Time Manaagement Schedule

SoundofMusic · Mar 24, 2008

Yes. We have one preceptor on our floor who took the time to sketch one out for me and it seems unrealistic, but if I at least attempt to follow it, I usually remain caught up throughout the day.

7:00 -- come in, get report, give/get handoff, give report to techs. (yes, only one half hour to do this -- sit around chatting and you blow that precious a.m. time to get things moving). At this point, I am coffee'd up and ready to GO. :smokin:

7:30 -- Round, introduce, Get vitals, do assessments, confirm accuchecks

8:00-8:20 (here is where it gets tight -- chart vitals and assessments, ac's.

8:20 - 9:00 - check labs, orders, read through last 12 hrs on chart.

9:00 -- 11:00 Meds, check new orders

11:00 check orders and start to sign off on them if you can.

12:00: Chart noon vitals (do them if not a total care pt), various assesments, provide mouth care, etc, meds,

12:30 -1:00 TAKE LUNCH

1:00 -- 2:00 COVER PT. FOR ANOTHER NURSE TAKING LUNCH, meds, check charts

2:00 - Meds, check charts

3:00 check orders

4:00 -- 6:00 write progress notes, check orders, do telephone reports, meds, if any

6:00 -- 7:00 -- wrap up any work left, (hour built in here for new admissions, discharges, etc.).

So far it's working ok for me. It keeps you hopping, but as you can see, it's check orders and keep up with orders all day. I check off a few every hours so by the end of the day I'm not frantically trying to check off orders and do my 12 hr chart checks in a hurry.

It's not written in stone, but it gives you a plan to follow. I just keep looking at it all day and it gives me something to grab onto mentally to keep me on track. Of course there are interuptions GALORE, but you just keep getting back on the schedule if you get off.

Sometimes I feel like a total geek following it, and many of the veterans just seem to go so seemlessly through their day, with time to laugh and socialize, but I just keep my nose to the grindstone with this and it has really helped me. Taking too long to get started in the first hour was where I was falling short.

CABG patch kid, BSN, RN · Mar 25, 2008

I agree with the above poster that the first hour can make or break you!! Last week I got floated to a different unit (with my preceptor), I'm supposed to learn a bit about this unit now because I WILL be floated there after I'm on my own. Anyway, I got really messed up because I didn't know where anything was, plus I walked into a discharge at the beginning of the shift, while my other pt. needed a new IV line to start an important med. Talk about time management issues!! But overall I do have a general time line that I really try to follow. Basically at this point in my career, I do not have a minute to spare talking at the nurses' station! Here's mine:

1900-get report

1930-vitals, assessments, print MARs

2015-chart vitals and assessments, check orders for the meds i'm going to pass (sometimes I don't have time to chart if there are too many things going on)

2100-give meds, do HS glucose checks, chart

2300-supposed to clock out for lunch by midnight (finish up any loose ends before lunch)

0000-take midnight vs, do any Q6h glucose, prns for BP or pain if needed, and any 0000 meds

0100-0300-this is the time for checking orders, catching up on charting, taking a second break if possible, doing any prns, rounding on pts

0400-vs, I/O, may have meds or prns

0500-0645-catch up on remaining charting, finish checking orders and sign off on 24 hour chart checks. may have 0600 meds. Get ready for report!

It is very busy and there are a thousand interruptions, hence all the catching up on charting. This guideline doesn't account for any admissions or discharges, I haven't figured out how to smoothly squeeze those in yet, I just do the best I can!

RNperdiem, RN · Mar 26, 2008

I second the above posters who tell you to get you shift off to a good start.

Push to get your first assessments done and charted and then your am meds given. I consider that point in the shift a milestone. Now you know your patients, the meds are given, and now you can focus on what else needs to get done.

Mornings can seem to be chaotic, but if you keep slogging through, the rest of the day goes smoothly.

angelina_zee · Mar 26, 2008

As a new nurse, I usually get my 8am meds for one patient and go into that patient's room, do assessment, get vitals, then give meds. I do this for each patient. By the time I get around my last patient (usally 4th or 5th)...Im like an hour and a half behind...or even 2 hours behind.

We have PCTs doing vitals signs on the patients and I wait for the VS results before I give my meds. Sometimes waiting for the techs to do the VS's can take FOREVER....so I end up doing many of the VS's on my own....which puts me further behind. Any suggestions on how to speed things up. At times I feel so slow....

allthingsbright · Mar 26, 2008

I like to go in and do my assessments first thing and chart as I do them--thankfully we have computers in all the pts rooms. THEN I go back and do meds. I go by hour--whats due, and in what order for each pt. What throws a wrench is when things happen unexpectedly. Then I have to play catch up. I know one person who writes each hr out for each pt and what needs to be done to organize her time. That takes a lot of work IMHO!

UM Review RN, ASN, RN · Mar 27, 2008

As a new nurse, I usually get my 8am meds for one patient and go into that patient's room, do assessment, get vitals, then give meds. I do this for each patient. By the time I get around my last patient (usally 4th or 5th)...Im like an hour and a half behind...or even 2 hours behind.
We have PCTs doing vitals signs on the patients and I wait for the VS results before I give my meds. Sometimes waiting for the techs to do the VS's can take FOREVER....so I end up doing many of the VS's on my own....which puts me further behind. Any suggestions on how to speed things up. At times I feel so slow....

I quickly check the chart for orders and meds that warrant vitals, then go in the room, do the assessment, come out and document the assessment for all of my patients. I try to find out where the PCT is in getting vitals and follow behind her with the meds. I only take the vitals absolutely necessary to complete the med pass -- for example, if I only need a BP on someone, that's all I have time to do.

That's not to say that I'm always on time with my med pass either. Sometimes things happen despite our best intentions and we have to prioritize appropriately.

november17, ASN, RN · Mar 27, 2008

It's really different on every unit you go to. My routine is like this;

1900 - Get report

1915 - Round on patients, offer analgesics

2000 - Chart assessments. Check orders. This is also the time I will start paging physicians if necessary for home med orders or things like that (before it gets too late and then they get grumpy).

2030 - Check vitals, glucose, etc. Start passing 2100 meds.

2130 - Finish charting. Check care paths, etc.

2200 - Change/reinforce bandages PRN

2300 - Check the MAR, analyze orders, etc.

0000 - Analgesic round

0100/0200 - go to lunch for an hour, cover the person that's off on lunch.

0400 - Reassess while vitals are being taken so I won't wake patients up more than necessary. Offer analgesics.

0500 - Change bandages/pull hemovacs. Check off care paths, chart variances, dot my i's and cross my t's.

0600 - Prepare to report off, call physicians if necessary for further orders.

It's really not exactly as cleancut as it looks. It's really more of a rough guide that I keep in my head. Any given moment I can be called into a patient's room, sending someone off to X-Ray/MRI, dealing with a crisis, providing basic nursing care, or getting a new admit. I'm also constantly educating whenever I'm in a patient's room as well. (I do a lot of analgesic rounds because we're an ortho surgical floor...gotta keep that pain under control!).

Also, every nurse does it differently. I've found that's just what generally works for me and my patients.