Organizing and prioritizing tip for a new grad

AJJKRN · Dec 29, 2013

Depends on the flow of your floor but for me I start off with writing my scheduled meds down on a med sheet that has five rows across for my five possible Pt's and then hourly slots up and down for the med times. I always start with assessments but pass meds/VS if they're scheduled around my assessment times. I always chart all of my WDL excepts and wounds/incisions when I assess. My med sheet also has at the end of it "assess, acuity, care plan, education, etc" for each Pt to mark off when I'm done. Backtracking is time consuming and annoying! Just mark things off as you go so you know what you have left as you run your tail off and maneuver the shift...GOOD LUCK!!!

hurleygirli1 · Dec 29, 2013

I learned the hard way that you should chart as you go. Sometimes this can be challenging, but leaving the charting for last can leave you in a crap position. In the beginning, I sometimes stayed charting an hour or more after my coworkers left from day shift. It's easy to let the day get away from you like that, especially if you have a lot of patients. Chart as you go seemed like more work at first, but much better knowing that you don't have a pile of things to get caught up on.

Lola Lou, BSN · Dec 30, 2013

I come into work about 20-30 minutes early so I can look up my assigned pt's, their most recent lab values, scheduled meds, wound care orders, etc. Having this done ahead of time allows me to ask the previously assigned nurse questions that I may have not thought of if I had not researched beforehand (ie: missed med,high/low lab value and if Dr. is aware...) I anticipate that I will not have to always come in early, it is just necessary while I am acclimating to the job.My facility uses the SBAR to hand off between shifts. Before I go in to each room in the morning to perform my assessment I fill in as much as possible(code status, diet, PT orders, precautions) and also make little boxes to checkoff when I have completed a task. I have an hour window before and after scheduled med times to pass the med. I pass the med ASAP because you never know what is going to be thrown at you 30 minutes down the road. I learned to chart as I perform tasks and not to wait until later to do it. You are able to charti n more detail and have less difficulty remembering stuff if done right afterwards. Really the few minutes it takes to chart in between pt's makes up for the hour that you may be staying later after your shift to catch up. My goal is to have all of my assessments in by 1200-1300. I usually try to document my first assessment if my other pt's are still sleeping. Some days this does not happen. Hmm I guess those are just a few skills that I feel I have started to develop and continue to do so each shift. Good luck!

psu_213, BSN, RN · Dec 30, 2013

I always wanted to make sure I knew if I had any pts. traveling off the floor (particularly early in the day). It really stinks when its 0745, you are in the middle of something, and the tech comes up to you to say "oh, transport is here to take Mrs. Smith for her stress test."

jess410 · Jan 7, 2014

Once I get my assignment I'll take report if the outgoing nurse is ready to give it or if not I'll just go on the computer and start looking up the basic information myself such as age, admitting diagnosis, diet, code status, primary physician, medical history, etc. I also like to look up when meds are due and write med times for each patient on the side of my sheet that I fill out. I also check if patients have blood sugar checks and if they're on blood pressure meds and when. I also like to take a quick check through the orders to see if there's anything I need to know such as tests ordered for the morning in case patient needs to be NPO after midnight, wound care, etc. After I get report I like to go with the outgoing nurse to see the patients. Technically we're all supposed to do this, but some nurses don't really like to. I think it's a good idea just in case you have any questions and also to make sure the patient is breathing and alive. Sometimes if you wait until the outgoing nurse leaves to see patients you get caught up in other things and it can take a while before you make it in to see everyone so it makes me feel better to know that all my patients are ok and that I've at least gone in to introduce myself. Once I'm on my own I look up any additional info that I didn't get a chance to check and if there's any 8pm meds to give I give them as well as any pain meds that patients need. I also tell the CNA what patients I need blood sugars and early VS for (such as if they're on blood pressure meds or neuro checks since normally VS for night shift are taken at midnight) and then I start my assessments. If any patients are complaining about pain, constipation, diarrhea or anything else that they don't have meds ordered for or anything that the physician needs to be aware of I'll put a call out ASAP before it gets too late. After assessments if it's before 9 pm I'll start doing my charting since most meds are due at 10 so I can't start giving them until 9. At 9 I start passing meds. Then once meds are passed I'll continue charting. Also sometimes if patients are sleeping comfortably I'll wait until I give their meds to do their full assessments. Also during the shift if I know I'm getting an admission I'll always make sure to check that the room their assigned to is clean and I'll let the CNA know so that they can have everything ready for the patient or if they're busy I'll get it ready, but it's always a good idea to make them aware that another patient is expected. I'll also go into the computer and get as much information as possible on the patient so when I get report I'm prepared.

Also now we have an Omnicell where all common meds are stored, but before when we just had individual med drawers for each patient I would go through and make sure that all the needed meds were there at the beginning of the shift. That way if you're missing anything you can let pharmacy know and hopefully get it in time.

BelleP · Jan 8, 2014

I always come in early so I have time to get ready before report. We just switched over to a new system so we had to get acclimated a bit to workflow adjustments.

I generally look up meds, h&p's, vs, orders, labs, progress notes and any significant events during the previous shift. Sometimes I do them all, and sometimes I look these up right before I go into the patient's rooms (except meds). Then bedside report from the previous nurse. Then I do my assessment and try to chart as I go. I go to fresh surgicals first or patients who have had some "issues" during the previous shift so I can look at them first. I have a sheet where I write down the info that I need. Of course it gets MUCH tougher when we have admissions (from ED, PACU or direct admits) during shift change. I think that makes things trickier because there is a window of time that you need certain things done for your new admission, but you need to do things for you other patients too (plus hourly rounding).

I second Jess410's method of checking for missing meds. We do not have a 24 hour pharmacy so it is really important to make sure that you have all your meds available before pharmacy leaves.