Accuracy and Patient Safety vs Time Management

[Goldenhare]

I've tried to post this in another area but have gotten no real feedback. Helpful feedback please.

I've been a nurse for about 6 years. I've always had issues with time management, but have made progress. I am always, always fighting the clock. I keep a 'brain', and I try to prioritize, but it is always a struggle. Since this is a struggle for me, I am always looking for ways to speed up. I must be careful sometimes, in how fast I do tasks, because I will make a mistake, like charting on the wrong patient, or reviewing labs or orders because sometimes I will misread (possibly a learning disability?). I am very careful with meds and my record shows.

Now I always read that the key to time management is prioritizing. However, this is what I am finding:

1) Pts who ask me "What are you doing?" when I check pedal pulses. ("No one has ever done that to me!") but they are charted-also amputees with pedal pulses charted.

2)Pts with home meds that have not been given in DAYS!

3) Full assessments charted on Psych patients, but I'm the only nurse who has a stethoscope (I float sometimes)

4) Meds charted that haven't been given.

5) Clear lung sounds charted on pts whose lungs are ANYTHING but clear.

6) Pts charted as 'non verbal' or 'comatose' who, though slow or quiet, can verbalize, and make their needs known.

I must begin to clock out ON TIME, EVERY SHIFT.

So what gets left out of my shift in order to finish on time? Do I sacrifice accuracy for speed? What am I missing? I worked hard to get where I am and I need this job, but this dilemma makes me want to leave nursing as it causes me a great deal of anxiety. Thank you for any help and opinion. Does anyone else find this? Am I too thorough??

[Zen123]

Do you work in hospital or ltc?

Some people can't handle first or second shift.

Some need to stay in one unit. Floating cause more anxiety.

Some people spend more time on what other's missed.

Do what must be done and move on to the next room.

I have 30 residents- 8 are skilled etc. Most days are impossible but

I get it done. Late to clock out on days with admission.

Also talk to the other nurses in your unit for a heads up. I know i've seen

a few when they start their shift their starting routine makes me wonder how

Effecient they are the rest of the shift.

That's all i got.

[sistasoul]

I fight the clock too. I have also had patients tell me that they have never had pedal pulses checked, etc. I am also a very careful nurse. I truly believe that people cut a lot of corners to get out on time. I am not judging anyone because I know how hard management can come down on us for OT. I am not willing to cut corners because if something is missed during an assessment it could be a bad outcome for the patient.

[Leda1st]

I agree with the poster who suggested that you not float, at least for awhile. You should NOT skimp on your assessments (and I have noticed the same "oversights" from time to time in charting), but I think working in one area for awhile will help you get a better "rhythm" down and will thus improve your ability to be a thorough nurse AND good at time management. Little things like not being sure where things are on a unit (I float also) can take a LOT more time than you realize.

[Goldenhare]

I appreciate all comments. I work in a hospital. Been doing this for 6 years now. Do night shift. I seem to be getting a bit better. I think its mostly the charting that gets me because I'm always finding mistakes. And like a previous poster mentioned, why chart it if its not accurate because I am responsible for the assessment. I also have never made a med error-knock wood. I guess I'm bothered that what passes as "time management' is actually' cutting corners' (ie falsifying charts and not giving good care). It's hard for me to leave a shift thinking I could have or should have done better. I've heard that nurse's who can't 'hack it' should not float, but maybe that's why they float me because I'm thorough?? Thanks for the input guys! :)

[SweetseRN]

I try to always keep in mind that I am only one person and there is only so much that is humanly possible to do in a day. That said, I take the time to get a good assessment no matter what. My next priority is to give all of my meds safely and with my full attention. Sometimes that means some things end up being a little late or passed to the next shift, but I always, always make sure all of the really critical stuff gets done and done right. I will probably get flamed for this but honestly, sometimes my charting suffers a bit. I know that some day that will bite me in the butt, but care of my patients is my priority. I can still sleep at night knowing that my charting wasn't perfect, I couldn't sleep if I was wondering if I forgot an important med or other critical aspect of care.

[MomRN0913]

I may get flamed for this myself...... but I learned something valuable from my first preceptor when I was med/surg tele float as a new grad.

Chart by exception. If nothing happened, no need to document it. There is not point writing "pt ate lunch, tolerated well, ate 75% of meal" just to fill in dead space. In the charting at the hospital I worked at, there was a section you initial for their meals and write in the percentage. No need to double chart. Now, if you read others notes, they had to write what I noted above in addition.

If an IV site is intact, with no infiltration, there is usually a section on the charting where you initial for a Q2 check and check off "intact" or something to that effect. No need to write it in the narrative, unless of course the site WAS infiltrated and you changed the site.

Yes, most nurses skimp on the assessments. I do what is legally required for charting and do good assessments and patient care.

You didn't mention it, but it is oK to use your ancillary staff. Delegate what you can to get your work that only an RN can do, done.

[Goldenhare]

Thanks guys! I think that you all have made some valid points. I hate going to work stressing about finishing on time. Hate it. so I think I will try to go tonight with a different outlook and see what happens. Thanks to all! :)

[TXNurse77]

As long as money is an issue we will always have a deficiency somewhere in this area. We're human and we can not be worked to death like robots. There is no way to get everything done in our shift per "the right way". Now, as far as the misappropriation of documentation, negligence on patient assessments, and medication errors, there is absolutely no sense in that.

[Goldenhare]

I have done a few shifts so far just trying to pare down what exactly has to happen and what doesn't. It is difficult as I still think I should do more. I'm still struggling with a balance and I struggle with what others leave undone. For instance, we had a drug seeking patient, very animated, and one night, I took over care and she was very, very sleepy-though vitals WNL. There was a small bag on the table directly in front of the pt so I opened it and found PO dilaudid! I mean what was the admission nurse doing? (Pt had no visitors). I think this kind of stuff is pt safety, but often feel that I am in the minority on this.

[Altra, BSN, RN]

I'm not sure what you're describing in the last post. Do you mean you went through the patient's personal belongings, such as a purse?

Other than on a psychiatric unit or other special situation ... a hospital is not the airport ... belongings don't get searched. If the patient brought in meds, or had visitors (who had been there a day or two prior) bring meds with the intent of taking them when s/he felt like it -- there's not a lot that can be done about that. Unless the patient is ordered a sitter, no one can be expected to have eyes on an alert & oriented patient every second of the day.

[MommyNurse2011]

I may get flamed for this myself...... but I learned something valuable from my first preceptor when I was med/surg tele float as a new grad.

Chart by exception. If nothing happened, no need to document it. There is not point writing "pt ate lunch, tolerated well, ate 75% of meal" just to fill in dead space. In the charting at the hospital I worked at, there was a section you initial for their meals and write in the percentage. No need to double chart.

I only have one thing to add about charting by exception. You have to be extra sure that your facility allows this. I did clinical at a hospital that there was sign posted in the break rooms to NOT chart by exception.