Time Management Reduces Errors

S. Enyard RN, BSN

A New Nurse's Perspective

Rose just graduated as an RN and passed her boards. For almost two weeks, she has been orientating to a position on a medical-surgical floor, and Rose has started taking a full load today.

She just got a report on five patients. Okay. Now, where do I start?!?

Do I sit with the chart and look at my orders and patient meds? Do I assess my patients first? If I assess my patients first, which one do I start with? All at once, anxiety hits.

An Experienced Nurse's Point of View

Does this sound familiar? All new nurses go through this, even seasoned nurses.

I've worked as a nurse on a medical-surgical floor for almost two decades. I have trained new grads to experienced nurses, some of which had not worked in the hospital setting. A lot of these nurses have trouble with time management.

As a new nurse, especially, time management feels impossible to attain. I felt this way as a new nurse. Even today, moments happen where I feel "behind."

Remember, everyone does time management differently. Finding what works best for you does take time and patience.

And, it never hurts to ask other nurses to see how they do it too. Remember to take it one shift at a time.

Getting Report

The report you received from the off-going shift can be invaluable. Day shift, night shift, it doesn't matter.

If you work in a facility that does bedside reporting, please, take advantage of this.

Laying eyes on the patient early in the shift, especially with more staff available, can help both your stress and time management immensely. If you find the patient in distress, you still have those extra hands available.

Don't be afraid to ask questions, but also be considerate of the nurse giving you the report. It's been a long shift for them, and they are ready to go home. If it is something you can look up yourself consider doing that. Finding the information yourself may also help lead you to other information that will help in the care of that patient.

Prioritizing After Report

Okay. You've got a report on your patients. What next?

Some things to think about at the start of your shift to help you prioritize:

Is everyone stable?
Did anyone ask for pain medication during the report?
Are any of your patient's call lights going off?

After all these questions have been answered, I would feel more comfortable either starting my assessments or looking at the patient's medications and orders. However, everyone has their preference on whether to assess first or look at the chart. Figure out what works best for you. So let us go into more detail.

Is Everyone Stable?

Being stable on a medical-surgical floor means using the ABCs (Airway, Breathing, and Circulation). It's that basic.

It's so easy to overthink the situation. If you're not sure, use your resources (the other nurses, the charge nurse, the house supervisor, etc.).

Did Anyone Ask For Pain Medication During the Report?

One way to help prioritize the need for pain medication would be to use the pain rating scale to determine who you would address first. Also, you can ask the patient if they would like it now or if they can wait until they receive their morning or evening medications, depending on which shift you work.

Are Any of Your Patient's Call Lights Going Off?

Multitasking can be incorporated here. Say a patient needs to go to the bathroom. Sometimes you can do their assessment at the same time.

Learning to Multitask as a New Nurse

Time management and multitasking go hand and hand as a nurse. You're taught in nursing school about listening to the patient and observing their outward appearance as a part of their assessment. How are they breathing? What is their behavior like? What is their skin color? You get the idea.

The point is you already know how to multitask. So you choose to do your assessments first. Okay, the report took a while, so it is also time now to pass medications. Do your assessment and pass the patient's medications at the same time. Simple.

This may sound like common sense, but when you feel overwhelmed in the moment, it's a lot harder to bring this to mind.

Basic Challenges You May Face

Every shift is different.
Different patients from one shift to the next.
Short staffed.
Shift change admissions or transfers.
Is it a weekday or a weekend?
How long did it take to get through the report?
Are other departments needing to work with the patient?

Example Scenario #1:

You have the same patients; however, tonight, "Betty" has increased shortness of breath.

This may not be new because of her COPD, but it's happening now, the first thing on your shift.

Taking time to help her with a breathing treatment and work her through her anxiety has now put you 30 minutes behind doing assessments and passing medications. Remember, one patient at a time. Rushing can create mistakes.

At this point, taking a deep breath and refocusing on where I need to go next has helped me the most.

Example Scenario #2:

You've just arrived for your shift and found out the CNA had called in for the night, and the house supervisor could not find a replacement.

You have five patient's that you are responsible for.

The shift house supervisor is helping with call lights, but now you are responsible for your responsibilities and what the CNA would normally do.

STOP!! BREATHE!! You have 12 hours to get done what needs to be done.

You need to get those time-sensitive tasks completed before you sit down to chart. What I mean by time-sensitive is passing medications, taking vital signs, doing dressing changes, etc.

Don't forget to take time for yourself. It may only be 10 minutes. You cannot care for your patients effectively if you are not at your best.

Example Scenario #3:

A shift change admission or one within a couple of hours of starting your shift has its unique challenges. You do not have complete that admission paperwork right when that patient hits the floor.

Making sure the patient is in bed with a set of vital signs completed with height and weight may be all you have time for at that moment. Looking over the admission orders right away would be a must just to check for any stat orders, collections needed, or meds that need to be given.

Starting those IV fluids, putting the patient on telemetry, and seeing if they need a urine collection or x-ray. All of these things improve your time management, stress level, and patient outcomes.

Summary

Working as a nurse for almost two decades and precepting many new nurses, I hope this will help someone be more at ease in their role as a nurse. As nurses, we have many responsibilities and expectations. So, learning time management skills can make you an invaluable asset to your organization and help with that stress relief.