How do you get out on time?????

allnurses Guide · Oct 20, 2012

Are you clustering your care? If you have meds due at 8 and at 10, give them together at 9. If you have a patient with q4h blood sugar checks make sure you are giving meds or turning them or whatever at the same time as your blood sugar checks when you can. Also make sure you are delegating non-nursing tasks to the nursing assistant so you can sit down and chart.

grahamd01 · Oct 20, 2012

I suppose I feel bad asking NA's to do things for my patients even when I know they should. Unfortunatly, we are generally always, 'down an aide today,' so I will typically try to do as much as I can when I'm in there. I get a little confused as to what is appropriate to ask them to do and what is their responsibility to do. For example, I know they usually bathe and toilet the patients, but I get stumped sometimes as what other care they can do for me....so I'll usually wind up doing it on my own. I agree, kinda time consuming.

I have been better at clustering care. I'll assess, give 0800 and 1000 at the same time if the meds are reasonable to do together, but if I'm starting at 0730, sometimes I'll try and do some 0800 and the assessment, but end up back in the room far to many times and getting behind because I'm so worried about meds being late.

born2circulateRN · Oct 21, 2012

I know what you mean. I just started orientation - 5 weeks into it. I'm horrible at delegating -that's the only thing my preceptor is telling me I am needing improvement on. Even though I've only been having 2 patients (1:3 is the ratio on the floor)- it's still easy to get swamped due to the acuity level of the patients: there's meds due almost every hour, always new orders, prn/stat meds, pain and anxiety meds, initiating new feedings, turning the patient, talking to family, rounding with the MDs and NPs...there's always things to do - and of course charting, charting, charting. I'm the type of person that likes to try and do everything. However, I do leave at a reasonable time. I'm finish with everything at about 1845 - give report and I'm at my car at about 1920. Our techs are also very very very helpful - they gather VS and blood sugars, empty the foleys and bath the patients - but sometimes I assist or do the job when I can.

And yeah I agree with the previous poster, clustering meds are definitely a good idea - if appropriate. I do try to get my meds in on time - and it's getting easier. And I sort of feel unsuccessful when I don't get then in on time. With our medication pass, we have a 30 minute time frame before or after it's due - so if it's due at 0800, we can give it between 0730 and 0830. During nursing school, it was an hour for that specific hospital - which was so much easier.

So, the only advice I can give -since I'm in the same shoes as you is to delegate, cluster when appropriate, and stay calm and think, it's easy so run around being clueless - also try to make a routine and stick with it - that's what I am doing and it's getting me through the day. And I see that your specialty is med-surg so I am sure your ratio is higher than 1:3 which I am sure complicates things much more. But, I'm sure you'll get through it - you seem to be doing awesome.

Good Luck!

Do-over, ASN, RN · Oct 21, 2012

The only thing that holds me up is charting. If I stick to "charting as I go", especially in the mornings (I work nights) I have no problem getting out on time, or within about 15 minutes.

dee78 · Oct 22, 2012

I am also a new grad. As others suggested, I cluster meds when possible. Post its are the key to my time management. At the beginning of each shift I cover my notebook with post its. We have an Emak but I like to have it in front of me. I list the pt and times meds are due...I also list any that are kept in the pyxis since that seems to be my time waster(running back to the med room) I have a separate post it for PRN meds...makes report easier.

I keep up with blood sugars on another one. Rm #, times, level, tx

AM LABS go on another. Diet list. I&Os.

Then another for extra tasks or information. When time allows, I also lookup AM lab results and note abnormals.

I chart in the room as I go. Each pt has a med box in their room so I also set up all my meds during my first round. This allows me to move quickly through each med pass...I can also request meds that aren't on the floor well before they are due. I check them off on my post it as I go.

All of this also helps me streamline report...which happens to be my weakness.

~PedsRN~, BSN, RN · Oct 25, 2012

It will get easier the more you do it. I am still a new nurse - (I'm in month 8!) and I'm really just now to the point where I can get on time. I usually only have my "report offs" to chart and then I'm out. I do spend some time making sure I can't do anything for my coworkers to help them get out on time... (give a med, finish up an admission, etc).

I can't even explain how I do it now I just do. It just got easier. LOL!

I do all my assessments, update my whiteboards in the patient rooms, educate about all the meds I will give and any labs/procedures due, etc all at the start of the shift. I will also ask them if they need anything like blankets, pillows, etc while I'm in there, so I can go ahead and get that for them too so I'm not getting called for it later. I like to be running on the floor by 1915 or 1930. If I have a 2000 med due, I will give with my assessment. I prioritize my assessments... if I have a trauma that is due pain meds, I'll do them first and get them medicated before continuing so I'm not trying to balance pain management with the rest of my assessments (if that makes sense) If we aren't NUTS I can get all assessments done by 2015/2030 or so, all the really important education done, pain meds given, and pampering of families complete. LOL!

I will start my next round of hourly checks around 2030 when I will take my 2100 meds around with me. We have a 1 hour window in which ti give meds... 30 mins early or 30 mins late. So if I have a million 2100 meds, if I start at 2030 I am done by 2130.

I sit down and chart my assessments, IPOC (which is our plan of care document), and our ETR (education documentation) all at the same time since I do them together and get them charted and out of the way. I will do one patients stuff at a time and chart until it's time to go thru hourly rounds again.

Etc, etc etc.

As long as I stay on task and get stuff done, I am able to balance the unexpected nursing care in there as well. Especially if I can get all my major charting done before 2300!

I work in pediatrics so there is really never a dull moment. I have my routine down now and even when the crazy happens I find that I can regain my footing easier now.

You will find your groove!

ashleyisawesome, BSN, RN · Oct 29, 2012

i work nights, so its a little different but i have always gotten out within a half hour of the end of my shift except for two times when I had a couple admissions to take care of.

1. cluster your care. like mentioned above i usually have 2000,2100, & 2200 meds. I will give them all at 2100. When I first get there I do all my assessments right away, grab bags of fluids that I know will run out in the middle of the night and slap stickers on them and leave them on the counter in the room for easy access when I need them, and while im in the rooms I clean up any clutter and ask if they need anything like water, a snack, pain meds, ice packs etc.once I am done with all of that its almost 2100, so I start the meds.

2. After med pass, I will again make sure everyone is comfortable and sit down around 10-10:30pm and do my chart checks. By the time I am done I can get around to midnight meds, which dont take very long.

3. By 0030-0100, I can start charting. Thankfully, night shift doesnt have to do a complete head to toe. We dont need to chart fall risk, braden scale, etc unless something has changed from dayshift. And we only chart by exception, so if respiratory is all within normal limits, all I need to chart is WNL. It still takes me to about 0230 to finish, which is when the computers go down EVERY NIGHT, so then I take my lunch.

4. 0300 I finish any charting I didnt get to before the computers went down, give any 0300 meds, then I sit and wait for bells to go off until 0400 when I can begin my blood draws. I try to lump blood draws, and 0500 meds together, as well as asking some pts if theyd like to get washed up (if they are awake).

now, this is all perfect case scenario. throw some ER admissions, medical emergencies, or additional computer down time in there and things can get messed up..

I suggest taking a sheet of paper, folding it into six squares, and in each square and making a small grid for each hour you work and fill in things that need to be done for that patient each hour. Then you can visualize what can be lumped together.

0800: meds, assessment, turn and reposition

-------------------------------------------

0900: meds, bath, feed

-------------------------------------------

1000: DTV, turn and reposition, iv antibiotic due

--------------------------------------------

^^^ i just made this up, but for this person you could go in at 8, assess and turn them, possibly wash them up a quick, move on to next patient.. at 0900 you can give all meds, including the abx, encourage them to void if they havent yet, ask the cna to feed turn patient when they are done feeding them. cross things off as they are done so you know youve got all your bases covered.

liveyourlife747 · Nov 1, 2012

I agree with all of the above posters, but I definitely have to have my "brain" to stay organized. We have report sheets that are one to each person, I work up one of those on each pt if I can (doesn't always happen.) And then I have my "top sheet/to do sheet" that has a grid with the hours down one side and enough columns for each pt. There I will list meds and must do schedule time things (as in Q4 NGT residual checks) Then I can figure out a mini "game plan" for the day (although it usually gets thrown down by 0800).

If you can, see if you can get a job description for your aides. That way you know what they can do and what you can delegate. We got a copy before getting off orientation. Also, if you are in the room giving meds at 0930 and the pt happens to be a Q4 vitals that are due at 1000, I go ahead and get vitals on that pt and help the aide out. I try to help the aides out when it is feasible, and it seems the aides are more responsive if I ask them to do something.

Lets see if I can post a copy of my "brain" so you can see what I am talking about too:

We carry phones to get in contact with each other, thats why I have room at the top for nurses and PCTs, so I can write their numbers down and have them ready if I need a cosigner for a med. I also have things that need to be done Q8hr Assessments, Q shift charting, Notes, tele strip checks, i&o, iv fluids cleared. That way I can cross them off as I chart so I don't have to worry about double checking before I leave.

Shift To do sheet-12.doc

MedChica · Nov 1, 2012

Hi everyone!
I'm a May 12' grad and am lucky to have landed a job as a per diem RN float for several different med surg floors in the hospital. I've been working on my own for about a month (I had 6 weeks of orientation). Although for the most part I feel better every shift, I'm trying to figure out why I rarely leave on time? My question for all of you, is what are your strategies to getting out on time?
Documentation seems to be one area I fall behind on no matter how hard I try to stay on top of it. Any advice? The other is when everyone seems to be due for meds at the same time. I work first shift, so the trend is 0800, 1000, 1200, and 1400's on 5 patients. I seem to just finish giving meds to everyone nd realize that if I go to lunch, I'll be too far behind by the time I return and end up not eating or taking a bathroom break all day.
How does everyone else manage their time and what can I be doing differently? Thanks!

- I can work for hours with no break and without sitting down. I thank the military for giving me the stamina of a ox and the work ethic of a slave. LOL

- For your situation, the 8 and 10 o-clocks can be done at 9a. The 12 and 2 oclocks can be done at 1p. I do two major med passes and lump everything that I can in when I hit specific pts. Thankfully, we have med aides and the nurses just handle peg tube meds and a few PRNs, but it's worth considering. I used to pass for 42 pts. It's rough. In the beginning, I popped meds for 7 hours straight. The medaide was like, "Are you going to sit down?"

- I jot down notes in my mini spiral and chart throughout the day. If I leave it, it holds me up.

- I minimize the talking. Some people like to laugh and joke all day. I can't do that AND work.

Most I've ever stayed over, thus far? 45 minutes. I've coming up on my 4th month.

When I was in school, I had a fellow student tell me of a new nurse at her clinical site that was staying over for hours. Another 8 hours later and she's STILL passing morning meds. Seriously?

But...she didn't do these things that I and others have mentioned and she socialized often.

turnforthenurse, MSN, NP · Nov 2, 2012

Clustering care is the biggest thing that helps, as mentioned before. And delegate! Don't just delegate something that you don't want to do. If I have time to do something, I will do it instead of delegating to my CNA. If I don't, then I will delegate. Your CNAs can make and break your shift. Your HUCs can be a great resource, too! Many of our HUCs are also CNAs but they primarily work as a HUC...but ours will go help out with tasks on the floor as long as someone stays at the desk.

I typically don't chart as I go unless I need to make a nurse's note...if I don't have time for that, I quickly jot down and a quick note regarding it on a sticky note so I can chart it later.

When I first started, I was getting out almost an hour after my shift...now I'm usually always out by 0655-0710. Once in a blue moon I will get out much later if it was a crazy night or if a nurse is late. After working awhile you will develop those time management skills and get into a routine that works for you.

grahamd01 · Nov 4, 2012

Med Chica: I'm glad to hear that there are others who absolutely do not have time to socialize. I kinda feel bad when co workers want to be chatty with me and all I'm trying to do is think of how I'm going to get away so I can keep to my schedule. Talkative co workers are sometimes worse than the chatty patients.