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.