Time Management

classicdame, MSN, EdD · Apr 6, 2007

Ask this question of 10 nurses and you will get 10 different responses. What I do is create a graph with hours listed across the top row and room numbers along the left edge. I then take information from the MAR to jot down "RX" when something is due. I use the the treatment MAR in the same way to write down "TX" when a dressing is due to be changed, or IV bag, or anything else. I can quickly look to see where overlaps and gaps in time are then plan accordingly. If the MD calls or comes by I jot "MD". If the patient leaves the floor I jot "out" and then "in" when he returns. If the patient is D/C I yellow highlight that row after jotting down the time he/she left the unit. I carry this folded up in my deepest pocket and only get it out when NOT in a room, in case I accidentally leave it behind. It is helpful for recall when I do charting. Our hospital supplied us with a laminated card that hangs next to our name badge. This tag lists topics used in reporting. I use it as a guide to do my hand off report and final charting. When the shift is over my cheat sheet goes in the shredder.

EmerNurse, BSN, RN · Apr 6, 2007

I'm a "jotter" too, and can't do without my little note pad. When I worked on the floors, we were given binders in which to place our notes/MARs for the day, along with a pre-printed pt info sheet we could fill in with info during our shift. Bought my own binder (with top holes, like charts) in a pretty color, and kept a zipper baggie in it with supplies like pens, paperclips, tape, whatever. It was great.

However, with or without binder, writing things down was my key. The key to THAT though was that I always wrote things in the SAME PLACE every single time. "To-do" lists were on the right, VS were at the bottom, etc, and once you get used to one consistent method (whatever works for you), doing it the same way every time trains your brain to spot omissions and differences very quickly. So if I forgot something, it was missing from "its spot" and stood out to my eye very quickly. Being very consistent in how I did things allowed me to handle the "out of nowhere" things much easier because at least everything else was relatively organized.

Hope this helps.

Kelly_the_Great · Apr 6, 2007

Hey luv2shopp85, thanks for starting this thread.

I saw where you said you have a PDA. I saw this one nurse post in another thread that she uses this program called Diddlebug with hers, where you can make notes and then set reminders for it to alarm.

Also, I bet you could create a program with excel spreadsheet and devise a system like Classicdame says she uses. Her system sounds pretty good at looking at all of your patients at one time, huh?

Emernurse, your system of consistency makes a lot of sense too!

Y'all keep these comin' :) I know I need all the ideas I can get

General E. Speaking, RN, RN · Apr 6, 2007

I made up my own "brain" and I too write everything in the same place. No PDA for me (yet). On the front I put demographics, consults, labs, IVF, etc. The back is where I put current VS and assessment notes for charting later- wheezes, IV site, when I called the doc, pain meds, etc. I fold this valuable piece of paper and pack it everywhere in my pocket.

We do have report sheets but I hate ruffling through paper after paper looking for something. I keep them for reference but I like my info condensed and available. Most of us carry binders that we bought ourselves. Mine is fluorescent green so I can spot it a mile away! Inside I have the pockets for each patient's MAR/Nurse notes and a ziplock-type canvas bag to throw meds into if needed. We are phasing into a computer charting and band scanning system soon so the binders may become obsolete but I will always carry my brain in my pocket! Once you get used to your own system and into a routine, time management will become easier.

I also load up my pockets with pretty much everything but a rabbit. At least that's what I tell my patient's

BrnEyedGirl, BSN, MSN, RN, APRN · Apr 7, 2007

when I worked on the floor I too, had a "brain",.my own design,..large graph like paper,.Pt name, age, sex, c/o for admit,all dx, tx's, IV, O2, hx, monitor #, rhythm, plan for pt,...all pts on one paper,.just a note,.I learned NEVER to carry around anything that was to be part of the pts chart!

You will eventually work out a routine that works for you,..get report, organize MARS, check meds,do assessments, pass meds, chart,...obviously things happen that don't "fit" your schedule, ie like someone decides NOT to breathe,..you will work it out though.

I've never used my PDA at work.

HR_LPN · Apr 7, 2007

Our hospital has Glucometers where you scan the barcode off the pt's "sticker" and then proceed to check their sugar. Well, when I work the floor (I'm in OB so not to many BS for us.), I take all the pt's stickers who have BS for the night and put them in order on a blank sheet of paper with ___ HS ___6A (Or whenever their times are) In the blanks I write the BS amount and if I gave insulin and the type and amount. Works like a charm!!!

I also wait to chart midnight and 4am vitals until I get finished with my I & O's (6 am) and chart them all at one time. That way I only handle the charts once. However, we have to chart vitals on a clipboard first so if dr's call for vs and that pt's nurse isn't around, whomever answers the phone can just glance at the clipboard.

When I pass meds, I do the same thing as one of the above posters with the graph and timeline. When I pass that med or do that tx, I just cross it off!

Hope these help!

fultzymom · Apr 7, 2007

At my faciltiy we have what we call "care tools" which list each patient, info on how they get around, continence, ect. I fold mine in half so that the names are showing et then there is blank page (from the back) by each name. I jot everything given in report by previous nurse that I would need et then jot anything through the day that I need to do. As for treatments, I sit down et go through treatment book et "flag" out anyone that needs a treatment done that way when I go to do them all I know which ones have something that needs to be done. I do that with my skilled patients also so that I know who needs an indepth skilled assessment done. (I used to work on a rehab at a LTC facility before I took an office position). I would do my med pass then after that start my treatments et assessments. I took the treatment cart from room to room, did treatments et assessments on each patient that needed to be done. Since they were already "flagged" I did not have to waste time flipping through the books. I could just turn right to the next thing that needed done. I would flag everything in the morning before I could start my med pass. (Our shifts start at 6am et breakfast comes at 8am.)

fultzymom · Apr 7, 2007

OH! I just remembered that we did have a nurse who used a PDA. He would set it to alarm if he had something due at an odd time so that he did not forget anything. Worked really well for him.

TrudyRN · Apr 7, 2007

I am old-fashioned. I use a clipboard. I usually have a list (printed by computer) of my patients, their MD, DX (some of them, by no means all), and room #.

I also write on it their allergies & other known DX's.

When I get report, I write, next to each name, things like IV site, type of fluid and rate, NPO or diet order, accucheck time and space for results (to be done), any info that I need from report, such as "waiting for MOM to work", "needs order for pain Rx renewed and PT/INR results", whatever.

I leave space to write anything that comes up on my shift and which I will then pass on in report.

I also keep a blank paper under my patient list. On it, I write notes to myself of things to do, supplies or orders needed, whatever I need to write down to remember it.

My schedule is: (3-11 in SNF/Rehab/Nursing home)

1500 get report with Day nurses who had just my team(10-13 patients, on

as many as 3 different hallways) (hunting down more than 1 nurse

can take a very long time, much longer than just the 10 minutes I

have indicated here)

1510 count on just my primary med cart if my partner hasn't done it;

1515 give report to my aide(s) and assign VS, accuchecks, dinner and

break times for them;

1525 quick walking rounds (just to check that everyone is present and

alive, has proper iV running, brakes locked, call bell, Kleenex, phone

handy, rails up); no more than a minute per pt

1535 pour meds; grab out of frij any known IVPB's; get any needed narcs

(we have 1 central location for heavy stuff, the rest is in our med

cart narc drawer), grab any supplies I know I need; I'd rather have it

and not need it than the opposite; check order rack for new orders;

1600 pass meds, deal with accucheck results, try to reach MD's if

needed before their offices close

1645 help get people ready for dinner and help transport them to dining

room; check VS, as reported by CNA; check rack for new orders;

1700 work dining room, if assigned (only for 1/2 hour) If not, cover our

hall while my partner work the dining room.

1730 help bring them back from dinner, help toilet a few ( I don't do too

much of this. It is not primarily my job, my health does not permit,

and I have too blame much of my own work to do. If someone is in

desperate need, though, I do it.); talk with families who approach me,

etc., usually give several PRN's; check rack for new orders;

1800 pour meds; cover while partner takes break; cover for CNA who goes

on break now; review TAR's; check rack for new orders;

1900 take my break (45 minutes)

1945 check rack for new orders; walking rounds on all my patients; cover

for CNA's at dinner;

1955 pass meds;

2000 start treatments; check rack for new orders;

2030 help get people ready for bed, help with accuchecks, help pass

snacks;

2100 yes, another check for new orders; start charting; usually more

PRN's to give;

2200 restock the med cart, treatment cart, start wrapping up, another

order check, another walking rounds to see that rails are up, etc.

2300 count, give report; check that CNA's have charted I/O, meal

consumption, BM's, etc.

2330 Leave

Mind you, there are lots of things that happen in between what I've

written - new admits and an occasional discharge, calling docs for

problems, meetings, inservices, calls from family members, falls,

other incidents, , IV tubing changes, going to lab for blood, going

to Pharmacy for missing meds, drawing blood, just so much. The

times I've given are approximate, as I must always be able to

re-prioritize at a moment's notice.

For you, just starting out and probably on 7-3 at that, it will be a little different, although the principles are the same. You will still be doing accuchecks, you will still be rounding often and checking often for orders. But you will probably have patients to get ready for OR, those coming back from Recovery, new admits, lots of PRN's; You just have to develop a system of finding out everything that must be done and organizing yourself so it actually gets done.

You will master it. We all have and you will, too.

Get a fanny pack and have your scissors, alcohol wipes, tape, extra pens of the required colors, and anything else you consider totally essential. Have a hearty snack that you can eat on the run, in case you just can't fit in a break. Cheese, Peanut butter, fruit, water, not a ton of food but at least you won't faint.

labcat01, BSN, RN · Apr 7, 2007

Thanks for the advice so far....more please!

burn out · Apr 8, 2007

I am too dysfunctional to keep track of notes and wipes schedules, I am doing good to keep a pen long enough to chart with. However I am highly organized. There are certain standard times that are universal i.e. medication times are 9-12-15-18-21-00-04-06 with the hardest passes being 9a and 9p...so at these times no matter how many patients you have you better be looking at medication records and giving someone something.

Assessment times are 8-12-4 in ICU so at those times you better be assessing someone..it works out really convenient to take their meds at that time to and be prepared to give or at least ask if they need pain meds at that time. Also at that time, reposition patient and replenish IV fluids and tube feedings .

Meal times think DIABETICS and do accuchecks.

The rest of the stuff you just have to be flexible and flow with like when doctors make rounds, off time ,lab draws etc and do it right then do not put off any order get it out of the way. I even go to pharmacy to get my own meds so I won't have to worry about forgetting it or waiting. You never know what is about to happen next.

The key to organizing is to be flexible and flow with it. If you can tell me how to hold on to a pen I may have this mastered.