Time Management and Accuracy

[Goldenhare]

I've been a nurse for about 6 years. I've always had issues with time management, but have made progress. I am always, always fighting the clock. I keep a 'brain', and I try to prioritize, but it is always a struggle. Since this is a struggle for me, I am always looking for ways to speed up. I must be careful sometimes, in how fast I do tasks, because I will make a mistake, like charting on the wrong patient, or reviewing labs or orders because sometimes I will misread (possibly a learning disability?). I am very careful with meds and my record shows.

Now I always read that the key to time management is prioritizing. However, this is what I am finding:

1) Pts who ask me "What are you doing?" when I check pedal pulses. ("No one has ever done that to me!") but they are charted-also amputees with pedal pulses charted.

2)Pts with home meds that have not been given in DAYS!

3) Full assessments charted on Psych patients, but I'm the only nurse who has a stethoscope (I float sometimes)

4) Meds charted that haven't been given.

5) Clear lung sounds charted on pts whose lungs are ANYTHING but clear.

6) Pts charted as 'non verbal' or 'comatose' who, though slow or quiet, can verbalize, and make their needs known.

I must begin to clock out ON TIME, EVERY SHIFT.

So what gets left out of my shift in order to finish on time? Do I sacrifice accuracy for speed? What am I missing? I worked hard to get where I am and I need this job, but this dilemma makes me want to leave nursing as it causes me a great deal of anxiety. Thank you for any help and opinion. Does anyone else find this? Am I too thorough??

[Guest296136]

Do you work 8 or 12hr shifts, I find that 8hr shifts are harder to get it all done, I do better with 12hr shifts.

[tokmom, BSN, RN]

How long does it take to do an assessment? What is your pt load? Any CNA help?

Can you give us more details?

[Goldenhare]

I am used to 12's but where I am now, they do mostly 8's. But my last shift was on PCU and it was an 8 (they usually do 12's) and it was a nightmare with me hanging 2 liters of blood at 1am that were ordered at 9am the previous the morning, 2 antibiotics, including vanc, that should have been hung on evening shift, a messy nasty dressing change that hadn't been changed at all that day despite a BID order. an admission who had a knife, (ER called security for the drug paraphernalia, wrote down that the pt had a knife, but didn't give that to the security.) The guy was high as a kite.

I am not fully familiar with the PCU unit, It had been at least 2 months since I had floated there. I had 3 heavy pts and the admission made 4, which wouldn't have been bad if it wasn't for all the unfinished stuff. I had support, but had to keep stopping and asking about who to call for what, in particular,concerning the admit, which I had never done on PCU.

I am trained as a med surg nurse but they float me alot. I usually get out on time from Gyn, mom and baby, psych and USUALLY PCU. But when I am on med surg, its always a struggle. We have 6-7 pts, out CNA's are pretty good, though lately, they have been taking more patients than usual, just like the rest of us.

It usually takes me 5-10 minutes to do an assessment, but I'm not sure that is completely accurate. I think I get caught up with pt requests, pain medication requests, bathroom requests. I try to be accurate, but as I said before, it is evident that I do a thorough assessment, (too through??). I try to take meds with me during assessments. I guess I'm just confused about how to speed up. I feel that I have to compromise my professionalism.. I'm really down about it. My patients seem to like me alot, often refusing the care of other nurses in preference to me. Its causing me alot of anxiety.

If I can add, the med/surg manager likes to do a daily meeting that can go from 0700-0720, I often have to give report to 4 different nurses, we often get out I's and O's late from our CNA's-we have to chart them. Last time I was there, she said that people MUST take there breaks and get out on time, so I can't be the only one having trouble, but if others are having trouble, then I feel there is no hope for me.

[mmeyer2554]

Sounds like floating may not be the best option for you. I have a learning disability, dyslexia. Things just take me longer then other people, but I do a good job. One of the ways I cope is to make myself as familiar with my surroundings as possible. Sounds like you could due without the added stress of reorienting to a new unit every time.