Time Management/ Leaving work on time

[Samurai15, ASN]

Hello,

I need some guidance. I work on a progressive care unit, a typical nurse to patient ratio is 4 to 5; take care of COVID patients as well, constantly short staff, which may be the norm for most places. This is my first job as a RN. I work days. Most days we have 1 CNA or no CNAs at all, therefore we are excepted to do holistic nursing care and hourly rounding. Even the days we have CNAs I find my self doing a lot of my own patient care because the CNAs are busy with another patient which is understandable. The max CNAs we could have is 2 and still the same issue, the unit is busy. There are moments that almost all of my patients are requesting me at the same time, and in those situations, I prioritize and , ask for help from the charge nurse, and sometimes they cannot help. I feel that the type of patient load I am frequently assigned contains high fall risks patient getting out the bed (room located away from the nursing station), isolations rooms, total care patients, and borderline critical patients; all in one team assignment.  

 I never find time to sit in chart, I try charting as I go. I try to start my med pass a little early around 8:30. I never find myself leaving work on time. I am clocking out about 45 to 1 hour late because I need to finish charting. Someone times nursing tasks such as pass meds, because it patient was admitted to the floor about 10 minutes before the next shift comes in, or patients coming back from surgery / procedures less than 30 minutes before the next shift. I have notice , it seems like I am the only one from my shift that doesn't leave work by 1930. I have asked for advice from other colleagues but  I am told try to get all of your assessments in by 8 or 8:30, I have found that to be impossible because I am constantly interrupted and I have to completed half of my assessments during my med pass. I have notice everyone else taking time and sitting to chart frequently( CNAs and nurses). I am constantly getting called on our phones because this patient needs this or that, or this department need to talk to me, or this family member wants to speak to me, or this family at the bedside and wants to speak with you. I am sure everyone else it have a similar experience with the phones too. When it is time to give report from the next shift , some nurses I give report to it'll take about 20 to 30 minutes. And the same thing when I get report from them in the morning. 

Overall I feel no matter what I do , I can never leave work by 7:30 or before. I need advice on time management?

[Davey Do]

My heart goes out to you, Samurai.

From what I understand, time management may not be the total problem. You have one year of experience, are short staffed, and have a lot of responsibilities.

I compare this to my wife Belinda who works at Anomaly Memorial on IMU/Covid. She's been a nurse for over 14 years, and in the medical field for over 30 years. Staffing is good and Belinda is very efficient, almost always clocking out on time. But she is always busy.

I sense you are a quality caregiver, wanting to improve. And improve you shall, but it's going to be a rough row to hoe.

I wish you the best.

 

[speedynurse, ADN, BSN, RN, EMT-P]

Honestly, I really don’t know if there is anything you can improve on. It sounds like you are a very good nurse and competent at your job.....that you care about your patients and put them before your charting. That’s really commendable. It sounds like you do not have an easy assignment at all. I am saying that because I have been there done that. I always seemed to get the harder assignments in the ER and always put my patients before charting....I was known as a really good critical care nurse but was always exhausted and staying over. I wish you the best in your career....if you ever need a change, there are areas of nursing that aren’t so mentally and physically exhausting.....like surgical nursing. I am in pre-op/PACU now and love it.

[Samurai15, ASN]

Thank you everyone for the hope and encouragement !

[Brownelfin, ADN]

Dear Samurai15, 

I am in the very same boat you are.  This is my first job as an RN, a little over a year and a half experience now, and I am always the last to leave.  I work in an inpatient rehabilitation facility where our average patient assignment is 6 or 7.  We are always understaffed with CNAs so that I feel responsible for performing patient care that many of my nursing colleagues will avoid; I can’t bring myself to tell a patient that they must wait until a CNA is free to take them to the bathroom.  Between med passes, patient needs, calls from MDs/therapists/families I am constantly interrupted and can’t seem to get all my assessments charted until the afternoon.  I don’t know if I’m simply slower at everything or if I’m doing more work than other nurses, but I often feel jealous and perplexed when my coworkers can sit and talk in the break room and still walk out the door on time.  Many days I feel that I’m expected to do far too much while doing my best to provide vigilant, safe and compassionate care, and I regret choosing to become a nurse.

[Samurai15, ASN]

Hello Brownelfin,

     I also feel that I may be "doing to much" compared to my coworkers.  I feel when I was being trained , they painted this perfect scenario of how they do all of their assessments at this and this , and stop , take their lunch because they are not worried about things that are "not acute or non-urgent" they say it " can wait".  But when I try to wait to address an "non-urgent matter" like getting a patient a drink or they want their meds "now", then I get called on the phone a lot until its done.   I feel that I am trying to work on the level of an "unrealistic expectation" that was spoken to me during training.  But lately , I have asked some coworkers , what they are doing , how they manage to leave on time,,, Some have stated that they take the time to chart in between patients, and they may skip a round and chart. .... I have seen a nurse draw all the meds for the day on a patient.... So I say this to say, there is nothing wrong with you, you just not taking shortcuts, you help patients when you can.  I just like you , will take a patient to the bathroom , but I'll call a CNA if one is working, and ask if they can come relief me from the room.  Where I work , we have to wait in the room until the patient is finished with the bathroom, unless the patient is independent.  But overall , I have had some days of feel regret but I also have days that I am grateful that I choose nursing.  I think stress of the work day , and the work environment can make someone rethink why nursing? But I do notice there is longevity in certain nurse specialties such as ICU, hospice, OR, etc.   

     

[LovingLife123]

Do you cluster your care at all?  Like do everything at once?  I will pull my meds, and do my assessments, and turning, hygiene all at once.  And if you get to patient 3 and patient 1 is calling, sometimes, patient 1 has to wait a minute.  

Have they cut back on your charting at all with Covid?  I am a minimal charter.  I chart what is required of me to chart, nothing more, unless there is an incident.

Our charting is constantly audited.  I’ve had a handful of times where I have missed something.  I refuse to stay late every shift.  

75% of this is that you are still a fairly new nurse and it will come with time as you learn to better organize your day.  You will also learn all those helpful shortcuts.  I organize my day way different now than I did as a new nurse.

Good Luck!

[Samurai15, ASN]

LovingLife123 ,

   I thought I was clustering care, but you gave me a different prospective, I would typical do 1 -2 assessments after report. Try to chart those assessments and then start my med. pass, and complete the other 3 assessments during the med pass. I have noticed some nurses would start their med. pass during their first assessment.  

Charting during COVID, charting is continued as normal, on PCU we chart 1 full assessment , and a focus assessment every 4 hours , we chart on pain even if the patient pain level is 0 it is to be chart along with safety checks, drains, tubes, IV/ access devices every 2 hours. ( That's the mandatory  minimum amount of chart). 

[LibraNurse27, BSN, RN]

that sounds like a really tough job. I work in PCU and we only have 3 patients each, but no CNAs, often no unit clerk so we have to answer all phone calls to the nursing station plus all call lights, no matter who's pt. And we have to transport our pts to imaging and wait with them. So much of my time is taken up answering phone calls and getting sucked into things that have nothing to do with my pts. With covid and so much donning and doffing when I have 3 sick covid pts, some on their way to becoming ICU pts, I had to set a boundary. 

Now I don't answer the phone unless I or a coworker has paged someone. I feel bad when I hear the phone ringing, but I need to focus on patient care, and my pts suffer when my time is taken away from them. Are there any "above and beyond" things you are doing that you can give up on? I agree asking pts to wait to use the bathroom is not nice and leads to falls, incontinence, frustration. My strategy for time management is: During bedside report I make sure my room has all the equipment, tubing not expired, address any immediate safety concerns. I let pt know we're doing report and I'll be back soon so they don't start asking for things and hold up the off going nurse. I come early to look up pts and make my schedule for the day/brain. After report I do all my assessments. I get interrupted helping pts set up breakfast, giving insulin, taking pts to bathroom, etc. I also gather any 0800 meds and give during my first round/assessment. Then try to chart all assessments/vitals.

Next give all 1000 meds. I usually start at 0900. Try to chart more, then give 1100/1200 meds, vitals, blood sugars, lunches, insulin. Try to chart. 1400 rounds/meds. I put bed alarms on almost all pts, unless they are totally independent, off monitors and I've seen them walk. Sometimes I only round q2 hrs if pts are stable, on monitors, and I'll hear the alarm if they get up. I also notice it lets my pts rest and they are happier. Of course there are interruptions throughout the day, phone calls, call lights, having to take my pt to imaging, RRTs, ADLs, transfers, etc. I try to be finishing my charting by 1430 (I finish at 1500), but sometimes I stay about 15 mins late, 30 mins on bad day. To me it's worth it to feel I gave good care, but it is frustrating. Do you get OT for staying late? and are you penalized/looked down on? I think 5  PCU pts and no help is hard. You sound like an excellent nurse who doesn't have a time management issue. I think you need to decide if you want to take shortcuts to get out on time or provide less "TLC" like helping pts wash up, brush teeth, etc. For me I don't like the feeling I get when I do this. If you are bothered by staying late or get in trouble for it but can't get out on time without shortcuts, maybe it's time for a new job. Wish you the best!

[RNBSC]

Very hard to be a brand new RN during this time.  This helps me 
Pack your VS stuff on a tool pouch incl your hand sanitizer pen and sticky note 

get to work a bit early and look through assignment / note chief complaint and be ready to look for suspected complications related to that 

check for new orders - see who needs labs / therapy etc 

as soon as report done - get your VS data I chart as I go - I thought about trying to find a way to do speech to text as I assess - there has to be a faster way then typing all the data 

it will get easier- 

we learn to play “ three blind mice” 

before we can play Bach- right?  Take care of yourself drink water on the way to work- get lots of sleep 

 

[Kooky Korky, BSN, RN]

Some years back I noticed that I was always staying overtime and was never getting a lunch break.  All of the other nurses left on time and took not only a meal break each shift they worked, but a couple of smoke breaks, too.

What I found out later was that they weren't charting!  They also were not checking to be sure that VS and I/O were charted by the aides.  

Makes a big difference when a person skips a whole lot of work.  

Best of luck to you.  Stay conscientious, keep true to yourself and God bless.