Shift routine and time management

Lovethenurse2b25, ASN, BSN, CNA, LPN, RN · Sep 15, 2020

It all depends on the nursing setting. I work at a rehabilitation hospital when I arrive I usually receive report and greet my patient, then I start my assessments and afterwards view the charts. Before receiving report I print out a rounds report form on all of my patients.

what type of setting do you currently work in ? Do you have time to arrive to work early to read pts charts?

Newnurse23 · Sep 15, 2020

Women’s health medical surgical and cosmetic surgery unit

LibraNurse27, BSN, RN · Sep 15, 2020

I get there (a little) early and review charts for name/age/code status/allergies, diagnosis, PMH, orders, meds. I make a rough outline of schedule/tasks for the day. I get report, do my room checks and greet my pts if they're awake. Then vitals and assessments, rest of day meds, repeat vitals, sugar checks, wounds, and whatever other million things come my way!

I do try to coordinate a time with the pt/MD for time consuming wound care or procedures. So pt can know the plan for the day, MD will know when to stop by if they want to see the wound. It avoids things like surgeon coming and taking off the dressing during 10 am med pass, interrupting everything. I work in Stepdown. I also have reminders on my brain to chart assessments, IVs, and I and O q4 based on our unit routine.

Newnurse23 · Sep 15, 2020

So helpful thank you!!

NightNerd, MSN, RN · Sep 16, 2020

Bedside report with safety check, double check any drips running (e.g., heparin) for the right rate.

GIve 0730 insulin for anyone who needs it.

Do a quick run through the chart, note what time meds are due, read some progress notes if there's time, see if any labs, dressing changes, imaging, etc. will be due during my shift. (Any dressings, hygiene, etc. I will typically cluster with a med pass, usually in the afternoon unless it's something timed (e.g., labs), in which case I'll try to get it as close to when ordered as possible, while also combining with other tasks to save some time.)

Assessments and first meds. I combine anything due between 8 and 10, 12 and 14, 16 and 18, and so on; otherwise I would literally never sit down.

Document a little, then give 1130/1200 insulin.

Start my afternoon meds and knocking out any tasks that aren't time-sensitive. Take a lunch break for me when I start to get hangry. Finish my afternoon meds. Document and look at any new notes, etc. that are in the chart.

Give 1700/1800 insulin with any final meds. Finish any lingering documentation, make sure I'm prepared for report (we have report sheets that we exchange every shift, so I update that and try to clean it up a little). If there's time, make sure my patients' rooms are picked up from the day, make sure they've got fresh water, etc. (I am trying to be better about delegating, but I feel like our techs get bombarded with like 15 patients at a time sometimes, so if I can take care of taking out dirty linen, walking someone to the bathroom, bringing them ice chips, and so on, I will.)

I am usually out on time, or not far from it, so I think I've got a decent system going. I love the tip above about coordinating dressing change with patient and doctor early on; that's a great idea. It will certainly prevent that awful moment when the MD removes the dressing you literally did an hour ago and tells you to re-do it.

Newnurse23 · Sep 16, 2020

You are amazing! Thank you !!❤️

LibraNurse27, BSN, RN · Sep 16, 2020

2 hours ago, NightNerd said:

It will certainly prevent that awful moment when the MD removes the dressing you literally did an hour ago and tells you to re-do it.

Yes! Pet peeve LOL

jag nurse, RN · Sep 20, 2020

On 9/16/2020 at 7:04 AM, NightNerd said:

Bedside report with safety check, double check any drips running (e.g., heparin) for the right rate.

GIve 0730 insulin for anyone who needs it.

Do a quick run through the chart, note what time meds are due, read some progress notes if there's time, see if any labs, dressing changes, imaging, etc. will be due during my shift. (Any dressings, hygiene, etc. I will typically cluster with a med pass, usually in the afternoon unless it's something timed (e.g., labs), in which case I'll try to get it as close to when ordered as possible, while also combining with other tasks to save some time.)

Assessments and first meds. I combine anything due between 8 and 10, 12 and 14, 16 and 18, and so on; otherwise I would literally never sit down.

Document a little, then give 1130/1200 insulin.

Start my afternoon meds and knocking out any tasks that aren't time-sensitive. Take a lunch break for me when I start to get hangry. Finish my afternoon meds. Document and look at any new notes, etc. that are in the chart.

Give 1700/1800 insulin with any final meds. Finish any lingering documentation, make sure I'm prepared for report (we have report sheets that we exchange every shift, so I update that and try to clean it up a little). If there's time, make sure my patients' rooms are picked up from the day, make sure they've got fresh water, etc. (I am trying to be better about delegating, but I feel like our techs get bombarded with like 15 patients at a time sometimes, so if I can take care of taking out dirty linen, walking someone to the bathroom, bringing them ice chips, and so on, I will.)

I am usually out on time, or not far from it, so I think I've got a decent system going. I love the tip above about coordinating dressing change with patient and doctor early on; that's a great idea. It will certainly prevent that awful moment when the MD removes the dressing you literally did an hour ago and tells you to re-do it.

That's exactly what I like to do. The computer, however, won't allow giving medications early. Yours does, I'm assuming?

HiddencatBSN, BSN · Sep 20, 2020

Ditto it being shift and unit dependent. I see my assignment, get report, check emergency equipment in my rooms as I’m saying hello and eyeballing my patients, and then task. But I’m in the ER and unless we have boarders, my orders are all stat so I just prioritize and do as I go. I work night shift too so I often walk in to active workups and generally don’t have a ton of “get myself organized” time.

When I worked med surg I made a report sheet that had a column and I put the hours of the shift on the left, my patients on the top, and wrote in meds, when vs and I/Os were do, anything else scheduled. Rounded and did initial assessments, bringing along with me any meds that were due at that time.

LibraNurse27, BSN, RN · Sep 20, 2020

9 hours ago, HiddencatBSN said:

Ditto it being shift and unit dependent. I see my assignment, get report, check emergency equipment in my rooms as I’m saying hello and eyeballing my patients, and then task. But I’m in the ER and unless we have boarders, my orders are all stat so I just prioritize and do as I go. I work night shift too so I often walk in to active workups and generally don’t have a ton of “get myself organized” time.

When I worked med surg I made a report sheet that had a column and I put the hours of the shift on the left, my patients on the top, and wrote in meds, when vs and I/Os were do, anything else scheduled. Rounded and did initial assessments, bringing along with me any meds that were due at that time.

Yes, that sheet helps a lot! Keeps you organized. I wouldn't have any idea how to organize myself in the ER though! I would hate to have my checklist interrupted by all those heart attacks and codes LOL

HiddencatBSN, BSN · Sep 20, 2020

1 hour ago, LibraNurse27 said:

Yes, that sheet helps a lot! Keeps you organized. I wouldn't have any idea how to organize myself in the ER though! I would hate to have my checklist interrupted by all those heart attacks and codes LOL

There’s really no checklist other than prioritizing and reprioritizing the ABCDs with D standing for discharge ?

Shift routine and time management

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