Picking up my pace. Need advice

mcleanl · Feb 19, 2007

Asheto,

I also can't stand leaving things for the next shift however, I do recognize that sometimes it is unavoidable. I also don't like staying late! Anyway, here are a few tips.

-always try and do the easiest things first and get them out of the way and then tackle the bigger "to-do's"

-anticipate what will happen....if I anticipate a patient will need a new line then I'll get the stuff ready so when the doc comes in we can get it done.

-be mentally prepared to start the day the second you walk in the door and be mentally prepared to walk out the door when your shift is done.

Insurance RN · Feb 19, 2007

As hard as it is to learn and follow through..............delegate, delegate, delegate.

wooh, BSN, RN · Feb 19, 2007

Well, for one thing, speed will come. I basically start my day with a to-do list, that includes all the meds for the day, treatments, education, basically ANYTHING I have to do that day. As the day goes on, I cross things off as I do them, and add them as they come up. I combine tasks as possible (meds and treatments and assessments so I'm just making one trip into the room instead of three.) I ask if there's anything I can get for them when I'm in the room so hopefully 2 minutes later they aren't calling, it's quicker to get it then than stop what I'm doing later. Not to mention, if I ask each time I'm in the room, they tend to know I'll be around and WAIT to ask for the little things that can wait instead of ringing the call light. And as you get more experience, you'll learn to anticipate needs. You'll walk in a room with ice before they ask for it. You'll know a doctor is going to want to do x procedure and you'll have already started gathering supplies when you had a break instead of once again stopping what your doing. But most important for me is that to do list. That way I have in front of me at all times what has to be done, and I can look and organize my day instead of running around from task to task with no plan.

SillyLilly · Feb 19, 2007

As hard as it is to learn and follow through..............delegate, delegate, delegate.

Most of the CNAs we work with look at you like I looked at my mother when she told me to do something when I was 13-and the look says it all.

We are having an issue on our particular unit with CNAs wanting to do anything you ask them to do.... the other day I asked one in particular to take a pt down to US because they did not have anyone to pick them up. The CNA was chatting the the lounge. Already had breakfast and lunch break btw. Said ok, and never got around to doing it, kept chatting. It was one where the pt had to have a full bladder. Pt was ready to pee.... I was verrrry busy. But dropped it all to take pt down myself. Managers ARE aware of the problem....

Also have asked to help feed a pt--when it was not even that busy. Or change batteries in a tele monitor, or fix the leads, or other little things.

Note: this is not all CNAs. This is our unit. I was once a nurses aid and worked with many helpful, professional CNAs.

Also have noted nursing students/prospective nursing students are more likely to help out than the reg. CNAs.

One claims she does not get paid for all the running around and constant work that is sometimes expected and just gets her minimum work done. Its frustrating, and adds extra time for me...... or I can just let the patient sit in urine/bm vomit while I have 30 things to do, and the CNA claims its quarter to shift change and she already had done her last rounds.

Most of the time, I find more help talking to another nurse than talking to the CNAs.

Frustrating.

Point of the rant....'delegating' does not always work.

Like one other person said and other nurses have told me--- nursing is a 24 job. Somethings may have to left to the next shift. You do all that you can. It is also how you inform the next shift that things have not been done.

That sounds like lying, but it the stressful environment I work in---most of us work in, I have realized that this is the only way to leave a 12 hour shift somewhat on time. (also how I observed from some of the other nurses) Im exhausted an cannot stay 2hours after every shift!

I agree with doing the easier tasks first. And I also learned to completely finish one task before starting another--if at all possible. So it is done and out of the way. Talk to other nurses, and let them know that you are doing this and that, or having problems with this and that. When you give report, you have back up that this and that happened, and were unable to finish everything you had hoped on time.

Good luck to you!

Anagray, BSN · Feb 19, 2007

Congrats on doing such an awesome job!! i am so proud of you :)

I often wondered why I was behind. Yes, part of it was my personality of a perfectionist, but also sometimes we are so used to doing things in a certain way that it may not work in every situation. I reviewed my skills of prioritizing and organazing, the amount of time I spend counseling my patients, etc.

I had to adjust the way I work.

If you feel really bothered that you are late comparing to others, then you will probably find ways to get things done on time, othere than that - who cares! If you are satisfied with yourself, stay late if that what makes you happy. Sometimes I stay an extra hour at work putting in IVs and training other nurses to work new equipment or to help set up a late discharge. I like it and do it when I can. My boss never says a word.

Good luck!

Natasha

Ann RN · Feb 19, 2007

Many of you have talked about getting supplies together for docs, but why can't they get their own? They know where they are.

Franksters · Feb 19, 2007

Well, for one thing, speed will come. I basically start my day with a to-do list, that includes all the meds for the day, treatments, education, basically ANYTHING I have to do that day. As the day goes on, I cross things off as I do them, and add them as they come up. I combine tasks as possible (meds and treatments and assessments so I'm just making one trip into the room instead of three.) I ask if there's anything I can get for them when I'm in the room so hopefully 2 minutes later they aren't calling, it's quicker to get it then than stop what I'm doing later. Not to mention, if I ask each time I'm in the room, they tend to know I'll be around and WAIT to ask for the little things that can wait instead of ringing the call light. And as you get more experience, you'll learn to anticipate needs. You'll walk in a room with ice before they ask for it. You'll know a doctor is going to want to do x procedure and you'll have already started gathering supplies when you had a break instead of once again stopping what your doing. But most important for me is that to do list. That way I have in front of me at all times what has to be done, and I can look and organize my day instead of running around from task to task with no plan.

It sounds like you are utilizing "Hourly Patient Rounding". My facility has just started this. At first I was very cautious about implementation. I don't have to tell you this, IT WORKS!! Basicly you train the patients. You tell them you will round hourly, you take care of all their needs at the time and then you follow through by returning in an hour. At my facility nurses round once to every 2 rounds by NA. Quality of care has improved, the nurses tell me they are more organized and our patients are happier. The best thing of all...the nurses and NAs tell me they go home feeling like they gave very good care to all their patients.

Franksters · Feb 19, 2007

Many of you have talked about getting supplies together for docs, but why can't they get their own? They know where they are.

It's simple. They do not want to get their own supplies. Actually, I prefer to get my own supplies. That way I am mentally prepared, physically prepared and not surprised by the MD showing up suddenly.

wooh, BSN, RN · Feb 19, 2007

Many of you have talked about getting supplies together for docs, but why can't they get their own? They know where they are.

Because I'm only one person, and that would take institutional change. And I've got bigger fish to fry at the moment than to take that on!!

Ann RN · Feb 19, 2007

It's simple. They do not want to get their own supplies. Actually, I prefer to get my own supplies. That way I am mentally prepared, physically prepared and not surprised by the MD showing up suddenly.

You "prefer to get my own supplies". They're not your supplies - they are the docs'. IMO it is not your responsibility to get them. If the procedure is delayed, it's their fault, not yours. Sorry, but I have enough to do in my 12 hour shift for my own job, let alone do the doc's, too.

RNKPCE · Feb 19, 2007

I would find someone on the unit that is considered very organized but does a good job and shadow that person for a few hours. See how they combine tasks. I remember as a new grad on day shift a very good, organized nurse, would fill a bath basin, bring in towel, sit an able person up at the bedside, wash the persons back and listen to their lungs, heart, abd etc. the patient would then wash the areas they could reach, then she would let their feet soak and check for pedal pulses, edema etc. She was killing two birds with one stone.

We don't do bedbaths on my shift, but I combine tasks such as if a patient needs to use the bathroom, after they are tolieted I will take them for their walk in the hall. The hardest part is usually getting oob. Or if an admit arrives I am assisting them to sit up on the guerney, listening to their lungs, checking their feet while putting on their slippers etc. If they are total care I will listen to their lungs and check their skin while smooth moving them into bed and removing the old linen.

If John Smith is due for a BID stool softener but he is sleeping at 5p and dinner will arrive at 6p, bring the stool softener in at 6p when you set him up for dinner. The patient gets more rest and you have more time.

If at the end of the shift you have things that aren't done pass them on, nursing is a 24 hour job, you can't wrap it up with a bow and present it to the next shift. Now if it is something that was imperative to get done and it wasn't prioritizing could be a problem. We had one nurse who could never replace potassium on her patients even though the results were in by 8a, day in and day out she would pass this onto the evening shift. Also anytime you work over be sure and charge for overtime. If you are staying over and restarting a patients IV and cause nerve damage during the stick, will the hospital's malpractice cover you if you weren't on the clock?