Organizing your med/surg day

mappers · Jul 12, 2010

I work a med/surg onc floor 7a - 7p. We usually have 5-7 patients, usually 6. We are allowed to clock in at 6:38. I get to work about then, clock in, get my Kardexes. I have created an assessment sheet that has an area at the top for what I get in report and then space at the bottom for my assessment, broken down by system. I staple one sheet per patient to their kardex.

I have another sheet that is basically a large grid with the hours across the top. I put my patients names down the side and in the first column I write their labs. Then under each hour, I write what meds are due. I'll also write in other things that need to be done, like lab draws, dressing changes, etc as I go. This gives me a one page snapshot of my day and helps me realize where I might have lulls where I can get some things done, reminds me when I need to recheck a BP or get a blood sugar before lunch, etc.

After report, which takes about 30 minutes (we do bedside reporting), I finish writing up any labs, meds, etc I didn't get to before the nurses were ready to start report. Most of our meds are due at 0900 and we have one hour on either side to give meds. Our aids do vitals and blood sugars and usually give those to me soon after report is done. I'll check for anything odd, see if there are some BPs that need addressing, etc. I usually do my diabetics first since trays are usually on their way up. Give their PO meds and insulin, etc. I give the patient their morning meds and do an assessment. I chart the meds, then move on to the next patient.

I usually circulate through the nurses station between patients to see if there are any new orders. We have a lot of early docs. I'll check the charts to see if there is anything I need to address immediately or if it can wait until after I'm done with the med pass/assessments.

Once all my meds are passed and my assessments are done, I'll see if there are any dressing changes I need to do (that weren't quick ones that I could do with my assessments), start transfusions, review charts - take off orders, etc. I try to chart my assessments in between the other things. And the day moves on from there.

Of course there are a LOT of days (let's say most) where this nice neat routine gets interupted with patients wanting pain meds, calls from doctors, patients going down for procedures, calls from family, stat orders, and on and on, and on. Having my one page grid where I can jot down things I have to do helps me keep up with things as I get interupted. I cross things off as I do them. My little assessment sheet helps when I give report at the end of the shift. I write down new orders, etc on there so that I can tell the oncoming nurse what's happened that day AND more importantly, I can tell the patient what the doctor ordered.

pharmgirl · Jul 12, 2010

Well, I will tell you my typical day on the med surg floor.

650am - report

710am - out of report, signing MARS

730am - on the floor to do assessments

830 - back to nurses station to chart assessments

900 - check new orders

915 - pull 1000 meds (some pull all pts meds and assembly line, some pull one pt at a time)

1000 - pass meds

1100 - blood sugars

1130 - check new orders

1200 - lunch? ummm usually not, usually charting

1230 - pull 1300 meds

1300 - pass 1300 meds and hang 1400 IVPB

1400 - check new orders

1430 - catch up on charting

1500 - pull 1600 meds

1600 - pass meds

1630 - blood sugars

1730 - start closing out nurses notes

1800 - get volume history and clear pumps

1830 - chart i & o's, close out notes

1900 - pray night shift is on time

In between all that figure that at every 15 minutes there will be someone's pump beeping, wanting pain medicine, needs a cup of coffee, family wants to talk to you, doctor phone calls, etc.etc., so it never EVER goes as smoothly as above but that gives you the jist.

Good luck!! hope this was what you wanted

TonyaM73, ASN, RN · Jul 12, 2010

This is exactly what I was looking for. Thank you both! Mappers: I do the same thing at LTC, but it is usually 2-3 pages since there are so many patients. I can't wait to be able to really assess people again.

jerrylundergard · Jul 12, 2010

My medsurg/tele/infx disease floor is pretty tuff. We have lots of new orders and banged up pts.

7-7:10-quick check of pts to make sure alive

7:10-8-report (longer than I like but our docs/surgeons are nuts about missed orders and nite nurses are slow)

8-9- assesment

9-11- med pass

11-12- chart check/errands

1-2-medd pass

2-3-chart check/errands

3-3:45-lunch break

3:45-5-dressings/chart checks/errands

5-6:30-med pass/chart checks/errand

6:30-7-wrap up chit chat with pts

7-8-report

steelydanfan · Jul 12, 2010

What I found that seems to slow down most new grads is this need to write EVERYTHING DOWN VERBATIM IN REPORT. You can't listen if you need to write down everything, you have to be able to listen and write a few pertinent memory cues. The sooner you can adapt your own SBAR type report sheet and develop your own shorthand system; the better you will be able to organize. Learn to hit the highlights, in your report taking and in your care plans for the day. Once you have your "Must do's" listed, then list the need to do's," etc. And yes, you will soon find out that you need to show up on the floor at 06:45 to be ready to take report at 07:00. With computer charting, it takes you that long to log in, get your pt. assignment and be able to scroll back and forth between pt. pages as you are getting report . Sorry, but we have'nt been able to clearly document the time factors for report to the PTB yet, but we ARE trying.

vashtee, RN · Jul 12, 2010

Our hospital uses SBARs for report, which are ideally updated by the previous shifts. The previous nurse photocopies it for us to keep during report. I just make notes on it I hear anything that isn't written on it.

I staple the SBARs to the back of my work grid, which lists every hour of the day along the left hand side (set up in a landscape direction), and patients hospital stickers across the top. Under each patient, I write diagnosis, diet, IV fluids running, and cardiac rhythm, and under each hour of the day, I list when meds are due, procedures, etc. I leave a blank space at the bottom for notes to ask the doctor about when they come in.

I get to work 15 minutes before clocking in to fill this out, and to print all my labs, and I update my SBARs for the next shift when there are holes in the schedule.