Seasoned bedside nurses.......how do you plan your day?

[Beffers81]

I need help with planning and organizing my day. Any tips?

[Susie2310]

What problems are you experiencing? What are you currently doing?

[Been there,done that, ASN, RN]

There is no planning or organizing. You get report.. and try to prioritize.

Eyeball all of your patients.. put out the biggest fire.

[ORNerd, BSN, RN]

When I worked inpatient I wrote down my patients, their injury/surgery (I worked ortho), any relevant medical history, tests they needed that day, medication times, etc. That gave me an overall plan for the day. However, things could and did change once I went to see my patients and assess them. They might need pain meds, nauseous, or heaven forbid, starting to crap out (it's happened). Give yourself an idea of how the day should be organized and then roll with the punches as they come. Always prioritize!

[Hollybobs]

My hypothetical day shift template, where all patients are equal and stable:

-Safety checks/introduction/ head to toe assessment

-Meds pass

-Assist with breakfast

-Ward round

-Vital signs and washes

-Removal of invasive and superfluous lines etc

-2nd meds pass

-Assist with Lunch

-Vital signs

-Dressings/interventions etc

-3rd meds pass-

-Assist with evening meal

-Vital signs

-Dressings/interventions

-Documentation

-Handover

This really depends where you work? More information about your current day and how you organise it currently is needed, please.

I try to adapt the template to real life by:

-Prioritising from the start of the shift as above, identifying if anyone is unwell or deteriorating and going on from there.

-Attempting to prevent mishaps or harm e.g. anti-nausea medication before the patient actually vomits, identifying a plan with any incontinent patients regarding communication throughout the shift, make sure my higher risk of falls patients are frequently observed etc

-Planning early for time black holes such as trips to scan, discharge planning etc

-Being proactive in communications with relatives, doctors, shift leaders and other team members about mutual needs and queries.

-Attempting to multi-task e.g. asking questions for risk assessments whilst washing a patient or changing their dressings.

Anything non-urgent sometimes sorts itself out!

[calivianya, BSN, RN]

It definitely depends on where you work. Ideally, if no one is terribly unstable at the moment, I like to read the H&P and the recent consult notes on my patients before I see them, so I can really get a grip on if the condition the patient is in matches what I got in report and that in return matches what the physicians think the condition of the patient is. It also gives me a clearer idea of the plan for the patient, especially if the MD rounded, didn't tell the day nurse what the plans were, and the day nurse did not have time to read the notes later.

This is obviously going to be dependent on what your patient load looks like - it's perfectly doable with two patients but not many more than that.

[RainMom]

While I'm waiting for the offgoing shift to be ready for report, I usually quickly scan over orders to get an idea of what special diets, dressing changes, activity restrictions I'm dealing with for the day. We do bedside report & when we finish the last pt, I'll go ahead & do my assessment of that pt while I'm there.

Then I look at my eMAR & use my med times along with acuity to determine the order I see my pts in. I usually leave dressing changes & dc of Foleys/fluids for late morning after breakfast & therapies.

If things are going smoothly, I try to chart the system assessments as I go & leave all the other charting until after I've at least seen all my pts & meds are passed.

That's about the extent of my planning because about 80% of the time, it all gets blown to heck with the first pt encounter. If I can at least have a minute to look at my meds so I'm not blindsided by a 0730 med that wasn't seen until 0900, I'm happy.

[dudette10, MSN, RN]

From a floor nurse...patients stable 9/10ths of the time.

--learn to take report with the chart open to the orders. Get verbal confirmation of any orders that still need to be carried out or an explanation of weird orders. Saves time investigating orders that have no context or being surprised by an order that wasn't done.

--regardless of the report, two physician notes will tell you everything you need to know: the H/P and the most recent internal medicine note. Learn to scan them quickly during report and get clarification as needed. If the off going nurse does not know, move on.

--round with the off going nurse to set eyes on the patient, at least. Ask the patient about pain and any other requests so you can bring items with you during vitals, assessments, med pass. Scan the room for things you need and jot them down if need be.

--get vitals and do a head to toe during the same round. Scan labs after entering vitals. Send out pages if needed.

Ok, so by 0830, you've got a good picture of your patients' history, stability, personality, needs and preferences, plan of care. Tell your CNAs in no uncertain terms what you want them to do for your patients and by what time. (Ambulation, blood sugars, up in chair, turning, etc.) Be prepared to follow up again and again and again.

For med pass, remember that list of stuff you need to do and your environmental scan during rounds? Get meds and ALL supplies. Supplies go into the room with med pass regardless of if you are going to do the task right then or not. Don't waste time gathering supplies for each task as you're going to do them.

Ask your patients, "Is there anything else you need right now?" Before you leave the room. As crazy as it sounds, it does cut down on requests that you weren't planning to fulfill.

Assess pain every time you go in the room of patients where acute pain is an issue. Again, as crazy as it sounds, it saves time. Put the PRN schedule on the white board for the clock watchers and ask them to call you 10 minutes before the time. It works. It really does, and I've found that they perceive less pain via pain rating with this method.

Never delay charting or tasks because your day is going smoothly. You never know when you're getting an admit or something else comes up so that you're in deep all of a sudden.

Here's where you must use your judgement regarding a number of factors...what to ask the off-going nurse to accomplish. 0600 to 0700 abx, central line blood draws, and documentation of lines/tubes? Yep, I expect the off-going to take care of those. Nearly everything else, I can do.

Get your patients up every day (walking in the hall is best) unless contraindicated or bed bound. Reduces positional pain, helps prevent PUs and deconditioning. Increases lung expansion, improves GI motility.

Take your lunch. iLunch break timing is sorta like having a child. There's never a perfect time to start a family, but some times are definitely better than others.