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??

[dudette10, MSN, RN]

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.

While I agree that you don't search belongings, some hospitals have a policy against keeping home meds at the bedside. There have been a number of times that I have seen the pharmacy bottles at the bedside, informed the patient and/or family that it was against policy for safety reasons, then took them away from the bedside for safe-keeping per policy until discharge.

Apparently, a confused patient was overdosing himself on heart meds, which led to this policy at my workplace.

[Valerie99]

I used to try to be more efficient at everything. Then I realized that I was doing too much. Before doing a task, I now ask "Should this be done at all?" This has helped me tremendously!

The idea was inspired by an article in a tremendously inspirational blog, which is here 6 Things The Most Productive People Do Every Day . (Point #3 in the blog addresses this).