Time Management Suggestions...

[robbnp22]

Hi all,

Im sure this is difficult to have a solid answer for but Im hopeful someone might help me a little...

Im just about done with my 3mos orientation as a new RN on a IMC/Tele floor...I have a 5 patient assignment of varying degree acuity including truamatic head injuries and fx's to LoL's with pneumonia....Im having trouble getting meds passed on time, chart checks, orders put in, people turned, IV's started, flushed, assessments complete, charting done, etc etc....seriously, how the hell does everone else do it?? Im running my a** off and dont sit down except to chart and the experience nurses are all sitting at the station with time on their hands...Im getting a "talkin to" by my manager last night after my 2nd 12 this week and very little sleep in between saying, "youre not progressing as fast as we'd like since youre nearing the end of orientation"....Me ":eek:...really?" my preceptor has only had me seeing 5 for the last 5 shifts and Im getting almost every task done barring being a little late on some meds or staying after report to complete charting....other than walking even faster or rushing thru meds and not ever talking to my patients to listen to their needs as a nurse, I dont know how else to be better....

So, how do y'all experience RN's get all this done and do it safely???? help please...

Thanks!!

R~

[llg, PhD, RN]

Here are a couple of the most common "reasons" for the problem you describe. It's very common for new grads, so don't feel too bad.

1. Experienced nurses multi-task. For example, they talk to their patients and assess their needs while they are giving meds and/or doing other things with them. New nurses tend to "stop and chat" before and after each thing they do. While it is a good thing to give your patients those few minutes of your undivided attention periodically throughout the shift, it is often a luxury that experienced nurses have learned to omit as needed. Experienced nurses know that those few minutes, repeated often enough throughout the shift put you behind in your meds and make you stay overtime to get your charting done. So, they incorporate those activities into their other duties.

If you watch an experienced nurse closely, you will see that she often does 2 or 3 tasks integrated together into one brief encounter ... give the med, check the IV site, ask a couple of questions, and out the door in a matter of minutes. A new nurse caring for the same patient would spend a couple of minutes talking to the patient and then another couple of minutes checking the IV site and then another few minutes giving the medication. The new nurse would do those things as separate activities and take twice as long.

2. New nurses often add time to each task by double- and triple-checking everything. They pause and think and look again to make sure they get things right. Experienced nurses have the confidence to "just do it and move on." New grads may also take more time as they stop to look things up or ask questions.

Neither of these typical new grad behaviors are unusual or horrible. But in order to carry your full weight as a member of the team, you need to pick up the pace as you get more experience. Some people have more trouble doing that than others. Experienced preceptors, educators, managers, etc. know what the typical rate of progress is for new grads on their unit and become concerned when someone lags behind that rate of progress. It doens't have to be a fatal flaw -- and you can turn things around by discussing details like the ones I just gave you with your preceptors and other key people in your environment. They may be able to help you identify the specific activities that slow you down so that you can focus on speeding them up.

[judycollingwell]

I'm currently only a tech but I feel the pain also. Some experienced techs often give me a frown and wonder why it took me too long to get some tasks done. I realize that I'd just need to get it done. Forget about making it beautiful or pretty or holistic or whatsoever that we've learned in nursing school. It's more about efficiency. It's like get it done quickly and safely. No need to make it beautiful.

Also, I've noted that if you are too nice to the patients, they tend to cling onto you a lot. Thus, they'll ask you a lot of questions. And, if you become stern to them, they will be less demanding.

And, yes, multitasks...

[Nurseinprocess]

Also, I've noted that if you are too nice to the patients, they tend to cling onto you a lot. Thus, they'll ask you a lot of questions. And, if you become stern to them, they will be less demanding.

And, yes, multitasks...

I have found this to be true, the nicer and more friendly you are, the more likely you will be stuck in a room with a chatty or needy pt. It's a hard balance between being nurturing and caring and being abrupt and all business. I had one patient this week say to me "You are so nice!" because I took the time to put a cool cloth on her forehead. I told her I strive to be a nice nurse, not a mean one . I never act stern, but sometimes you do have to act a little indifferent to get out of the room in a timely manner.

[CrufflerJJ, BSN, RN, EMT-P]

One other suggestion I might offer is that you think about what you need to do BEFORE entering a pt's room. By this, I mean try to group your assessments, med passes, gluc checks, dressing changes,... all together. If you do one thing, leave the room, come back to do a second thing, leave the room, come back to do a 3rd thing,.... You'll never catch up.

Also, if you're in a room with a "chatty" patient, don't be afraid to say "I'm going to check on my patient next door, but I'll be back to check on you."

Time management was one of the most difficult things for me to get a handle on as a newbie, and I'm still getting better at it.

Good luck!

[classicdame, MSN, EdD]

ask for advice, rather than criticism. When they respond with "well, you should be faster (or whatever)" say that is still criticism, not advice.

Do you do hourly rounding at your facility? This is covered in an above post, but asking about potty, pain, possessions and positioning while in the room saves steps which saves time.

[himilayaneyes]

the key is experience which takes time. as a new nurse, especially one just getting off orientation, expect to be late on almost everything, feeling inadequate as a nurse, and leaving late to chart. plus, your boss should be more understanding of that. it takes time to develop your own routine. good luck.

[68wildcat]

Like the nurses here, I too must time manage as a caregiver, and for the newbies, all I can say is it will happen. You will learn to 'fly' through your shift and be able to manage your time successfully, meaning you got everything done! Multi-tasking is a must. Hold the friendly chatter down to a minimum. You can still be a 'nice' nurse but you need to stay on track. Know what you're doing before you go to the patient. Then get it done done done and move on to the next one. In this field you need to know your next move before you do it, divide your tasks by the clock and be ready when the poop hits the fan. After report where I work, our mantra is 'let's rock and roll'. It's the only way to survive! LOL

[robbnp22]

Thanks for all the great advice...I definitely see some ways I can improve my processes so Im gonna try to pre-plan and multi-task some more....

Yes we do hourly rounding and follow the P's check....I'll try to use that more to my advantage and see what I can accomplish....

Thanks again everyone!!

R~

[sistasoul]

Here are a couple of the most common "reasons" for the problem you describe. It's very common for new grads, so don't feel too bad.

1. Experienced nurses multi-task. For example, they talk to their patients and assess their needs while they are giving meds and/or doing other things with them. New nurses tend to "stop and chat" before and after each thing they do. While it is a good thing to give your patients those few minutes of your undivided attention periodically throughout the shift, it is often a luxury that experienced nurses have learned to omit as needed. Experienced nurses know that those few minutes, repeated often enough throughout the shift put you behind in your meds and make you stay overtime to get your charting done. So, they incorporate those activities into their other duties.

If you watch an experienced nurse closely, you will see that she often does 2 or 3 tasks integrated together into one brief encounter ... give the med, check the IV site, ask a couple of questions, and out the door in a matter of minutes. A new nurse caring for the same patient would spend a couple of minutes talking to the patient and then another couple of minutes checking the IV site and then another few minutes giving the medication. The new nurse would do those things as separate activities and take twice as long.

2. New nurses often add time to each task by double- and triple-checking everything. They pause and think and look again to make sure they get things right. Experienced nurses have the confidence to "just do it and move on." New grads may also take more time as they stop to look things up or ask questions.

Neither of these typical new grad behaviors are unusual or horrible. But in order to carry your full weight as a member of the team, you need to pick up the pace as you get more experience. Some people have more trouble doing that than others. Experienced preceptors, educators, managers, etc. know what the typical rate of progress is for new grads on their unit and become concerned when someone lags behind that rate of progress. It doens't have to be a fatal flaw -- and you can turn things around by discussing details like the ones I just gave you with your preceptors and other key people in your environment. They may be able to help you identify the specific activities that slow you down so that you can focus on speeding them up.

While your paragraph one is unfortunately true regarding being able to give your patients a FEW MINUTES of undivided attention, it is the reason I am looking to leave bedside nursing in the future. It is a sad state when you are stressed for time to the point where actively listening to your patient is all but impossible. I define active listening as giving your undivided attention to a patient and not multitasking when the patient is talking. I find this appears to be uncaring and disrespectful to the patient. If the patient starts to go off on a tangent then of course you have to move on to your next task. It really does not feel very good when you are trying to talk to someone and they are checking IV sites, foley catheters, looking up meds on the computer, etc. I am not being critical of anyone because unfortunately this is the reality of hospital nursing. Even though I know management is going to come down on me I stop and listen to my patients for a few minutes. Does this put me behind? Of course it does. It is disheartening to me that as nurses we are not able to fully be in the moment with our patients because of time constrictions. If nurses cannot give 5 minutes to a patient to talk with them and truly listen to them the system is broken.

[tewdles, RN]

While your paragraph one is unfortunately true regarding being able to give your patients a FEW MINUTES of undivided attention, it is the reason I am looking to leave bedside nursing in the future. It is a sad state when you are stressed for time to the point where actively listening to your patient is all but impossible. I define active listening as giving your undivided attention to a patient and not multitasking when the patient is talking. I find this appears to be uncaring and disrespectful to the patient. If the patient starts to go off on a tangent then of course you have to move on to your next task. It really does not feel very good when you are trying to talk to someone and they are checking IV sites, foley catheters, looking up meds on the computer, etc. I am not being critical of anyone because unfortunately this is the reality of hospital nursing. Even though I know management is going to come down on me I stop and listen to my patients for a few minutes. Does this put me behind? Of course it does. It is disheartening to me that as nurses we are not able to fully be in the moment with our patients because of time constrictions. If nurses cannot give 5 minutes to a patient to talk with them and truly listen to them the system is broken.

This is a huge part of the reason that I prefer hospice at this point in my career...hospice understands that it is necessary to communicate "in the moment" with people. Hospice understands that we must be "present" when patients or families are talking with us.

[Minnie2006]

I could have written your post myself. I think most conscientious new nurses go through this. They say it gets better and I hope thats the case. Some days I feel good about how things went and others I would just as soon forget. Even considering having the benefit of experience, I still don't see how some nurses get it all done as you say. Seems like there is always something else that could be done. I think thats my problem, knowing when to say enough for my shift and passing the work on to the next.