Learning to prioritise/become effecient

HollyHobby · Feb 26, 2010

First and most importantly (IMHO) you MUST have a brain sheet. Without it, you can't prioritize your care and you'll end up with so many things in your mind at once that you'll go crazy. I suggest you look at the way your co-workers organize their time. You don't need a preprinted brain to keep things in order, but you have to have some kind of system. Everyone's system is a little different, so choose one or improvise one that works for you.

My tactic is to use the assessment time to also do the fluff and puff things. This shows that I care about my patient's comfort. I make sure the patient has what he needs at that moment so he can wait a while before I come back. And I assure him I will be back, say, to give meds at nine o'clock. Sometimes just reassuring the patient that you will be back at about a certain time gives them enough reassurance to stay off the call light for insignificant things. And if a patient tells me, "Will you bring me some apple juice (or whatever) when you come back?" I actually make a note of this, and I do it. This way, my patients know I'm not being dismissive, they know they'll get what they need, and they can rely on me.

I gently steer the conversation away from the irrelevant and tedious details of the patient's life. I don't really need to hear all about how the patient's neighbor is a PIA or the exact ages of each of her 25 grandchildren. I direct the conversation back to the patient, what she understands about her illness, what kind of support she has at home, or whatever is relevant to the patient.

If necessary, I tell my patient that I don't have any more time to talk right now, but when I come back later for her such-and-such treatment at such-and-such time, I'll be thrilled to chat a little more.

Certain things have to take priority. If you tell sweet little grandma you don't have time to talk now because you're worried about another patient, she will almost always understand.

talaxandra · Feb 26, 2010

I'm with HollyHobby - learn to multitask, so that you can assess your patients while you make them more comfortable. Getting away from a chatty patient requires a combination of skill, experience and good luck (I still get caught sometimes), but saying "I have to do something urgent for another patient but will get back to you as soon as I can" often helps.

Can you let other nurses know ahead of time that you'll need med check? If someone can come to you at 1800 at least you won't waste time tracking staff down. We incorporate team nursing on my ward, which helps - in the first instance we go to our partners for checking and other assistance.

Which brings me to organisation. I don't know what a brainsheet is, but we use a shift organiser where I work. It's a table, with patients down one side and the shift broken down by hour across the top. Straight after handover we fill out all the scheduled interventions - obs, meds, assistance with feeds, IDC measures etc. I also write in red anything I need to contact a doctor about (new IV orders, a med r/v) , and green anything I need to follow up (OT referral, phone call to son). I can see when I'm going to be busiest and slot my less time-based interventions then - daily dressings, for example. I cross things off as I've done them, allowing me to see where I'm up to and what's ahead, and allowing any other nurse to pick up my work if I get caught up in an emergency or just get snowed.

Hope that helps, and remember that prioritising is a learned skill, in part because (short of an arrest) there's nothing that will automatically always take priority - blood sugars are vital on a brittle T1DM, but a random daily check of a patient of steroids is less important that getting Mrs M off the floor, for example.

Orange Tree · Feb 28, 2010

Becoming efficient is my biggest struggle, too. And since I'm still new, it's difficult for me to have a conversation with a patient while I'm getting their meds ready....I need to be able to think and focus on the meds. I often find myself zoning patients out when they're chatty and responding with things like a friendly, smiling "Uh hu..." or "That could be true...." Most people seem to be happy to talk and aren't too worried about being talked to (thank goodness). I also write down any non-essential requests and promise to come back as soon as possible. And when I pass a CNA on the floor, I ask them to get the blanket/ice/etc. for room 123 if they find themselves headed in that direction or happen to become freeeee before I do.