Tips and Advice for Prioritizing Care

[ThatChickOmi, ADN, RN]

This is going to sound kinda silly, but I'm a second year (3rd semester of 4 semester ADN program) and I was assigned two patients today for the first time on a busy med-surg floor.

I had a hard time and was all over the place.

One patient was a ETOH detox with a lot going on, platelet precaution, NPO, alcoholic liver disease, cirrhosis, pancreatitis, tele, several IV/IVP meds, and my other patient was an elderly man with an arm fx, fall risk, confusion, condom cath, agitated ordered not to get OOB. Up until now I only ever had one patient at a time and I was able to manage relatively fine. Last semester, I was at a very slow paced nursing home with literally no opportunity to give any IV meds so I'm not 100% comfortable quite yet. I looked at the charts first then we're instructed to wait on report before doing anything. One nurse gave report on time, but the other nurse didn't give report until maybe an hour later. I didn't really plan my day effectively because just when I wanted to get VS on one patient and do an assessment, the other nurse was ready to give report, then I had to abort mission and listen to the report, then go back, then rushed back to get vitals and assessment on other, then the detox pt needed all his meds, then I went back to help out with the other fellow, then everything kinda melted into the next and by the time I finally got around to give my more acute patient a bed bath, it was like 11:30am which my instructor wasn't too thrilled with. (Holy rambling long sentence, Batman!).

What are some tips and tricks and words of wisdom you seasoned nurses have for a student like me for taking on multiple patients and time prioritization? I'm whining about 2 patients and I know some of you people take like 10.......all the power to you.

[Neats, BSN]

There is no one who can teach you organizational skills but yourself. I can give you tips and tricks but until you do it and discover and think...why didn't I pick up those other supplies when I was in the supply room (which is a 5 min walk one way) for my other patient? You have to experience those what if's in nursing to learn and grow.

I can tell you what I did when I first became a nurse was this; I folded a piece of paper into 4 squares and wrote times in each square that correlated with my shift. I would then write what should be completed by a certain time in each square i.e. patient introduction, report, VS should be done in the first square. Medications could be in all squares, same with charting. If an IV was just changed and set to run for 4 hours I would place the IV in the first 2 squares (so you can check on it). This piece of paper is not an all do list but rather a gentle reminder of staying on track.

Observe what the nurses do when they come in for a couple days see what they repeat and note the times--those are routine tasks and they have found ways to be organized with those tasks. Give yourself some grace as this appears to be very new to you. Give yourself some time. With each clinical experience you will gain the confidence to take charge more, feel empowered to advocate and step up more, and will develop those organizational skills that work best for you and your patients.

Lastly you stated the other nurse didn't give report until about an hour later. I would most certainly ask my instructor if you could introduce your self to the patient or review the chart. If you did have to wait on them I would be finding other things to do. I remember I had 2 hours of time that to me would be wasted one day in clinical and I asked if I could follow the x-ray tech around. They let me and I learned a lot in those 2 hours.

Good Luck to you.

[meanmaryjean, DNP, RN]

A good brain sheet is invaluable. Also, keep moving! I never fail to be amazed at the students who will sit down when there is work to be done.

[peachtreednurse, RN]

What did you do with the hour of time between reports? Depending on the report received you might have assessed that patient, taken vital signs, and perhaps even administered 1 set of meds. It would help to know what nursing care duties each patient required.

[KrysyRN, BSN]

I agree with the others that a good brain sheet, that lists what will be due each hour, is really helpful with organization.

Also...when or if this is possible and appropriate, always try to complete a task(s) on the patient that will require less time than the other, first.

For example:

-Patient A is heavyset and will require assist from a second staff member with turning and positioning the patient for the assessment. Patient B sits up, turns, moves easily with no assistance. Complete the assessment on Patient B first, then Patient A.

-Patient A has ten PO meds due and an IV antibiotic. Patient A has six PO meds due. Administer meds to Patient A first, then Patient B.