Time management issues

[sameasalways]

I have been working for a about 14 months on the busiest floor in the hospital (does everyone say that? haha) where I started as a new graduate. When we first started (I had another new nurse start at the same time), we were not leaving until around 9 pm often (for a 7-7 shift). Leaving at 8 pm was "early". Well, like I said it has been a little over a year, and for the past few months now I am almost always leaving at 7:45 to 8 pm..or so I thought. The other night I had 7 patients from 3-7 and I had to stay until 9 because at around 5:30 they gave me a transfer from the ICU. (This ended up being 7 patients). We use Medi-tech for our computer documentation. Anyway, I sent my manager an email because she said that whenever we leave late like that we need to send her an email or a note under her door explaining why. So I did, and also because the charge nurse gave me the 7th patient when there was another nurse that only had 5 patients.

My manager wrote me back saying she pulled all my time sheets since July and that I am supposed to be leaving between 7:30-7:45 and that I am only doing that 70-75% of the time, so I need to make a list of what is making me late and meet with her so she can make sure I am making use of my resources. Honestly this is really freaking me out. I have been wanting to leave the floor and the hospital for a long time because I feel like I barely get a lunch and sometimes don't have time to use the restroom even once during the day. I am moving in about 4 months and I knew this six months ago so I felt it woudln't be prudent to look for a different job and then have to leave that job in six months time to start at another one. Plus I really at the time wanted to see if I could handle this job and stick it out and learn even more. I know I have talked to the girl that started at the same time as me and she usually leaves around 7:40. Like I said, I thought the past few months I have been leaving around 7:45 to 8 on average.

There are the times you have a really bad day and get caught up of course. But the nursing assistants have been treating me so much better the past few months and I thought I was finally starting to get better at the time management. Now I am seriously doubting myself and I don't know EXACTLY what is causing me to be held up but often times I am still in the hall documenting on the computer waiting to give report while I document or I have one patients meds to give or I have a few patients I/O's to collect so I can document them Or I have some charts to check off before I can go. When this is all going on, often I don't give report until 720 pm and there have been a few times that I am there giving report at 730 pm. I can give report whenever the night nurse wants but I don't want to leave my computer in the middle of documentation to go to the nurses station to give report when they can see I am right there. I think sometimes they think I am busy so they just go get report on their other patients first or are getting their information together since I am not "bugging them" to get report. In the meantime, my pager often times goes off or PARTICULARLY when a specific charge nurse that works from 3-7 is on, I will get paged by the secretary to go to a patients room when it is after 7 pm. Maybe I am partly answering my own question...Maybe I need to make it a priority to give report ASAP..even if I am not finished documenting, so that this doesn't happen. The bad thing is, when that specific charge nurse and secretary are working (they are tight) then even if I have given report, I will still get asked to go to a room for an IV beeping or whatever "because it's right there". This is the same charge nurse who gave me 7 patients that night and the same charge nurse who comes in at 3 and goes to lunch between 530 and 6 or who is too busy checking off a chart when something is going on that I don't knwo what to do about.

I sound like such a complainer...but I am trying (along with a few other people) to figure out exactly what the charge nurse does. It is hard for some of us to understand not only because we aren't charge nurses, but because some charge nurses are REALLY helpful and a few seem to just sit there..there is a difference when you work with some of them...and it can make your life easier or harder. But I guess that is a seperate issue from the time management stuff. Maybe I should have titled my post "hard time adjusting after first year of nursing". The worst part is, now I am seriously wondering if I even belong in the hospital...I have never felt so incompetant in my whole life and I always thought I was a hard worker and try so hard to put the patients first and their safety first...I didn't want to be the nurse who never makes eye contact and tries to rush out of their room ASAP but maybe that is what it takes?

I have talked to night nurses and they say they don't know how we do it on day shift there..even other floors say they woudln't work this floor (but I am honest when i say I believe the manager is one of the very best in the hospital). I feel bad and incompetant and I never thought I would feel this way a year after starting.

[kmmRN,BSN]

I wouldn't look for a new job at this point, however, I would definitely sit down with your manager and discuss some major issues that seem to be occuring on the floor. Ask your manager what exactly the charge nurse is expected to do on your floor. I work night shift on a busy med surg floor, and without the charge nurse, I would be drowning most nights as well. On our floor, the charge nurse does not take patients, and her role is to complete all of the admissions and take care of the post-ops when they first get to the floor. She is also expected to help out the nurses as much as possible. Not having to do the admissions is a huge life saver for me, as they can take a huge chunk of time out of your shift. If I am really busy, I will ask the charge to do a med pass for me, hang more IV fluids, start a new IV, etc. However, when you do utilize the charge, remember that she is there to help everyone, not just you, so do as much as you can, but when you need help, be certain to ask!

I think you also need to discuss with your manager the obvious safety/infection issues going on. A nurses using the same flush on all her patient?! Not assessing patient properly? You need to tell your manager about these things! I know that you probably don't want to get any of your coworkers in trouble, however, as a nurse, you are the patient advocate, and if you know that there are things going on that could be harmful to the patient, you can't just ignore the fact, it has to be brought to the attention of the manager, so this can be resolved.

To help with your time management, there are a few things

-Most definitely give report as soon as possible, and then finish up your loose ends. And get rid of that phone/pager ASAP! haha, if you don't have it then you can't be interrupted when you are trying to finish charting. If i still have some charting to do at the end of my shift, I give report to the nurse coming on shift (don't be afraid to bug them about starting report, they need to be there and ready to work at a certain time, and once that time hits, report should begin. some of our nurses like to look everything up before you give report, drives me crazy), and then as soon as I give report I get rid of my phone, and go into a quiet area and finish my charting. I don't know if you guys use computer charting and charting by exception, but that is what we do. With charting by exception, you can mark WDL(within defined, or normal, limits) for each system, and only do detailed charting on those that are not. Some of the nurses I work with do a detailed documentation on every body system! I don't know how they can get everything done this way, but I guess they manage. This might seem like it is cutting corners in documenting, but its not, its simply charting by exception. Then, when we reassess, we simply mark no change, if everything is the same, or document on those systems that have improved or worsened.

-Marking times down for when meds and tasks are due is also important, that way you can see the big picture from the start of your shift, and can try to clump things together as much as possible when you are in the room.

-We also do bedside report at our facility, which is actually super helpful, bc you can meet all your patients right away, and do a quick assessment when you are in the room

-I also try to go over the plan for the shift with each patient at the beginning after I have all my times marked down, that way they know what to expect for the next 12 hours. I can answer questions at that time, and do some quick education if needed. This cuts down a lot on questions throughout the shift from my patient.

-Make sure to utilize your tech. Our techs do vitals, I&Os, remove foleys/IVs, and do other basic patient care. If these are the same tasks for your techs, then ask them to do these things, that is what they are there for

-I would definitely try to chart as you go as much as possible, and be sure to write down everything that you are planning on charting later so you dont forget anything, or have to try to remember things later

Sounds like you are doing as best you can for the situation you are in, 7 patients on day shift, wow! I work nights, and we max out at 6 per nurse! Good luck with everything!

[Ruby Vee, BSN]

my husband and i used to work in the same icu and ride to work together. i'd always get done 15 minutes early; he was always late. sometimes really late. the difference was, he spent a good part of his day chatting. i didn't. are you spending a lot of your day chatting with patients, families, pt, other nurses? if so, learn to chat briefly and move on.

make an effort to give report on time. once you've given report, you've handed off the patients and shouldn't be asked to go take care of a beeping iv or anything else, except maybe a full arrest. then find someplace to "hide" to finish your charting. if they can't see you sitting at the station, they can't ask you to go take care of something.

it also helps to chart as you go rather than save it all for the end of the shift.

[whtepketfences]

When I read your initial post is brougt back memories from more than 20 years ago when I first started. I could feel your stress, but it also brought up fond memories in a masochistic kind of way. You sound like you are on your way to becoming an excellent nurse. Don't lose your spirit just because your a little overwhelmed. Watch and ask for tips in some of the nurses you admire, but don't ever put your patient in danger just to save a little time. And don't ever, ever use the same anything for more than one patietn - YUCK. Please don't give up on hospital nursing just yet - not all hospitals are as disfunctional as yours sounds. Ask for help when you need it and once you have a few years in your nursing shoes you'll be more comfortable, then don't forget to offer help to that frazzled new nurse and encourage her to carry on as well. (and definately hand over the pager as soon as you can get it to the next shift - the have their whole shift left to catch up)

[BluegrassRN]

Also, I would hand my pager over to the night shift, or back to that secretary at 1915. The night shift is there, and has taken over care of the patients at that point. Don't forget that you are the RN, and don't be afraid to put someone who is supposed to be your subordinate in her place.

No ******* way. You don't give me report, you don't give me the pager or the patient.

Giving report is a PRIORITY. You won't be getting interrupted with calls and needs from patients if you have already given them over to someone else. This will free up that last little bit of your shift to pick up all your loose ends and still get out on time.

I must say, this is a pet peeve of mine. I theoretically can't start MY day if I'm waiting for YOU to give me my patients. I start behind then, as well. Give report in a punctual, timely manner. It's disrespectful of your oncoming coworkers AND if causes more unnecessary stress for you because you are still caring for these patients past your shift.

Your job isn't on the line. Your nurse manager pulled all reports from July. If there truly is a trend of you leaving before 7:45 most of the time in the last couple of months, point that out. Tell her 1-2 items that you feel the charge nurse/fellow nurses/support staff could do to help you out a little; but also take responsibility for yourself. Tell her you feel you are continuing to improve, give her some ideas of how you've improved your time management over the last several months, listen to any suggestions or thoughts she has, and implement what you can.

And DO NOT come in with a list like you gave us (Nurses clicking off assessments without doing them, etc) unless you have cold hard proof. I click off assessments all the time, and no, I'm not in the room doing them as I have clicked it off; I did it an hour ago, but I didn't have to opportunity to chart. If you're busy doing your own thing, how can you possibly know that the other nurses are somehow skipping their assessments and work and falsifying their charting? That is a terribly serious charge, and unless you are following these nurses around observing them for their entire shift, I don't know how you can possibly know all this.

[r.oxymoron]

Do you organize yourself before heading out onto the floor? Do you use a time grid? Do you chart as you go or save it all for the end? All of these things helped me tremendously in getting out on time. I also use Meditech and work AM's. How I work it is: Get report, figure out which patient(s) to see first. Go and pull up the eMar and get the meds to be given over the next 8 hours, mark those down on my time grid. On the same grid, mark when to do specific tasks for patients (dressing changes, IVs, etc.). Round and get all my initial assessments--this also allows me to adjust anything on my grid (for example, if someone is having an issue that I need to address.) After that 1st round, when I've gone a done my head to toe assessment and given out any meds--I chart. Then, I just keep charting as I go, marking down on my grid any PRN meds given for that patient/or abnormal assessments. It makes giving report so much easier to have everything in one spot.

Good luck!

I'd like to see you're chart. The facility I'm presently at isn't yet computerized, so it can be a real challenge. If you'd be willing to email me something like the one you use, I'd greatly appreciate it. It's difficult not to feel 'dumped on' at times; I have some truly amazing charge nurses that can do anything, it seems, but they're on a different floor and I haven't the opportunity to watch and observe they're style. Whew, it can be a jungle out there!!

[OttawaRPN]

then find someplace to "hide" to finish your charting. if they can't see you sitting at the station, they can't ask you to go take care of something.

ahhh yes, the proverbial "hiding" to chart, i do this all the time and think it's sad that nurses have to resort to such unsophisticated conduct in order to complete an increasingly important function of their duties, but unfortunately it is a necessary evil. regrettably, the good hiding spots are getting harder to find and figure one of these days i may just have to hole myself up in the staff washroom.

:uhoh21:

[SlightlyMental_RN]

I'd like to see you're chart. The facility I'm presently at isn't yet computerized, so it can be a real challenge. If you'd be willing to email me something like the one you use, I'd greatly appreciate it. It's difficult not to feel 'dumped on' at times; I have some truly amazing charge nurses that can do anything, it seems, but they're on a different floor and I haven't the opportunity to watch and observe they're style. Whew, it can be a jungle out there!!

Do you mean my time grid? It really wouldn't help anyone out if they didn't work in my field/facility--it's just very specific to the work that I do. I can describe it though: I have a column for each patient running vertically. Along the right vertical part of the grid I have the hours listed. For each cell of the column, I have prompts like meds due, IV, PRNs given, VS/assessment due. I highlight those accordingly before my shift.

Hope that helps!

[steelydanfan]

No ******* way. You don't give me report, you don't give me the pager or the patient.

Giving report is a PRIORITY. You won't be getting interrupted with calls and needs from patients if you have already given them over to someone else. This will free up that last little bit of your shift to pick up all your loose ends and still get out on time.

Sometimes you can give report and still have things to do that you CANNOT pass on, like a late or forgotten med. It happens to us all, "how did I miis that 0600 Decadron?" Sometimes a shift just gets nuts and you CAN't get out on time. I am a VERY competent nurse, and because of this, I am often given the toughest assignments. When everybody else gets thier breaks, and gets out on time, I am left behind. I can't justify it, because it's not acuity, it's no.s where I work. But I'm not lazy, or suffering from poor time managent skills, I simply get overloaded. It HAPPENS!

Bluegrass makes a good point here, the oncoming shift just wants report and to get on with their day. HOWEVER, stuff that is unavoidable does happen at 6:55, and you cannot ignore it.

I must say, this is a pet peeve of mine. I theoretically can't start MY day if I'm waiting for YOU to give me my patients. I start behind then, as well. Give report in a punctual, timely manner. It's disrespectful of your oncoming coworkers AND if causes more unnecessary stress for you because you are still caring for these patients past your shift.

I repeat, sometimes those calls for pain meds come in at 06:55, what do you do?

Your job isn't on the line. Your nurse manager pulled all reports from July. If there truly is a trend of you leaving before 7:45 most of the time in the last couple of months, point that out. Tell her 1-2 items that you feel the charge nurse/fellow nurses/support staff could do to help you out a little; but also take responsibility for yourself. Tell her you feel you are continuing to improve, give her some ideas of how you've improved your time management over the last several months, listen to any suggestions or thoughts she has, and implement what you can.

And DO NOT come in with a list like you gave us (Nurses clicking off assessments without doing them, etc) unless you have cold hard proof. I click off assessments all the time, and no, I'm not in the room doing them as I have clicked it off; I did it an hour ago, but I didn't have to opportunity to chart. If you're busy doing your own thing, how can you possibly know that the other nurses are somehow skipping their assessments and work and falsifying their charting? That is a terribly serious charge, and unless you are following these nurses around observing them for their entire shift, I don't know how you can possibly know all this.

Not a good idea in my book, either.

[steelydanfan]

Bluegrass, somehow my responses to your post came out entertwined with yours. Sorry for that, please correct or disclaim as you wish.