Help! Need Time Management Tips

[Serenyd]

Please can anyone share their tips on time managment for floor nursing? Like tips on how to give meds, keep track of I+O, chart, do assessments - faster and with less stress?

also, anyone have tips on how to keep patients happy when you can't get back to them right away - and how to bow out gracefully and without hurting feelings when they want to tell you their life story and you're in the middle of med pass ect.?

Thanks in advance

- frustrated and tired of being the last person to leave at nite!

[ahoye5199]

I've only been on the floor for a little over a month, but here are a couple of things that have helped me:

1) Our hospital does hourly rounding. If you go into the patient's room once an hour (I know it sounds unrealistic, but it actually gives you more time) and let them know that you'll be doing that, the call light frequency goes down dramatically, and studies show that you do less walking on the floor. When they know you're coming back, they don't call you as much.

2) I have designed my worksheets that I take report on to be almost totally check boxes, with a blank column on the side for "to-do"'s and reminders. I would be happy to show it to you, but, from a technical perspective, I'm not sure I know how. It helps me when it seems like the nurses coming off shift are speed-reading and I would be hopeless if I didn't check stuff off. For example, most of the patients have either D5 1/2 NS running at ___ ml/hr, that plus some amount of potassium, or just NS. So, I have those as check boxes instead of writing it all out. I'll let you know how it works out long term, but as a newbie feeling lost and slow, it's helping me!

[PatricksRNMommy]

Well I am just a new nurse, but I'm pretty good at time management (most days LOL). So heres how I do things....

I work night shift... I usually come in 15-30 minutes before my shift and get my assignment, check all my charts for new orders and write them all down, check my kardexes. If the day nurse isn't ready to give report yet, I go meet my patients right away. This is a good time to check if your patient needs ANYTHING right now(pain med, pillow, snack, help to the bathroom, etc.). This usually minimizes interruptions during report. While in the room, I check IV site (usually bring in some saline flushes and check patency on saline locks), fluids running, dressings, etc. I then tell them that I will be back shortly to see them and speak to them more.

After I get report from the day shift nurse, I look through my MARs and check what times I have meds to give and write them down on my report sheet (I cross these off as I give them). Any special tasks (dressing changes, IV starts, etc.) I write on my report sheet in red or another color that will stand out. After I get report, I check lab results while I am waiting for my 8 o clock vital signs. As soon as I get those vital signs, I do my assessments. I aim to have these done by 2130 so if anything is abnormal or needs attention, I can call the MD before it gets TOO late at night.

As soon as assessments are done, the 2200 med pass begins. Little old ladies who go to bed at sunset at home get their meds first so they can sleep. At the evening med pass, I make sure everyones got enough blankets, side rails are up, bedside commode is nearby, urinal at the bedside (if male pt of course), and tele leads all in place.

Some nurses like to wait until all this is done, to start charting... That scares me a little. To each his (or her) own, but if your patient codes at midnight and you havent documented a thing in 5 hours... doesnt look so good. Or god forbid if you threw out your back helping a patient to bed and had to go home or to the ER... and none of your charting was done.... So I document my assessments (we use a flowsheet) right away and at least one initial note within the first couple hours of the shift.

After all this, I start my 24 hour chart checks. Safety rounds on my patients, check all the rooms. Usually another note on each pt.

MAR checks. More safety rounds. Another note only if needed.

Usually it's about 2 am now. Check in with monitor tech and make sure everyones alive and their heart rhythm is the same. See if any other nurses need help with anything. Help CNAs as needed with baths. Report to charge nurse, nursing supervisor.

Walk around and check patients again.

About 5 am, walk around and collect I and O's, clear IV pumps, make sure foleys and urinals are emptied. Tally up I and O sheets. Give any 6 o clock meds, write final nurses notes, file I and Os, MARS, nurses notes, assessments in charts. Check if AM labs up yet. Call MD as needed.

630-7am day shift comes in. Walking rounds with day shift nurse. Go Home!! :)

[isis73]

Thanks to everyone for their helpful advice and encouragement! I am in my senior semester, about to graduate in May, and my biggest fear is time management.

I feel slow and all thumbs, and I tend to proceed cautiously until I am sure of what I am doing...I know I will get faster as I get used to different tasks and gain more conifidence, but my attention to detail and hesitancy has resulted in one instructor telling me that I was very slow and sure to have a very hard time in my final semester. Our last round of clinicals start next week and I really want them to be great!

Thanks for the help!

[EmmaG, RN]

"I tend to proceed cautiously until I am sure of what I am doing..."

That is a good thing

[HM2VikingRN, RN]

Nothing wrong with "Measure twice cut once"

[CABG patch kid, BSN, RN]

Another thing I learned (just last night, in fact) was balancing workload between patients. For example, on one patient I had about 10 meds/tasks to do at 2200 and only 2 meds on my other patient (only 2 patients, lol). Anyway, I asked my preceptor which to do first and she said its usually better to do the least time-consuming thing first, then procede to the more time-consuming patient. I'm still orienting and gradually building up to my full patient load, so I'm doing the best I can to organize and time-manage now so when I add on it will be that much easier :)