Before prioritizing...

  1. I wish I had a dollar for every time someone said "prioritize, prioritize, prioritize." I mean, everyone prioritizes. But the worst thing is that the more prioritization you do, the less time you spend getting stuff done.

    The big trick, and I learned this after nursing school, is to PRE-prioritize, basically, simplify by throwing out everything you can before prioritizing, because prioritizing is a time-intensive process.

    Just throw stuff out. Even throwing 1 thing out helps tons.

    Let's say you have a dozen items to prioritize. It's going to take you a long time to prioritize them, and if you re-prioritize every time you get through with, or stuck on something, it's going to cost time. But if you have only 3 or 4 things to consider, then re-prioritization is almost instantaneous.

    Every item you add to your mental prioritization list increases the time of re-prioritization geometrically. Um, let me figure out how to put this.

    OK, you have 3 things. You can order them 123, 132, 213, 231, 312, 321. That's all, 6 priority orderings.

    Now if you have 4 things, you can order them 1234, 1243, 1324, 1342, 1423, 1432, 2134, 2143, 2341, 2314, 2413, 2431, 3124, 3142, 3241, 3214, 3412, 3421, 4123, 4132, 4213, 4132, 4312, 4321. That's 24 priority orderings, in other words, 24 different ways to look at it.

    So just by adding 1 item, you've created for yourself 4 times the work prioritizing them--IF you can even track well enough to consider all those combinations.

    Now you can reduce the number in many different ways.

    One, move fast enough that nothing sticks to you. Hello Mrs Richards, I'm Bubba, I'll be your RN today until X this afternoon and X will be your aide (writing names on whiteboard), are you feeling any pain right now? Feeling short of breath? Good to meet you, just stopped by to say hi, I'll be back after I say hi to all my other pts and I'll take care of whatever you need at that time (going out door).

    Second, combine items. As soon as you're out of that room, you're charting your second entry, "Pt denies pain/dyspnea." So charting is part of exiting a room, no need for exiting a room and charting to be 2 different items. Chart right there on the chart, not on an intermediate piece of paper.

    Third, throw out every piece of paper you get as soon as you're through with it. You get the vitals sheet, as soon as you transcribe your pts' vitals and weights and blood sugars to your flow sheet or kardex margins, you toss it. Keep your binder and workspaces free of extra papers.

    Fourth, you establish a single scratch paper. The kardex is best even if you have a written report system, because you don't have to file it or pass it on. It's yours. You toss it only at the end of shift. If you haven't been blessed with an instructor to teach you how to work a kardex the med-surg way, find one and ask.

    Fifth, as you work your kardexes before seeing anyone, you write down on 1 piece of paper (which you'll photocopy) what your aide(s) need to do for you, so-and-so total care, daily wt, Q2 BP/HR, foley, up to chair to eat, ambulate, whatever. Not long after that you will catch your aide doing vitals and hand it off while that pt is unloading their list of little chores on the aide (they're stuck there doing vitals whereas you previously just breezed through).

    There are lots more simplifications. Like, there's a time to hand things off to the next shift, and you don't want to hang around. They're not your pts any more, so lay off. Or get help early, because if things feel like they're getting crowded, they're going to get worse. Or know what things need to be done at what times, and don't even think about them until you get close to those times.

    But mainly, say if you have 3 or 4 things on your list, if the first two get hung up on waiting for this or that, you'll just automatically know what the 3rd is and do it without thinking, instead of wading through a long list. Everyone will think you're a champion multitasker, when really you're no better than anyone else. You just have way fewer balls in the air to juggle is all.

    Maybe you don't need this, but I typed it out just because I really needed it in school and even after and there was no one to tell me.
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  2. 3 Comments

  3. by   Daytonite
    was this a joke post? if not, after writing such a long dissertation about how to prioritize, i can understand why you have trouble with prioritizing and you feel that "the more prioritization you do, the less time you spend getting stuff done". your l-o-n-g explanation alone attests to it.
  4. by   psalm
    Hmmmm...I use a sheet for my "brain. I take report in black ink, and my assessment on my brain in red ink. I highlight MUST Do stuff in yellow highlighter. I usually assess all my pts. and then go back and chart at 24 hour sheet, that way I see everyone, have info right in my pocket (my brain sheet), and can chart as I go back and do IV checks, IV meds, etc. It helps me to have room #, Pt. name, age, day of stay, & doc, diagnosis, IVF highlighted; PICCs and PORTs written in red; procedures circled, etc. I can look at a glance and zero in on pt. needs quicker that way.

    Everyone has a system. I am glad yours works for you but it is too complicated for me! I don't use the clipboard after I kept leaving it in pt. rooms or it would fall of the side table and slide under pt. bed. My brain goes in my left scrub pocket and my alcohol swabs, pens, gauzes, in right scrub pocket. Scrub pants pockets are for scissors, penlight, PCA key and misc. I never look as cool as the gals in the scrub catalogs...too many bulges in pockets, lol.
  5. by   anonymurse
    Quote from daytonite
    was this a joke post? if not, after writing such a long dissertation about how to prioritize, i can understand why you have trouble with prioritizing and you feel that "the more prioritization you do, the less time you spend getting stuff done". your l-o-n-g explanation alone attests to it.
    well, i figure from your reply, you never had problems. but many folks do, and that's where this kind of stuff comes in. it's understandable that f you never had problems, it's hard for you to understand how anyone could have problems. and of course, this is the prevailing view, which is why it doesn't get any attention--the most it usually gets is "maybe nursing isn't for you."

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