Need help with time mgnt/organization on med/surg floor

RNPATL, DNP, RN · Sep 30, 2004

Hi, I'm a new grad on a med/surg floor. I'm curious how everyone starts off their day at the beginning of their shift when you have 4 to 5 patients, need to give meds, do assessments, may have an admit and a discharge, other tx. and still need to do your computer charting that requires you to chart on each patient's IV q2h and their pain q4h. My system just doesn't seem to be working and I constantly feel behind. Any advice would be greatly appreciated. Thank you

Unfortunately, time management is really an acquired skill that you learn through experience. It can be very tough in the beginning, but recognize what works well for you and what does not. For me, after I get report, I check my labs and put together a "to do" list of tasks that I need to accomplish for each patient. This helps me remain focused and on task. Generally, if I can get my assessments completed as soon as I come on the floor, this helps me with my comfort level and also helps me know who may need more of my attention during the initial part of the shift.

Falling behind is a part of the job and, unfortuantely, is all too common as a nurse. Sometimes, no matter how organized you may be .... things happen which throws off your schedule. Try and go with the flow and be as flexible as you can. Reognize the things that MUST get done (i.e stat meds, labs, etc.) and do the best that you can. Don't forget, it is ok to ask for help. Often, when I get into a crisis and fall behind, I depend on my team mates to get me through. Sometimes they can and other times they are as in the weeds as I am and we all just try to do the best we can. Keep up the faith and you will be fine.

Nellie Nurse · Sep 30, 2004

I am also a new nurse and I often get behind as well. I find that it does indeed take time to figure out how you are going to fit so many tasks into your shift. One of the most helpful things that I did for myself was to make my own shift report paper, something that worked for me. I also use a pencil to jot down things that I want to chart if I don't have time right then, meds to give, tasks that need to be completed,etc. After I do each task I will erase it from my paper, at the end of the day if there is nothing written in that designated space then I know that I have finished everything.

Another thing that I am beginning to realize is very important is that you must take time to chart during your shift, don't wait until the end to try to catch up on your charting. We also have computer charting where I work and so I know how easy it is to get behind on that. Of course patient care comes first but even if I am very busy I will make myself sit down and at least work on charting for a few minutes in between tasks. Hope these suggestions help. Good luck.:)

AndyLyn · Oct 4, 2004

I've worked on a medical floor for 6 years, and have a routine that works for me. First of all, we have a graph sheet that has each hour of our 12 hour shift printed across the top, with the patients' room numbers on the left. I get the MARs and write in a slash for each PO med, and IVPB or IVP for each med. The sheet also has a space for glucometer checks, a space for meds I need to track down, and a TO DO list. After I've got the meds on my graph sheet, I take my kardexes on a clipboard and do a quick check of each patient. Are they on O2? Are the IV's right? Are they in pain now? Is there anything that needs immediate attention? If not, I go back to the first patient and start assessments right away, breakfast or not. I make notes on my Kardexes all day long, chart when I have a chance, and check labs before 1000, when the first round of meds usually occurs. Some days are smooth as silk, and others are one fire after another.

Give yourself a break, but at the same time, try and develop a routine that works well. It's a safety net for the really hectic days.

barefootlady, ADN, RN · Oct 5, 2004

There are lot of great tips just in the posts already written, but I do find I must put an eyeball on my patients before I do about anything else. I can quickly scan the IV to see if a new bag is needed and make a check on my to do now list, I can find out if someone is in real pain and needs it now, if the patient going for the early test is truly ready, if the incontient patient is dry, and a dozen or so things that a quick eye can pick up. I then check my labs, then my am meds/insulins, check box for new orders or call the do now labs to the dr. I try to get this done within the first 15 or 20 minutes after I complete report. Sometimes it works and sometimes not. There are days that one emergency after another happens and I never seem to get on track, but for the most part, I do better if I can put a face and name together with the diagnosis.

Schweetnsazzy · Oct 6, 2004

Thank you all so much for your advice. I seem to have ambiguous feelings about med/surg and I don't understand it at all. I know each day I work I feel as though I have learned a lot, but realize there is so much more to still learn and I have only one more month of my preceptorship left.

Anyways, your advice has been great!

RNKPCE · Oct 6, 2004

I have always used a form like the following attachment. I put the patients room numbers in the far left hand column and then I put an x under the time they have meds, I put a line in the box where I have to do a fingerstick or other note in a box when I need to look for lab results, do a dressing change etc. on the far right I put notes like bp>180, which tells me I need to give a prn if sbp over 180, or ua( I need to get a ua). As I do things I cross them off. Such a good feeling when that last x is crossed off.

This way before I get out of report I have an idea of what my busiest times are going to be, or which patients are going to need more of my time, or when might be best for me to go to dinner.

If you start out organized, even if things get hectic, you will be in a better position.

workmed sheeta.doc

General E. Speaking, RN, RN · Nov 3, 2004

I keep a homemade report sheet in my pocket (looks like hell after 12 hrs) aka "my brain". This has really helped me to stay organized. On my report sheet I write down the usual graphics plus the admitting docs and consulted docs. This helps me to remember which docs to look out for when they trickle in for rounds so I can make sure I check my charts for orders. Also, I write down when labs are due or what a.m. labs were (for quick reference). Meds times are on this sheet as well as IVF's. Then on the back of my sheet, I write down names/room # of patient's. This way I can write down my vs and jot down assessment notes for charting later. This is also helpful for writing things/times of events that happen during the day (important on those really busy days when it seems everything happens at once and you are running from room to room!) I agree with the other nurse's comments on falling behind- it just happens. I can't tell you how many times I have given 0900 meds with 1200 meds. You just need to prioritize. Eventually, you will get a routinue down! Hope this helps. Good Luck!

meownsmile, BSN, RN · Nov 4, 2004

The graphics and self organization tips are great, everyone has their own way to do things and keep things together. My biggest thing is keep it together, full hands in full hands out.

When we do have to do TPC, we usually have 5-6 patients. I start with of course report, look at labs, then i usually take the med cart/MAR to the rooms with me,, i start at one end and work my way down the hall. Do assessment, give meds, check IV's, and do any uncomplicated dressing changes at the time i go in if I can. It takes a good 10-15 min per patient,or more, but it beats running up and down the hall and getting stopped millions of times to help someone with other things. I can usually get the first couple patients done by the time breakfast trays get there then the docs start coming in. In my hospital we are expected to make rounds with the doctors for our patients so any orders can be "decifered" at the time they are written. ( we all know what wonderful handwriting doctors have). In between doctors coming in, i will work on the next patient. I can usually get all that done by 10 or 11 then i start working on the complex dressings if there are any and the new surgicals start coming in. I can get my shift notes done by about 2:30 if im lucky and dont get a load of new surgicals that come back at the same time.

But, ive said it before,,and ill say it again. The more you let yourself get flustered the worse it gets. One thing at a time, dont sweat the little things if they have to wait, and keep working toward getting it done. Eventually it does get done, and if you have to ask for help, do it before it gets out of hand. If you dont, you will be so frazzled you wont know what to have someone do when they can help you.