Time Management

[dmckague]

So I just started my first job on a post surgical unit and I really love it. I am currently managing 3 patients and it is just so overwhelming. It is not the nursing part that I find overwhelming, I can do that; but the paper work! The hospital I work at uses both a computer chart and a paper chart. Doctors come an write orders and it takes me a while to figure out that they have written a new order. Also is it me or does every patient have meds at the same time, so I give some of my meds late (past hospital policy 1/2 hr). It is really hard to keep track of everything I have to do. I stumble around questions that are asked to me about the patient because I just don't have time to go and read the entire H and P (unlike nursing school).

Any advice for this new grad? Does it get better?

[evolvingrn, BSN, RN]

You have 3 pts correct? so you start you med pass 1/2 hour before the due date,(which fits in with your policy as you stated) that gives you a full hour to give meds to 3 pts which is definitely doable. I find that making a game plan ahead of time keeps you on time. You will definately get there.

[regularRN]

If you have time... arrive at work before the beginning of your shift to read your pts' H&Ps, orders, labs, MAR etc. Sketch out a routine that you try to follow every shift - admittedly there will be many distractions - e.g., take report, introduce yourself to the pts, figure out what their goals are for that shift and how you can help them to meet these goals... liaise with your CNA, and address any emergent requests/problems; then start on your med pass.

If it helps, make a check list for each pt - depending on the shift, one might include 0730 meds e.g., insulin; 0800 meds e.g., antibiotics; 0900 scheduled daily meds; 1130 - digoxin, finger sticks; 1200 insulin, antibiotics etc., 1300 etc. etc.

Add IV fluids - e.g., the rough time IV bags require changing - and times when PRN meds were last given and when they are next due...

Include orders such as "remove foley", collect U/A etc. Sort of a spread sheet - include tests (x-rays etc.), PT, OT, ST, and your physical assessment. Check off items as they are completed.

[glutton4punishment]

We get an hour grace on each side of the time the med is to be given.

[WillowNMe]

What type of brainsheet are you using? I find the more patients I have, the more I rely on my brainsheet. I have one that I can share with you if you would like.

[MntnGirl]

If you're really concerned about getting meds administered within that 1/2 hour window maybe you could administer meds to each of your patients and after administration go back and begin your assessments. This way your introducing yourself right away and getting meds passed and basically starting all over with the patients. Patients (most) seem to like this because they get to see you 2 times within the first hour/hour and half of the start of your shift. I imagine you will be getting bigger patient assignments as your training progresses? With more patients (a typical pt load on my floor is on days 4-5 and nights 5-7) comes more meds and more assessments and more orders, so time management becomes extremely important. What can really throw me through a loop is change of shift admits - I still have a hard time juggling the admit and passing meds, assessing, and managing my patient load. It will take time and experience to develop your own routine, I've been on a surgical floor for 15 months (started as a new grad) and I can say that it took me a good 9 months to recognize that I wasn't as rushed as when I first began, and I was doing more 'looking at the big picture' versus just checking off tasks on my daily checklist. At 15 months experience, I'm comfortable with managing my 5-7 pts at night (minus that dreaded admit right at the start of my shift), I have developed my own routine and have my own brainsheet which is my organizational lifeline during my shifts. Good Luck!!!

[steelcityrn, RN]

ORGANIZATION is key. You need to form a certain flow of how you are going to work on a fast paced floor. On med surgical, back when I started we usually had 5-6 on days, 7-8 on 3-11 and 10 on nights. I sometimes even had 11 or 12. If you like fast paced, you have no choice but to perfect your own flow.

[General E. Speaking, RN, RN]

Yes, it will get better. A brain sheet is a must. You will get better at anticipating what to bring to the room (avoiding the back and forth). Your skills will improve with some time.

We have an hour before and after to give meds (which seems more doable). It is nice to be able to pass those 1200 and 1400 meds at 1300.

[JulieCVICURN, BSN, RN]

You say this is your first job? You'll get faster. You won't even notice it, but it will happen. I didn't realize how fast I'd gotten until I started precepting new nurses who would ask me to slow down or tell me I made them feel like they'd never be as fast. I had no idea, and the same will happen to you.

[llerkl, ADN]

Posts are referring to a brain sheet.........I ALWAYS used this when I worked even with one or two patients in the ICU. Truly the BRAINS of the operation some nights!!

Get an index card ......large if you can..........or I even used EKG paper too. You can tear off the size you need and fold it for safe keeping in your pocket. Write the hours of the shift (hour by hour) and leave a space for meds or tasks you will be doing. Take a quick minute at the beginning of the shift to fill it in. IT WILL SAVE TIME LATER!! Cross items off as they are completed. Use whatever system that works for you, but very important, come up with a system. Be patient with yourself. Try not to waste time waiting. There is always something you can be doing, while waiting for a doc to return a page, waiting for a medication from the pharmacy etc...... you see what I mean.

You will be fine but it takes time. It is good that you know you want to be managing your time well!!!

CHEERS!