Organizational tips?

AlwaysLearning247, BSN · Oct 1, 2016

I always research my patients at the beginning of my shifts and look at the orders and medication times. I'll put boxes on each patient's paper. So say someone is getting a chest X-ray, speech consult, and has meds due at 1600, 1800, 2000, and 2200 I'll put a box for chest X-ray and speech consult and I'll group medication times with boxes. For 1600 and 1800 meds I'll group together at 1700 and 2000 and 2200 meds I'll do at 2100. If the patient needs blood sugar checks I'll put little boxes for dinner blood sugar and bedtime blood sugar. I always make it a priority to research, get report, and do an assessment on each patient and document right away. When you do that you have more time later on in the shift and you're not trying to catch up constantly. I work 3-1130 and usually from 3-330 I'll get report and research then 330-4 I'll assess my patients, right after I document everything (usually done by 430-5) then I start checking blood sugars for dinner and med passes!

I work on a med-surg telemetry floor so I understand how hectic this can be at first. You'll get into a routine and become more comfortable as time goes on.

vintagemother, BSN, CNA, LVN, RN · Oct 8, 2016

I'm new, like you. But my organization has been improving. From 1 new RN to another, here are some things that have immensely helped me to complete all of my tasks.

-My facility provides several blank report hand off sheets. I use one of these. I have a blank master copy that has the really important items that I need to collect data on highlighted. For me, this is Name of pt, age, names of all MDs, code status, allergies (sometimes I just write yes Allergies and collect the specific details later) main dx, hx(*), pain meds currently taking(*), diet, activity (ie weak, up ad lib, W/C, walker, 2 person assist, stand by assist) FSBS results, IV access site, guage, types of fluids running, tests to be done and dx test results(*), discharge plan(*) Date of most recent BM

* starred items indicate that I may not gather that info at the start of the shift, I will add it later on in my shift though.

This may seem like a lot, but I'm actually just filling in a preprinted form.

I also record lab values - I've learned to reduce this to only Na/K/BUN/Creat and WBC, H&H, Plt. Plus any pertinent or abnormals. I also look up whether they have orders to replace K or Mag and whether that's been started or I need to initiate it or call the MD for orders.

That is my prep! It takes me 30 mins - 1hr. It takes the experienced nurses

I've created a checklist of the assessments/charting tasks I must complete each shift. I make 1 post it per pt at home, before I go to work and stick it to my report sheet so that I can check off each item as I do it. This is a lot of work, but actually helps me work faster because I know what I've already finished.

I use another sheet of paper to record times that meds/big procedures are due. I create columns and write room 1 1700 5 meds, 2200 2 meds room 2 1630 2 meds 2000 9 meds room 3 etc. I put a line through each med administration as I complete it. I highlight times IV ATB are due as well as FSBS. I can look at my whole shift due med times on 1 sheet this way. I try to write out not just 3 meds due, but the names of the meds, as well. Sometimes I don't have time to write them all out though.

In a nutshell, my "brain" sheet is more like a brain package. But, I'm simply copying what the other nurses who've oriented me do. I have 1 sheet per pt with specific pt info and 1 more sheet with an overview of meds due and their times. I staple them all together.

Another thing I started doing a few weeks ago is when I go home I review my day. What questions do I have? What did I mess up on? What meds / procedures / facility processes was I unclear on. I look up this info and make a note for myself. I use youtube videos and CDC articles to refresh my learning. I also review my orientation notes. If a piece of info is pertinent to my providing daily care, I try to add it to my work clipboard so that I can reference it later. For example, a list of items reqd to be done on discharge.

Whew! That was a novel. And my system made may be a little too complex / detailed for some nurses. I, personally, feel better having a checklist, rather than trying to remember all of the things I have to do for each pt and going home wondering if I did it all.

ClaraRedheart, BSN, RN · Oct 17, 2016

We have a nurse that comes in and researches and writes down everything. I like giving report to her because she already knows everything and if I forget anything, she will remind me I used to, but now I find that I do just fine coming in at the scheduled time. You will get the hang of things with time and might not need to put in additional time to feel organized/calm/cool/collected. Until then, coming in early (if your boss will let you) is a great way to focus your chi.

The only organizational tool I still use is my multicolored clicky pen and the overview sheet that we are allowed to print off on our patient group that states their docs, why they are there, Diet, etc. . Meds-blue, Lines/drains/airways/incisions - Green, important stuff that needs to be done, Labs to do something about- Red, Everything else in black. Best wishes! It will get easier with time!

Dorali, BSN, LPN, RN · Oct 25, 2016

I'm new too! I'm about halfway through my 12 weeks of orientation and up to 4 patients now. I was a CNA before and passed meds in a nursing home for 5 years and I thought I had a good idea of what I was getting in to. I was very, very wrong! Lol!

I have 2 essential things I bring to work with me every day:

1.) My clipboard. Most of the nurses I work with have one of these. I ordered from the website and had it engraved with my name so it won't get stolen, but you can also find them on Amazon. It is my most prized nursing possession!!! It folds in half and can fit in most scrub pockets, but I usually put it in...

2.) My tool belt. I got some good-natured teasing for having this thing strapped to my waist, but I love it! 2 other nurses I work with have them now. I purchased the small one initially, but my clipboard had to go in up & down and got in the way. One of those nurses I mentioned got the medium sized one and her clipboard fits in there perfectly, so I just ordered it and like it a lot better. I always have everything I need. It holds flushes, alcohol pads, pens, scissors, theres a velcro pocket that I keep my personal stuff in--like chapstick, and the little loop holds my tape and curos.

We get report sheets at the beginning of our shift that have basic pt info on them. It has room to take notes, but I don't like them very much. Sometimes the information has changed (diet, whether they have a foley, etc) and isn't updated on the sheet. I have always used my own little cheat sheet and I have made my own that I will attach here. It may not work for you because I made it based on our report sheets, since most of the nurses do use them throughout their shift & I want to make sure they are getting the information they need at shift change.

I check orders to make sure everything is the same as what I received in report and write it on my cheat sheet.

On the notes section, at the bottom are "shift assessment" & "flu shot" because I already know I'll have to do it & check to see if a flu shot has been given to each pt. 'Tis the season! My work list of Things To Do I write from the bottom up & things I need to remember I write from the top down. This sheet is super handy when getting a report from another department. I can make sure I have everything I need to know.

I *try* to keep track of when PRNs are given so I don't have to keep logging in to the computer and looking it up.

On the area next to PRNs, I write down any out of range labs. I save this area for important things.

Yesterday was my first day off after a SUPER CRAZY weekend. I had an admit from ICU mid-shift that coded and passed away right at shift change on Friday. Sunday I had another that was in restraints (meaning q2h documenting) and q1h CIWA. So I struggled a lot.

Yesterday, I sat down with a piece of notebook paper and made myself a schedule of when & what needs to be done. Very generic:

------------------------------------------------------------------------

0630-0700 - Get report.

0700-0800 - Check pt's charts for histories, code status, meds due, etc.

0800-1000 - Med pass. Try to do 1-2 shift assessments.

~~2 hours for med pass with 8 pt's (our max) = 15min per pt. More time if you have less patients.)

1000-1100 - Catch up on anything that needs to be done, check on next round of meds due.

1100-1200 - Insulins & med pass. Do a few more shift assessments.

Lunch - Once I've reached some sort of stopping place, I have to break to eat. I'm usually starving by now.

------------------------------------------------------------------------

Writing all of this down and SEEING what my day SHOULD look like, I'm hoping, will help me feel & stay a little more on track. We all know by now that this never actually happens, but here's to wishful thinking!

I hope I didn't confuse you with my post. I'm on recovery day 2 from this hectic weekend! Ha ha! :blackeye:

One of my struggles right now is keeping track of WHEN THINGS HAPPEN! Pt admitted to floor, discharged and left for home, left for a procedure, etc. We are supposed to be writing notes for everything, but I can never remember what time and rarely get to document as it happens. Any tips for that??

Cheat Sheet 2pt:pg.docx

vintagemother, BSN, CNA, LVN, RN · Oct 25, 2016

As far as remembering the times things occur, 1 nurse told me she jots a quick note to herself on her clipboard / brain / report sheet with the time so she'll remember.

I like to to go Into my daily note section in the EHR and wrote 0910: son Walter at bedside then I pend the note, so I can add to it later. Then I'll save/pend the note again, but won't sign it. Then later I'll write 1115: transported to MRI 1200: returned from MRI. Even if my online notes have typos or are written in shorthand, I simply edit and save at the end of the shift.

Dorali, BSN, LPN, RN · Oct 26, 2016

Jotting things down is mostly what I *try* to do. Plan B is to remember that the pt did/went to ___ when I gave so&so they're PRN at 1130. Lol!

So you're basically just starting one note per patient and adding to it throughout the day?Thats a good idea!

vintagemother, BSN, CNA, LVN, RN · Oct 27, 2016

Yes just updating it with pertinent info as needed. Not all pts have things occur that require a note, but if they do... this is my method

meanmaryjean, DNP, RN · Oct 27, 2016

Former M/S nurse (when night shift had 8-10 patients) offers you two words of advice:

Color Code

Handy-dandy four color pen will make your life easier.

Dorali, BSN, LPN, RN · Nov 1, 2016

Color Code
Handy-dandy four color pen will make your life easier.

Funny you mention that! I just ordered this 4 colored pen today! With "fashionable" colors! Pink, purple, turquoise, and lime green! I'm hoping it will help.