Organize your day: Paper Brain

kamakasigirl · Jun 19, 2008

Thanks for that sheet Ben, I just started my new grad position 2 weeks ago and keeping track of all that info has been a challenge. This sheet will be very helpful.

Thank you again

Nicole:D

BridgetJones · Jun 19, 2008

Great brain! Can you upload it as an attachment so I can print it off?

cursenurse · Jun 19, 2008

Very nice sheet.

MrsMommaRN · Jun 19, 2008

nice work on the brain sheet.

one of the things i like to do is on the back of my patient list i do this:

801

chart

mar

2200 med

0200 med

_____ iv total

chart check

____ foley

bgt____

i'll do this for each room and adjust the info needed for each.

DukeNurse86 · Jun 20, 2008

silly question, i'm probably thinking too hard:

on the paper brain sheet, "bg" is in the time chart, as well as treatments/ current status. are they both "blood gases?" if not, please correct me. also, what is "l/m"?

that is all!

brighella · Jun 20, 2008

My guess is that BG stands for Blood Glucose, thats more common than blood gasses unless youre on a pulm floor or icu or something...they still would use blood glucose tests there too though

liv2b · Jun 20, 2008

i'm so sorry. :banghead: i am reposting that last one because i was experiencing technical difficulties.

[color=#333333]:crying2:sorry about the long post...i'm chronically wordy. wow...really wordy. hope you can follow...

[color=#333333]ok...first this isn't my sheet; i can't upload the original excel because i just scanned it in. i'm a first year and still trying to develop an eye. tune your paper brain to your unit. i'm really trying to learn this mrs. bridgetjones and don't know how to upload it here so will someone pull it and upload the image until i find out how to... i remember using computers had a black screen with green type; and it never strained my eyes like monitors now. :) screens are better but we're using the same basic programs to chart...haha.

[color=#333333]anyhow... on the questions:

[color=#333333]1) l/m may be liters per minute (the o2 above could be sat levels po2) for those being weaned or to schedule step down after general anesth.

[color=#333333]2) blood gas may be part of an arterial line for continual monitoring but that is a "special circumstance" that would take too much room on a sheet like this (maybe make a fill in below pain for spec. values)...in my opinion. bg is blood glucose and in a sensitive individual, new regimen, someone changing meds, or someone on watch from doc (>400 or whatever policy) these values need monitored or will be need spit out on report. the bg under diet i believe is also blood glucose for meals (ie. am and noon for morning shifts) for bg stable patients with morning meds. blood gas would better fit down by labs...lots of space under gfr to write it in.

[color=#333333]that reminds me of a point i missed on the first post...stop reading if you become easily agitated [color=#333333]; my purpose for the paper brain is to 1) organize my day (not everything is on regular schedule (some docs like to be "special") ...maybe make reg time boxes bigger to accommodate more for those times? anyone have improvements yet?; 2) have it all there so i don't need to rely on my faulty memory (and w/ all the distractions, increase pt/nurse ratios, etc) it is nice to have something for quick reference for holistic care, and 3) provide better report (more holistic) when someone wants to talk history or whatever and i don't know about something. sure you can break out the chart but if you are just learning or want to more; it's nice to have it all there to connect the dots. main idea: i haven't seen a charting system that was oriented to us doing our jobs the best possible; the primary purpose you may feel that you 'hate charting' is because it is meant to cover your butt in court.

[color=#333333]another point; don't rely on your paper brain when you have a real brain. if you aren't redundant about safety, you will make mistake in transcribing values. you will make critical mistakes if you aren't the type of person to double check yourself (math, interactions, vitals for meds)...especially if you're just putting everything together. i think we can also become lulled into "following orders", and though we share less responsibility for our actions, we are not abdicated from the role as advocate.

[color=#333333]finally, you know that the longer you have been practicing the less this post becomes relevant. if you don't use this paper brain, it just means your awesome mom2bears. some nurses have developed esp and can empathize where their patient is at..."oh she is coming off ____ so i will need to get in there and make sure she is ok." you will know use charting more effectively, develop prognosis, and become more in tune with the medical model machine and (hopefully) we will come to empathize better.

[color=#333333]thank you for reading.

liv2b · Jun 20, 2008

Wow, I initially just wanted to get that paper brain out there but I've included a bunch of posts from Allnurses that deals with the same stuff. By no means is this exhaustive...Just a summary of what I had a chance to read.

*Long term care (30+ pts, less critical, little need for schedualed paper brain?)

https://allnurses.com/forums/f22/new-ltc-how-do-i-organize-226012.html

Some main ideas from the post:

Creating priorities

Organizing your day

Difference between school and "real life" nursing

Reliance on long term interaction for baselines

*NICU/PICU (single room, few pts, critical)

https://allnurses.com/forums/f224/how-do-you-organize-your-day-175388.html

Some main ideas from the post:

Unique single room setup for NICU/PICU: place paper brain next to each baby. Good for nurses covering you.

*Ortho?

https://allnurses.com/forums/f38/help-how-do-you-organize-your-day-278694.html

Main Ideas:

Move from less stable to more stable patients

Use right side of patient list for med times...and timed tasks (step down)?

Check off system

Thats all I have... Anyone else have good posts to ref? :yeah:

pagandeva2000, LPN · Jun 21, 2008

Nice...very nice!

jspacegirl · Jun 22, 2008

I'm first year...hey I'm on the right thread! I don't read a lot here (sorry no time) so this might not be a novel input.
I have been trying to organize myself on the floor during clinical and have been able to observe a number of nurses. I want to be calm and have info ready for the charge nurse, the changing of the guard, docs and family. Having that ready is difficult when your being pulled in so may directions.
I have observed that many older nurses are intuitive to prioritize intervention and information. In particular, one nurse just remembered out of the blue something she had read that morning. She wrote it down but I don't think she looked at her "paper brain" all day.
Anyways, the best I've seen for us newbees was a nurse who used a full sheet per person (two pts per page). They wrote down labs, prn on the margin, and of course had a time table. It was a little difficult to 'put it all together' for coordinated care compared to a single time table but the the sheet was something to draw more detailed care when assessing images, labs, etc.
I've included the scan of this paper brain in an external link here; I hope it comes through.
Good luck! -Ben

Thanks for scanning the "paper brain." I love it! I'm in my last semester of NS and have attempted to use something similar (but less detailed). My only problem is that I forget to look at it, which renders it useless!

It sounds kind of like a pain to me, but my preceptor last week had a great way of reminding herself to do important things. She would set the alarm on her cell phone to go off when she needed to hang new meds, etc.

liv2b · Jun 23, 2008

Oops.... I'm a first year student. I totally posted this in the wrong spot. This is for first year RNs. :imbar Well kudos if anyone uses it.

As a follow up, I would just like to say...

1) Thank you to all you nurses who are tolerant of your student ducklings....

2) Keep it up....That from the students perspective a well organized nurse that is 2 years out of school is hard to find. In my limited experience, they are still running around answering phones, directing family to rooms, and generally, having a hard time prioritizing care. ...and spending too much time answering nursing student's questions. :) The best ones I had were 4yrs+ experience; they knew their stuff (student lingo and knew the new drugs well), had gotten to a point they used their real brain more than their paper brain, and I suspect that the 1-3yrs quit by that time if they hadn't become the embodyment of peace from a bleeding ulcer.

When I grow up, I hope I don't have a critical student watching over my shoulder. haha.

3) Time management or controlled chaos? The wrench thrown into it is accomodating schedualed interventions for multiple patients, remembering stat orders, adjusting for priority, delegating as needed/able, and delivering effective care. ...All without a break or eating lunch on a busy day. How do you perform at your peak if you don't schedual a break in their too? Jumping from unit to unit, I see that some UNITS have developed effective coping and retained staff while others burn out. Any of you good ones hiring!?

That is all...