Time management

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.

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.

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.

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....

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.

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.

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.