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Discussion

ICU time management

Hi! I’m an ICU float now at new establishment. I am not happy about that  but I am stuck here due to family dynamics etc.

  Each unit is run soooooo different and so it pt population , neuro vs ecmo, vs msicu vs CVICU. I’m having a hard time with time management. I’m night shift so baths are included. How do u balance 2 pt assignment? I like to get report eyeball pt ( A line, pumps at said rates) then Dayshift leaves I get into assessment and always find myself struggling with untwisting tubing n lines or finding something that needs sorting. Now I grab meds and by time given.... like when am I supposed to chart? I try to chart vs and I/o hourly. But this hospital wants assessment/skin/IV/adl charted Q2. 
I find myself being behind and not stopping to ever have time to read progress notes. I’m making myself ill from the stress. Any advice appreciated. 

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    My general approach sounds much like yours. I use the whiteboard in the room for many charting aspects, like hourly I/O, or other observations during assessment and wrap it all up later in the shift. I'm also 7p-7a or 11p-7a and when I'm in at 7p I rarely get to charting before midnight because I'm in and out of my patient rooms. I try to get hex baths done by 10pm and usually the majority of HS meds are done by 11 so I can catch up on charting after that. I don't usually get to any notes until 2-3am, so if someone crashes I don't get to look through notes at all. Not ideal, I know that the "chart as you go" method works for many people, but I just never end up doing it that way. You'll get a better system when you've got more time under your belt. Good luck!

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    Floating in general is hard to adjust to because as you said, each unit is so different, the culture is different, even simple things like supply locations or room stock is different so that in itself is a learning curve - I still joke that I spent half of my day as a float nurse staring at the supply omnicell trying to find out where the unit I’m on keeps the tegaderm, or whatever simple thing I’m looking for. 

    It’s been a while since I’ve worked ICU but I do remember clustering care was so important, as well as prioritizing based on acuity. As soon as I have “downtime,” I try to get any general shift requirements out of the way so I don’t have to worry about it the rest of the night - whether that’s a bath as soon as possible, dressing changes, etc. As you get your rhythm, charting as you go will come easier. Unless a patient is actively crashing or in pain or something urgent like that, I realized that I can take the extra 5 minutes to quickly chart my assessment and then go do what I need to do. As ICU nurses (I started in ICU as a new grad) we tend to be more OCD-ish when it comes to things like twisted lines or maybe a messy counter space...by all means if you have the time to clean it all up and make it pretty then of course do so, but don’t let this get you behind if it isn’t a necessity and isn’t impacting patient care. You’ll eventually find your groove but in the meantime give yourself some grace. 

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    A few things I have learned:

    The first hour of two is focused on assessments, daily meds, turns and getting that stuff charted before rounds. 

    Detangling lines, daily dressing changes, baths, getting OOB and other non-urgent tasks can wait until I have the first round of charting done.

    Sometimes the assessment will be incomplete to be filled in later, but vitals, I&Os, restraints and other required documentation needs to be done pronto.

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    Should we have a tenure( 5 years Max) for nurse managers and Directors? Will it help with nurse retention?

    This thought came to mind based on some nurses experience in XYZ hospital. Inputs are welcome.

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    3 hours ago, Aspire2020 said:

    Should we have a tenure( 5 years Max) for nurse managers and Directors? Will it help with nurse retention?

    You mean like term limits for Congress, ha,ha? I don't think that limiting nurse managers and directors would make much business sense. Although when you're stuck with a bad one knowing that there's a light at the end of the tunnel might be a welcome thing from a floor nurse perspective. The hospital doesn't want to hire and train a manager, which probably take 4-6 months for them to come up to speed, only to have to turn around and do it again within five years. There are many managers that are excellent and stay in those roles for 15-20 years with good results. (Sadly not mine but- oh well) 

    How is it that you think it would help with retention? It might when there's a bad manager in there as I already mentioned, but five years can still do a lot of damage to a unit. 

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    • Experts
    3 hours ago, Aspire2020 said:

    Should we have a tenure( 5 years Max) for nurse managers and Directors? Will it help with nurse retention?

    This thought came to mind based on some nurses experience in XYZ hospital. Inputs are welcome.

    I don’t think that would be helpful overall. But I do notice that managers who come into staffing more frequently, be that as needing to charge some days or resource some days, seem to “get it” more. My hospital requires the unit educators an manager to be in staffing in some way at least one shift a month.

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