new grad prioritization/time management

[Iwander]

Hello all seasoned nurses,

I am a new grad on a med-surg unit in orientation. I find that my two main struggles besides honing my skills are, as always, prioritization and time management. A lot of new grads will stay an hour or so past their shift on my floor to finish charting. Here are some things that bother me:

There are days when I go back and forth between patients and don't get to chart a single thing for say, 5 hours. By the time I sit down to chart, I feel I will leave something out. Although this is not the end of the world, I want to be thorough and safe in my charting. Examples that have bothered me:

not charting I and O accurately for a patient with bladder irrigation because I couldn't remember the exact times/numbers of the input and output (even though I had some written down it still wasn't correct)

giving a new medication to a patient one hour before shift change and forgetting to waste it (our Pyxis lets us "waste later" and I was busy trying to do 3 things at once before shift change). Any time I forget to waste a controlled substance it scares me.

I struggle with organization. How do I go for several hours and still have enough notes written down in an organized way to chart accurately later? For example, with the I's and O's, I went in that patient room maybe 6 times with a different I/O each time, yet I didn't have enough paper on me to write down all of that accurately. I hesitate to bring an entire clip board with me into patient rooms every time as I'm spreading around germs, but I guess that might have to be my way for now. Also I used to carry papers around in my scrub pockets but this is actually looked down upon by another nurse.

Everyone has his/her own style. I want to make it through my first year. I just need help organizing my notes or being quick enough at skills to chart as I go. I feel that I must give my meds on time, so I don't always have time to chart an assessment as I go. Any focused assessment tips or priority skills on the important things to chart right then? I don't want it to be 1300 and I have 5 patients who don't even have a full assessment charted yet.

Any way to become better at giving meds? Even if I'm done within an hour, there seems to always be that one patient that takes an extra 30 minutes of my time and I'm behind again. Maybe I'm not prioritizing correctly in that case?

Thanks everyone for listening :)

[Lev, MSN, RN, NP]

I'm not a seasoned nurse, but I do work in Med-Surg and have fairly good time management/organizational skills IMHO. A very important part of organization is having a good brain-sheet. There are many of these available on AN. This is your go to place for important information about your patients. Another thing I am very strict about is to chart as I go, unless it is really impossible. If I empty a foley catheter, empty a drain, take a patient off a bedpan, or clear a pump, I document immediately after. Regarding wastes, it's good to do that right away, unless of course there is no one around. I have gone home with half full vials of dilaudid. If the patient is still there, I will waste with someone who worked the last shift with me. If not, I will toss it in the sharps container. It happens to all of us. As long as it doesn't happen to often, it will be ok. Regarding assessments, again, I document right after I do the assessment, unless I'm running out of time to give my meds. Then, I will stop documenting as I go, and focus on giving meds. I will still do the assessments (They take 2-5 minutes). Usually, I will open up the powerform and just document mental status or lung sounds or wound measurements or something off that I don't want to forget and save the rest of the documentation for later. If I have a patient going off the floor in the early morning, I will see them first and get all their documentation done. I save my heaviest patients for last, unless they are acutely declining. If I have a gtube or NG tube or anyone with crushed pills, I try to save for last. I prioritize who I give meds to first based on vital signs, blood sugar levels, and electrolyte levels, who is leaving the floor/going to surgery, and obviously by what time meds are due. Many of my patients are on q4 vitals, so I will follow the tech around and give antihypertensives after she finishes taking the patient's vital signs. Usually, by 11:30, I am finished all my morning documentation. If you would like to carry around small pieces of paper to jot down information, maybe purchase a small mini notebook so you won't lose important info. You can find these at dollar stores. I used them as a tech, but as a nurse, I just write on my report sheet. I use one report sheet for each patient.

[Iwander]

Thank you, this is very helpful. As far as prioritization, I didn't think to do the easy patients first, I actually thought I should visit the complex ones first but as long as they're ok, I see how I should document and give meds to the "easy" ones first to save time. Also, we have our own report sheets for the floor but we have to pass them on to the next nurse for report. So I can't write all over them or that is sent to the next nurse; they are "summary sheets" only, I'm only supposed to write updates. Thus I have these sheets (5-6) plus my own version and that just becomes a lot of paper to deal with. But I'll create my own I think so that I can write as I go. I agree that I should document as I go. We have about 4-5 tabs to fill out besides the assessment, so for us it can be 20-30 mins per patient of documentation instead of 5. I'll get faster eventually :). So like you said, I should just do some vital assessment documentation like neuro, heart/lungs, whatever the focused assessment body system would be. Thank you for your help!

[ktenor]

Hi lev, thanks for the tips. If you have a report sheet for each patient where do you keep all of them so you dont lose them and also stay organized? Thank!

[Lev, MSN, RN, NP]

Hi lev, thanks for the tips. If you have a report sheet for each patient where do you keep all of them so you dont lose them and also stay organized? Thank!

I usually keep them in my clipboard on a COW (computer on wheels).

[sag1871]

First of all.. Don't be to hard on yourself...time management and prioritization take time to develop...

#1 always check your pockets before you leave the unit..always..it's easy to develop bad habits..don't let this be one of them.

#2 Chart as you go...It is the right way to document..you want the information you document to be correct and thorough.. This will not happen if your charting rounds 3 hours later..

#3 document those outputs,they are a vital part of patient care...they determine if drains come out or stay or if a patients urinary out put is sufficient or if intervention is needed..

If I think I may forget.. I write it on their white board...(patient information board that is in every patients room)

If you are going into a patients room.. Or if they are calling on the call light..think of what they may need...is it time for pain medication..is it time for the next antibiotic or other scheduled med?..take it with you...

#4 Every time you leave the patients room..even if all they wanted was for you to close the door...Ask them,is there anything that they need..4p's

Pain, position,potty,placement... Do this and it saves you wasted time...They will not call you if their needs are being met.

#5 Delegate a task that can be done by a tech..they are there to help you..

#6 Ask for help when you need it..other nurses on your unit can help you..But always be the nurse who is willing to help others when they need it.

#7 I carry a binder with dividers..each of my printed out assignments go into the dividers.. I carry that with me all day.. I call it my brain..I fill it out when I get report and add to it throughout the day.. If orders,consults or meds are added I write it down.. I also write down abnormal labs and I&O's...

It takes time to develop as a nurse...the first year is the hardest..it helps to ask yourself at the end of the day.."What could I have done different to make the most of my time"? Nursing is one of the hardest jobs in the world..if this is what you are meant to do...you'll figure it out!!!! I wish you much success..you can do this..just know that there will be days when you will want to quit..just remember ..no bad day can last forever..you will get through it..The good ones always do!!