Organization and Time Management

TheCommuter, BSN, RN · Mar 6, 2008

I carry a notebook around me. Before my shift begins, I create a "To Do" list of all tasks that must be accomplished before the shift ends.

I worked on the rehab unit of a nursing home for 2 years, and I typically cared for about 15 patients. We tended to deal with elderly patients who were recovering from knee and hip arthroplasties, back surgeries, CVAs, post MIs, debility, thromboembolectomies, CABGs, and other assorted issues. Anyway, here is how I organized for the day. I worked 16 hour shifts, from 6am to 10pm. At the beginning of the shift, I went through the MARs and TARs with a fine tooth comb and, as I browsed, I jotted down the things that needed to be done in my notebook. My notebook was how I organized the rest of the day, and I usually didn't forget to do anything. Here is how a recent notebook page looked (names have been changed due to HIPAA):

3-6-2008

DIABETICS, FINGERSTICKS: Agnes (BID), Agatha (AC & HS), Bill (AC & HS), Wendy (AC & HS), Rex (BID), Jack (BID), Esther (AC & HS), Margie (0600, 1200, 1800, 2400)

NEBULIZERS: Margie, Esther, Bill, Jack, Jane

WOUND TREATMENTS: Jane, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Wendy (Vancomycin), Laura (Flagyl), Rex (ProcAlamine)

COUMADINS: Agnes, Agatha, John, Lucille

INJECTIONS: Agnes (lovenox), Jane (arixtra), Rex (heparin), Bill (70/30 insulin), Esther (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Wendy (wound), Laura (C-diff), Rex (pneumonia), Agatha (MRSA)

1200, 1300, 1400 meds: Margie, June, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura

REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Jane's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

Blee O'Myacin, BSN, RN · Mar 6, 2008

Organization and time management are critical factors that make up a good nurse. Is there any advice or tools available that would help me or others be more organized and manage time better?

Plan out your day, reassessing every few hours to see if the plan has changed. Don't forget to plan in time for eating and lavatory breaks!

When I was new, I'd write sticky notes and place them on the sheet I used to take report on. Now I just manage my time mentally - but I've had lots of practice.

Good luck. Time management comes with experience.

Blee

nservice · Mar 6, 2008

I use the CURE approach when teaching time management / prioritization.

C = Critical

U = Urgent

R = Routine

E = Extras

Of course the key is to constantly re-evaluate. Often times, new graduates are very task oriented and their stress level rises when something happens to throw off their schedule of tasks. Ask yourself, "What can wait 30 minutes?" What can wait and hour? What can be delegated? When should I ask for help? It's a skill in itself to be able to prioritize and it takes practice.

imanedrn · Mar 6, 2008

Good luck. Time management comes with experience.

THank God, there is hope! I'm a new grad and a nervous wreck to boot! I've never had trouble with time management before. Now, I DREAD going to work because I'm terrified. I know things will get done, I just don't like waiting 'til the end of my shift and having to eat "lunch" at 4 pm.

I know there's hope for the future... but I can't see the forest through the trees :crying2:

imanedrn · Mar 6, 2008

I use the CURE approach when teaching time management / prioritization.
C = Critical
U = Urgent
R = Routine
E = Extras
Of course the key is to constantly re-evaluate. Often times, new graduates are very task oriented and their stress level rises when something happens to throw off their schedule of tasks. Ask yourself, "What can wait 30 minutes?" What can wait and hour? What can be delegated? When should I ask for help? It's a skill in itself to be able to prioritize and it takes practice.

YES! I am SO task oriented because that's what I've spent my whole life learning! It's so difficult to break from the tradition!

Although I know this "CURE" idea in my mind, it's such a change to think about not get "things" done but actually seeing the big picture.

2bNurseNik · Mar 6, 2008

3-6-2008
DIABETICS, FINGERSTICKS: Agnes (BID), Agatha (AC & HS), Bill (AC & HS), Wendy (AC & HS), Rex (BID), Jack (BID), Esther (AC & HS), Margie (0600, 1200, 1800, 2400)
NEBULIZERS: Margie, Esther, Bill, Jack, Jane
WOUND TREATMENTS: Jane, Bill, John, Jack, Lillian, Rose, Lucille
IV THERAPY: Wendy (Vancomycin), Laura (Flagyl), Rex (ProcAlamine)
COUMADINS: Agnes, Agatha, John, Lucille
INJECTIONS: Agnes (lovenox), Jane (arixtra), Rex (heparin), Bill (70/30 insulin), Esther (lantus), Mary (vitamin B12 shot)
ANTIBIOTICS: Wendy (wound), Laura (C-diff), Rex (pneumonia), Agatha (MRSA)
1200, 1300, 1400 meds: Margie, June, Rose, John, Jane, Jack
1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura
REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Jane's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

That seems like a lot of patients to handle on one shift. What is a typical nurse to patient ratio?

TheCommuter, BSN, RN · Mar 7, 2008

That seems like a lot of patients to handle on one shift. What is a typical nurse to patient ratio?

1 nurse to 15 patients on a rehab unit. Yes, this was day shift.

-MNC_RN- · Jun 4, 2008

This is something I hand out to new grads. I take absolutely no credit for this, and have permission to distribute.

3 Minute Miracle (Linda P.,

RN

)

Remarkable care is usually measured by the amount of genuine focused attention given by primary nurses.

This valuable impression can start at the beginning of every shift with what could be called the "3 Minute Miracle." After you have researched your assignment and been given report from the previous caregiver, a 3 minute visit to each patient can often initiate a positive tone for the entire shift. The miracle begins by pleasantly entering the room, greeting the patient by name and introducing yourself as their nurse. In the next 2 1/2 minutes, important information can be obtained as you focus on signs and symptoms particular to that patient's diagnosis while also observing the entire setting that is presented.

The big picture may reveal such things as:

- patient orientation per your communication

- pain control either stated and/or demonstrated

- skin color and condition

- family/friends' presence and support

- emotional status

- lines and equipment function

- patient position and comfort

- room order

Focus areas may include:

- breath sounds

- signs of respiratory distress

- quick look at incisions

- pulse checks

- bowel sounds

- bowel and bladder function

Before leaving the room, a brief plan of action should be vocalized including when you will be back for such things as meds, treatments, fresh water, or ambulation. Prioritize any specific needs you have identified and deal with them accordingly.

Just what does this 3 minute miracle accomplish?

- you see and meet all of your patients

- your patient know your name and what you look like

- a much smoother transition of caregivers is accomplished

- training and keen senses have produced concise information on each patient's current condition

- you get a jump-start on your assessments

- your patients are given an opportunity to express immediate concerns

- you are less likely to be interrupted aw you get into the initial duties of your shift

- you are better able to take ownership of your assignment by having a mental and tangible grasp of each patient

Go ahead... Make some miracles... And have a great shift!