How to manage three patients

lucymalfoy · Mar 31, 2015

Cluster care when possible. Start out by getting report and jumping into getting an initial assessment, vitals, and blood sugar on each patient. Try to be proactive when you go to see your patients. Have all of your supplies with you when getting ready to give a bath. Bring extra fluids with your initial med pass so you are not running back and forth for that. If you are responsible for toileting your patients, encourage them to take that opportunity while you are doing other tasks with them so that it does not have to get done when you are in the middle of something else. Try your best to chart quickly and in real time. I have a computer on wheels that I push around with me, so if I am waiting in line for my turn at the Pyxis, I at least try to type a quick nurses note or an initial head to toe. If you find that you are pressed for time for charting in real time and you use an EMR, at least try to make a column for yourself of when you were in the room and note specific out of the ordinary details of your assessment that you want to chart for later. Good luck!

Jenngirl34RN · Apr 1, 2015

Make yourself a good brain sheet for each patient so you can make a list of med times, care your patient needs, and can jot down your vitals and anything you need to pass on to your preceptor. That will keep you from forgetting anything. I like to write out a basic schedule for myself after I know when I need to pass meds for each patient and what each patient has going on that day, but it usually includes getting report and then vitals first thing. Blood sugars obviously depend on mealtimes, and most of the hospitals in my area do not have scheduled meals (the patient orders whenever they like), so make sure to find out when they are going to order breakfast. I like to do my personal care right after breakfast when possible. I make sure to chart as I go, and I write down things I want to make sure I include in my nursing note so I don't forget anything.

SopranoKris, MSN, RN, NP · Apr 1, 2015

I use a chart. At the top of the chart I have columns for each hour of my shift. I can add patients in each row. I first write in all the med passes. Then I determine from the patients' acuity which I should do assessments on first & prioritize. I write in orders that still need to be done (e.g. dressing change, Accuchecks, wound care, re-position, etc.) If the schedule looks really tight, I determine what I can delegate to the tech (e.g. bed bath, positioning), but for the most part, I try do to as much as possible on my own.

Using the chart keeps me on track. I do have to make adjustments as necessary. But it's a good outline of the day. Underneath the chart, I have an area where I write pertinent labs, shift report, and any other info that's important for each patient. As things happen during my shift, I make notes. Then when it's time to do shift change, I can easily give report using my chart notes.

anh06005, MSN, APRN, NP · Apr 1, 2015

Brain sheet!! I just made up a word document with some info that I needed and left room for random notes. We had 5 patients so I had a binder with 5 tabs to keep everybody separated.

As I charted stuff I would highlight so I knew it was done. I even had little numbers at the bottom signifying my rounding times (even hours) and highlighted each little number as I charted my round.

Info I had on my brain sheet:

Diagnosis

PMH

Tele

I&O columns

BUN/creat

H&H

Few other labs

Little lines for blood sugars

And a space for my assessment:

Something like:

CV:___edema BLLE murmur___

Resp:___CTA____

Abd:___BSx4, LOW colostomy__

Skin:___pressure ulcer R heel___

Too much info but I sometimes miss my brain sheet lol. I'm in a new job/role now with computer charting so no need

Lisanan67 · Apr 7, 2015

Thank you so much for the advice. I survived my clinical days last week. I had three patients both days. I was late with medications. I'm having trouble administering meds on time.