Teaching time management

Hi, I am a preceptor for a new nurse and she has excellent assessment skills, is very intelligent, but just can't get time management skills down. We have only left on time once, and have worked together I think 10-11 shifts now; other than that one time we leave anywhere from 30minutes-over 2hrs late, and if that's the case when she is still orienting/has a preceptor to help out, I dread to see what will happen to her when she is off orientation. I'm not sure how to teach her this skill; and I only have a few shifts left with her; have tried giving her different sheets to make notes on/organize her shift, etc, tell her how I do things; but it's just not helping. It seems to be the charting that gets her the farthest behind, and I don't know how I can help her get faster with it; or when she gets a new admission. She is frustrated as well and keeps asking me what she should do differently. I don't know what else to tell her, or what I should do differently as her preceptor- I really feel that I have failed her. It wouldn't bother me so much if I felt she just didn't care, but she does and I think she is going to be a really great nurse, if she can overcome this hurdle. I really want her to succeed. Thanks for any advice/suggestions.

personally, I felt that when I started(just got done with my 14th month)...I had to retrain myself to what was needed. It became the goal to see each patient asap, first the ones with 6am meds, then everyone else...and then sit down chart on half my patients before I ate breakfast. Often, there are sections that every pt gets and then ones that only need to be filled on certain patients. There's not really much else you can do, short of saying "look, you can't do x, y, z until you chart. it will get better. but unless something urgent comes up(new order, test, pain meds) sit here and chart until you need to check on your patients again."

It will get better, but if she is brand new to the charting, it will take tme. often it's the little things, like people not realizing all they have left to chart. once you get the head to toe, you only usually have to chart followup charting on my floor, do you have to chart full assessment every 4 or 6 hrs? that could be another reason.

I'm in my last semester and this was a hurdle for me as well. What has helped was charting as I do things. When I do an assessment, I go chart it RIGHT THEN. Then I don't get behind because once I'm behind it takes me far longer to get caught up. I think some of it comes with time. I've been fortunate enough to use the same charting system in 4 of my rotations, which means almost 500 hrs of practice. I know it pretty well so I'm not stuck looking for something and trying to remember where something is.

How long has she been on orientation? How acute are the patients on her floor?

First, kudos to you for being a good preceptor who wants her to succeed. Second, maybe the floor she is on is too acute for a new grad or she may just need some more orientation time. When I have precepted, I would regularly verbalise my thought processes and time management out loud. This can be bothersome to them at times because it is a lot of information, but I normally warn them ahead of time that I give a lot of detail and if it is overwhelming to let me know. How I would approach it is this... (you may have already done this) suggest she get to the floor about 15 minutes (at least) before report starts so she can review her patients, set up her "brain" sheet etc. Help her priortize how she will start her day (and give her the rationale why). If you were alone with the patient assignment, how would you schedule your day, why etc. Help her block tasks together (giving meds, vitals, assessments etc together) and give her the rationale behind why you would do it this way. One of the best things my initial preceptor told me when I was out of school (and I was on a very acute floor) was, every time you have a second to catch your breath, think to yourself, what can I be doing right now to keep me on schedule? The first answer for me was always CHART! It is a habit I still do now. For seasoned nurses, there are things we do throughout the day that are second nature to us, that helps us stay ahead of the day. Run a typical day on the floor in your mind and point out to her the things you do that keep you on track and the little processes that you do over and over so you don't forget things. What in the charting is difficult for her? How do YOU do it and can she mimic your style? Maybe you could do a day together where she does everything but you direct her on how to go from task to task (like you would do it if youwere alone). The key is giving her the reason WHY you would do it that way. For some, all of this information is too much, but she seems to be seeking improvement so I think she would be happy to have it. I remember being very overwhelmed with all I had to do when I was a new grad. It helped me for my precepter to break each process down and explain to me why she did it in a certain order (saved time etc). Helped me to develope my own time management skills. Good Luck!

I think time management isn't something you can teach. It is an instinct and a skill. It either clicks in like a light bulb clicking on, or it doesn't. I see so much time wastage..... time management and prioritizing are almost more important than the clinical knowledge..... we always call them book-smart, brain-dead. those nurses that know it all, and cant do any of it! (or can't do any of it with any amout of efficiancy!)

..... we always call them book-smart, brain-dead. those nurses that know it all, and cant do any of it! (or can't do any of it with any amout of efficiancy!)

I can only imagine what the new grads call you...

i can only imagine what the new grads call you...

i probably don't want to know! and we don't call them that to their faces.... but im sure most of us know the type. you can be a good nurse and not have good time management skills...but don't try to do it on a busy floor. the busy floor is cut-throat nursing. it doesn't matter if you have done an extensive head to toe assessment, generated a top of the line care plan, and delved into the labs of your first 4 patients in the first 2 hrs of your shift....if you haven't even seen the other 4 patients in your assignment! get in-get out, prioritize, then strategize.

i always teach new staf to chart on their feet. we are still at paper charting... don't go into a room to do anything without the note in hand. i see nurses go in to hang blood and only bring the blood sheet!!!! your in there for 15 minutes.... bring all your notes in. when does a nurse get 15 minutes to sit! chart! and you can still observe your blood patient, do vs, lung sounds ect.... same with iv lasix....you know you are in there giving a slow push for a few minutes....bring that care plan or teaching sheet! what better time to talk about chf then when you are giving lasix push. i print off the drug teaching sheets ...talk about it, have the patient sign, and they are on the chart. teaching before discharge.

i think sticky notes are one of the worst invention. in the time it takes to jot vitial signs on a sticky note, transfer them to the vs board, and to the note...just chart them. or any note you put on a scrap pad. and yea, i write on my arm/hand/papertowel durring a code.... but if im going to grab iv cardiazem to give to a patient, i have time to grab my nurses note sheet.....

even when admitting a patient....when i go to the ed to pick up my patient... i start my assessment and history right there. maybe im not one for chit-chat with the patients if im busy.... but just the short trip from the ed to the floor, i can find out what brought them to the ed, symptoms etc... not things i would have to write down....i don't ask them their current meds or allergies... but have you ever had mrsa? did you get the flu shot this year? things that are easy to remember...or i start telling them the ward routine.... smoking rules, call bell, saving urine for i&o, that family needs a pin number. those things i cover on the trip to the room, all things i can check off easily when i start the actual admission.

you can't teach time management, you have to realize the value and it comes to you.

Chart as you go.

I was terrible at time management when I was a new grad nurse - and yet time management hasn't been a problem in other non-clinical, healthcare jobs; in fact I've been dropped in the deep end in senior jobs and did quite well. My guess is, the pressure of having so much responsibility at a young age overwhelmed me psychologically and I probably couldn't cope at first. I mean, I did my tasks fairly well, but seemed always to be chasing my tail in those first few months. I copped a lot of flack for it too, and not much support so that didn't help, I basically thought I was a bad nurse for the first 2 years then realised I was pretty good, and stopped beating myself up.

My feelings are that some people can hit the ground running and manage their time pretty much straight away and others, like me, needed a bit more time (that said, I think a lot of people come across as being more confident, whereas me - not so much). Time management is not something you can learn as others have said, its more instinctive. I just think I was one of those people who would have benefited from hospital training but when I left school, university education had taken over and I didn't have a choice.

Regarding your student - maybe she needs more orientation time? How long has she been a nurse? What kind of ward is it? There are so many variables really.

She sounds like a very promising new nurse, it would be a shame for this to hold her back when all she probably needs is time. Not everyone learns at the same rate. I agree with the others who've said chart as you go, and always be thinking of what you can be doing right now - maybe try shadowing her very closely to see exactly where the problem is and try to get this across.

She will get her rhythm sooner or later. Eventually the drive to be home rather than work kicks in and you will do anything to get out of work faster :)

Tait

Thank you all for your advice!! I appreciate all the different perspectives.

We work in acute care, have 4-5 patients per shift. She has been a nurse for a year but worked in a very different patient population before, with very poor orientation & support & only worked there... 6 months I think? before she said she realized it just wasn't safe & left. She has been on orientation since July on day shift, but has been with me a little over 3 weeks or so on night shift.

Last night she seemed to do better but we also did not get an admission. But she did seem more organized, more confident, and a little faster with her charting. (We have computer charting by the way; a little bit harder to chart exactly as you go, but I am working on having her chart as much as possible whenever she gets the chance.) I am going to give her some scenarios to work through and ask her the "whys" of her prioritizing maybe, to make her think and realize she knows more than she thinks she does. I just hope my management continues to give her a chance, although I know orienting someone is expensive.

(Tait... you made me laugh thanks :) )

Anyway... thanks for the advice; I'm going to use it and I'll let you all know how it goes. If anyone else has any more advice for me, please jump right in and I'll definitely appreciate it!!!

Okay... I'm back.

Since I last posted, this nurse seemed to improve somewhat in time management, and do better with managing her team. She went off orientation for a couple days; did fairly well the first day with a stable team, one admission; did stay late about an hour and a half.

The second day, she had a patient who had some respiratory "issues", and some other patients who were generally needy. She did not get to do any of her charting that shift until after giving report to the oncoming nurses. She then was there charting for 5-6 hours. She was getting help from other nurses on paperwork, and on the patient that was having the most "issues" and some of the other needs of patients. Per management/higher-up request/decision, she is back with me for another week now.

I don't know what else to do or teach her. I tried giving her the scenarios, and she did well with the abstract patients (says it is much more "flustering" when with real patients; I can see that); I have tried showing & telling how I organize my shift; I have tried to help her with areas where she is "overcharting" or "double-charting", but I am so terrified now of what is going to happen if she has another busy night. Any unexpected situation that requires calling the doctor, etc., seems to throw her permanently behind. I don't know if I am expecting too much from her or forgetting what it is like to be new. But I am so worried about her. She is not going to make it at that rate. I know she will improve with time, and I still believe she will make a great nurse. But I'm afraid she will crash and burn first at this rate.

What can I do? How can I help her? Any and all suggestions welcome...

OP, it seems that there's only so much you or the new nurse can do at this point. It sounds like maybe she needs a slower pace or lighter workload to build up to handling a full-load of patients both efficiently and safely. Unfortunately, that may not be an option at your facility. Unfortunately, there aren't many opportunities at all out there for a newbie to more slowly build up to a fully-functioning floor nurse. A student has 2+ years of nursing schools to study meds, diseases, nursing care plans, psychsoc issues, etc. Then they have 2-3 months to go from the 10% that nursing students do on clinical day to the 110% that floor nurses do.

I do think it's a shame that some grads who might make great nurses if they just had a chance to build their skills more gradually instead are let go after just 8 or 12 weeks because they're not up to speed yet, don't have sharp clinical judgement yet, and can't keep all the balls juggling that experienced nurses often still have to work hard at.

For a new nurse, just about every aspect of their job may be almost completely new to them... dealing with physicians, starting IVs, finding supplies, making the call on clinical situations, doing focused assessments, caring for more than 2 patients, seeing a patient go bad, etc. While some newbies may take to it like a duck to water, I don't think it's something we should expect new grads to pick up in just a few weeks along with all of the other new info, skills, people that the newbie is dealing with.