Please help with Time management techniques

  1. I really have to take my hats off to the great nurses in the LTC area, how do you do it all? I am a new RN, this is my first month on the job after 5 days of orientation, I am the charge nurse on nights with 3 sometimes 4 CNAs and 40 residents. The night nurse has to pick up orders, do monthly renewals, do meds and treatment sheets, review all the CNA assignments, then chart..chart..chart.
    Last night for example 2 residents fell during the night, after I finished the mounds of paperwork required I barely had time to do my 6am med pass!!! The 8 hours are just not enough to get ready for 7am morning rounds. I find myself constantly behind and can't seem to get all my charting and paperwork done. Any advice on how to be more effective? I loved helping people and that's why I became a nurse but after 3 weeks I'm ready to QUIT... Please help. any time management tips that worked for others would be appreciated
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  2. 12 Comments

  3. by   Genista
    Hi Cornelia-
    Though I do not work in LTC, I can relate to your problem. Time management is something that all nurses deal with. I am improving (slowly), but it is a challenge. I have two tips. One: When I was a new grad , I had a more experienced RN give me a time line of how she prioritized tasks during the shift (ie when we got report, when the narc count takes place, when the first med pass/assessments were done at x time frame, then at which time the meal was served, then initial charting was started at Z time, etc.) . Another trick I am still implementing is to "set goals" for the day. I try and pass my meds 30 min before the scheduled time if possible (and if I have a pt's meds due @ say, 9 am and 10 am... if not contraindicated, I will give them both at 9:30am to save a trip).

    I like to set a goal to have my charting completed by "X" time of day (not always met!) & get my I/Os into the charts by a certain time, too. One thing that REALLY helps organize my day is at the start of shift, I write a time line of the hours of my shift, and I write in the times of the med pass, and blood sugars, and work the rest of my nursing care around that. So, for me on day shift, 9 am is a big med pass time, so I try and do other procedures like dressing changes, ambulation, etc. during non peak times. Ask your coworkers what tips they have, and if they see you wasting time or working too hard in any one area. Critical feedback can be helpful. It's all about prioritizing. It's a true art! This link has some good advice:
    http://www.advancefornurses.com/past...rinterfriendly

    Good luck to you! Let us know how it goes. It should get easier w/ practice.
  4. by   cornelia
    Thank you for your helpful suggestions, I appreciate you taking the time to respond.
  5. by   JillRN
    Hi Cornelia,

    Although I do not work in a LTC facility, I can assure you that time management is something all nurses struggle with. I think like anything, it is one of those things that comes with time and experience. However, we all have those nights that start off great and you get hammered half way through. I work on a busy Ortho unit at a large hospital. It is nothing on afternoons to have 10-12 patients plus cover the LPN's IV's, etc. Just keep telling yourself that you are only one person and that your main function is to keep your residents safe, clean and dry.

    JillRN
  6. by   jb224179
    I am a nursing student right now and during clinical I feel as though I am very sufficient with time management and all of your tips helped. One thing that I was wondering about was, does it work better to do all of one patients treatments at the same time or does it work better if multiple patients receive the same treatments to do all of them at the same time then move on to the next task. Also anymore time saving task would be very helpful!
  7. by   JillRN
    I find that you must take each assignment individually. On my floor, I encourage everyone to make their safety checks first and get those into the computer. THEN begin with vitals, meds, etc., IV's, dressing changes, etc. We usually have 10 patients on a busy orthopedic surgical floor, so it takes more than one person to ambulate the patient, pivot them to the BSC, turn them for dressing changes, etc. Always, safety comes first, then you work with the vitals and meds, etc. You always have to take into consideration that you may have one or two patients who require a lot more care or who are going downhill and you need to spend more time in their rooms. I dont think you can do all the treatments on one patient and move onto the next in a realistic clinical setting. I hope this was helpful!

    Jill
  8. by   betts
    Corneila,

    LOL...I've been in LTC for many years and what you have to learn is simply two things if you're the Charge Nurse, they are:

    1. Prioritize
    2. Delegate

    You'll learn that in LTC that scheduling will not work, you just do it.
  9. by   rdhdnrs
    Work in OB, not LTC, but here are a few ideas:
    Prioritize. Remember in nursing school how we learned that the actual takes precedence over the potential? All those nursing diagnosis excercises were for just this purpose!!
    Don't feel that you have to get everything done. You are just one person. Give 100% on your shift, then turn it over. Nursing is a 24-hour continuity of care job-the next shift picks up where you left off. I've seen nursery nurses change shifts and get report in the middle of a code!!!
    Develop your own routine by watching experienced nurses and doing what they do. Then you can modify their routine to fit you.

    You'll hit your stride. It just takes a while.
    Good luck.
  10. by   nur20
    Want a good laugh ? One LTC facility wanted us to complete a "TIME AND MOTION " sheet daily!!!!!
  11. by   thisnurse
    good link, thank you very much. im always looking for hints to improve my time management.

    ive never worked in LTC other than in clinicals but i know those nurses work very hard.
    thats why im always amused when we get CNA's from LTC at our hospital...they all say the same thing...go to a nursing home, those nurses dont do anything...lol
  12. by   betts
    COPY and PASTE and your answers await!



    http://www.beebware.com/directory/se...h%2FNursing%2F
  13. by   kids
    I spent most of the first years in Nursing working in "nursing homes", I am using the tern genericly as my experience ranged from custodial type care to SNF/rehab, to subacute track/vent (the MDs didn't admit until they needed to go to ICU)...the drill is pretty much the same for all. I haven't been on the floor as 'staff' in a "nursing home" in severl years but still pick up an occasional agency shift for the big bucks and my routine still works for me (actually it's my Mom's routine, she's been doing it for 30 years, she oriented me on my first job and was my first Charge Nurse):

    It works best on nights---

    Get there a couple of minutes early so at time for report you have your census sheet and pen in hand and are ready.

    If the previous shift is running behind give them a minute then nicely tell/ask them "can I go ahead and get report so you can finish up?".

    Get report, keep it to the facts, write down only what you do not already know or need to pass on to the next shift.

    Count narcs.

    Make a fast round, just a head check. As you encounter a NAC give them a brief report on their patients, just what they need to know to safely get started.

    Get the med and treatment books and go through them, flag all of your meds/tx/blood sugars. If you have the dividers that have colored pullout tabs use them-designate (for your self) a color code system...ie red is blood sugar, blue is 12mn, green is 6am, yellow is weird times. Slide that colored tab back in when you are done with the task.

    Get your NAC's together, give them a more detailed report if needed, go over what you need from them and when...if some one has a tx, vs or you need to do an assessment, tell the NAC to let you know when they are rounding on the pt-you can go in together and help each other get done what you need to (also minimizes the number of times the patient gets disturbed. You can also time your assessment for when you are giving a med.

    Once the previous shift has cleared out of the nurses station pull out and stack all of the charts you need to chart in. Unless your facility has another policy- chart only to the problem they are on 'alert' for and then by exception. If some one is getting a PRN med and the admin and results are charted on the MAR you do not have to do multiple entries in the notes, you can do one note (Sleeping w/ NAD, c/o's pain relieved with admin of PRN Vicodin. ) Chart as time allows, you can start early in the shift, if there is a change you can make another entry. When you are done with a chart (VS etc) put it away.

    I don't know the law in your state, here in WA we are required to give a med within 1 hour before or after the scheduled time. Don't put off doing the meds, start as early as you legally can, that way if something happens midway through a pass you won't get so far behind.

    Good Luck, it really does get easier. I would still be doing it if I hadn't discovered Peds!

    -nancy
  14. by   SKM-NURSIEPOOH
    Originally posted by kids-r-fun
    I spent most of the first years in Nursing working in "nursing homes", I am using the tern genericly as my experience ranged from custodial type care to SNF/rehab, to subacute track/vent (the MDs didn't admit until they needed to go to ICU)...the drill is pretty much the same for all. I haven't been on the floor as 'staff' in a "nursing home" in severl years but still pick up an occasional agency shift for the big bucks and my routine still works for me (actually it's my Mom's routine, she's been doing it for 30 years, she oriented me on my first job and was my first Charge Nurse):

    It works best on nights---

    Get there a couple of minutes early so at time for report you have your census sheet and pen in hand and are ready.

    If the previous shift is running behind give them a minute then nicely tell/ask them "can I go ahead and get report so you can finish up?".

    Get report, keep it to the facts, write down only what you do not already know or need to pass on to the next shift.

    Count narcs.

    Make a fast round, just a head check. As you encounter a NAC give them a brief report on their patients, just what they need to know to safely get started.

    Get the med and treatment books and go through them, flag all of your meds/tx/blood sugars. If you have the dividers that have colored pullout tabs use them-designate (for your self) a color code system...ie red is blood sugar, blue is 12mn, green is 6am, yellow is weird times. Slide that colored tab back in when you are done with the task.

    Get your NAC's together, give them a more detailed report if needed, go over what you need from them and when...if some one has a tx, vs or you need to do an assessment, tell the NAC to let you know when they are rounding on the pt-you can go in together and help each other get done what you need to (also minimizes the number of times the patient gets disturbed. You can also time your assessment for when you are giving a med.

    Once the previous shift has cleared out of the nurses station pull out and stack all of the charts you need to chart in. Unless your facility has another policy- chart only to the problem they are on 'alert' for and then by exception. If some one is getting a PRN med and the admin and results are charted on the MAR you do not have to do multiple entries in the notes, you can do one note (Sleeping w/ NAD, c/o's pain relieved with admin of PRN Vicodin. ) Chart as time allows, you can start early in the shift, if there is a change you can make another entry. When you are done with a chart (VS etc) put it away.

    I don't know the law in your state, here in WA we are required to give a med within 1 hour before or after the scheduled time. Don't put off doing the meds, start as early as you legally can, that way if something happens midway through a pass you won't get so far behind.

    Good Luck, it really does get easier. I would still be doing it if I hadn't discovered Peds!

    -nancy
    I concur!!!

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