how did you develop your flow??

[kimber3ks, ASN, BSN, RN, EMT-B]

I graduate next week!!!!! I am in the middle of doing my six 12-hour shifts in the ICU, 2 days down, 4 to go. So far, so good.

I am still feeling terribly disorganized and find myself forgetting basic things, like med times, q.2 hour blood sugars, etc. How have you new RNs developed the flow of your day, or even the first hour or two? Do you have set things you do (or try to do), and then move on from there?

Of course I know we have to improvise, but I feel like I need a skeleton plan and then at least I will have something to work from.

Thankx

Kim

[NotReady4PrimeTime, RN]

I like to use my flowsheet to remind me of when things need to be done. Try finding a spot where you can write in when your blood work and meds are due, and any other things that might need to be done such as dressing or line changes, xrays etc. Our flowsheet has a column down one side that is left blank for jotting down notes or unusual occurances; that's where I put my reminders. Of course this won't work with computerized charting, but you could make a worklist on a piece of paper with each hour of the shift down the left and a column for each patient; then you can jot down your schedule for each one next to the hour it's due.

[truern]

Not sure how your hospital does things, but we have "onlines" that are printed out at the beginning of each shift for each patient. They include orders, labs, etc. I highlight the pertinent info and then I list times meds, BGs, etc are to be done in green along the left side. I also include procedures, xrays, etc in green along the left side (green for "go do") I write history, date of/reason for admission at the top, and any info from report at the bottom in black or blue. Things that I want to make sure to include in report at the end of my shift I write or circle in red.

Anyway, with the things to "go do" listed in one area of each online I have somewhat of a schedule to follow.

Trust me...you'll discover what works for YOU with time. Look around at how the other nurses plan their day for some tips :)

[crawlyberry]

Thanks for asking the question. I am not out of school yet, but I have been nervous about time management issues. I keep hearing about something called a "brainsheet" and on other posts some nurses gave the actual document. I, for some reason, cant open them. Hopefully someone will read this section and resend it for you. I want to know how often are you suppose to check for new orders from the doctors. What is the norm. Any advice would be appreciated. Thanks.

[Hoozdo, ADN]

I graduate next week!!!!! I am in the middle of doing my six 12-hour shifts in the ICU, 2 days down, 4 to go. So far, so good. ..........

How have you new RNs developed the flow of your day, or even the first hour or two? Do you have set things you do (or try to do), and then move on from there?

Here is my first one to two hour flow for the ICU.

1. Get report on both patients. Be SURE to go through the orders in the chart during report to see what needs to be done. Make sure you can read all the handwriting on the orders. The nurse you are getting report from should have looked at them already and deciphered the hand writing. I make a note on my brain sheet about anything special that needs to be done, ie....cat scan at 2:00 AM, Vanco trough level and peak levels.

2.After report, go in and assess your patients. Write down anything out of the ordinary in any body system because it might be quite awhile before you can sit down and chart. Confirm anything you were told in report about this pt. For example, confirm vent settings, what drips are set to and are the concentrations correct, and throw out uneeded things cluttering the area while I am in there.

3. Go to MAR and figure out when my meds are due and see if any meds were missed by previous shift.

That should cover the first hour unless there is a code, rapid response, families asking questions, doctors asking questions. Your biggest priority in that first hour is to assess your patients unless there is a pretty big emergency that you are needed for.

The next big priority will be your meds. Whenever you have a spare 2 minutes then CHART. I can't count the times in the first year of nursing I have gone an entire shift and hadn't even started to chart! Try to allocate a certain time to chart between meds......it's nice to have a plan to chart

Well that should be enough to get you started for two hours! Remember, this is time for you to learn. Ask, ask, ask.....and have some fun too

[tamari07]

Find your routine! That's what has saved me. When I walk out of report I know what I'm going to do... get my MARs, nurses' notes, record med times on my index card, check labs/results on the computer, do rounds... and so on. Once I have my basic routine, if things get messy or crazy, I know I can fall back into my routine.