How to approach the beginning of shift?

Always_Learning, BSN, RN · Jul 20, 2011

First thing, before I get report, I check the Kardex (not every facility uses these, but it's kind of like a "cheat sheet" for each patient that tells you their admit date, diagnosis, doctors, activity/diet restrictions, ordered tests, and so forth). This gives me an overview of the patient before I even get report.

After report, my priority is getting in there and assessing my patients. After all, I am now responsible to make sure they stay alive! While I'm in there, I check my IVs (is one bag about to run out? Does tubing need to be changed? Is my site good or infiltrated?) and surroundings for safety (side rails up? call light in reach?) Rinse and repeat with next patient.

Once I'm done with this, I next look at the MAR and note when meds need to be given (0800, 1200, 1600, etc.) I then check orders to see if there is anything new or pressing.

Baths and other stuff comes after this. It helps me to prioritize by thinking, "Can this wait?" If it's a bath, yes, it can be done later. If there is an order for a stat med, or I still haven't assessed someone, that needs to be done ASAP.

Hope this helps a tiny bit; everyone has their own flow, so it can be hard to explain. It comes with practice, and I'm still learning. :)

juniorminty · Jul 22, 2011

First thing, before I get report, I check the Kardex (not every facility uses these, but it's kind of like a "cheat sheet" for each patient that tells you their admit date, diagnosis, doctors, activity/diet restrictions, ordered tests, and so forth). This gives me an overview of the patient before I even get report.
After report, my priority is getting in there and assessing my patients. After all, I am now responsible to make sure they stay alive! While I'm in there, I check my IVs (is one bag about to run out? Does tubing need to be changed? Is my site good or infiltrated?) and surroundings for safety (side rails up? call light in reach?) Rinse and repeat with next patient.
Once I'm done with this, I next look at the MAR and note when meds need to be given (0800, 1200, 1600, etc.) I then check orders to see if there is anything new or pressing.
Baths and other stuff comes after this. It helps me to prioritize by thinking, "Can this wait?" If it's a bath, yes, it can be done later. If there is an order for a stat med, or I still haven't assessed someone, that needs to be done ASAP.
Hope this helps a tiny bit; everyone has their own flow, so it can be hard to explain. It comes with practice, and I'm still learning. :)

I agree! While it is important to get vitals and meet patients, you never want to go into a room not even know anything about your patient. Our hospital is doing away with Kardexs, so I just take a quick glance over their meds and the h&p to see why they are actually there. Bathing is very important but unless the patient has urinated or defecated on themselves, it can usually wait -- especially if meds are due or an assessment needs to be done. After glancing at the kardex/computer (note things that are vital such as NPO orders, that they have an NGT, are they on bedrest or fluid restrictions etc), I go introduce myself and do vitals/assessment -- while I am doing that I note their IV fluids and tubing, ask about bathing (can they do it themselves or do they need assistance). If they need blood sugar checks, I take that in the room with me and do that as I am assessing.

I've found the best thing to remember is that you are not there to be the patient's babysitter. You do not need or want to be in and out of the room constantly (unless they are total care of course) so I try to do as much as I without being unsafe each time I am in the room.

BellsRNBSN · Jul 22, 2011

First, it should be noted that it's going to be different at each hospital you go to. It also depends if the unit you are on has CNAs or PCTs that can assist with the bathing and vital signs.

If you are having issues with time management during your shifts, I would start with coming to the hospital early, like around 6:15 or 6:30 to more thoroughly examine your patients' charts ahead of time so you can get a head start. Also, getting a good thorough report from the nurse of the previous shift can make all the difference. Make sure you have a good "brain" on which you can write down all the pertinent details of each patient. Fill out your "brain" while you get report and ask the nurse from the previous shift questions if you end up with any holes that haven't been filled in. During or right after you get report, check each pt's MAR and the current doctor's orders for each pt. I have found it helpful to make a time sheet that has a column for each of your pts. I write details on the time sheet like when each pt will need to get meds or have procedures done, and I also use it to write when certain events happen or when VS have been taken. This time sheet is extremely helpful in remembering what needs to be done and remembering what already HAS been done for when you need to chart.

Once you have received report on all of your pts and you are ready to start, it is vital that you perform assessments on all of your pts ASAP. Assess your pts with higher acuity first, and before you get trapped with bathing and assisting pts with eating, make sure you get all of your assessments done. Like a previous poster mentioned, you need to make sure all of your pts are okay as soon as you can. A large part of nursing is prioritizing, and checking the status and safety of all of your pts takes preference over bathing and feeding.

Mastering time management as a nurse is VERY difficult. While it may come naturally to some lucky people, I think it's expected that it will take a while before you find your groove and the perfect method that works for you. You can also always ask the nurses you are working with for advice - a lot of them have been doing it for years and have time management down pat.

Good luck! :nurse:

glovedgoddess · Jul 25, 2011

Thanks for everyones answers!

WKredz5 · Aug 2, 2011

I love this thread.