primary care nursing

CHATSDALE · Jun 21, 2008

i don't know how ill the patients that you are responsibile for but focus on

most important things first

assessment

meds

the patient really needs to have orders followed but just because you are responsible those who slack off should be left feedback so that it doesn't happen again

f you don't have bedside charting carry a scratch pad with you when you take report compare the info given to what you observe

check off each task as it is done

you will develop a system and rythem and it will become second nature to you soon

imanedrn · Jun 22, 2008

I think most hospitals use primary care nursing now-a-days, though they've strayed from the true form. In any case, it's all I've learned, so it works for me. Here's how I organized my days:

0630-0700: get to work early & review Kardexes (chief complaint, brief pt histories, meds, labs, scheduled procedures)
0700-0730: take report from night nurse; do 12 hr chart checks w/ night nurse
0730-0830: pt rounds (make sure everyone's safe, no falls, alive, etc.) & assessments
0830-1000: pass meds (pts who need pain meds come first; pts who are on isolation or need meds through NG tube or PEG come last)
1000-1200: chart assessments (initial shift & 0800 pain assessments)
1200-1400: pass meds; reassess pain / chart 1200 pain assessments; reassess pts / chart problem focused care
1330-1430: 1/2 hr lunch sometimes w/i this window
1430-1600: pass meds; perform teaching (i.e., on procedures, meds, etc.) / nursing interventions (i.e., dressing changes, wound care, etc.)
1600-1700: reassess pain / chart 1200 pain assessments; reassess pts / chart problem focused care
1700-1800: pass meds; review charts to make sure I'm caught up on all orders (i.e., meds have been added to E-MAR by pharmacy, procedures are scheduled)
1800-1900: final review of charts to ensure that all orders are in; F/U w/ pharamacy / other depts if orders are not in; chart I&Os; review computer chart to ensure eveything has been charted that needs to be

Of course, the above schedule is a "best" case scenario, and things NEVER progress that smoothly in med/surg! I have to keep on my toes every step of the way. For example:

I make sure ALL my initial shift assessments are charted before 1200 (as I noted above). I will not even discharge pts or start noon med passes until my charting is done. This helps keep me sane throughout the day, knowing that the most time-comsuming part of charting is complete.
Keep up on scheduled procedures throughout the day because pts can be taken at any given time (way too early or way too late). We use a "hand-off" form now when pts leave the unit for procedures, so I try to make sure those are complete (pretty simple paper form to fill out for the receiving dept) at the beginning of my shift or as soon as I find out a procedure is scheduled.
I group med passes together to save time also. For example, if I have 0900 & 1000 meds or 1200 & 1300 meds, I make sure to pass them together for that time-saving benefit.
Although I do a final chart of I&Os at the end of the shift, I do them throughout the day also. For example, if I hang a Mg rider or IV abx, I chart the volume immediately. I even do this w/ the 10 ml saline flushes. Also, if there is output (urine or BM), I chart that and let my CNA know that I did it, so they don't have to worry about it.
As with the I&Os, I chart my pain meds / assessments at the time I give them.
With regard to the charting, I try to do it all as I go along. I used to write down everything I did in my notes and chart later, when I have "free" time, but I quickly realized that ended up taking more time in the long run, and I'd always end up starting late to chart my pain meds / assessments & I&Os.

So that's my basic run-down. Although those time frames are rough estiamtes, I've gotten my time management down pretty well, so that I'm actually able to follow that schedule pretty well -- unless I have a more acute / time-consuming patient. Of course, that changes everything.

Hope this helps in some way!