Time management

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Specializes in ER/Ortho.

I am a new nurse, and I am trying to improve on time management. My normal evening usually goes something like this.

Get my kardexes, Mar etc

Get report

Get my patients set on the computer

Organize my information

Gather my meds for the night

Get vitals from my tech

Go in and assess each patient make a note of any needs the may have

Depending on when meds are due I may give some meds when I go assess or have a period of time before I can start passing meds. I may have a night when I have meds due 3 times or I may have someone who basically needs meds almost every hour.

When I assess the pt I make note the IV fluid, and replace that when needed.

In between meds I take care of patient needs (restarting IV's that have gone bad, Foleys that might be ordered, skin creams for skin breakdown, dressing changes etc).

Get DFS's from techs, and give insulin to diabetics.

I usually have between 5-6 patients. I may start with anywhere from 4-6, but if I start low then I know I will get new admission at any time.

New admits require getting set up in room, assessment, vitals, and then vitals again in an hour. Then you have to call the Dr. for orders, make sure the meds are faxed the the pharm, get the chart together, a ton of paper work, forms to be filled out by pt, a 5 page list of questions to ask patient, pain control, and catch of any late meds once pharm send them.

I work Ortho trauma so most of my patients have severe and chronic pain control issues. This means I am running pain meds constantly.

At some point I have to chart. We are still using paper charting when is time consuming. I have to do a 24 hour assessment sheet on each patient, a graphics sheet of vitals etc, a PCA sheet (for patients on PCA) with 2 hour checks, a Q pump sheet for patients on Q pumps, a fluids sheet for patients on IV fluids, DFS sheet for diabetics, and Focus notes where we long hand out what we have done. The focus notes have to include Safety:Fall prevention, Neuro assessment, Cath associated UTI prevention, Pressure Ulcer prevention, any procedure (IV start, foley insert/remove, dressing change etc), and anything that happen throughout the shift.

If its a new patient there are many other things that must be done in the chart. And I must enter everything in the patient admission database in the computer. I must check the written orders of all patients for the last two days and make sure they were entered for each patient every shift.

In addition, I must put out fires, call the Dr for high-low BP, heart rates, Blood Sugars etc, Resp issues, RRT's, crumping pts.

I must make sure that pts going to surg the next day have all the consents signed and a check list of things completed and in their charts.

I must help techs move patients when needed.

Draw nurse draw labs at 4am.

And many more things that I am leaving out.

Any tips on time management from you seasoned nurses. I am sure there are other threads on here relating to this topic, but I want some fresh insight. The hospital has started a new thing, and they want everyone to leave within 30 minutes of the end of their shift, but I am having trouble getting it all done. Even some of the older nurses are clocking out and staying to finish up. I am sure there is some little thing I am missing that I am just not getting or aware of. Give me some wisdom !!!!!

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Specializes in LTC.

First off I put the time I leave whether its 11:10pm, 12:42am, or 7:20am(double shift :x)

As for time management. I've found I have more time if I don't put things off. Ex.. do MD orders right away, call MD's to review meds for admissions right away. I hang G-tubes early, I do treatments when the CNA's are getting the resident washed and changed. instead of when I finish the HS meds at 10pm.

The more you do things, the quicker it takes.

Make sure you go pee too. I find I'm more productive when I'm not doing the "pee pee dance" around the unit lol.

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We are not allowed to pull meds ahead of time and we aren't allowed to pull meds for more than one patient at a time. That changes time management.

I think this may be a JC safety thing, but not sure.

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Specializes in Developmental Disabilites,.

I feel ya. It is hard being new. You will get faster with time. I have about a yrs experince on an ortho floor. It is amazing how much faster I am now. The thing that helps me the most is delegating. When I first started if a pt said that they needed to use the rest room, I would get them in and wait for them to finish and then help them back to bed. Now I will help them to the bathroom and tell the aide they are in there. If time is really tight I will have the CNA get them to the bathroom too. Ortho pts take along time to move and it can wreck your time table.

I will also make a game plan so I can do as much in 1 pts room at a time as possible. Also grab all the supplies you think you might need. It is amazing how much time is wasted walking back and forth to the med/ supply room. If I go near an ortho pts room when pain meds are around due I go ahead and bring them with me. Saves you a trip later.

Don't worry you will get faster.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Never mind the faster part--concentrate on remaining SAFE.

Tasking can get you into a lot of trouble if you are not careful...focus on your overall view of each patient and PRIORITIZE needs....

And remember if it can't get done, nursing is 24 hours and your next nurse needs to GET OVER IT if she/he starts the eye-rolling....

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Specializes in Hospital Education Coordinator.

I agree with JoPACURN. Nursing is 24 hours and you might not get it all done. I used to create a grid with hours across the top and room numbers on the side and then put into the grid what had to be done or what had been done. Then when I charted I could get the times right, etc. But if you are using EMR you will have to chart as you go. When I read your list I noticed that several things you do are clerical and PRIOR to seeing your patient. I think it is sad that our first priority is to cover ourselves before checking on our patient.

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Specializes in ER/Ortho.

There is a lot of eye rolling and gnashing of teeth...(Reminds me of Where the Wild Things are)lol. I am feeling a lot of stress the be faster. Don't get me wrong no one has said anything to me about spending up, and my charge has even said, "Hey your doing great, and it will come with time."

That being said the week I came off orientation, my very first week on my own we all (everyone on the floor) had to sign something. This something said that out of so many days I had stayed more than 30 minutes past shift end (I had stayed more than half of those days). This was weird since I had been on orientation the whole time, and I stayed until my preceptor ended her shift. Anyway, It was made clear that we were expected to be gone 30 minutes after the end of our shift. I got the impression that if I continue to do that it will reflect neg on my review/raises at the very least. At the worst maybe written up, and we know what happens if you get too many of those. Again, this is just my impression, but I can tell you that other coworkers who are not new are clocking out and staying late off the clock to finish up so I must not be wrong.

I just don't want to work for free, and I feel I am just some magical little click away from being able to figure it out. Sort of like when you try to pack a suit case with far too much stuff, but you just know you can get it to fit.

If you don't get something done there is a lot of eye rolling, and being new I am always afraid that someone will go to the manager and tell her I am not doing my job. Again, I have no reason to think anyone has or will do that will I work. At the ER will I did clinicals, and and went through an internship I saw it all the time. The oncoming nurse would not feel the new nurse did something completely or right, and instead of saying something to her she would run to the manager as soon as he left. Horrible, and one of the reasons I left. I swear I have PTSD from my brief few months there. It was that bad. It left me fearful of what could happen even though I have not seen anything like that at my current hospital.

I did have a recent experience where census was low, and it was my turn to be let go early (we rotate). I had come in at 7p, would be going home at 11p, and I found this out at 9p.

I had assessed everyone, giving out 8p meds, and then gave out 9p meds. I had a patient who had a rapid response called on him early, and I felt a need to carefully monitor him. He was also a major pain management case and I was running back and forth. In addition, I had a patient who had a peg tube, and had to be fed through his peg, and all his meds had to go through his peg so this was time consuming. Two of my patients were contact isolation which was also time consuming. I had a patient whose IV infiltrated around 9:45, IV services leaves at 9pm, and he was on antibiotics. I restarted his IV so he could continue with his meds. I had a patient who had been due to void since 8am, and the Dr ordered a Foley so I inserted her Foley. I made sure everyone had fluid, and was given their pain meds, I passed out the 10pm meds for the couple of people who needed them. I had never left early before, and asked what I needed to do before I left as far as charting (we paper chart). I was told I had to do a full chart and this takes a while so I started charting at 10:30 pm, knowing I would be lucky to finishing by midnight even though I have to leave at 11p.

The new nurse showed up at 10:45 I gave report, and explained that one man needed a new bag of antibiotic hung at 11p. He was the only patient that needed a med at that hour, and it was just one med, and I continued to chart like a mad women. At 11:00p she came up to me and asked me if I had hung the med, and I said no I had been charting. She then started on a rant that it was my responsibility to do it because it was at 11p, and didn't I know it was my responsibility. I explained that I had never left early before. I had only be on shift for four hours, and had to prioritize what was important which I think i did. That I had been trying to full chart which generally we have all night to do in 30 minutes, and that I felt that since I told her when she came one that the med was do at 11p, and she had an hour window before it was late she wouldn't have problem hanging that one med. She did it but she was rolling her eyes, and mumbling under her breath the entire time.

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Specializes in ER/Ortho.

Its not really clerical things I do before seeing my patients. I get my kardexes/Mar together so I know who the patient is, and can use that to take report, and know what meds the patient has. Then I set them up on the computer because the Mar is not always right or updated. This allows me to double check my information so I am not passing out a med that has been discontinued/changed/ or had the time moved. I get report so I know whats been done, and any information I need to care for the patient. And I gather meds so I can pass them out when I go in the room if they are due instead of making multiple trips. I also grab vitals from the tech which is part of assessment, and allows me to safely pass out any meds they may have.

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