How to be more time efficient in med/surg?

[studiousnurse]

I have a new job having come from a med/surg background, 6 years experience. This med/surg floor has 45 beds. About 6 or 7 RNs including charge, two CNA, one clerk on staff. I want other nurses feedback on my routine and how I can make it better to be more time efficient.

So I will lay out my routine here:

0655 - Clock in

0700 - Check assignment

0705 - Check which night nurse has my patients Some night nurses are occupied and I need to wait for them or search for them if they are too "busy".

0705-0710 - "Huddle" with night charge nurse This takes too long and probably should be omitted to just charge nurse to charge nurse. Why do we all need to be in the same room to hear info that we would otherwise get in bedside report?

0710-0755 - Get bedside report on 5 to 6 patients The time on this varies from nurse to nurse depending on the patient and situation.

0755-0820 - Find a working computer (workstation on wheels), assign my patients in Meditech, and write down morning lab and which meds are due on all 5-6 patients. If no aides (and there usually isn't enough of them... I check blood sugars). Many computers are broken and are already taken by day shift nurses who arrive at 0630. Why do nurses get here so early? Aides have vitals done by at least 0800 to 0820. Some have them done earlier.

0820-1020 - Passing meds to patients, giving care, cleaning, assisting to restroom. I was told to chart on each patient while still in their room. This doesn't save time but it helps with accuracy. Some patients are heavier and require more time at the bedside anyway. I was also told to get meds for two patients at a time instead of one at a time. I found this to help somewhat but didn't work out in the long run as far as saving time or being more efficient. It clutters my workspace.

1020-1100 - Charting assessments and rounds/meal intake/intake and output/Braden/Sepsis screening/other things Meditech said were due at 0800 and 1000. Again, told I was "behind" on charting. How is it possible to chart when patients need care/meds/cleaning/positioning? Also how am I supposed to be on time when doctors/other departments/aides/or clerk are calling me? I have to address everyone. I chart at this time because my patients needs were met and I can address the chart now. Also, patients get discharged at this time.

1100-1220 - Check blood sugars, Med pass for diabetics and anything else due at noon. Repeat of the morning except it is noon now. Also addressing calls and discharges/admissions. Lucky if I get to have a break.

1220-1300 - Charting again. Addressing calls at the same time. Would like a break but I have learned nurses do not relieve each other. I have learned some nurses "Just go on break" with their phones still on them. This makes it difficult to have a real 30-minute uninterrupted break.

1310-1500 - Med pass again, patient care, more charting. At this point I may have 2 or 3 discharged patients and 2 or 3 new patients admitted, leaving little time for charting.

1500-1600 - Blood sugar checks, patient care, med pass. Answering phone calls... ect.

1630-1730 - Med pass and meds for diabetics, patient care. Still answering phone calls and spending time with patient care, may get admissions too.

1730-1830 - Charting evening things, chart checks, patient goals, outcomes, and reviewing charting accuracy. This time for some reason the ER likes to send patients to us. Why? We can't address everything in the 30 minutes left until 1900. So now I'm on the phone again getting report and such.

1830-1900 - Night shift nurses/aides are coming in. Check which night nurse has my patients. Final rounding on patients before report. Sometimes patients will have meds to be given at these times. I am busy with them too.

1900-1930 - Giving report to night nurses on all my patients. I still answer phone calls even in report.

1930-1945 - Document final nursing rounds and other items before clocking out. Oftentimes I need to catch up on things in the chart at this point.

So! If you've come this far in reading my routine... kudos. What are your thoughts/words of advice for me? I really would like to know how to be a "relaxed" nurse who's got her stuff down because I feel like a frantic mess most of the time.

[Daisy4RN]

And Kudos to you for the new job. Everyone has to work out their own routine that works best for them. That being said, I would grab a computer as soon as you get there, ask if it is working and put your name on it if NOC is still using it. I really don't understand your report from the Charge, we only did nurse to nurse report, but keep it short and sweet and move on. In order to get everything done you need to cut out those things that you don't necessarily need to do, you have aides for a reason, also sometimes the phone just needs to ring, if important they will call back. I used to get way too many dumb calls which interrupt and make you lose your place etc. Hospitals always tell you there policies knowing full well there is no way to follow all the requirements, find out (by experience or a trusted co-worker) which ones are important to them, which ones they really check etc. For instance one placed I worked wanted assessments done by 1000 but they didn't ding you for that therefore that can wait. Did you use your schedule at your last place, did it work, just start there and tweak it to your new place. Good luck!!

[Sour Lemon]

Cluster care as opposed to sticking to a rigid schedule. If someone calls for ice 10 minutes into the shift, grab your stethoscope and do a quick head to toe. If you go to the supply room for patient A, grab dressing change supplies for patient B while you're there.

I tend to jot down simple notes, then find a "hole" to camp in while I knock out my charting in a hurry. I do let everyone know where I'm at, though.

Constant reprioritization is also key. The most important things will absolutely get done. The least important things have a chance, too ...but there are no guarantees.