Are You Providing Great Patient Care?

This article points out the difference between good and great patient care. I use an example from my experience with my recent orientee. Also, it shows what appears to be great time management is not always indicative of quality patient care. Nurses Announcements Archive Article

I thought about this question as I reflected on my day with my new orientee who has been with me for almost two weeks now. She is a new grad but does have previous military experience as a medic. She has far exceeded my expectations so far during this orientation. We were extremely busy the other day but still able to provide great care for our patients.

These are patients with new head and neck cancer with flaps that have new tracheostomies and require a lot of teaching. We were successful in ambulating all of these patients and teaching them to the best of our ability.

Now, I know what you are going to say. These are just part of basic nursing care.

That is true, but some nurses will avoid those tasks since they can get through the day without actually having to do them. What I mean by that is these are often things that need to be initiated by the nurse since the patient does not know they need to be done or is not motivated.

The point is, I have been a nurse for a while now and have noticed through the years that some nurses seem to always have their work done and this is not always indicative of a job well done.

The nurses that seem to have it all figured out from a time management perspective do not always provide a high level of patient care. I will see these same nurses talking about personal issues or navigating the internet when there are things that can be done to raise the quality of care they provide to their patients. This does not surprise me and I am sure it happens in every profession, but I think some nurses label themselves as slow when they are actually just providing great care.

My orientee and I did not have to ambulate and teach these patients as much as we did and we did not have to think critically or keep their rooms as clean as we did. We did it, because it is the best thing for the patient, and it will allow them to recover faster and have a more successful transition back into their normal life with a decreased chance of re-admittance.

That day my orientee seemed to be a little worried about her time management as she observed other nurses having an easier day. I pointed out to her that she has only been on orientation for two weeks and she is providing a very high level of care which she should be proud of. I told her it takes more time to provide high level care and others may not be doing the same.

Almost always there is something that can be done to improve your patient's level of care. If you have time after providing great care for your patients then be a team player by helping another nurse who is struggling. This will help her bring up her level of patient care. In the end we all want what is best for our patients. What is one example of where you have gone the extra mile to provide better patient care when you did not have to?

Specializes in Med-Surg., Oncology, Observational Units.

Thank you everyone for all the responses. I have enjoyed reading them all. I wanted to clarify a few things. The whole basis of the article is to point out why my orientee should not compare herself to other nurses, because she does not know what their level of care really is. She should focus on the quality of her care and bring it to the highest level possible.

Some of you mentioned you are lucky to do basic care. I have those days as well and on those days you do the best you can with what is priority. If you can look back on your day and say I did the best I could then that is all anyone can ask and you should feel successful. Sometimes it would take two or three nurses to do everything on our patients 100%. In that case, you have to look at your priorities and go down the list until you run out of time. So you often are unable to get to everything on your list and that is ok because it is not within your control. You have done the best you can with the resources available to you.

I know there are nurses that have their time management down and everything done on their patients from A to Z. If that is you great more power to you. Now go help someone else out and if it is the same nurses, so what. Be excellent and be a leader. If you’re already doing all this then I hope to be where you are very soon. I strive for that level of excellence every day. It is hard to give 100% all the time but that is what your employer is paying you to do. It may not seem like the people you work with will notice but they do. Trust me on that. Besides making you feel excellent it may open some doors of opportunity for you when you least expect it. In the end being excellent will benefit you the most.

Specializes in LTC, Psych, M/S.

And for the nurse that "always has to help the same nurses" maybe they just need some pointers on how to multitask? Unless they are truly being lazy, to many personal phone calls, smoke breaks, ect. Sigh. Who knows.

Specializes in Gerontology RN-BC and FNP MSN student.

Time management and great patient care is an art. Somedays are master pieces...other days well, not so much.

Excellent. Thank you for speaking up to that comment, duskyjewel.

I agree with you as well. I found statements such as lazy nurses leaving on time, lazy night shifters to be unfounded. I am efficient and I leave on time; however, I can accomplish and meet the needs of my patients within my shift. I prioritize things that only I can do, and I do ask support staff to do things within their scope. I am able to maximize and provide better care for my patient by allowing everyone to do the job they are supposed to.

Communication is more so the key to an ideal day. Incremental overtime is expensive.

t

Specializes in ICU, Tele,.

I consider myself a good nurse with good time management skills who, gets off on time most shifts. I choose not to focus on what the other RN's are or aren't doing, and focus on my assignment. If your orientee focuses on HER pt.'s and HER work AT ALL TIMES, then as she grows professionally she too will have good time mgmt. & provide a great service to her pt.'s...... This is the down side to nursing, everyone wants to compare and snitch about others, females can be so petty....that's why our profession gets so little respect. Rarely will you see Physicians acting like this. - Think about it, and focus on what YOU do, not others.

Specializes in Oncology, Ortho/trauma,.
. Rarely will you see Physicians acting like this.

It actually happens a lot more than you think. My husbands in Med/school and I am friends with a lot of doctors and they all have stories of comparing and one uping or being thrown under the bus.

I think the point is that people are people regardless of the profession. Some are co-workers are lazy, some are motivated. I personally keep to my area, make sure my tasks are done and leave most days on time. How do I do this? I work orthopedic 5-6 patients a shift day shift. We do walking rounds so by 0730 I have looked in on everyone to see whose awake, who is critical, who needs prn meds now asked about bm needs checked call light and bed. I then go get the first persons morning meds with pain meds if they can have it and are stable enough to get it (regardless if they asked for it or not because if you get all of your patients on the same pain med schedule it will make it a lot easier and you won't be riding what I call the pain med revolving door- constantly going from room to room trying to catch up with pain- better to treat it before it gets above 4) The walky talkies I get them to the bathroom so now I know how they walk and did a skin assess on them. set up the tray with a wash basin. assist in sponge bath and change dressings .call the aid to change the bed refill the water (actually my aides know my routine by now and are usually doing this parallel to me) do the rest of my assessment, give meds set them in the chair or back to bed set up bfast, document assesment, plan of care, nurse note and education. (computers are in the room.)

I chit chat with the patient while doing all this, if calls come I address them as I can or if a pt wants me in another room I let them know how long I will be or if urgent I send another nurse. I write down on their wipe board when they can have their pain meds again and that I will automatically bring them in at that time if they wish or with their next meds due. The aide finishes the pt applying lotion to them. Total time 20-30 minutes. those that are total care with the assistance of my aide same stuff with bed bath and bed change 45-1 hour. But I have found that if you address everything early you can then be prepared when you start to get admits/dismissals your pt appreciate how you made them feel and that you spent a lot of time with them.

I offer help to those when I can (not just the nurses but ancillary staff as well, and I delegate a lot (which is an art in itself, how to ask for help and get help took a lot of practice)

If you look to other nurses and start comparing/complaining it makes for a more stressful environment, you will feel jipped and possibly bitter. It has helped me to just stay with the tasks at hand and say to myself, "You can only control YOUR behavior, YOUR actions- keep your pts safe, healing and happy to the best of your ability"

We started a new program at my hospital where the upper management goes into the patients room and asks the patient how their nurse is doing and what could be done better do they come in hourly ect... This is to help management get a clear picture on who is doing their job and who needs to be further counseled and correct behavior.

Specializes in Pediatrics, Emergency, Trauma.
It actually happens a lot more than you think. My husbands in Med/school and I am friends with a lot of doctors and they all have stories of comparing and one uping or being thrown under the bus. I think the point is that people are people regardless of the profession. Some are co-workers are lazy, some are motivated. I personally keep to my area, make sure my tasks are done and leave most days on time. How do I do this? I work orthopedic 5-6 patients a shift day shift. We do walking rounds so by 0730 I have looked in on everyone to see whose awake, who is critical, who needs prn meds now asked about bm needs checked call light and bed. I then go get the first persons morning meds with pain meds if they can have it and are stable enough to get it (regardless if they asked for it or not because if you get all of your patients on the same pain med schedule it will make it a lot easier and you won't be riding what I call the pain med revolving door- constantly going from room to room trying to catch up with pain- better to treat it before it gets above 4) The walky talkies I get them to the bathroom so now I know how they walk and did a skin assess on them. set up the tray with a wash basin. assist in sponge bath and change dressings .call the aid to change the bed refill the water (actually my aides know my routine by now and are usually doing this parallel to me) do the rest of my assessment, give meds set them in the chair or back to bed set up bfast, document assesment, plan of care, nurse note and education. (computers are in the room.) I chit chat with the patient while doing all this, if calls come I address them as I can or if a pt wants me in another room I let them know how long I will be or if urgent I send another nurse. I write down on their wipe board when they can have their pain meds again and that I will automatically bring them in at that time if they wish or with their next meds due. The aide finishes the pt applying lotion to them. Total time 20-30 minutes. those that are total care with the assistance of my aide same stuff with bed bath and bed change 45-1 hour.

******* But I have found that if you address everything early you can then be prepared when you start to get admits/dismissals your pt appreciate how you made them feel and that you spent a lot of time with them. I offer help to those when I can (not just the nurses but ancillary staff as well, and I delegate a lot (which is an art in itself, how to ask for help and get help took a lot of practice) If you look to other nurses and start comparing/complaining it makes for a more stressful environment, you will feel jipped and possibly bitter. It has helped me to just stay with the tasks at hand and say to myself, "You can only control YOUR behavior, YOUR actions- keep your pts safe, healing and happy to the best of your ability"******

We started a new program at my hospital where the upper management goes into the patients room and asks the patient how their nurse is doing and what could be done better do they come in hourly ect... This is to help management get a clear picture on who is doing their job and who needs to be further counseled and correct behavior.

This post is sooo SPOT ON!!!!!

:up:

Specializes in ob, med surg.

I have always wondered about this, as I have struggled with 'getting it all done' for 9 years now. I think some nurses are talented and have terrific time management skills. But some do skimp. They HAVE to. We presently have one nurse who lies about what he has accomplished with the pt, stating in a recent report that he had "ambulated the pt to the bathroom with portable o2", when in fact the o2 canister was in the room standing alone with out the wheels to go with it and no oxygen tubing in the room. Then there was the nurse I followed who charted that the pt had had episodes of afib as recorded by the tele unit, except that the pt NEVER had a tele box, and then there was the time that I worked as an agency placement on a psych ward. We had 9 pts each and physical assessments to do on all pts. I noticed that all the nurses charted physical assessments on pts despite ME being the only nurse on the floor with a stethoscope. When I asked my direct supervisor about this, she stated " I was wondering the same thing!" Thank you for this post. I know I might be slow, but I give great care.

I have found that some nurses are just efficient time-wise; usually they arrive early , have their same chair and then look over assignments. This is key---they usually don't take difficult or time consuming patients if they can help it. Also they befriend the charge nurse so they get the assignment they want. Another thing worth noting is they never miss breaks and always leave work on the dot. You might say they are on the starting block ( in reversal). Are they great nurses? Or even good teammates? I think not , but Supervisors love them-----they look so good on paper. I have known a few of these types of nurses and a few is just one too many!

Specializes in Med Surg, Home Health.

Thank you, Lady.Free, for describing what a well-managed day looks like.

Let me describe my less-well managed one.

I'm in my first 6 mos of nursing and struggling with time management a lot, on an acute care floor where we have 4-5 of a very broad variety of patients. We get a distilled collection of the most acute patients in a very small state, plus a fair population of routine surgical patients and, occasionally, patients awaiting skilled placement for ages.

I've made progress- used to leave at 8:20 nearly every day, now generally by 7:15-30. But I run around more than any other nurse on the floor. So clearly there are many more areas of progress ahead.

The struggle starts at 1900 when report has been given and I'm trying to look up everything on the chart. I like to not only look up but write down lab values, VS, allergies, IV size & date inserted, code, med times, orders, Hx, Dx. Also like to scan prev assessments, get a sense of PRN's & when last given, and read MD's daily notes. Try to get that done by 1915, but usually report runs late and patients call immediately so lucky if I can complete that at all let alone by 1930. Then round on patients, lay eyes, start assessing. I very seldom find everyone's pain managed well though so often that's a med round as well. We have 1 CNA for the floor and they're usually doing vitals at that time, and often no med clerk so I also toilet, bring refreshments, answer phones, remind folks to order food before the kitchen closes. I seldom get this round done before 2045. Try to call MD for semi-urgent matters during this time (no BM for 4 days w/no BM meds, moderately odd VS; I call for URGENT changes as soon as they come up whenever they come up) and then it's time to start bedtime meds. Usually I still have 1-2 more assessments to do, more turns, toileting, complex dressing changes. By 2345 am mostly done with that but there are usually a few midnight meds, esp because the patients I pain-medicated at start of shift now are often in pain again. So I round and ask about pain.

Oh yeah, forgot to mention but I've been hourly rounding and reflective-listening, encouraging my patients to ask questions about their care, and doing education wherever I can fit it, introducing myself to family members and hearing their concerns the whole time. Also, head to toe on everyone and only the other day a more experienced nurse said when she gets patients from me she always feels confident they've been thoroughly assessed.

Around 0030-0100 is when I usually START charting, (while eating at the desk) which is late compared to most of my peers. (They start 2030-2245) We have an EHR that takes about 10-25 minutes per patient, 10 if you do the minimum and 25 if you do everything desired by management (and good for license). Also am answering call lights and helping other nurses, and continuing to round hourly. A few med passes in the time period between 0100 and 0300 as well, mainly IV antibiotics and more pain meds. Then at 0300 start gathering blood draw kits, start blood draws, round again. If all has gone well am done with charting by 0430, and can start preparing for report by digging further into MD notes. If not, I am desperately charting. I would ideally start last rounds at 0515, because now folks are waking up, in pain, have scheduled meds, need to pee, and need to be turned and changed that one last time. However, due to still finishing charting sometimes I only START this at 0545, which is never enough time. I try to ask each pt what they'd like me to tell the day nurse, then it's on to the last bits of charting and report at 0630. Report is often held up by needing to wait for the nurses to get on the floor/become free, or by a last-minute patient need, or by me running late. On only half the days would I even get to sign out on time even with all charting and rounding done on time. Practicing report beforehand on paper does help though when I have time.

And one thing about this schedule: it leaves no wiggle room. No room for the dressing that unexpectedly falls off, the cast that needs to be re-assessed, cut, and re-wrapped; the psych patient having a screaming fit, an escalation of care, or especially an admission at the start of shift. But I deal with these as they come up, at the expense of charting and a few extras. I do go above and beyond for everyone whenever no one else is crashing, am great at noticing changes in condition, very good at pain management most days, good at patient rapport. Can take the most behaviorally challenging patients and do well with them, have since the start.

Struggle with: doing all of this ON TIME and remembering all my supplies the first time, delegating (am embarrassed to ask our over stretched aide to help me go above and beyond as opposed to giving basic care; am slow in general to ask for help from other RN's; working on that!). Ok at prioritization but that's a work in progress still.

This is not a time-management pattern to be imitated, clearly. It would help if I could come early to look at charts but that's never an option due to assignments being made last-minute at all times.

Does anyone see what I'm doing wrong here? Or is this just a natural result of newness plus not having all my ducks in a row yet, plus (perhaps dysfunctional) standards for myself?? Or does this sound like I should quit worrying and allow myself to just keep getting better over time?

Specializes in Oncology, Ortho/trauma,.

Does anyone see what I'm doing wrong here? Or is this just a natural result of newness plus not having all my ducks in a row yet, plus (perhaps dysfunctional) standards for myself?? Or does this sound like I should quit worrying and allow myself to just keep getting better over time?

Okay couple of thoughts. You are doing great! As you get the EHR system more memorized- it always asks the same questions. entering in your data will go a lot faster.

Delegation comes easier if you can practice reciprocal generosity- and this I have found to be completely team building and will endear you further to your coworkers.

Start by bringing food to share with co-workers. Then every once in awhile offer to buy one of them b-fast, or dinner at the cafeteria ( make sure you switch who it is, I usually start buying the aide food, then another day it will be the charge- those two people will make or break your shift- then I usually give some food to a newbie because it is hard being a new kid on the block) Food promotes endorphin and good feelings- and so those good feelings will now be associated with you!

Second- now start offering to help your aide. Or inform your aide on tasks that you did to help them like " Hey, I took 22 to the bathroom and washed her up so she should be good to go for awhile" now here is the important thing to follow it up with "When you get a chance in the next five minutes or so can you make sure insert task is done for 22. I really appreciate your help!"

Give a time limit give a specific task and always follow up if it was done or not., if completed praise them " Wow thanks you are really a life saver, I don't know what I would do without you. Is their anything I can do to make your job easier" or a little back rub while their charting vs- trust me you are building a team and this works time and time again.

Now lets say you are in one room and the patient in the next room wants pain meds. Do you carry a phone? If so I call the patient and let them know I am in another pt's room at the time will be there for x amount of time and will see if another nurse can bring them meds or that you will be there when you finish your tasks. I will also ask them to rate their pain and what pain meds do they want.

Now when asking a Nurse for help tread with caution you are still a newbie so I always went to my preceptor and asked them while on orientation who is a good resource nurse here?

When you are more established as a nurse on the floor you can seek out your buddies ( I always have 1 or 2 every shift.) I always start my shift with going up to my helper nurse and say " Hey here is my phone number I have such and such area- give me a call if you need help. Let me know what your number is too! I thought we could watch each others area for break or if I go to the cafe and get something I will give you a call and let you know what is there."

If you don't have a nurse helper call the charge first and say " Hey I am swamped and tied up in another room. If you get a chance can you take ____ to room___,?" then when the task is done you say "thanks I owe you one"

Now meds and labs and stuff will come easier as you will get use to the patient population and not have to look everything up all the time.

I would strongly suggest coming in earlier I know you said that they switch things up a lot but do they do it every shift?

Also I personally only write down lab abnormal and look up meds for the first four hours ( I cluster my work into 4 hour increments because in our hospital you could be floated somewhere different every four hours depending on census.) You can judge a lot on a person med hx by the pills they take. When I have down time then I look at dr notes and such. plus the floor I work on has the medical hx typed up on our kardex.

Are there computers in the rooms. If so document there. It is easier to tell a pt who wants you that you are in another pt room (even if you are just documenting) and that you will be there when you are done, then to document out at the desk and have the pt family come out there and stare you down until you get up and get what they want. Documentation will help you keep your license and just as important as pt needs.

another suggestion is to offer to the whole floors lab draw or your buddy nurses lab draw if they will pass your meds or vice versa.