New Nurse

Home Health Columnist / Guide · Nov 4, 2013

Moved to our First Year After Nursing Licensure forum ...much advice here for new grads.

HouTxNurse832 · Nov 4, 2013

Well I graduated in May and work on an extremely busy Med Surg unit with 5-6 patients/shift 7am-7pm. I would suggest what's called a brain sheet to organize your day. Everyone has different techniques. I usually use the print out the Charge RN prints out every shift for each patient that has on it patient's name, dx, admitting doc, spaces for me to fill in where their IV is placed, telemetry box number, if they are blood sugars ACHS, history etc. So after I get report I sit down at the computer and go over everyone's labs..write down the most common ones (K, Hgb, Hct, etc) and any abnormals just in case I get a call from a MD I don't have to scramble for lab values. I also write down my vital signs as well since for some meds you need to know the values (b/p meds). I write down my blood sugars and usually start with those patients b/c they need the insulin before breakfast arrives. I pull meds next. Some people do it differently, but I usually start with my "easier" patients first (given they are my blood sugars as well) b/c I like to do my assessments and chart while in room. On most days I get my shift assessments in the computer by 11 am (given that I don't have any new admits or discharges prior to) b/c the rest of the day is spent checking charts for new orders and fullfilling those. It's rare that I'm still there after 720pm....of course granted I didn't have any admits and discharges but still rarely stay late if ever.

Don't be afraid to ask for help from other RN's and your Charge RN. They probably are alot more willing to help than you realize. Nursing is a 24 hours job and you can't do every single thing sometimes and that's ok. I hope you find a system that works for you. Everyone is different, but you will get it down :)

SubSippi · Nov 4, 2013

I'm new also...all the nurses on my unit tell me not to worry too much about getting behind, because I'll get better and stressing out won't help anything. Just make sure that if there is a medication that's important to give on time that you do that first, before anything else.

Things that have made me faster:

-Always seeing my patients in order from the easiest to the hardest (as far as time consuming goes).

-Making sure my med cart is fully stocked before I start.

-During my assessment when I first see the patient, I check and see what they have hanging, which will let me know if I need to bring IV tubing with me during my med pass.

-Anticipating needs, such as pain, constipation, trouble sleeping...I'll go ahead and bring these pills with me if I think the patient will ask for them.

-With patients who are always asking for pain medication, I write on their white board the earliest they can have it again will be, and tell them if I'm not in there at that exact time to just give me a few minutes because I got caught up with another patient. I also write the time down for myself and tell them I'm writing the time down. I've found that this keeps people off the call light.

I'm not sure how obvious all those are to most people, but for me it took a couple months to catch on. I've also gotten better at telling my patients or their families, when they ask for me things like blankets, that I'm in the middle of handing out medications but I'll be glad to get it for them afterwards. For a while there I would drop what I was doing and get blankets and coffee for whoever was asking.

allnurses Guide · Nov 5, 2013

Number one thing in managing time? Delegation. Know how and when to use your aid. Know how and when to ask your hall buddy nurses or charge nurse for help.

Number two in time management? Prioritizing and clustering care. Line those pockets before you hit the floor - blunt tips, alcohol swabs, flushes, pens, etc. The stuff you need randomly all day long. Look at your patient load, determine who to see first. Look at all their meds and determine what you will need to give them. Miralax? Bring a cup of water in with you. IV Lasix? Make sure you have a 5 ml syringe. Half a tablet of something? Make sure you have your pill splitter. Etc etc. All these little things add up to big chunks of time if you are running back and forth.

Number three, hourly round. It seems counterintuitive - if you do hourly rounding, doesn't that chew up time? Well no, it doesn't and here's why. If your patients know they are going to see you frequently (and lets be honest - hourly rounding is often more hour and a half to two hour rounding even with the best of intentions, but it still works), and you address the major reasons people call for the nurse while you are in there, you are going to get FEWER interruptions. Check if they are in pain. Check if they need to use the potty while you are there. Check if they need repositioning. Make sure their personal items are all where they can get them. And check your IV pump to make sure you don't need a new bag of fluids anytime soon. The fewer interruptions you have by call light summoning, the smoother your time management will go. You still have to meet all of your patient's needs, but if you build trust and anticipate their needs, they know they will be cared for and you get to do that caring on YOUR schedule, not theirs.

Number four, get a good brain sheet and use it. Look up Esme. She has many samples for you to choose from.