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5 Myths of Multitasking

Nurses Article   (1,138 Views 17 Comments 893 Words)
by Nurse Beth Nurse Beth, MSN (Advice Column) Writer Innovator Expert

Nurse Beth has 30 years experience as a MSN and works as a Nursing Professional Development Specialist.

334 Likes; 10 Followers; 81 Articles; 224,791 Visitors; 1,688 Posts

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Many of us pride ourselves on multitasking. After all, the nature of nursing is to juggle constantly changing priorities. But what if multitasking causes us to be less productive and less safe in certain situations? 

5 Myths of Multitasking

Many of us pride ourselves on multitasking. After all, the nature of nursing is to juggle constantly changing priorities. But what if multitasking causes us to be less productive and less safe in certain situations? 

1. Multitasking is a Myth

Multi-tasking is a bit of an oxymoron. It doesn’t work. Try listening to your spouse or child whispering something to you while watching a movie. You will either be listening to them or listening to the movie.

We can really only pay attention to one thing at a time. As an educator, I’m reminded of this whenever I give an in-service at the nurses' station. I can see by the expression on the nurses’ faces that they are not fully there. They are listening to their own internal thoughts, with one ear cocked to hear call lights and alarms. You can hold them captive for 10 minutes or so, but you can’t make them process.

In the old "pat your head and rub your stomach" exercise, you can pat your head just fine until you add in rubbing your tummy. Do both and one or the other suffers. “Split attention” is more descriptive than “multitasking”.

Here’s an entertaining version of the old “pat your head and rub your stomach” trick: While sitting at a desk, rotate your right foot clockwise. Now draw the number “6” in the air. See what happens to your right foot. The brain does have certain cognitive limitations when it comes to multitasking.

2. Cognitive Stacking

Cognitive stacking is the new term for multi-tasking. Cognitive load theory says that when overloaded with information, the ability to process new incoming information is affected.

Extraneous load is when workflow increases cognitive load, such as going multiple places to obtain equipment to perform a procedure. When cognitive load theory is ignored, workflows are created that set nurses up to fail.

An everyday example is when entering pt information in the electronic health record (EHR)  in multiple places or non-intuitive places.

Sometimes when I’ve visited my personal doctor, he asks me a question I already answered. His ears heard what I said, but his brain didn’t process it. Maybe he was still ruminating over what the previous patient said, or thinking about a lab result the MA brought to his attention before entering the room.

How many times have you given patients education that you knew they weren’t really comprehending? 

3. Blink Effect

There’s a phenomenon called the “blink effect” that happens when shifting attention from one thing to another.  It says that data is ignored or missed during the switch. It’s a small amount of data, lost in a small amount of time, but in certain situations, it can be serious. That’s why texting and driving is so dangerous.

Safety and productivity are affected each time we change tasks.

4. Danger of Distractions

The risk of making an error increases by 12.5% for each interruption, according to the Institute for Safe Medication Practice (ISMP).

A doctor was interrupted in the middle of placing an order to discontinue anticoagulation by a personal text message. She never went back to finish placing the order and the patient had a significant bleed that required surgery.

A well known med error reported many years ago to the Institute for Safe Medication Practice (ISMP) is about the nurse who poured chloral hydrate liquid into a medicine cup, stopped on her way down the hall to talk with a coworker and absentmindedly sipped on the chloral hydrate as if it were coffee! It was in her coffee hand and it was a social conversation. Her automatic and routine mannerisms took over. She was driven home to sleep it off.

Anything that draws attention away from the task at hand and forces attention on the new distraction, disturbance or diversion, even temporarily, puts the person at risk for making an error. Attending to the new task increases the risk of an error because the stress of the distraction or interruption causes cognitive fatigue, which leads to omissions, mental slips, lapses, and mistakes.

Alerts and notifications in the electronic health record (EHR) are intended to be safeguards, but opening the EHR for one reason and receiving multiple alerts and notifications is a distraction that increases cognitive load.

5. Combating Multitasking: What Helps

Take breaks when able to clear your mind and step back. If possible, walk outside briefly for fresh air. If not, walk to another part of the unit to briefly change your surroundings.

Practice mindfulness during key tasks such as medication administration. Likewise, avoid interrupting colleagues when they are administering medications.

Be aware of the effect of distractions and being "out of routine". Compensate by using memory aids and lists so key tasks are not missed.

Workflow designs in healthcare must be designed around natural limitations in human cognition.

What strategies for multitasking have you found helps your practice?
 


Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!
 

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Nurse Beth works in acute care and is the career guru at the Ask Nurse Beth career advice column. She has an award-winning blog, nursecode.com Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

334 Likes; 10 Followers; 81 Articles; 224,791 Visitors; 1,688 Posts

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Davey Do has 35 years experience and works as a Behavioral Health RN.

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"What strategies for multitasking have you found helps your practice?"

When I catch myself not focusing on the task at hand, especially at work, my inner voice will tell me so. "Dave- you're not focusing". "Oh yeah", I say to myself, "This is how mistakes are made". I then do an inner narrative in order to refocus.

This technique works for me if something is going on in my life that easily distracts me. I remind myself that I can do nothing about whatever is going on outside of my work and my attention needs to be on what I'm doing at the time.

Daniel Gilbert, in his book, Stumbling On Happiness, refers to another phenomena our brains do called "nexting". Nexting is exemplified by your statement of "I can see by the expression on the nurses’ faces that they are not fully there". 

For example, the nurses are thinking of patient care, treatments, or what they have to remember to document, etc.

Here's an excerpt from Stumbling On Happiness about nexting:

"(Your brain) is nexting right now. For example, at this moment you may be consciously thinking about the sentence you just read, or about the key ring in your pocket that is jammed uncomfortably against your thigh, or about whether the War of 1812 really deserves its own overture. Whatever you are thinking, your thoughts are surely about something other than the word with which this sentence will end. But even as you hear these very words echoing in your very head, and think whatever thoughts they inspire, your brain is using the word it is reading right now and the words it read just before to make a reasonable guess about the identity of the word it will read next, which is what allows you to read so fluently. Any brain that has been raised on a steady diet of film noir and cheap detective novels fully expects the word night to follow the phrase It was a dark and stormy, and thus when it does encounter the word night, it is especially well prepared to digest it. As long as your brain's guess about the next word turns out to be right, you cruise along happily, left to right, left to right, turning black squiggles into ideas, scenes, characters, and concepts, blissfully unaware that your nexting brain is predicting the future of the sentence at a fantastic rate. It is only when your brain predicts badly that you suddenly feel avocado."

So, to answer your inquiry about multitasking strategies that help my practice, Nurse Beth, is that I try to avoid multitasking!

Good article!

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Daisy4RN has 20 years experience.

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Great article! I think that our society encourages multi-tasking which is obviously not a good thing in general but especially for certain professions like ours. Yes, we all need to try to be mindful.

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Nurse Beth has 30 years experience as a MSN and works as a Nursing Professional Development Specialist.

334 Likes; 10 Followers; 81 Articles; 224,791 Visitors; 1,688 Posts

4 hours ago, Davey Do said:

 

When I catch myself not focusing on the task at hand, especially at work, my inner voice will tell me so. "Dave- you're not focusing". "Oh yeah", I say to myself, "This is how mistakes are made". I then do an inner narrative in order to refocus.

This technique works for me if something is going on in my life that easily distracts me. I remind myself that I can do nothing about whatever is going on outside of my work and my attention needs to be on what I'm doing at the time.

Daniel Gilbert, in his book, Stumbling On Happiness, refers to another phenomena our brains do called "nexting". Nexting is exemplified by your statement of "I can see by the expression on the nurses’ faces that they are not fully there". 

 

Your strategy in the bolded text really resonates with me. Compartmentalizing and focusing.

I love to hear about "nexting"! I had not heard about it and I love to learn something new. I didn't even know I do this. All the time.

 

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TriciaJ has 35 years experience as a RN and works as a Retired.

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Great article, but it didn't mention the "S" word - STAFFING.   Multitasking (and cognitive stacking) are a direct result of unrealistic workloads.   Adequately staffed work places would greatly cut down on the need to multitask.

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bluegeegoo2 has 11 years experience as a LPN and works as a LPN.

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My father-in-law's definition of multitasking: Doing a bunch of things half-a**ed. 

Great article!

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This is why “multitasking” should not be used during an interview, because it can be dangerous. If we have learned anything over the years, when we are overloaded things suffer. So, my answer to the multitasking question is “I write lists of the things I have to do”, that is my form of multitasking, as it were. We should leave that at home. 

 

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SNF is all about multi-tasking. DON says: you need to improve time management. Me: you have left me here at dinner time on till midnight with 60 patients, a doctor who wants to give me orders, 3 cnas that magically disappear when I need something, phones ringing off the hook while I'm trying to pass meds. DON: We need to have a meeting and figure out some solutions. We want you to take the portable phone with you on your cart and answer the phone while you pass out meds. Me: ????? 😖🤕thinking to myself, time to look for new employment.

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Just a note. Once upon a time, I was able to talk to somebody and listen to somebody else conversation. I could chat to my classmate and listen to the teacher’s lecture. It was never a problem to answer teacher’s request who noticed me talking during the class “ repeat what I have just said”. I used to do my homework and watch TV at the same time, I think this is from where this ability, or whatever you wish to call it, came from. Things have changed when I moved to my father who turned off TV and provided the best quiet environment  for me to do my homework. Since then, I can listen only to one person at a time. 

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Nurse Beth has 30 years experience as a MSN and works as a Nursing Professional Development Specialist.

334 Likes; 10 Followers; 81 Articles; 224,791 Visitors; 1,688 Posts

14 hours ago, Wlaurie said:

SNF is all about multi-tasking. DON says: you need to improve time management. Me: you have left me here at dinner time on till midnight with 60 patients, a doctor who wants to give me orders, 3 cnas that magically disappear when I need something, phones ringing off the hook while I'm trying to pass meds. DON: We need to have a meeting and figure out some solutions. We want you to take the portable phone with you on your cart and answer the phone while you pass out meds. Me: ????? 😖🤕thinking to myself, time to look for new employment.

Giving nurses an untenable and unsafe patient care assignment and then blaming them in the name of "your time management" is so wrong.

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VivaLasViejas has 20 years experience as a ASN, RN and works as a Retired/Disabled Nurse and Blogger.

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One of the reasons I left nursing was because I lost whatever ability I had to multitask. I got to a point where my brain just crashed, like a computer with too many apps running. There were too many patients/residents, too much to do with too little time to do it, too many distractions. I have never been able to listen to more than one conversation at a time, or work on the computer while watching TV. Nursing made that worse, and then I developed trouble with focus in the later years. I was either scattered, or I was hyperfocused to the detriment of the other tasks that needed my attention at the same time. Highly frustrating, to say the least, and I know from my son's tales of work and my reading here that it's only gotten worse in the five years since I left. 

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TriciaJ has 35 years experience as a RN and works as a Retired.

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13 minutes ago, VivaLasViejas said:

One of the reasons I left nursing was because I lost whatever ability I had to multitask. I got to a point where my brain just crashed, like a computer with too many apps running. There were too many patients/residents, too much to do with too little time to do it, too many distractions. I have never been able to listen to more than one conversation at a time, or work on the computer while watching TV. Nursing made that worse, and then I developed trouble with focus in the later years. I was either scattered, or I was hyperfocused to the detriment of the other tasks that needed my attention at the same time. Highly frustrating, to say the least, and I know from my son's tales of work and my reading here that it's only gotten worse in the five years since I left. 

I can relate.  Even though my last job was a cake walk comparatively speaking, I could feel myself losing my edge.  Keeping multiple balls in the air began feeling more onerous, I was feeling less sharp and decided to retire before I became that coworker.

Even a year later I find myself scattered, which is the real term for "multi-tasking".  I knit a row, then sweep the floor, then peel the potatoes, then do a yoga posture, then dust the furniture, then put the potatoes on to cook, etc etc.  When I spend too much time doing one thing, I feel guilty about the other things I should also be doing.  Just like at work.  I call it nurse brain.

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