS from the previous day, night, and if I can quickly glance over their chart. I work in pediatrics, so unless a kiddo is really sick, I usually don't disturb them until they wake up. Then I start with VS, assessments going from my sickest kiddo down.

The biggest thing to remember is that you will learn as you go, just remember to remain open to learning opportunities, and you will make mistakes, you are human.

I am sure you will do a great job!!!

EDIT: Just a note that in my facility we usually get only 4 kids max, so the block may not work if you get more patients than that.

Editorial Team / Admin · Aug 13, 2003

I did it kinda the same way, KailuaNurse. I called my clipboard my brains, as I'd write in times things were due, had the paper organized for ea. pt (Room, dx, pertinent info on lefthand side, then columns for times down the page, and then meds, tx, surgery times, etc written in). I'm with you, make it so you can tell at a glance what is due when. Takes you a few min. to organize before report, so you gotta get there a little early.

Oh, and I practiced in the days before IV pumps, we had to gauge our own (count the drips, etc.) - I wrote when the IVs would need changing, too. I can still eyeball an IV (off a pump) and tell you in three drips what the rate of the IV is!!

I've had anywhere from 1 - 2 (ICU) to 4 - 5 (DOU) to 6 - 7 (Med-Surg or Ortho or Onc ) pts and used the same method.

Good luck, and again, KailuaNurse is right on, saying you will learn as you go.

Tweety, BSN, RN · Aug 13, 2003

I work 7p to 7a and my prioritizing might be different than somone on days. My priority is to get meds passed, patients assessed and settled down for the night. Labs should have already been addressed, chart reviews can come later, the secretary or charge nurse can let me know if new orders come through before I can review the charts.

The first thing I do when out of report is make a quick round of the patients. Very quickly moving through the rooms, introducing myself, seeing if they are breathing are they on the floor, etc. I eyeball the IVs, etc. If anyone has any pressing needs, like to toilet, etc. I take care that right then.

I then take a look at the med sheets. I try to connect with the aide to make sure he/she knows who is q4 vitals, what accu checks I have, who needs a weight, a bath, etc.

I then pass meds and do a head-to-assessment room by room. Drawing up the meds only one room at a time. I prioritize who I see based on my first rounds, if someone is in pain they get meds and assessments first, etc. Confused patients who aren't in need get assessed last, because they don't know the time of day.

Being flexible and willing to throw organization out the window is being able to move from task to task sometimes without rhyme or reason has helped me to survive.

But now I'm doing charge nurse and usually don't start out with patient assignment.

AndyLyn · Aug 13, 2003

I work 7a-7p on a adult medical/designated pediatric floor, and here's what I do.

As soon as report is over, I check my mar. We use a grid paper with a column down the left hand side for room numbers, and a column across the top for the hour, I use a slash for each med, write in IVPB, BS (blood sugar check), etc for each med, or tx needed. Then I go from room to room checking what I see against what I've been told (like IV's, o2, LOC, pain) and then get the 0800 meds and any pain meds needed and pass them. Then I start on assessments. Usually on our floor the first two and a half hours are chaotic, no matter how good your organizational skills are... but doing things the same was as much as I can every time helps me feel a little more in control.

Hope this helps a little bit!

purplemania, BSN, RN · Aug 13, 2003

I don't really have any new advice to offer, but want to say I think you are using your resources wisely and that is essential to new grads especially. Keep posting those questions!

Louie18 · Aug 13, 2003

Is making it into work.

Next is to get my assignment and see who is in need of the most care.

Then it is going through the rudiments in hopes all wll be done.

Then leave just knowing I forgot something.

Ehen getting home, sitting in my chair and asking myself "Did that really just happen?"

redwinggirlie · Aug 14, 2003

Everyone, it's been a GREAT help. And Louie, I'm glad to know there's thousands of others out there doing the same stuff I do when I get home! Too funny and too true.

Keep the tips coming! And thanks for being a great resource everyone...

teeituptom, BSN, RN · Aug 14, 2003

A big cup of coffee and a few donuts gets me off to a good start