I know time management skills, lack there of, is really killing me as a new grad. I know my stuff, but my time management skills are starting to make me look bad! I know some of it is that I am not the most organized person in the world, not the worst because I am fairly anal, but learning how to be a nurse makes me feel like a "dysfunction Type A"; I am having a hard time getting my grove down.
I have read several threads on there with new grads struggling as being new grads and many mention time management skills. Most responses are "it will come with time". Can any of you experienced nurses give us actual tips, tricks of the trade, things you do to manage your time?
My time management is not up to standards according to my instructor, I was failed in med-surg clinical rotation due to spending 1 1/2 hours bathing, changeing bandage, bed linen, and gown that was soaked in blood from hip surgery the day before. According to my instructor it was not priorty. I dont understand, you wouldn't allow a patient to sit in their own urine or feces why their own blood?
I work 7pm-7am on a busy med-surg/ortho unit where time management skills is a common problem and cause of poor nursing care and patient complaints.
We do bedside report, during bedside report I make sure to notice the environment as well as the patient. Is there IV bag on the last 100ccs, are they out of water, is the foley not emptied? I ask them what their pain level is and if they are okay with it. If not I request that day shift address these issues before they leave. Otherwise I tell the patient I will be getting report on the rest of my patients and will be back in about an hour (always overestimate).
When I finish getting report on my patients I prioritize them. I get all meds for patient A (including pain meds and insulin and prn blood pressure meds (if they've been running high) which all may or may not be needed) I put extra alcohol, flushes, syringes in my pocket along with a spare set of primary/secondary tubing and IV labels and a vital signs machine and accucheck machine when needed. I check vitals, do an assessment, get a blood sugar and administer meds accordingly. I then update pt A on plan of care and tell them I will check back in around two hours (unless I gave IV pain/BP meds and they need to be reassessed sooner.
Then return all unused meds for Pt A while retrieving meds for Pt B. Repeat steps above for as many pts as you have. Then before I sit down I re-round on everyone, hopefully this is around 10 o'clock, when I can assist everyone with getting ready for bed as needed (turning off lights, getting water, toothbrush/toothpaste, toileting). I tell them I will be back to check on them in an hour or two and when their next medication is due/available. This usually gives me a good uninterrupted hour or two to chart and do twelve hour chart checks.
Around midnight I will repeat rounds and update assessments/interventions as needed and repeat q2 hours and PRN, each time updating the patients (if they are awake) when their next medication is due, when I'll be back and to call if they need anything in the meantime.
I have found this to be ideal at reducing pt call lights and improving their satisfaction with the care I provide while giving me uninterrupted time to get my charting and misc things done. This includes spending extra time/care on a high acuity pt or providing additional education, preparation for the next day.
It may not work for everyone, every unit or everyday, but doing this I can count the number of days I have stayed late in two years on one hand.
My time management is not up to standards according to my instructor, I was failed in med-surg clinical rotation due to spending 1 1/2 hours bathing, changeing bandage, bed linen, and gown that was soaked in blood from hip surgery the day before. According to my instructor it was not priorty. I dont understand, you wouldn't allow a patient to sit in their own urine or feces why their own blood?
No, you definitely wouldn't allow a person to sit in their own blood all day, but the person is not going to die if they do. While something you'd definitely want to address it would not be priority. And 90 minutes on a bed-bath and linen change?!? I think that was the problem. That is one eighth of your day! I know ortho patients are often difficult to bathe/change linens because repositioning is difficult, but get help. Also, I know on our floor we are not supposed to change ortho dressings, the doctor always wants to do it or have it done as specified. We just pad with abds and re-wrap, but even so the dressing change, bath and changing the linens should have taken at most 20-30 minutes.
Specializes in Peds Urology,primary care, hem/onc.
Way back when I was a new grad 12 years ago (yikes I am getting old)... my preceptor gave me some valuable advice. Whenever you have 2 seconds to take a breath, stop for a second and ask yourself (what can I be doing NOW). As you get more experienced, try to stay a few steps ahead of yourself. Oh, I have 2 minutes... I can get everything for my labs together, I can get all of my meds together, I can chart for 2 minutes etc. Don't save anything for later that you can do now. When you are waiting for something (call from lab, MD, radiology) think to yourself...what can I do while I wait? Prioritize what needs to be done first, as has been advised already, and check it off your list as it has been done. Get into a routine and do it over and over, you will shave off a lot of time with repetition.
If certain things take you a lot of time (IV set up, procedure set up etc) think ahead of who may need these during your shift and when you have a minute, get set up.
Always stop for a second and think when you go to the supply closet/linen cart....think what else do I need and bring it all at the same time. Bring 2 of everything to a room, you can always put back what you don't use on your next trip, but saves you time from going back/forth.
Even as a PNP, I do this now....
Waiting for them to room my patient- start their visit note
On the phone and on hold with lab, md office etc- check my labs, answer my work emails etc.
Waiting for call back from MD- write down all of the pertinent information for the call
I use tons of sticky notes, keep a pad in my pocket at all times.
I also started to try and multitask/priortize when I did things at my house. When I cleaned etc...got in the habit of clustering things together, just like I did at work. After time, your mind is just programed to think that way.
One of the biggest frustrations is that even as a newbie makes great strides from day to day or week to week or month to month, they are likely to keep hearing that they don't manage their time well enough because it will be a long time before they can function on par with their more experienced peers. In fact, for where they are, they may very well be managing their time wonderfully! No matter how much great advice the newbie receives and how much effort they put into it and how much progress they make, some things just take time and experience.
So, the newbie may be so proud of an incremental improvement just to be chastised (again!)... "it took you how long?! you really need to learn to manage your time better!"
I learned this back in my days waiting tables and finally "got it" after being a nurse for a couple of years... write things down!! Your short term memory can only hold so many things and you don't want to get that feeling of "what did I forget??!" at the end of the shift. I used to grab a fresh sheet of paper and tape it to my clipboard every am. On it I would list various things that I needed to attend to as they came up i.e. "Call Dr. X to clarify 225 x-ray orders" and by writing it down, put it completely out of my mind. Then whenever I had a free moment, I would flip over my papers and glance at the sheet. Someone else mentioned giving things a priority number, 1,2, or 3. I think I mentally would do that. Cross the most essential items off the list as soon as possible, then you will be left with things that don't absolutely need done this shift. I tried writing things on each individual pt. report sheet, but missed too much. I did however write things like lab values that I wanted to report to the MD or the next shift so each pt's info was in one place. Sometimes this would involve writing something in more than one place, but it was a small sacrifice for a clear head and smoother shift.
If something comes up that needs done NOW, drop what you are doing and do it. As soon as that critical lab comes in, call the MD. take care of things and move on.
I definitely do cluster care. If I have a dressing change to do that day, then I make sure that I bring the supplies in with their am meds and do it then. Also, if there is a med due at 4pm and a med due at 5pm, I will give them both around 4:30pm to cut out trips. Of course, I don't do this with important meds, like IV antibiotics.
When I was new, I created a flow sheet that had spots for pt notes on it at my house and printed it out for work. In the am when I got report, I would make enough copies to cover my pts. Then, when I had a moment, I would look at the MARs and write beside each pt what times they had meds due. Double check. This way, you don't spend so much time flipping through the MARs all day. And, if you were called to go to the pts room, you could look at your flowsheet to see if you could go ahead and bring a med in with you since you're going there anyway. I use my cell phone's alarm feature to remind me of important times, like if I need to check my pt's recent lab draw to see if I needed to increase their heparin gtt. I got a drug guide app for my phone to make referencing quicker. Oh, and never get in the mindset of "this HAS to be done NOW" b/c it can really stress you out. I have my little routines, but when they get messed up, I just think "well, I have a 12hr shift to get it done in." Granted, this may not always work, but it definitely lowers the stress level if you are very flexible.
Haven't read all the posts but a "brain sheet" is a must.
Also, give yourself a break. It does get easier with time. An experienced nurse is starting her assessment and plan for the day the minute the nurse begins report. It continues as soon as he/she walks into the room. It will become second nature. A quick scan of the room and brief conversation will tell you a lot in a few seconds:
If you know where you are working, start the assessment as you walk in the door. I usually do 1/2 of them on my way to the desk to sign in. I just go from room to room on my way in. Then after report I finish it. Then when I start work I already have seen everyone, and can start the vitals on the ones that need it, and give pain meds to those that need it. I am already ahead of the game that way.
When I first started nursing, I was following a nurse who was in her 70's and had an arthertic limp. But, she could run circles around me. She would be done and having a break, and she had the hard patients, while I ran around in circles. It was so frustrating. I vowed to learn one new thing every day. I hoped it would catch up with me, and it did. One of the first things I memorized was: what to bring to a room. I remember the day I actually had a break on time. It took a couple of months, but it finally worked.
Just keep at it. You are certian to find your stride.
I work 7pm-7am on a busy med-surg/ortho unit where time management skills is a common problem and cause of poor nursing care and patient complaints.
When I finish getting report on my patients I prioritize them. I get all meds for patient A (including pain meds and insulin and prn blood pressure meds (if they've been running high) which all may or may not be needed)
Then return all unused meds for Pt A while retrieving meds for Pt B. Repeat steps above for as many pts as you have. It may not work for everyone, every unit or everyday, but doing this I can count the number of days I have stayed late in two years on one hand.
Risk for error. Hopefully you go with your paper MAR or some sort of identification. Or you're just one smart nurse.
justbeingme
1 Post
My time management is not up to standards according to my instructor, I was failed in med-surg clinical rotation due to spending 1 1/2 hours bathing, changeing bandage, bed linen, and gown that was soaked in blood from hip surgery the day before. According to my instructor it was not priorty. I dont understand, you wouldn't allow a patient to sit in their own urine or feces why their own blood?