Priorities and time management

meownsmile, BSN, RN · Jun 3, 2005

It's a little hard to coach someone about time management and prioritizing for your specific unit. Each unit is different in what kinds of patients they have, how their unit routines are set up.

All i can say is remembering s/s as they relate to each individuals case is going to be your key. Try to make sure you do your daily assessments early in the shift while you still have report fresh in your head. Maybe even notate on your paper who you want to see first from shift report. Try to get that patient first, then do the roomate while you are in there. Get some assessments done while the rest of the team is passing trays, finishing up vitals, getting someone to the commode. Try not to wait till the last hour of your shift to do your notes. Get them done by 2 hrs prior to your end of shift and you can always document any changes on individual patients.

Im not sure what to tell you, evey place is different. You will soon find your comfortable routine. Observe how some of the others organize and how they prioitize and adjust your own style to their lead.

jjtwins · Jun 3, 2005

Hi.
In a nut shell, I am a new grad orienting on the M/S floor and am looking for good ideas, tips, pointers, or tools to assist me with prioritization and time management. I know that every nurse has his or her own method of doing things, I'm just trying to find the best one for me. I have found orientation a bit frustrating, nerve racking, and wonderful all at the same time. I know my strengths and weaknesses, and am hoping to improve while keeping a positive spin on every shift that I work. Any advice from all of you experienced people out there? How do you keep your act together throughout your shift ( mine is 3-11, and yes I know that it is one of the busiest).
Thanks
Anna

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RN-PA, RN · Jun 3, 2005

Hi Anna! I answered a similar question over a year ago on a thread entitled, "What are your routines like on a medsurg unit" and found the thread here:

https://allnurses.com/forums/showthread.php?t=63805

Here are the suggestions I gave on that thread which I hope will be of some help:

I work med-surg 3-11 (1445-2315) shift, and I'm always looking for ways to use my time well. If the 7-3 nurse is late in giving me report at the beginning of my shift, I'll start checking charts and/or going through the medication kardexes and begin writing down when all my meds are due. If I see that patients have INT's (heplocks) or PICC lines, I may begin filling syringes with NSS and putting them in their med drawers while I'm waiting. I work part-time, so I rarely get the same patient assignment 2 nights in a row, so I'm frequently "starting from scratch" each time I work. If you get the same patients a few days in a row, it'll help you because you'll know how best to organize yourself-- when the most meds are due, when a patient prefers his wound care, this patient needs his heparin gtt renewed daily, etc.

After report, I do quick chart checks on my 4-6 patients (if I only have 4 patients, I will usually have at least one more patient assigned-- admission, post-op, or transfer before I'm out of report, and a total of 6 by the end of the shift.) I then go through all the med kardexes and write out when meds are due in columns from 1600 to 2200. (I just write room # and "PO X 5", "SQ Hep", "IV Ancef or IV Lev"-- abbreviations to give me an idea of what's due) I gather any 1600 meds, and will see either a patient who has an IV piggyback med due or the patient(s) with highest acuity first, as others have mentioned. Since dinner comes at 1700, I try to get as many assessments done between 1600 and 1700. If I have an NPO or tube-feeding patient, (and they're stable), I leave their assessments for last. If I'm REALLY swamped, I say hello to patients whose dinner's arrived and promise to assess them when they're done (after asking if they need anything). At some point in this first hour, I give a quick report to the PCT I'm working with and will delegate anything I can to her at that time. I check over the vital signs and write the temps and BP's on my report sheet, as well as accuchecks of all my patients if she's obtained them by that time.

As you get an assessment routine down and become more comfortable, you will learn to do two-three things at once. While you're assessing their orientation, you can be checking pedal pulses and edema; as I'm introducing myself, I'm checking their IV fluids and their IV site, maybe hanging an IV med. Listen to heart, bowel sounds, lungs (check sacrum and skin while they're lying on their side), check incisions, wounds, etc. Check urine output, remind patient to use urinal or "hat" if on I&O, ask about pain/nausea/SOB/DOE. Check O2 and do a pulse ox. I write my ABNORMAL findings only on the back of my report sheet and will document them on the computer when I have time (sometimes that's at 2330 or midnight...) With 8 patients, you'll have to do more focused-type assessments as others have mentioned, to save time. If I have a chatty patient, or as I'm doing teaching, I'll tidy up their room-- fold a blanket, throw away excess cups, take out their leftover lunch tray, make a neat stack of newspapers. This is ONLY if I'm not crazy-busy at the beginning of a shift (rare), but I'll neaten up at some point during the shift.

I sometimes combine 1600 and 1700 meds if it's really busy (and depending on what the meds are), and I'm always trying to combine trips to the med room and save time by making a mental list or quickly scribbling all the things I need to save a trip: 302-1-- juice. 304-1-- Percocet & denture cup. 305-2-- IV Ancef/IV Flagyl. I also make a list of things I need to remember to do at the bottom of the sheet where I have my meds and times due listed like: 310-1--PTT at 1800/Coumadin order. 310-1-- sleeper (means I need to order a sleeping pill when house doc comes on at 1900) 308-1 check pulse ox at 1900. 308-2-- pre-op teaching.

I keep a list on my clipboard of frequently called extensions so I don't waste time looking for phone numbers. And all I've mentioned is just a basic "structure" for my routine. It all goes out the window, of course, when you're calling docs for problems and orders, hanging blood products, helping the LPN with her needs, walking people to the bathroom, running for pain meds, taking report from PACU on your post-op or from the GI lab about your patient's colonoscopy, talking to family members, taking off orders, etc. etc. etc.

Kitty-MayRN, BSN, RN · Jun 4, 2005

Hi RN-PA,

I'm going to be starting as a graduate nurse on a med/surg unit and I saw your post. I liked your tips so much I printed them off to use. Thanks for the good info!! :)

Kitty-MayRN

:nurse:

RN-PA, RN · Jun 4, 2005

Hi RN-PA,
I'm going to be starting as a graduate nurse on a med/surg unit and I saw your post. I liked your tips so much I printed them off to use. Thanks for the good info!! :)
Kitty-MayRN

You're very welcome, Kitty-May! I was a slow-learner and late-bloomer as a nurse. I didn't have Allnurses or mentors to help me in those first challenging years. I wanted to quit many times, so I'm glad to be able to pass on what's helped me make my way in med-surg. All the best to you!

RNAnna · Jun 7, 2005

Hi RN-PA,

Your responce is the best that I have received so far. What valuable information you have. I've been searching for sources to manage my time and case load more efficiently, but as a first year nurse, I have to admit that it gets discouraging. I always have the feeling that I should have "gotten it" by now. One of my charge nurses is always asking me "how do you think you are doing?" which always means "you did something that could have been done better". I just wish she would come out and say what she is thinking rather than have me fish through my brain trying to remember the exact things that I did that evening. I know that I'm not perfect, I just want to be the best that I can be within the confines of being human.

Thank you so much for your responce. I'm looking forward to reading that thread that you mentioned and possibly hearing from other nurses who remember what it was like trying to make sense of their first year of nursing.

Anna

RN-PA, RN · Jun 7, 2005

Glad to be of any help, Anna! I've been a med-surg nurse for 11 years now and it took me a long time to find my way. I did a lot of observing of other nurses over the years to see what works and what doesn't. 3-11 shift is rough, especially the 3-7 part, and I think of it as surfing a big wave-- trying to keep my head above water and not drowning. There's so much rushing around and I've made a few bad errors from rushing, so please remember to step back, take a deep breath, pray (if you're so inclined), and do ONE THING AT A TIME. Your mind may be going a mile-a-minute, but you have to focus and not get swept away in the mayhem.

I would take your charge nurse aside at some point when things have quieted down during a shift and ask her point-blank if she can be specific about anything you could do better. And mention that you're trying to be the best you can be, but if she sees something you can improve upon to let you know. I can't stand having to try to read someone's mind. My imagination always conjures up the worst, and the truth is usually better than my imagination.

Please be patient with and kind to yourself, and try to find a mentor at work who you can speak with honestly and vent to when needed. None of us is perfect and we make mistakes with the demands and stresses of our jobs, and although it's a cliche', I still learn something(s) new every shift I work. All the best to you!

RNAnna · Jun 7, 2005

Glad to be of any help, Anna! I've been a med-surg nurse for 11 years now and it took me a long time to find my way. I did a lot of observing of other nurses over the years to see what works and what doesn't. 3-11 shift is rough, especially the 3-7 part, and I think of it as surfing a big wave-- trying to keep my head above water and not drowning. There's so much rushing around and I've made a few bad errors from rushing, so please remember to step back, take a deep breath, pray (if you're so inclined), and do ONE THING AT A TIME. Your mind may be going a mile-a-minute, but you have to focus and not get swept away in the mayhem.
I would take your charge nurse aside at some point when things have quieted down during a shift and ask her point-blank if she can be specific about anything you could do better. And mention that you're trying to be the best you can be, but if she sees something you can improve upon to let you know. I can't stand having to try to read someone's mind. My imagination always conjures up the worst, and the truth is usually better than my imagination.
Please be patient with and kind to yourself, and try to find a mentor at work who you can speak with honestly and vent to when needed. None of us is perfect and we make mistakes with the demands and stresses of our jobs, and although it's a cliche', I still learn something(s) new every shift I work. All the best to you!

I have to say Thanks again to you RN-PA. After 3 months on the job, I need to hear advice like this over and over again. I am always amazed at how we are quick to point out the things that need improving but we are slow on pointing out the things that are done well. I'm not a person that just assumes that things are going well if nothing is said. I need to hear it, stopping short of attention seeking of course. I am going to have a look at that thread that you posted the link to and find some ideas on how I can continue to improve my skills in all areas. Someday, deep in my heart, I know that I will make a great nurse. It is just really tough right now. Thanks again.

Anna