Time management

Specialties Emergency

Published

I'm a new grad that started out in the ED and we're about 10 weeks into the orientation.

I'm finding that my time management sucks. It takes me so long to assess, start a line, labs, and document.

I know that in time I'll start picking it up but what can I do to keep a faster pace.

Also, when I come on and already have 4 patients in my rooms, what is the best way for you to see all of your patients in the first hour? Do you see the sickest patient first and then do you start catching up on what you need to do with that patient? Or do you do an assessment on all the patients first then go back and start on what needs to be done on the sickest patient? And I know that this is all situation dependent but let's say all patients are stable.

I'm asking this because I tried to do set of v/s on all my patients when I first came on then my preceptor told me to concentrate on my first patient and go to my other patients when I was done. It literally took me about 1 hour to get my first patient set who was in DKA. Then I moved onto my next patient...........but it looked bad on my charting also because it looks like I didn't even touch my other patients until 1 hour after I came onto the shift.

Thanks in advance to all your replies,

Chris

Thanks for all the great replies. They have really helped me think about how I deal with the patients on my shift.

I know that I should be doing more focused assessments, but during the orientation they want us doing complete head to toe exams on all patients!! I think this is what is really making me lag.

I'm starting to feel more confident with what I'm doing now and I know speed will come to me with time. Right now I'm just learning as much as I can and absorbing everything like a sponge-bob. I guess it also takes me longer too because I'm always triple and quadruple checking things. I guess I'd rather take too long than to screw up on an order or mix a med up.

I do like the idea of at least getting a full set of vitals on all patients first then proceeding with the day.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

One thing we've implemented in our ED is bedside introduction/report during shift change. It allows the outgoing nurse to introduce the incoming nurse to the patient, and give highlights of the patient's visit/needs/etc. This reduces anxiety in the patient ("Who are you? Where did the other nurse go?!") and gives the incoming nurse a chance to eyeball each patient.

Obviously there isn't always time for this, but it's good when it can be done. And it's not a full report at the bedside, necessarily ... there are things that need to be said that the patients don't always need to hear! ;)

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I like this idea too. I've been trying to do this and get report at the bedside and it does give me a chance to ask the patient to let me know if they're having any new chest pain or to let me know if they're feeling anything else new.

And at least to give an introduction. There have been times where I got so caught up in the work that I didn't even introduce myself to the patient and I got that "Where's my nurse?"

If I were the patient I would have felt a bit nervous.

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.
One thing we've implemented in our ED is bedside introduction/report during shift change. It allows the outgoing nurse to introduce the incoming nurse to the patient, and give highlights of the patient's visit/needs/etc. This reduces anxiety in the patient ("Who are you? Where did the other nurse go?!") and gives the incoming nurse a chance to eyeball each patient.

Obviously there isn't always time for this, but it's good when it can be done. And it's not a full report at the bedside, necessarily ... there are things that need to be said that the patients don't always need to hear! ;)

Great Idea!

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FYI drawing labs without lab tags is setting yourself up for errors. I know, it makes sence and we all have done in it the ER. But an increase in labs errors is making this a no no. Hospital liability and cost of labs is rising. At my facility getting caught doing this can and will get you written up and even suspended. What I have done is start two IV's and cap one off for lab draws and use the other for access. Even in the trauma rooms we have to wait for slips .( well we r suppose to).

Can't you handwrite the pt's name, acct #, date, time and your initials directly on the vial and leave the blood in a biohazard bag (that you'd send the blood IN to the lab) until you have orders? This is what I do... which is why I keep one of those mini-Sharpie markers hanging from the same lanyard my badges is on... :)

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I usually write the pt's name, DOB, my initials, date, and time (we don't always have the account number right away). We also accept blood drawn by EMS in the field, so those are without order slips from the get-go! But EMS does have an armband they apply to patients that has corresponding stickers to apply to the tube, just to tie them to the patient.

We're one of the only hospitals in the area to still accept EMS-drawn blood, though. But the medical director has argued for it -- it does cut down on the time lapse between arrival and getting bloodwork to the lab.

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.
Can't you handwrite the pt's name, acct #, date, time and your initials directly on the vial and leave the blood in a biohazard bag (that you'd send the blood IN to the lab) until you have orders? This is what I do... which is why I keep one of those mini-Sharpie markers hanging from the same lanyard my badges is on... :)

You would think we could, but nope, it is not aloud. They have to be lab slips. Silly, but I guess with lawsuits and the increase in lab errors,they have to show that they are correcting the problem. Just another step nurses have to take.

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Specializes in Emergency.

[quote=InmyblooD;2417581

I do like the idea of at least getting a full set of vitals on all patients first then proceeding with the day.

You may not need a full set of VS at the beginning of your shift. The patients that you'll be assuming care of will have come in to the ER at staggered times. A patient that has only been there an hour and is not a critical patient (or had abnormal VS) won't need a new set right away. Also, your off going shift should have up to date VS/ assessment. I'm not saying that it's wrong to get new VS, I'm just trying to help you shave some of time off of your initial walk through.

Your overlap with the previous shift is going to be very short - 30 minutes if you're lucky. Make sure everybody is breathing (have I mentioned this before? can you guess why?), make sure there are VS and a recent assessment from the previous RN (and one that you basically agree with), ALWAYS check that the crash cart is still locked, that you have an intubation tray available, and that suction is actually set up for every bed that you have - these are things that MUST be done before the other nurse leaves the unit. Doing these things will save you LOTS of grief.

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Specializes in ER.
(OFF-TOPIC)

Given this, why are new grads given full assignments so soon? I'd guess because to schedule otherwise would be a nightmare. But the outcome is that the new nurse can't "carry their weight" for sometime, meaning that they are always behind, their patients aren't getting their care as quickly, and other nurses have to pick up their slack until the newbie can pull it all together... six months to a year?! I can see that one can't really learn how to handle a full load without having a full load, but why not a 3/4 load for the first 6 months to a year?

I totally agree.

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hi everyone! i graduated in may and started in a local emergency dept the same month. finished orientation in july, and passed the RN exam, yay!!!! anyways, so i've been off orientation since the end of july and although there are many things i'm still struggling with/learning, i am soo far ahead of where i was in june it's like a miracle. here's my advice:

first, know what you can do before the doc ever lays eyes on a pt's chart. protocols for labs, x-rays, lines, fluids, masks, etc will make everyone's life easier

second, if you poke the pt 2 or 3 times and can't get the bw/iv started, get someone else to try and do something for that nurse in return!

third, learn a polite but firm manner to deal with pt's and their families. i hate saying no to people or telling them to get something for themselves. however, someone who has a sore ear is perfectly capable of getting their own blanket/drink etc. if there are visitors with the pt even better. although i like being able to personally make my pts comfortable and happy, the bottom line is i'm more concerned about helping sick people get better, not get warmer. sounds harsh, but you don't have to mean about it, just firm.

lastly, show the people you work with that you are willing to learn and work bloody hard and help them out with their pts whenever you can - it will be worth it when they have some time and come to help you!

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