Time management and brain sheet

Ruby Vee, BSN · Oct 2, 2016

A brain sheet is helpful in organizing your day. I'd take a plain sheet of paper and fold it into fourths. One fourth for each patient. On the left side of that fourth, not down key items from report, and on the right side put reminders -- things to check on, timed lab draws, etc. That right side will turn into a list of things you need to do, possibly organized into time slots. I usually take report and put in my reminders in pencil. As the night progresses, I put in notes in pen.

Report says Mrs. M has "tales 1/2 up bilat". When I do my assessment, if her lungs sound different than that, I'll jot a quick note in pen. Generally, if I discover anything in my assessment that is different from what I expect to find, I'll jot that down. That's the basis for my AM report. On the right side of the fourth, I'll write other things to follow up on -- "rales to the top", for example -- and what I did about it. (Lasix 40 IV @ 2300). I write small -- I used to use index cards, before I lost my enthusiasm for buying them, keeping them in my locker and carrying around several for each shift. You may find that folding your paper into halves and then using both sides works better.

Many newer nurses have elaborate "report sheets" that they've put together on their computers, email to themselves and print out before each shift. If that's what you need to do, that's fine. I don't think it's any more helpful, but some folks like the structure.

On the back of my sheet, I put things I need to look up -- new drugs, a disease process I know nothing about, how to interpret cardiac enzymes, the policy on dogs visiting. At the end of the shift I usually have at least a few things I'm curious about, and will look them up in any downtime at work, or after I get home. Using the "Note" function on my phone, I have a list of standard drip concentrations (I haven't looked at it for years, since I became familiar with them all), the most frequently used phone numbers (lab, pharmacy, blood bank, the stop down unit, the house supervisor's pager), and any standard protocols/policies/lab normals, etc. I don't waste time trying to look things up over and over, because it's right in my phone and I can get to it in a few clicks. This is a huge improvement over the mini notebook I used to carry around in the 70s, 80s, and 90s.

Immediately after report, I try to quickly eyeball each of my patients to make sure none of them is on the verge of coding. A quick "Hi, I'm Ruby and I'm your nurse today. I'll be back to check you over and give you your meds in 10 minutes, but is there anything you need right now?" Gives you a chance to quickly assess skin color, breathing, facial symmetry, mobility and a plethora of other mini assessments. Check all your patients as quickly as possible, and then you'll be able to prioritize your time for assessments and meds. Never enter or leave a room without doing the "nurse eyeball sweep". Scan the patient and the room for anything that could potentially be a problem -- rhythm changes, a call hell out of reach, family with a bag full of take-out for an NPO patient, etc.

I'll let someone else take it from here.

Other people will have different tips, some of which conflict with mine. Pick out what you can use and don't worry about discarding the rest. Some things are important enough that most of us will mention it -- those are tips you don't discard.

TriciaJ, RN · Oct 2, 2016

I can't improve on Ruby's system, especially when I worked on a regular surgical floor, not critical care. My unit had preprinted worksheets that worked for me, so it saved me the step of developing my own. There was a horizontal slot for each patient. On the left was room number, name, age, type of sugery, and postop day. The next column was IV fluid and rate, the next was for hardware: foley, NGT, etc. You get the idea.

The far right-hand column was a wide one because it became my to-do list. If it wasn't big enough, I folded it over and continued on the back. Hope this makes sense. I was very persnickety about my worksheet; other nurses had a looser arrangement. But looking at all the information neatly organized helped to calm my whirling brain and keep me on track.

nursinghealth · Oct 9, 2016

I arrive about 20 min early to get my schedule in order. I eyeball my patients before my shift starts to get a sense of their status, as stated by previous posters. Next, I review the Kardex and get report. My hospital uses pre-printed worksheets. I photocopy my worksheet so I have TWO IDENTICAL SHEETS, which I staple together. The first one contains info from the kardex and report - diet type, IV fluids, procedures booked for that day, code status, med administration times, whether they have a foley, NG, ext. This is my "blueprint" for my shift. It's a quick birds-eye view of my day (what my patients look like and what needs to be done for them). The next one, stapled below, is the one I use to document during my shift as the day goes on - vitals, assessment findings, the time PRN meds were given, things requiring follow up. etc. This method allows me to keep my "blueprint" clean so I don't lose sight of the big picture on the first page.

After reviewing the kardex and getting report, I take vital signs. I then chart my vital signs quickly and start my med pass. I don't do a proper physical assessment when I take vitals unless their vitals are unstable or they appear unwell. There's just not enough time. I do my physical assessment while giving meds and providing bed baths. When med pass and physical assessments are done, I sit down to chart my assessments. This way my vitals are in early for the doctor and the assessment comes shortly thereafter.

Also: Don't leave the room without making sure the call bell is close, their tray is within reach, they have their glasses, etc. Reduce the opportunity for them to call you back for something you can take care of when you're there the first time.

nutella, MSN, RN · Oct 9, 2016

Look at those sheets for ICU for ideas and there are also many others on pinterest and such

Brain Sheets - Straight A Nursing Student

Main thing is to keep oversight and patient safety.

Structure you shift around the set times and events that you can not change.

Report, filling in the cheat sheet with the most important data for right away like dx, code status..., eyeball all patients quickly and if there is enough time you can do the first part of your assessment while you are in there. After that structure the rest of your day.

Find out who needs BS, insulin, diet, medication times, blood draws, lab results to look up before medication or VS to check before, wound dressing, PICC line/central line dressings, other checks specific to your area (pupils or peripheral pulses or whatever you do), more assessment, ambulating, measuring tele, line change, and so on and forth. Who needs to be NPO for next day procedure, who gets confused and delirious...

And you work everything in around the set times.

Like 7 pm report, 7:30 eyeballing patients including their ivs, suction, make sure that all tele alarms are activated (!) , bedalarms are on, bed in low position 7:45 sitting down outlining shift, 8 pm medications / assessment, 9 pm more assessment, 10 pm BS, medications, tele strip, 11 pm sitting down documenting, 12 am medication / VS, NPO sign up I & O , ...and so on.Towards morning find out if you have to draw blood or get a patient ready for surgery / travel. At 5:30 start going around an empty the foley bags, NG suctions and start I& O for your shift, if somebody is on PCA pumps you also need to document bolus/rate. Before you give report at 7 am one last round to make sure your patients are ok, straighten out the room if you have to, make sure that the patients who need pain medication get it before report if they are due. Give report and run home ....