Experienced nurses: teach us your time management skills

**canoehead, BSN, RN** · Dec 15, 2009

Well, first, most of the technical skills are going to get faster with repetition. Like twice as fast, that's a lot of extra time. If you can halve your time for a bedbath, voila! you've got time to brush dentures, and make the bed before you leave. Imagine how efficient you'll feel!

Next, you'll learn how to talk and retain informaion while you do those tasks. You know how when you start an IV you have to take time and concentrate on your work, meditate over the vein, and pray a little...no more. Equipment out, deep breath, STICK! and on with your day. The more you talk to the patient the less time you spend on an official interviewing mode, and the more they see you as relating to them as a friend, not so much as a census taker. Better relationships mean less stress on both sides.

The more experience you get the more you can anticipate needs and problems. Like extra linen, emergency equipment, comfort measures that you walk in with at the beginning of the shift instead of making 3 trips to the supply room.

Start with water, and call bell at the bedside, and bedside table cleaned of garbage and in arms reach. A garbage container within sight of the patient will save cleaning up for you too. Also suction and oxygen in the room. I SWEAR it drives away evil spirits, and if you need it having it right there starts the whole mess making you look very professional and efficient...always a good thing.

Start with trying to walk in with everything you need for your patient contact, and keep mental score as to how many time you need to go fetch something. Over a few months things will get better and better.

stressgal, RN · Dec 15, 2009

I agree with the above poster. New grads are very task oriented. Nursing often does not allow for a set "routine", some days you are simply stamping out fires as they occur. With that said I attempt to take report from the off going nurse, doing so with walking rounds helps me lay eyes on the patient, address any urgent needs. Then I glance at my labs, grab meds and head in to assess the patients. Usually after that it's about time to check my new orders, and then reassess my patients. Some days go better than others. Some days I have radiology, physicians, pharmacy and whoever else coming at me in all directions. It really does take time to find your groove. But as the above poster stated, try to find ways to streamline your tasks. It's a 24 hour day and everything will get done eventualy.

Supernrse01, BSN · Dec 15, 2009

I agree with both posters... it will get better and faster with time. When I worked in the hospital, I woudl try and get everything done in one room before I went on to the next. Sometimes that isn't something that works but more often than not... I would try and get the pt bathed, beds straightened or changed, meds passed, etc... keeps from making multiple passes to the same room. I also kept my "brain" with me. I kept a clipboard with all the days events written down, who needed foley care, I&O, dressing changes, etc... that way if I was in the room for something else, I had that little reminder card there to help me out! Also helped at the end of the shift when giving report because all the important info was right there. Good luck :0)

SoundofMusic · Dec 15, 2009

I just cluster, cluster, cluster. I think about what I need everytime I go into a room. I combine 8 with 10 meds, and so on. I will also just do a little at a time -- one assessment in, then go off to do something else. I do it little by little and somehow it all adds up gets done. But I believe a lot of it is grabbing what you need, as much as you can, everytime you go into a room.

I also try my best to arrive 15 mins early to just get my sheets, label everything, get my book ready, etc. before I start report. It just makes me calmer and better able to absorb everything.

I always check labs first. That's what the docs look at first also. Usually they drive any urgent need most times.

And then you just get faster at everything. Admission interviews is what drives me the battiest. People will just take their time in telling you everything while you've got a million things going on in other rooms.

I don't think there's any magic thing --just cluster the care and move very fast. Make use of every moment to either write a note, chart a med, do whatever. I also keep an SBAR column running for when I get to talk to a doc. (situation, background, assessment, recommendation). I also have a sheet I stick on the top of my notebook w/ all 4-5 patients listed in a box. That way I can glance at all four and keep little to do lists on each one. It's as if I know what is going on at all times in each room. It's my brain divided by four -- or five.

I think taking a few minutes to look at each test done w/ results, each lab result, each md note on each patient saves time. You understand what is going on -- what the plan is, what is priority -- and THAT can really help you plan what is important and what is not. If I know that all the tests are done, all blood drawn, etc, then I know I might not have to spend as much time w/ a certain patient as I do another. If you know the big picture, it helps to know where to put your efforts.

ellakate · Dec 15, 2009

Hello, HeartsOpenWide!

There is some really good advice in this thread. Remember, nursing is a process, an evolution, not a revolution. You will find your own best practices, using things that you learn here

It has been a long time since I was in a hospital, but when I tried to keep the following schedule, things seemed to flow better for me. Plan to get all your VS and see all your patients in the first hour. After VS, prepare medications. Breakfast time. Go to the restroom! Open your charts. Pass meds. Perform AM care. Time for lunch and noon meds. Finish AM care for patients requiring extra assistance. Check your charts for new orders. Finish passing noon, mid-day meds. Chart some more. Answer lights. Prepare for change of shift report. Try to finish charting 30 minutes before you start report. If something happens to a patient, you can then add an additional note.

Patients are very understanding. Let them know that you are training for a patient care marathon and that you need their help to become more efficient. Combine tasks, like VS, assessment, passing meds. Remember to check VS before passing meds, so that - - -- you know the rest! Remember to check AM blood sugars before breakfast, unless otherwise ordered. Take the pulse with your left hand so that you can see your watch at the same time, for right handers.

There was a time in nursing care when we were educated to not be 'task oriented,' but that was also some other century. When you get discouraged, take a deep breath. Your heart is in the right place. Your hands are some of the ones that God has put on the earth to help.

Sometimes being a nurse is like being pecked to death by ducks. :specs:

Blackheartednurse · Dec 15, 2009

I'm not an experienced nurse but I have read a lot of stuff about time management and I came to conclusion that it all comes down to one thing; how well organized you are,without a solid organizational skills it is impossible to learn time management skills,I would start with your organization skills; do you have an awsome brain sheet? If not take a look around this forum (cardiac section has some great examples of cheat sheets). Once you find one that works for you best invest in a three ring binder and then buy couple of dividers with pockets. Put in your report sheet for each patient in the divider pockets,behind dividers put in their other important info like MAR (if your unit lets you print out MAR),Labs,Vitals. Originally I thought carrying a clip board would be a better option but once I read here that one of the nurses uses binder and she found it to be very helpful so I personally made a decision to try out a binder and see how it wil work for me,it sounds like a more organized method of keeping your patient info together and not confuse it with other clients papers. Of course the first thing I would do after report would make quick rounds to see if patients are still alived,check labs,then print out organize my paperwork using binder method I described earlier,then spend few minutes figuring out which patient is the priority for the day...which needs immediate attention,which sacrifice more time than the others..but then again becareful the patient who appears most stable might be the one who will need most help at the end,you just never know how things will turn by the end of the day.

Florencebyondthepale · Dec 15, 2009

I'm still in my first year, but I have discovered some ways to make things go faster. First, I never wait to get report...at my hospital we have 15 minutes before report time. I never hang out in the lounge and wait, I get my assignment and go out on the floor. If the nurses on the floor are still busy, I check my charts. If we have no tech for the shift, I'll start getting vitals (and avoid having to wait for or share a Dinamap). Once pharmacy delivers meds for the am, I check my emars and the med drawers/fridge to see that the medications my patients have are actually there. Unfortunately, my pharmacy is notorious for missing meds and also notorious for taking forever to send them when a request is made. It is a huge waste of time to track down a med at the time it is actually due. I fill water glasses, bring in linen and other supplies with my initial assessments. If I know my patient is always going to ask for something, I bring it first thing in the morning.

As the day goes on, if I feel like I am getting behind, I try to assign a time limit to a task and stick with it (15 minutes for a dressing change, 5 minutes to change a bed, etc). I also try to chart everything as I go along. If I can't manage to chart it at that moment, I write down the task and the time it was completed (especially when I give pain meds-so I can remember to re-assess and chart). I will write down I & O's during the shift, so that all I have to do is add them up at the end. I also try to buddy up with another nurse to set times where we can help each other with heavy patients. I also try to do the tasks I dread or deal with the most difficult patients first, so the rest of the day will go smoother. And above all, when I see my day going downhill, I ask for help.

Tait, MSN, RN · Dec 15, 2009

1. Breathe

2. Stay calm.

3. Breathe again.

4. Mental note critical/time sensitive issues. For me this is anything that NEEDS to be done by nine (PM for me, night nurse here). Such as med clarification, a random late discharge, ANTIBIOTICS, pain/nausea, bleeding/oozing/limbs falling off.

5. If everyone is settled for a bit work meds and always ask "is there anything else you need while I get this cup/ice/spoon/crackers/stack $100 bills and med rare fillet of tenderloin? Don't let rooms run you ragged with constant requests.

6. At night I feel pretty safe saving all my charting fro the witching hour, 11p-2a before I start the assignment for the day, so I tend to take care of my patients first, chart later. I figure if Lord save me something bad happens I can always sit down AFTER my shift and organize the charting on a patient or two if need be. I am generally always out well before 8am even with walking rounds.

I am sure I have some other nuggets of wisdom in here, but for the time that is most of what I can think of. (Day three work brain fuzzies).

Take care!

Tait

Virgo_RN, BSN, RN · Dec 15, 2009

I don't consider myself an "experienced" nurse, but I have completed that transition from student nurse to professional nurse. The single most helpful bit of advice I ever got from an experienced nurse during my transition was twofold (and from two different nurses; one of the perks of having more than one preceptor):

#1) Do an assessment you can bank on. In other words, your head to toe assessment is not the place to cut corners. While charting as you go is better so that everything is fresh in your mind when you chart your assessment, if you cannot chart as you go due to a time crunch, make sure you note all pertinent abnormals on your worksheet so that when you do chart, you don't forget anything. My worksheet had a section with my systems assessment, arranged by system, and common abnormals that I could just circle instead of having to write notes for everything. For example, under "Neuro", I had "A&O X 1 2 3 4" and would just circle the patient's level of consciousness. I had enough room in the box to write in "drowsy" or any other shorthand info. Under "Cardiovascular", I had "Murmur/irregular/S3/S4" and so on. For "Respiratory" I had things like "RA NC SM NRB" and "F. Crack./C. Crack." etc. These were all things that were COMMONLY encountered in my patient population, with enough room for shorthand notes for the less common findings. In this way, I could do my head to toes, and even by the end of my shift, be able to look at my worksheet and form a picture in my mind of what this patient looked like. I could also use it for giving shift report, just going system by system with significant findings.

#2) Triage your care. This is a biggie. There are some things that absolutely MUST get done at a certain time or within a certain time frame. These are your top priority. Assign them a "1". There are things that need to get done, but you have some leeway as to when. These are a "2". There are things that should get done, but the world will not end if you don't do them, and you can pass them on to the next shift if you absolutely have to. These are "3". Prioritize all of your 1s, squeeze in your 2s as time allows, and don't worry about the 3s. If you end up having time, then do them. Never let laziness allow you to not do a 3. But if you are working your buns off and just can't get to a 3, don't worry about it. Just be sure to give the oncoming nurse a heads up that it didn't get done, so they don't have any surprises when they go in to do their assessment and find something not done.

Eventually, as you develop your practice, you will get better at managing your time, and there will be less and less 3s. You will find your efficiency improving and your ability to multitask becoming stronger. One day, a new grad will pass on a bunch of 3s to you, and you will remember when, not so long ago, that was you, and you will smile and be patient and tell that new grad they did a good job and to go home and get some well deserved rest.

locolorenzo22, BSN, RN · Dec 15, 2009

I find that often it is a matter of prioritizing different patients and what exactly I'm going to have to do for someone.

I work nights, so I pull all my 6pm meds together for each patient(including pain meds if the patient is due for them). I then plan who I have to go see. Admits, post-ops, and critical patients(hospice/going for sx/going to a test/etc) come before people who are just hanging out. Then I go see anyone with IV fluids or any kind of advance care(dressing changes/suctioning/total care/hospices again). some nights are quick and I can get the head to toe done, and see everyone by 45mins to 1 hr. sometimes I get delayed and as soon as I get back to the station, I need to go see patients again for 8pm meds....then back for 10pm meds.....usually, I can get a few people charted on between med passes.

Plan to always get your head to toe done ASAP....the faster you get done with those, then all you have to do is followup pain charting/dr pages/etc or another head to toe if needed.

I rewrite what I want to say in report around 2-3 AM so I don't miss anything....helps me to reorganize things...

sistasoul · Jan 4, 2010

I don't consider myself an "experienced" nurse, but I have completed that transition from student nurse to professional nurse. The single most helpful bit of advice I ever got from an experienced nurse during my transition was twofold (and from two different nurses; one of the perks of having more than one preceptor):
#1) Do an assessment you can bank on. In other words, your head to toe assessment is not the place to cut corners. While charting as you go is better so that everything is fresh in your mind when you chart your assessment, if you cannot chart as you go due to a time crunch, make sure you note all pertinent abnormals on your worksheet so that when you do chart, you don't forget anything. My worksheet had a section with my systems assessment, arranged by system, and common abnormals that I could just circle instead of having to write notes for everything. For example, under "Neuro", I had "A&O X 1 2 3 4" and would just circle the patient's level of consciousness. I had enough room in the box to write in "drowsy" or any other shorthand info. Under "Cardiovascular", I had "Murmur/irregular/S3/S4" and so on. For "Respiratory" I had things like "RA NC SM NRB" and "F. Crack./C. Crack." etc. These were all things that were COMMONLY encountered in my patient population, with enough room for shorthand notes for the less common findings. In this way, I could do my head to toes, and even by the end of my shift, be able to look at my worksheet and form a picture in my mind of what this patient looked like. I could also use it for giving shift report, just going system by system with significant findings.
#2) Triage your care. This is a biggie. There are some things that absolutely MUST get done at a certain time or within a certain time frame. These are your top priority. Assign them a "1". There are things that need to get done, but you have some leeway as to when. These are a "2". There are things that should get done, but the world will not end if you don't do them, and you can pass them on to the next shift if you absolutely have to. These are "3". Prioritize all of your 1s, squeeze in your 2s as time allows, and don't worry about the 3s. If you end up having time, then do them. Never let laziness allow you to not do a 3. But if you are working your buns off and just can't get to a 3, don't worry about it. Just be sure to give the oncoming nurse a heads up that it didn't get done, so they don't have any surprises when they go in to do their assessment and find something not done.
Eventually, as you develop your practice, you will get better at managing your time, and there will be less and less 3s. You will find your efficiency improving and your ability to multitask becoming stronger. One day, a new grad will pass on a bunch of 3s to you, and you will remember when, not so long ago, that was you, and you will smile and be patient and tell that new grad they did a good job and to go home and get some well deserved rest.

I think this the best advice I have read regarding time management. I still get done so late and have been off of orientation now for 8 months. I still struggle with this. I don't think only having 3 weeks of orientation helped either. I have noticed the new grads who were lucky enough to get in to the 3 month residency programs get out earlier than I do. I really need to get this time management under control. It is depressing and I feel like a failure because of it.