Me again... What is your approach to prioritizing and organizing your day?

Wren · Aug 14, 2003

My two cents worth..... when I was working in critical care I had a gridded sheet on my computer like some of you have described and I'd print off a few at a time. I had a space for every hour of the shift, per patient.

I had enough room for 4 patients and prayed I wouldn't have that many! I noted key info on each pt during report and as I looked at labs, meds and orders, I jotted them down on the appropriate pt. I have a crummy memory and if it isn't written, I am likely to forget it. I also took the 5 to 10 minutes needed to jot down interventions that needed to be done at certain times. So if pt A needed to have an IV changed at 13:00, I noted IV during that hr for that pt.

It sounds time consuming but it isn't once you get a system down. I think it takes more time to keep checking the chart all of the time.

:nurse:

agent · Aug 14, 2003

How many patients on average do you guys have?

RN-PA, RN · Aug 14, 2003

I work 3-11 Med/Surg and can get up to 7 patients. Before report, I have a paper with columns drawn and times at the top of each column-- from 1600 to 2200. During report, I write down Accuchecks due, IV's that will need to be hung, wound care, or any special meds-- along with room no. in the proper column. I've even taken to writing "Restraints" in the 2200 column to remind me to fill out the Restraints flowsheet for any restrained Pts. After report, I go to the charts and pull the flowsheets for each patient which I will chart my assessments on and give report from (I refuse to write twice); I also check the most recent orders to see if there are any "STATs" not reported to me and to get a feel for what's ahead.

I then go to the med room and go through the Med Kardexes and write the room no. and meds due on that sheet of paper under the correct time column. (I write abbreviations of IV piggybacks due and the rest I write "PO x 4" or however many PO's they have; if BP parameters are needed, I write "BP" next to a PO.)

If I'm not running too late (I try to get out to the floor no later than 1600) and the PCT is finished taking VS, I give him/her report. I may have to call docs for Coumadin or IV renewal orders if I notice during my chart checks that they haven't been ordered, or pain med needs if I learned something wasn't working for a Pt. during report.

I take any 1600 meds with me and will see those patients first, unless there's a fresh post-op or unstable pt. I need to see. If I get an E.D. admit near the change of shift and I know they're stable, I introduce myself, ask if they want anything, and tell them I will eventually be back to admit them. Of course, I'm interrupted by needs for pain meds, help needed by a PCT, Pt. needing to be transported for tests, PACU calling report, etc. It's difficult to assess all my patients sometimes before dinner arrives just after 1700, so I leave the most "stable" Pt's. assessments for last, but I poke my head in, introduce myself, ask if they need anything, and assure them I'll return to check them over after they've had their dinner.

Most shifts I feel like a pinball pinging from Pt. to Med room to telephone to Pt. to laundry cart to family member to Pt. to well, you get the idea and have certainly experienced it. I just keep trying to remember to do the next thing and prioritize as best as possible. I also encourage Pts. to use their callbell to remind me to give a pain med or if I haven't returned with a drink in a timely manner because my good intentions can be suddenly forgotten when I leave a Pt's. room, and am suddenly called to the phone, or another Pt. needs something.