Advice For Workflow Routine
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Hey, everyone. I’ll try to keep this as brief as I can so as not to exhaust readers.
So, I am a PCU nurse with about 5 years of experience, and at this point I feel pretty confident in my clinical skills and the knowledge I’ve acquired (though I know there is always tons more to learn). The issue I am having is my workflow, in that I worry I am too slow or over analyzing things. My routine goes something like this on a “regular” night: Get report, look at the MAR and orders to see if something was missed throughout the day that needs to be immediately followed up on. Or if there is, say, a q 6 or 8 hour antibiotic due soon that needs to be brought in with my first assessment. I then complete all of my assessments and return to the computer to write down which patients have AM labs, review the patient’s lab results (sometimes from admission to current date if it’s not too much, in order to look at trends and get a better overall clinical picture), check micro for cultures as applicable, and then vitals to note which meds to hold or question, as applicable. I also fill in anything I didn’t receive in report, like history, consults, bed status, etc. I then begin my med pass as normal. The thing is, I always seem to be behind other nurses. But, I don’t know if that is because I over analyze things or if they don’t look at orders and labs and other important details. I can’t tell you how many times I have caught orders that were missed that would have been caught had the patient been reviewed thoroughly and systematically. That’s not to toot my own horn, and I don’t ask annoying and petty questions during report—it’s just pointing out that even though I am slower in my routine, I think it’s because I am being conscientious and trying to do a good job. But I wonder if others are doing what I’m doing and doing it faster, or if they’re not checking all they should.
In light of the aforementioned, do you all get the perception I am taking too long? For the most part, I am able to give meds and see patients on time, prioritize seeing sicker patients first, at least lay eyes on them during report, and keep up with things (at least on night shift…ha.). But, when I was training in the past, I got the impression from my preceptors sometimes that I was taking too long (granted, I was newer then). More recently, when I was “up training” for ICU to help out during the height of COVID last year, I still got that sense sometimes from the ICU nurses I trained with. I am acutely aware the floor or unit moves very quickly at times, and that you never know when sh** is going to hit the fan. But I also hate not knowing what’s going on with my patients and feel an urgency to fill in missing details from a bad bedside handover, say, or when getting an admission right before shift change. I am also aware you have to use your clinical judgment and prioritize patient care and safety, so that may mean dealing with a sick patient all or most of a shift with an incomplete report or clinical picture due to lack of time to review properly.
All that to say, do you all have any suggestions about what I can do to improve my current routine? Do you have a similar routine? How do you all balance the need to have solid information and prioritizing patient care and safety?
I really appreciate your time. A part of me has the ICU bug and would like to give it a shot, but even though I have five years of experience and feel confident in my clinical knowledge and ability, I don’t feel particularly confident in my routine and don’t want to run into problems with it if I were to transfer to ICU. As you all know, even though details matter and ICU nurses tend to be on top of things, stuff can happen very fast and you don’t want to get too far behind and overwhelmed.
Thanks again and hope you all are well where you are.
Sincerely,
Ethan