Best way to prepare for 5 pts at start of 12h day?

Nurses General Nursing

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hi, all! after i get my 5 id/med/surg pt assignment and reports, i'm already behind. once everything hits the fan at 8am, it may be 1pm before some of my pts get their 8am qd meds. i'm trying my best to set priorities, but giving pain meds, hanging iv antibiotics/antivirals, blood products and transferring everyone here and there for tests (we usually don't have a unit sec), and doing tech work (we don't have enough), and still everything seems to snowball. when 6pm rolls around, i totally start to freak out, knowing how much documentation and work still needs to be done. i've made up an hour-by-hour organizational sheet for each pt, which i keep in a binder, with a different tab for each pt, but i can never catch up. any thoughts on how to keep things running calmly and smoothly? thanks in advance!

The key is assessing your patients early, quickly and efficiently & charting the asess.; priortizing; getting your meds passed early (1/2hr) or on schedule to stay atop of things; and responding to problems, phone calls, pt/family questions/teaching. Good luck!

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Specializes in psych. rehab nursing, float pool.

I am not sure exactly what someone considers tech work. I do know however, if I clean up a patient that is a great opportunity to not only fully assess their skin, but to assess bowel and bladder function. I also like to transfer my patients again I get to assess how their balance is. To each their own.

I start my day after report, checking mars, then run quickly from room to room trying to catch the patient's before they get dressed for the day. I document all prn meds in the computer as I give them. Also blood pressure pulse as I go along. Somedays I am lucky and the CNA has already gotten the vitals before I need somedays they are busy with am cares so I do my own. I try and have all my assessments charted before 11am as that frees me up for the unexpected or expected new admissions to the unit. I hate waiting to document until the end of the shift as I am tired, find it takes me much longer to chart and to remember important points that were different on my shift.

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Specializes in ER,ICU,L+D,OR.

I always start with a fresh peeled orange and a cup of espresso.Gets my mind in gear

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Just to clarify:

At my hospital we have computerizing charting. We are able to "save" our progress and return to it later, just like you do a MS word file. I fill out as much as I know early in the shift and make more specific updates later on as I know the pt better. Once fully completed, I "check off" the completed record.

By keeping an updated "to do" list as your constant go to guide, I know what still needs to be done today.

It also helps if you work on a floor where they pts have long stays. This way you really know what to expect and can streamline your assessment as is appropriate.

But like I said earlier, the best help is experience. With time, you will find your perfect routine!

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Specializes in cardiac rehab, medical/tele, psychiatric.

I have the same question..but the monkey wrench is making it to rounds at 10AM with the expectation that all meds are passed and assessments are done. HA HA! Any other suggestions to address that. (I listen to report, verify abn. labs,test results, orders,consults, when meds are due..everything is on the computer) I pull my tele strips, see who is covering my pts, and check my charts. It is now 8AM..and I start passing me meds...I can generally finish my med pass by 10:00 but not my assessments. Anything I could do different from the posted suggestions?

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try assessing when your in giving your meds. since your in there anyway and it can streamline your time

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As someone getting ready to start my second year of an RN program, I really benefit from threads like these. However, they also scare me -- I can't imagine being able to get it all done. Plus, my hospital is getting ready to get rid of all techs/aides and make nurse:pt ratios 5:1 with the RNs responsible for everything the techs/aides do now. I just don't see how that will work out well for the nurses or the patients...

That is really scary,I'm senior and handle two patients at my clinical (total care) and I'm exhausted at the end of the day,I cant imagine doing total care for five and be on time!:(

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I work on a pulmonary stepdown where most pts are trached or ETT on vents. I take care of 5-6 pts regularly and 7-8 when we are short staffed. When I first started, I would always leave 1-2 hrs late just catching up on documentation. Some things just take time. You have to learn where all the supplies are, what is best to delegate to who, and of course, prioritization. Especially if you are working consective days, you can learn what needs to be done today and what can be done tomorrow or what to endorse.

Anyways, here is what I do:

Get assignment

Spend 1-2 min in each room

I look at: ID bands (which colors), IV access, Any IVs going, O2 source (nasal cannula, trach, etc), Alert/Orientation, Foley, SCDs, and everything else that is visible without even touching the pt. I say hi to pt/family member and introduce myself and see if there are any pressing concerns.

Get report

Go through orders for each pt and make sure they correlate with report; Check to see if applicable DNR/DNI are in chart and correctly filled out; Document my daily assessment for 1-1.5hr with hopefully minimal interuptions

Do 1st round of meds while looking at morning set of vitals; While in the room I do a more detailed assessment since I'm already gloved (pulses, edema, lung sounds, etc)

Back to documentation

The rest of the shift: meds, cleaning pts, nrsg care (trach care, priming tube feed tubing, etc)

I write my PIE notes in the chart at around 2-3 pm.

The key here is that my big priority is documentation. Once that is out of the way nice and early, I have the rest of the shift to be a nurse. I felt like a was running around with no time if I still had to do my documentation and kept putting it off until it was 8pm and the shift was over.

What I've seen some nurses do is start meds early and give pt #1 meds and document on pt #1, go give pt #2 meds and documents on pt#2, etc. I prefer to document what I know (even if I haven't completed my detailed assessment) and go back and modify as necessary. It's imp to look at diagnosis and past medical hx to know what to look out for. For example, PMHx Afib and AM set of vital signs show HR110 and pt to receive meds at 10am, pulse is prob going to be irregular. Or pt receives breathing tx, they will prob having wheezing upon auscultation. Pt had no BM x2 days and receives colace, the bowel sounds should be diminished. So on and so on. I make these educated guesses, and when I complete my detailed assessment with meds and go back and modify as needed. (we have computerize documentation so it works well this way). Not all will agree with this, but this is how it works for me.

During my shift I have three papers. I keep them either in the report book or in a folder with my name on it:

1. The first one is my "dirty" one that I scribble down my rough assessments that I throw out once I'm done with my daily documentation in my computer. This is made within the first 15 min at work.

2. The second is the print out of my patient list where I have two columns. The first is for me, where I write down things I need to get back to sooner or later (pt needs to new IV, don't forget to complete x flowsheet, look at CXR, etc). The second column is what I need to tell the MD (d/c blood glucose monitoring q 4hr, reorder IVF, d/c NPO and reorder tube feeds, etc). I check off each phrase as I complete them or as the MD places the orders. I continually update this throughout the shift as new things occur (ie, pt NPO for PEG tomorrow, hang IVF). This is also where I give my report from to next shift since it has all the new stuff on there.

3. The third and last paper is my assignment sheet with for my nrsg techs. I keep the original for myself and make copies for the techs. Here is where i right if they are PO/PEG/NPO, Full code or DNR, blood glucose checks and the results as I get them, foley or bs commode or incontinent, isolation pt or clean, and any other pertinent info (ie no BP right arm, daily weight). I complete this hopefully by 9-10am. I like this because it's a quick overview of all the pts and help remember their names and general status.

Hope this helps!

Good luck, but don't stress!

Wow I'm suprised you dont take your vital signs before giving meds,my instructors always teach us to take our own vital signs BEFORE giving meds not 2 hours before...

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Specializes in Med/Surg, Home Health.

I work med/surg too. I always carry my clipboard with all my assessments on it. I gather meds for 1st patient and go into room, assess (and fill out parts of assessment while im in the room with them so I dont forget their sats, lung sounds, etc), give them their meds and then move onto the next patient and do the same. I always take my meds in with me as I assess. Then once I see the last patient, I then make one more round to check on them and then go chart. It will take you a while to get down a "system" that works for you.

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Specializes in psych. rehab nursing, float pool.

In many facilities the aides do the morning vitals and chart them to be ready for the nurse who is doing meds. That way the only vitals the nurse needs to repeat are the ones with specific parameters with them. Or the vitals which were out of the norm. It helps to speed up process in the morning.

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Specializes in Telemetry & Obs.

Channeling Bobby Vee:

Come back when you grow up, girl

You're still living in a paper doll world

Living ain't easy, loving's twice as tough

So come back, baby, when you grow up

lovehospital, come back when you're taking care of MORE THAN two patients. Nurses usually have CNAs to take VS...and unless they're giving a medication that affects BP or HR they don't have to check VS again before administering.

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Specializes in Telemetry & Obs.
In many facilities the aides do the morning vitals and chart them to be ready for the nurse who is doing meds. That way the only vitals the nurse needs to repeat are the ones with specific parameters with them. Or the vitals which were out of the norm. It helps to speed up process in the morning.

That's what I get for taking a bathroom break while posting a reply...repeating a reply!! Ooops, wasn't there a recent thread about just that?!? :D

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